Lipolymph node presenting as a pulmonary nodule: A case report

Abstract

A 53‐year‐old man was admitted to our hospital with a history of a right lung nodule which had gradually increased in size. Wedge resection of the right middle lobe using video‐assisted thoracoscopic surgery (VATS) was performed and revealed a yellowish, soft, well circumscribed nodule. Histological analysis confirmed the diagnosis of an uncommon lipolymph node. The patient recovered well from surgery, and there has been no recurrence in the lung for over one‐year of follow‐up. To the best of our knowledge, this is the first report of a lipolymph node in the lung.

Lipolymph nodes are defined as enlargement of lymph nodes caused by abnormal accumulation of fat, due to mature, benign adipocytes within lymph node capsules. To the best of our knowledge, this is the first report of a lipolymph node in the lung. Although rare and benign, lipolymph nodes should be considered in the differential diagnosis of pulmonary nodules.

INTRODUCTION

Lipolymph nodes are defined as enlargement of lymph nodes caused by abnormal accumulation of fat, due to mature, benign adipocytes within lymph node capsules. Although rare and benign, lipolymph nodes should be considered in the differential diagnosis of pulmonary nodules. Whilst their etiology is unknown, obesity, gender, age and previous inflammation are considered to be related to their occurrence.

Here, we report a case of a lipolymph node in the lung that was successfully removed.

CASE REPORT

A 53‐year‐old man who was asymptomatic was admitted to the Lung Cancer Center with a history of a right lung nodule which had increased in size from 0.5 cm to 1.1 cm in diameter over a three year period. The patient was overweight (BMI = 27.8 kg/m²) and an active smoker, with a smoking history of 37‐pack years. Computed tomography (CT) of the chest revealed a low‐density (−80 Hounsfield Units) nodule in the right middle lobe (Figure 1a, arrow). Wedge resection of the right middle lobe was subsequently performed using VATS and revealed a rare yellowish, soft, and well circumscribed pulmonary nodule which was similar to adipose tissue (Figure 1b). Histological analysis confirmed the diagnosis of an uncommon lipolymph node. The patient recovered well from surgery, and there was no recurrence in the lung for over one‐year of follow‐up.

FIGURE 1.

(a) Computed tomography (CT) of the chest revealed a nodule with a diameter of 1.1 cm in the right middle lobe (arrow). (b) The pulmonary nodule was yellowish, soft, well circumscribed and similar to adipose tissue. (c) and (d) Histological analysis showed abnormal accumulation of mature fat (c and d, pentagram) within the enlarged lymph node capsule (c, arrows) (c, hematoxylin and eosin, ×40; d, hematoxylin and eosin, ×200)

DISCUSSION

A lipolymph node, also known as lipoplastic lymphadenopathy, is a rare but benign pathological entity, defined as enlargement of the lymph node caused by abnormal accumulation of mature and benign fat (Figure 1c,d, pentagram) within the lymph node capsule (Figure 1c, arrows). ¹ , ² The process has mostly been observed in the drainage area of axillary, pelvic and abdominal lymph nodes, but has not been found in the parenchymal organs, apart from the ovary. ² , ³ Although the etiology of lipolymph nodes is unknown, obesity, gender, age and previous inflammation are considered to be related to their occurrence. We found that there were mild histiocytic and lymphocytic infiltration in the lung tissues surrounding the lipolymph node (Figure S1a,b). It was possible that previous inflammation in the right middle lobe was the cause of nodular growth. On CT image, a well‐defined, round, homogeneous nodule with fat attenuation CT values were the characteristics of the lipolymph node. Given the benign nature of this disease, regular follow‐up is preferrable for the management of lipolymph nodes. However, in this case, considering the enlargement of the lesion, resection was performed to rule out the possibility of malignancy.

To the best of our knowledge, this is the first case report of a lipolymph node in the lung. Although rare and benign, lipolymph nodes should be considered in the differential diagnosis of lung nodules.

CONFLICT OF INTEREST

The authors declare that there are no conflicts of interest.

Supporting information

Figure S1. The surrounding of lipolymph node were infiltrated by mild histiocytes and lymphocytes in the lung tissues.

Huang Y, Huang K, Fan M, Jiang L, Zhu D, Zhou Q. Lipolymph node presenting as a pulmonary nodule: A case report. Thorac Cancer. 2021;12:993–994. 10.1111/1759-7714.13881