Issue: Vojnosanit Pregl 2019; Vol.76 (No. 3)
Large hibernoma of the neck: A case report
Authors:
Anton Mikić, Miljan Folić, Ivan Boričić, Nenad Arsović
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Introduction. A hibernoma is a rare benign tumor derived
from vestigial remnants of brown adipose tissue. In neonates
this tissue makes up about 5% of the body mass and
its amount greatly decreases after birth, persisting only in
scattered subcutaneous areas. In rare cases, brown fat continues
to grow leading to a hibernoma that may be located
in the head and neck. We present an illustrative case of a
large hibernoma of the neck with infraclavicular extension
and discuss about diagnostic and treatment difficulties. Case
report. A 29-year-old male presented with large, slowly
progressive, painless neck mass that was noticed 6 months
earlier. Computed tomography (CT) and magnetic resonance
(MR) showed a well-vascularized, soft tissue tumor of
the lateral region of the neck and supraclavicular fossa with
extension below clavicle. Treatment included arterial embolization
followed by challenging surgical removal of the
tumor. Dissection was performed at III, IV and V levels of
the neck, making complete resection possible without the
tumor fragmentation or major blood vessels and cranial
nerves injuries. The final diagnosis of the hibernoma was
made by histopathological analysis. The patient had no signs
of recurrence during three-year follow-up. Conclusion. Although
the CT scan and MR may raise the suspicion, hibernoma
is definitely diagnosed by a pathologist. It is very important
to exclude the malignant processes, foremost liposarcoma.
The tumor fragmentation during surgery should be avoided
because the high vascularity of the tumor tissue carries a substantial
risk for hemorrhage. Our experience with preoperative
embolization and complete tumor resection in this case
showed positive impact on the final outcome.
