Management of Tonsillar Lipoma: Is Tonsillectomy Essential?

Tonsillar lipomas are rare benign tumors, with only a limited number of cases reported in the literature. Excision of the lipoma along with tonsillectomy has been proposed as the usual treatment option. We report a case of tonsillar lipoma which was managed by excision of the lesion without the need for a tonsillectomy. No recurrence was reported at a 2-year followup. A worldwide literature review was done to better define the clinical and histopathological features of these lesions. The authors propose that routine tonsillectomy is not required for these benign lesions and that simple excision of the stalk of the lipoma is sufficient. 1. Introduction Benign tumors of the palatine tonsil are rare, usually presenting as polypoidal masses, and include papillomas, lymphangiomas, fibromas, and lipomas [1]. Although lipomas are the most common mesenchymal tumors of the body, only 15% of all lipomas occur in the head and neck region and are usually seen in the parotid gland, oral cavity, hypopharynx, retropharynx, and the larynx [1]. Lipomas of the tonsil are extremely rare with only a limited number of cases reported worldwide. We present a case of lipoma arising from the palatine tonsil which was managed with excision of the lesion without the need of a tonsillectomy. A literature review is done to discuss the varied clinical presentation of these rare tumors and to highlight the fact that, though benign, these lesions can have unusual and sometimes dangerous presentation. 2. Case Report A 28-year-old male presented with a one-year history of progressively increasing respiratory difficulty which was exacerbated in the left lateral decubitus position. The patient gave a history of multiple apneic spells at night. Upon initial examination of the oral cavity, no abnormality was observed. However, the patient, on making an effort, regurgitated a smooth surfaced polypoidal mass from the oropharynx. A large multilobulated polypoidal mass was seen arising from the inferior pole of the right tonsillar fossa and extending into the oropharynx (Figure 1). Laryngeal examination revealed a large smooth surfaced globular mass with intact mucosa obscuring the right pyriform fossa and partially occluding the airway. A MRI of the neck on T2-weighted sagittal image showed a hyperintense mass extending inferiorly from the lower pole of the right palatine tonsil into the oropharynx (Figures 2 and 3). A fat saturated image showed attenuation of the hyperintense lesion. The mass was excised under general anesthesia after clamping the base of the pedicle. The postoperative period