Giant parathyroid lipoadenoma case report: A parathyroid phenomenon.

INTRODUCTION: Parathyroid lipoadenomas are a rare parathyroid phenomenon and an unusual cause of primary hyperparathyroidism. A difficult diagnosis to make, there are less than 100 cases in the literature since they were first described in 1958, and to our knowledge this is the largest parathyroid lipoadenoma to be reported. PRESENTATION OF CASE: A minimally-invasive parathyroidectomy with intraoperative parathyroid hormone monitoring was performed in the case of a male with a large neck mass and symptomatic primary hyperparathyroidism. A giant parathyroid lipoadenoma was excised, with an appropriate decrease in intraoperative parathyroid hormone level observed. DISCUSSION: This lesion poses a challenge to the surgeon, radiologist and pathologist alike and is an important addition to the scant literature available. Clinically it presents similarly to a simple adenoma. The high adipose content of this lesion leads to difficulty localising it on imaging, and the histology study can lead pathologists astray. CONCLUSION: We highlight the importance of having the parathyroid lipoadenoma as a differential diagnosis for patients who develop primary hyperparathyroidism.

Incidentally discovered parathyroid lipoadenoma in thyroid surgery: A case report and review of the literature.

Parathyroid lipoadenoma is a rare type of parathyroid adenoma, described as a single parathyroid adenoma with more than 50% fat on histologic examination and an unknown etiology, which is one of the rare causes of primary hyperparathyroidism. The difficulty of parathyroid lipoadenoma is mainly diagnosed by preoperative imaging localization. We hope to arouse attention to the parathyroid adenoma which is difficult to locate through our case report. The patient was a middle-aged male with a body mass index of 38.4 kg/m2 who admitted to our hospital with a 40-day history of an untreated thyroid nodule. We incidentally discovered parathyroid lipoadenoma in his thyroid surgery. His prognosis was good, and there were no signs of recurrence at his 12-month follow-up appointment. We believe that parathyroid lipoadenoma needs to rely on paraffin pathology to make a final diagnosis. This case report serves as a reminder that parathyroid lipoadenomas are also possible in patients who do not have primary hyperparathyroidism preoperatively and who have negative imaging. Clinicians must carefully examine the adipose tissue for the presence of parathyroid lipoadenomas during thyroid surgery to avoid postoperative hypoparathyroidism and persistent hypocalcaemia.

Thyrolipoma: A Rare Presentation of the Thyroid Gland.

Thyrolipoma is a rare disorder marked by substantial adipose tissue growth inside the thyroid gland. Fatty tissue is frequently seen in salivary glands, thymus, breasts, and pancreas but rarely in the thyroid gland. The fascinating and unusual illness known as thyrolipoma presents challenging diagnostic and therapeutic issues. Due to the rarity of thyrolipoma, doctors must evaluate thyroid nodules with a high index of suspicion, especially those who are radiologically and clinically worrisome. We present a study of a 50-year-old female who came with the complaint of midline neck mass for one year. On clinical examination, a diagnosis of multinodular goiter was made. Computed tomography (CT) scan was suggestive of a heterogenous enhanced thyroid mass lesion. Thus, a total thyroidectomy was performed. On histopathological examination, a final diagnosis of thyrolipoma was made. The abstract aims to provide an overview of the clinical presentation, diagnosis, and treatment options of thyrolipoma, as well as highlight the importance of early recognition and appropriate management of this rare tumor.

Oncocytic sialolipoma of parotid gland: Case report and literature review.

Neoplastic lipomatous lesions of the salivary glands constitute ≤0.5% of all the salivary gland tumors. Oncocytic sialolipoma of the parotid glands is extremely uncommon. We report a case of oncocytic sialolipoma of the parotid gland in a 59-year-old male who presented with a gradually increasing swelling of the right parotid. Excisional parotid biopsy performed in view of possible pleomorphic adenoma as suggested on ultrasonography showed histological features consistent with oncocytic sialolipoma. We also described the characteristics of 24 previously reported cases of oncocytic sialolipoma of the parotid gland. The median age of the patients including the present case was 56 years (range 7-89), and 14 were male. The largest and the least reported sizes of the tumor were 7.0 and 1.4 cm, respectively. The left-sided parotid gland was more commonly involved (14/23). Despite its rarity, oncocytic sialolipoma should be considered in lipomatous parotid lesions showing epithelial components with oncocytic changes.

Lipoadenoma of the parathyroid: characteristics of a rare cause of hyperparathyroidism.

Parathyroid Lipoadenoma (PLA) contains abundant mature adipose tissue and is a rare cause of hyperparathyroidism. This study aimed to investigate the clinical features of PLA in nine patients with primary hyperparathyroidism, including two men and seven women, with ages ranging from 45-84 years (median 60 years). PLA accounted for 0.5% of all parathyroid tumors during the study period. One patient presented with anorexia due to hypercalcemia; however, the other eight patients were asymptomatic. The median preoperative serum intact-parathyroid hormone (iPTH) and calcium levels were 143 pg/mL (range, 102-378) and 10.8 mg/dL (range, 10.3-11.3), respectively. PLA was difficult to identify using ultrasonography (US) as it appears as a moderately hyperechoic nodule and is difficult to distinguish from the surrounding adipose tissues. Only 33% of the lesions (three out of nine lesions) were accurately identified. However, they could be distinctly differentiated from the surrounding tissue using computed tomography (CT). All PLAs were also detected using the sesta-methoxyisobutylisonitrile single-photon emission-computed tomography (SPECT). All the patients were treated by a single gland extirpation. The median size and weight of the PLA were 14 mm (range, 10-22) and 567 mg (range, 200-1,533), respectively. In conclusion, the clinical manifestations of PLA are similar to those of ordinal parathyroid adenomas, except for their unique US and CT images. PLA should be considered as a potential etiologic factor in cases of hyperparathyroidism when the lesions are demonstrated as hyperechoic nodules or unidentified by US but detected by CT or SPECT imaging.

Oncocytic Lipoadenoma: Report of 3 Rare Cases Involving the Parotid Gland, Including a Synchronous Presentation With Paraganglioma of the Right Carotid Bifurcation and Literature Review.

Oncocytic lipoadenoma (OL) is a rare salivary gland tumor characterized by the presence of oncocytic cells and mature adipose tissue. To date, only 30 cases of OL have been reported in the English-language literature. We present 3 additional OL cases involving the parotid, including a synchronous presentation with paraganglioma of the right carotid bifurcation. Microscopically, both the OLs were composed of a mixed population of oncocytes and adipocytes in varying proportions surrounded by a thin, connective tissue fibrous capsule. Oncocytes were positive for pan-cytokeratins (CKs) AE1/AE3, epithelial membrane antigen, CK5, CK7, CK14, CK18, and CK19. Calponin, p63, alpha-smooth muscle actin, and carcinoembryonic antigen were negative. Vimentin and S-100 protein were positive only in adipose cells. Despite distinctive morphologic features, OL is often misdiagnosed, given its rarity. We hope to contribute to surgeons' and pathologists' awareness and knowledge regarding the existence of this tumor and provide adequate management through conservative surgical excision.

Complex Component of Oncocytic and Non-Oncocytic Lipoadenomas in the Parotid Gland: A Case Report.

Oncocytic lipoadenoma of the salivary gland is a rare tumor that develops mainly in the parotid gland. We report a case of oncocytic lipoadenoma of the parotid gland in a 70-year-old woman. The tumor measured 30 × 20 mm and had a well-circumscribed tan-brown surface. The tumor was histologically composed of oncocytic and lipomatous lesions without atypia. In addition to the oncocytic lipoadenoma, a small lipomatous tumor, measuring 10 × 7 mm, was found in the resected parotid gland. Macroscopically, this tumor was yellow and indistinguishable from the parotid gland. Microscopically, the tumor was rich in fats and contained an area of conglomerated duct-like proliferation and salivary gland components. Therefore, the tumor was diagnosed as a non-oncocytic lipoadenoma with a sialoadenoma component. We report the first case of double component oncocytic and non-oncocytic lipoadenomas of the salivary gland.

Parathyroid lipoadenoma: The particularities of a rare entity a case report and review of the literature.

Parathyroid lipoadenoma is a rare and anusual cause of primary hyperparathyroidism. The clinical presentation usually resembles other causes of primary hyperparathyroidism and the imaging is not always contributory considering its location. However, the histologic criteria are specific. We present a case that supplements and supports the rare literature data concerning the clinical and therapeutic aspects of parathyroid lipoadenoma. The case is about a 73 years old female with a right inferior parathyroid lipoadenoma that caused biological primary hyperparathyroidism. Initially followed and treated in Rheumatology department for hypercalcemia and osteoporosis, she was sent to our structure to diagnose and possibly treat the causal etiology. After non-contributory clinical examination and ultrasound imaging, the tumor was diagnosed in the cervical CT scan. The patient underwent successful surgical removal of the lipoadenoma, confirmed postoperatively on histological analysis. The follow up showed rapid normalization of the parathormon level. Even if it's a rare condition, the diagnosis of lipoadenoma should always be considered in front of primary hyperparathyroidism with a parathyroid lesion.

An extremely rare case of giant oncocytic adenolipoma of the parotid gland.

Oncocytic adenolipoma is a rare tumor to occur in the salivary gland, which can present as a giant neck mass. Until now, <20 such cases are reported. We report this rare case for surgeons to consider it as one of the differential diagnoses.

Lipoadenoma of the Parathyroid Gland: Characterization of an Institutional Series Spanning 28 Years.

Parathyroid lipoadenomas (PLAs) are rare tumors, and case descriptions are limited, < 80 to date. As a consequence, scarce information regarding the etiology of these enigmatic lesions is available. We searched our departmental pathology database for PLAs diagnosed between 1992 and 2020, reexamined the histology of each case, and recorded clinical parameters from the patients' medical charts. As the diagnostic criteria of this lesion vary over this time period, we defined PLA as an enlarged parathyroid gland with > 50% fat on histologic examination with preoperative evidence of primary hyperparathyroidism (PHPT). A total of 8 bona fide PLA cases and 2 equivocal PLAs (close to 50% fat) were included. As approximately 4000 conventional parathyroid adenomas were diagnosed at our department during the same time interval, the prevalence of PLA was 0.20%. PLA patients were predominately female (63%) and presented with classical PHPT-related symptoms. Majority of cases were successfully located preoperatively and had an average tumor weight of 445 mg. Histologically, all PLAs consisted of > 50% mature adipose tissue, except a single case with brown fat. Of note, PLA patients exhibited a body mass index in line with PHPT patients in general, but a relatively high, near-significant prevalence of arterial hypertension was observed when compared to tumors with less fat (P = 0.0584). Future studies on this finding might be warranted. To summarize, we present one of the largest institutional PLA case series to date, and conclude that PLAs are rare, sporadic tumors mirroring many clinical aspects of conventional adenomas-with a potential coupling to hypertension worthy of follow-up studies.

A case of oncocytic lipoadenoma of the submandibular gland and its diagnostic cytology challenges.

Lipomatous tumors of the salivary gland in general are rare and oncocytic lipoadenomas are even much rarer. Most of the reported cases of oncocytic lipoadenoma were located in the parotid gland and to the best of our knowledge, only four cases reported to arise from the submandibular gland. The preoperative interpretation of the aspirates taken from these lesions can be difficult and challenging. We report a case of a 41 year old gentleman who presented with submandibular gland swelling. CT scan of the neck revealed an oval-shape enhancing mass in the inferior aspect of the right submandibular gland measuring 19 × 12 mm. Fine needle aspiration biopsy (FNAB) showed hypocellular smears with few clusters of epithelial cells having oncocytic appearance. The cytologic findings were interpreted as "oncocytic lesion." Submandibular gland excision was done. Histologically, a final diagnosis of oncocytic lipoadenoma was rendered. We present this rare entity to add to the few cases reported to date and to upsurge awareness during cytologic examination of oncocytic salivary gland lesions.

A Case of Oncocytic Lipoadenoma Arising in the Submandibular Gland / 대한두경부종양학회지

Oncocytic lipoadenoma is a rare salivary gland tumor composed of adipose tissue and oncocytic epithelial cells in varied proportions. We report a case of an oncocytic lipoadenoma of the submandibular gland, which presented as a submandibular gland mass. The patient was a 65-year-old woman with a right submandibular mass measuring 2 × 2 × 1.6 cm. As a sonographic evaluation and computed tomograph scan gave us the impression of benign submandibular gland tumor such as pleomorphic adenoma, we resected the right side submandibular gland. Grossly, the tumor was well circumscribed with yellow to brown cut surface. Microscopically, the tumor was surrounded by a thin, fibrous capsule and composed of oncocytic epithelial cells admixed with mature adipose tissue. Final diagnosis was an oncocytic lipoadenoma. We discussed here radiologic and pathologic finding of this rare salivary gland tumor.

A rare cause of primary hyperparathyroidism: Parathyroid lipoadenoma.

OBJECTIVE: The main cause of primary hyperparathyroidism is a single parathyroid adenoma. Parathyroid lipoadenomas contain abundance of fat cells. Because of these histological features, they can mimic normal parathyroid tissue at the histopathologic examination and radiological imaging could be difficult to localize lipoadenomas. CLINICAL PRESENTATION: In this case report, we present three cases of functional parathyroid lipoadenomas. CONCLUSION: Preoperative imaging modalities often can't localize lipoadenoma. In our cases, SPECT has seen more successful than ultrasonography or CT. There may not be gender predominance at parathyroid lipoadenomas. Intraoperative pathology consultation and rapid biochemical workup can help the surgeon in difficult cases.

Parathyroid Lipoadenoma: a Clinicopathological Diagnosis and Possible Trap for the Unaware Pathologist.

The authors present clinicopathological features of parathyroid lipoadenoma in a 48-year-old woman who presented with symptomatic primary hyperparathyroidism manifesting with pathological fractures and osteoporosis. Preoperative sestamibi scan failed to localize the source of her disease. Exploratory surgery identified an enlarged parathyroid gland with abundant fat tissue. The significant drop of intraoperative serum parathyroid hormone after the removal of this gland and postoperative biochemical cure justified the presence of a single gland disease presenting as parathyroid lipoadenoma. From an educational perspective, the presented case emphasizes why the historical approach to parathyroid proliferations by assessing alone the ratio of parenchymal cells to adipocytes is not a reliable method in the diagnostic evaluation of parathyroid disease. While the accurate size and weight of a parathyroid gland are defining parameters of an abnormal gland, intraoperative and postoperative biochemical workup distinguishes uniglandular disease (adenoma) from multiglandular disease (hyperplasia). The authors also provide a brief review of the previously published cases of parathyroid lipoadenomas to highlight their clinicopathological characteristics of relevance to surgical pathologists.

Lipoadenoma of the adrenal gland: report of a rare entity and review of literature.

Adrenal lipoadenoma is an extremely rare tumor. Only four cases have been reported so far. The authors reported a case of adrenal lipoadenoma in a 46-year-old man with the history of abdominal pain. The present case, manifesting as a nonfunctional adrenal tumor, is characteristically comprised of a mixture of mature adipocytes and adrenocortical cells. We also reviewed this tumor in different organs which have been published in the literature.

Oncocytic lipoadenoma: a rare case of parotid gland tumor and review of the literature.

Oncocytic lipoadenoma is a rare tumor, with only 18 cases having been reported since the first in 1998. We encountered a case of oncocytic lipoadenoma presenting as a slowly growing parotid mass in a 71-year-old man. This tumor is characteristically comprised of a mixture of oncocytes and adipocytes. The present case is one of five reported cases of oncocytic lipoadenoma showing sebaceous differentiation. The results of immunohistochemical study with DOG1 antibody supported the origination of this tumor in the striated duct.

Oncocytic Lipoadenoma: A Rare Case of Parotid Gland Tumor and Review of the Literature

Oncocytic lipoadenoma is a rare tumor, with only 18 cases having been reported since the first in 1998. We encountered a case of oncocytic lipoadenoma presenting as a slowly growing parotid mass in a 71-year-old man. This tumor is characteristically comprised of a mixture of oncocytes and adipocytes. The present case is one of five reported cases of oncocytic lipoadenoma showing sebaceous differentiation. The results of immunohistochemical study with DOG1 antibody supported the origination of this tumor in the striated duct.

Oncocytic lipoadenoma of the parotid gland: cytological findings and differential diagnosis on fine-needle aspiration.

Oncocytic lipoadenoma is a rare benign neoplastic lesion of salivary gland. To the best of our knowledge, the detailed cytomorphological findings were described only in two cases. We are reporting a 56-year-old woman who presented with 1-year history of right parotid gland mass. Cytologic examination revealed tight clusters of bland looking oncocytic ductal cells with few aggregates of mature adipose tissue in a lipoid background and a benign oncocytic tumor of parotid gland was rendered. Histologically, a tumor with islands of oncocytic epithelial cells admixed with abundant mature adipose tissue was identified. Oncocytic lipoadenoma despite its rarity should be considered in the differential diagnosis of salivary gland fine-needle aspirations containing oncocytes especially those which are accompanied by mature adipose tissue and lipoid background.

Oncocytic sialolipoma of the submandibular gland.

Sialolipoma, a rare tumor of the salivary gland, is a recently described variant of salivary gland lipoma. Oncocytic sialolipoma was first described by Pusiol et al. in 2009. We report the case of an oncocytic sialolipoma of the submandibular gland in a 43-year-old female. Excision of the tumor was performed with preservation of the submandibular gland. The tumor had a thin, fibrous capsule and consisted of abundant adipose tissue, an oncocytic nodule, and scattered normal glandular structures surrounded by adipose tissue. Four cases of sialolipoma of the submandibular gland, including the present case, were reviewed. All 4 tumors were developed on the right submandibular glands, with a composition of adipose tissue as high as that of sialolipoma of the parotid gland; in contrast to previous reports, three cases were in females. As newly described tumor type, care should be taken to distinguish oncocytic sialolipoma from other salivary gland neoplasms such as simple lipoma, pleomorphic adenoma, or oncocytoma.