Pricop Marius Octavian, Balica Nicolae Constantin, Poenaru Mărioara, Goţia Smaranda Laura, Baderca Flavia, Petrescu Pompiliu Horaţiu, Urechescu Horaţiu Constantin
Department of Microscopic Morphology, Department of Otorhinolaryngology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania;
Rom J Morphol Embryol. 2018;59(2):533-542.
Cervical lipomas are tumors that may present as painless masses with slow growth. This type of tumors is usually asymptomatic until they reach a large size. They can be solitary or multiple. When multiple and symmetrical distributed around neck area, the lesions can be classified as Madelung's disease, a rare condition that affects mostly Mediterranean men. Our objective was to describe the symptoms, cytological and histological aspects, diagnostic problems and treatment strategies of the large size lipomas and to highlights that the differential diagnosis between common lipoma of cervical area and Madelung's disease can be established only on clinical grounds, with major implications in the treatment options.
The study was retrospective and analyzed archived material. We selected four cases of cervical lipomas, each with its particularities, treated in the Clinic of Oral and Maxillofacial Surgery, Timişoara City Hospital, Romania. For all the cases, we performed a fine-needle aspiration with consequent cytological exam. The microscopic evaluation of Papanicolaou-stained slides established the diagnosis of lipomas. The surgically removed specimens were sent to the Department of Pathology. The excised specimens were prepared with routine histological technique.
The cases presented one or more lateral cervical swelling of the neck, inserted among major vascular-nervous elements, becoming life-threatening conditions. All the cases studied had the same cytological and histopathological features consistent with lipoma, fibrolipoma or angiolipoma, but, instead of this, clinical aspects differed from case to case. On clinical grounds, two patients were considered as Madelung's diseases.
Despite of the same histopathological aspects, lateral cervical lipomas can be classified in varies categories with different treatment strategies and prognostic factors. The correct diagnosis of Madelung's disease is important in order to add other treatment options to the surgery or liposuction as avoiding alcohol or medication for metabolic disorders.
颈部脂肪瘤是一种可能表现为无痛性肿块且生长缓慢的肿瘤。这类肿瘤通常在体积增大之前没有症状。它们可以是单发或多发的。当脂肪瘤多发且对称分布于颈部时，这些病变可被归类为马德隆病，这是一种主要影响地中海地区男性的罕见疾病。我们的目的是描述大型脂肪瘤的症状、细胞学和组织学特征、诊断问题及治疗策略，并强调颈部常见脂肪瘤与马德隆病之间的鉴别诊断只能基于临床依据，这对治疗方案有重大影响。
本研究为回顾性研究，分析存档资料。我们选取了罗马尼亚蒂米什瓦拉市医院口腔颌面外科诊所治疗过的4例颈部脂肪瘤病例，每例都有其独特之处。对所有病例进行了细针穿刺并随后进行细胞学检查。对巴氏染色玻片的显微镜评估确定了脂肪瘤的诊断。手术切除的标本被送至病理科。切除的标本采用常规组织学技术制备。
这些病例表现为颈部一侧或多侧肿胀，位于主要血管神经结构之间，成为危及生命的情况。所有研究病例具有与脂肪瘤、纤维脂肪瘤或血管脂肪瘤一致的相同细胞学和组织病理学特征，但临床症状因病例而异。基于临床依据，两名患者被诊断为马德隆病。
尽管组织病理学表现相同，但颈部外侧脂肪瘤可分为不同类别，具有不同的治疗策略和预后因素。正确诊断马德隆病很重要，以便在手术或抽脂之外增加其他治疗选择，如避免饮酒或治疗代谢紊乱的药物。
