Giant cervical lipoblastoma in infant: a rare case report

Abstract

Introduction and importance:

Lipoblastomas are benign mesenchymal tumors derived from embryonal white fat, primarily affecting children under 3 years of age. While typically located in the extremities and trunk, cervical lipoblastomas are exceedingly rare and may pose diagnostic and surgical challenges due to the proximity of vital structures.

Case presentation:

We report a case of a 13-month-old male with an 8-month history of a progressively enlarging, painless mass in the right anterolateral neck. There were no signs of mass effect. Neck CT scan revealed a large fat-density lesion with multiple internal septations, displacing carotid vessels posteromedially and abutting the right subclavian artery. Surgical excision was performed, and histopathology confirmed a lipoblastoma. The patient recovered well and remained recurrence-free at 6-month follow-up.

Clinical discussion:

Cervical lipoblastomas can grow to significant sizes before diagnosis due to their indolent nature. Imaging studies often show a well-circumscribed, lobulated, fat-containing mass with septations. Differential diagnoses include lipoma, teratoma, neuroblastoma, liposarcoma, and lymphangioma. Histopathology is important in confirming the diagnosis. Complete surgical excision remains the treatment of choice, and recurrence is rare following total resection.

Conclusion:

Cervical lipoblastomas are rare but should be considered in pediatric patients with large, slowly growing neck masses. Timely diagnosis and complete excision are essential to prevent complications and ensure favorable outcomes.

Introduction

Lipoblastoma is a rare benign tumor composed of embryonal adipose tissue, first described by Jaffe in 1926^[1]. These tumors almost exclusively affect infants and young children, with over 90% of cases occurring before the age of 3 years^[2,3]. They account for less than 1% of all childhood tumors^[4].

Lipoblastomas usually arise in the extremities (approximately 70%), but have also been reported in the trunk, mediastinum, retroperitoneum, and rarely in the head and neck region^[5,6]. Cervical lipoblastomas are particularly rare^[7].

Due to their location and potential for significant growth, cervical lipoblastomas may cause compression of vital structures, including the trachea, esophagus, and major neurovascular bundles. Although histologically benign, the clinical behavior of lipoblastoma can mimic malignancy due to rapid growth or large size^[8]. The work has been reported in line with the SCARE criteria^[9].

HIGHLIGHTS

• Cervical lipoblastoma is an uncommon presentation of a rare benign adipocyte tumor in infants.

• Lipoblastoma may displace but typically does not invade adjacent structures.

• Complete surgical excision is curative, and recurrence is rare if completely resected.

We present a case of a large cervical lipoblastoma in a 13-month-old male child, with clinical, radiologic, surgical, and histopathologic findings, and a literature review.

Case presentation

A 13-month-old male child presented to our pediatric surgical clinic with a history of a progressively enlarging mass on the right side of the neck for 8 months. The swelling was painless, with no associated respiratory symptoms, dysphagia, hoarseness, or systemic illness.

Clinical examination revealed a non-tender, soft, lobulated mass measuring approximately 10 × 8 cm located in the right anterolateral aspect of the neck. The overlying skin was normal. The mass was mobile in the horizontal plane but had a poorly defined inferior margin, extending below the clavicle. No cervical lymphadenopathy was noted.

A contrast-enhanced computed tomography (CT) scan of the neck, which was ordered by the primary physician, demonstrated a well-defined, lobulated, fat-density mass. The mass measured approximately 10 × 10 × 8 cm and showed multiple thin internal septations. It displaced the carotid sheath contents posteromedially and closely abutted the right subclavian vessels without evidence of invasion (Fig. 1). Since the mass was well defined and there was no sign of vascular invasion, we proceeded without requiring further imaging, MRI.

Figure 1.

Fatty density soft tissue mass, which displaced the right carotid vessels posterior medially (blue arrow). The left carotid artery is marked with a white arrow (A). The mass has extension below the clavicle (B).

The patient underwent complete surgical excision under general anesthesia. A transverse cervical incision was made along a natural skin crease. The tumor was identified as a yellowish, encapsulated, multilobulated fatty mass. Careful dissection was carried out to separate the tumor from the surrounding vessels and nerves. Despite proximity, there was no invasion of the carotid or subclavian vessels. The mass was excised completely and sent for histopathologic evaluation (Fig. 2).

Figure 2.

Lobulated, yellowish, soft mass after excision.

Gross examination revealed a 10.5 × 9.8 × 8.2 cm lobulated, yellow, soft mass. Histological sections showed lobules of immature and mature adipocytes with a myxoid background and fibrous septa. No atypia or mitoses were observed. The features were consistent with lipoblastoma.

The child recovered well postoperatively and was discharged on the second postoperative day. At 6-month follow-up, he was asymptomatic, and no recurrence was observed clinically or on ultrasound.

Discussion

Lipoblastomas are rare benign adipocytic tumors composed of embryonal fat cells at varying stages of maturation. They are characterized by rapid growth but lack metastatic potential^[10]. Two histological variants are recognized: localized lipoblastoma and diffuse lipoblastomatosis. The former is encapsulated and more amenable to excision, whereas the latter may infiltrate surrounding tissues^[11].

The head and neck region, although infrequent, represents a critical site due to the density of vital structures. Reported cervical lipoblastomas range from a few centimeters to over 10 cm in diameter, often displacing tracheal, vascular, or nervous structures^[7,12].

Differential diagnosis includes lipoma, which lacks immature adipocytes and myxoid stroma; liposarcoma, which is extremely rare in children under 10 years and demonstrates cellular atypia and mitotic activity; and teratoma or lymphangioma^[6,13].

Imaging features on CT and MRI are vital in preoperative assessment. CT typically shows a low-density mass with septations, while MRI provides better contrast resolution and assessment of deep extension. Fat suppression sequences on MRI are particularly useful in characterizing lipomatous tumors^[14]. Histopathology remains the gold standard for diagnosis^[15].

Surgical excision is curative. Complete removal is crucial, as recurrence rates of up to 20–25% have been reported in cases of incomplete resection or diffuse lipoblastomatosis. Malignant transformation has not been documented^[16,17].

Our case adds to the limited literature on large cervical lipoblastomas in infants, reinforcing the importance of early recognition and complete excision to avoid complications.

Conclusion

Cervical lipoblastoma is a rare pediatric tumor that can grow significantly before detection. Despite its benign nature, it requires careful evaluation due to its proximity to vital neck structures. Imaging and histopathology are essential for accurate diagnosis. Complete surgical excision is curative with an excellent prognosis.

Ethical approval

Ethical approval is held to be unnecessary by the Institutional Review Board, as this is a single, rare case encountered during clinical practice.

Consent

Written informed consent has been obtained from the patient to have the case details and any accompanying images published. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.

Sources of funding

Not applicable.

Author contributions

All authors contributed to different aspects. T.G.M. operated on the patient, wrote the final case report, and also followed the patient. D.G. operated on the patient and wrote the case presentation draft. S.K. thoroughly evaluated the radiologic images. T.E. was the leading anesthesiologist during surgical planning. All authors read and approved the final manuscript.

Conflicts of interest disclosure

No authors have disclosed any conflicts of interest.

Guarantor

Tafese Gudissa Merga.

Research registration unique identifying number (UIN)

Not applicable.

Provenance and peer review

Not commissioned.

Data availability statement

Not applicable.