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School of Veterinary Medicine,
University of Glasgow School
of Life Sciences, Glasgow, UK
Correspondence to
Verónica Rodiño Tilve;
​vero.​rotil@g​ mail.​com
Received 15 October 2016
Revised 23 January 2017
Accepted 30 March 2017
To cite:
Rodiño Tilve V, Finck M,
Leach JDG, et al. Vet Rec
Case Rep Published Online
First: [please include Day
Month Year]. doi:10.1136/
vetreccr-2016-000376
Rodiño Tilve V, et al. Vet Rec Case Rep 2017;5:e000376. doi:10.1136/vetreccr-2016-000376
Companion or pet animals
Sialolipoma of the parotid salivary gland in two dogs
Verónica Rodiño Tilve, Marlene Finck, Joshua DG Leach, Michael J Macfarlane
Summary
An eight-year-old male neutered boxer and a 10-year-
old female neutered lurcher were presented with
palpable masses in the region of the right parotid
salivary gland. In both cases, fine needle aspirates
yielded adipose cells, normal salivary epithelium and
some blood contamination. CT images showed a
mixed fat attenuating mass in the region of the right
parotid salivary gland, without a normal ipsilateral
parotid salivary gland. Surgical excision was performed
in both cases and histopathology was consistent with
sialolipoma. Neither mass has recurred 7 and 16 months
after surgery. Sialolipoma should therefore be considered
as a differential in dogs with a mass in this location. Fine
needle aspirates showing salivary epithelium and adipose
cells should not be dismissed as non-diagnostic. To the
authors’ knowledge, these are the two first reported
cases of sialolipomas of the parotid salivary gland in
dogs and the first description of cross-sectional imaging
of sialolipomas.
Background
Sialolipomas are benign lipomatous salivary
tumours. There has been one report to date in the
dog, affecting a minor salivary gland within the
tonsillar fossa (Clark and others 2013), which did
not recur after six months of follow-up.
As there are no previous reports of this tumour
in this location, dogs with masses in the region of
the parotid gland, which are not consistent with
a sialocele or an abscess, are often considered to
have a poor prognosis. Extrapolating from human
literature, the prognosis for sialolipoma would be
expected to be favourable, and it is hoped that this
case report will result in increased awareness of this
uncommon neoplasm.
CT features of sialolipoma in the dog have not
previously been reported: the findings of a well-de-
marcated fat attenuating mass in the location of a
salivary gland could help orientate the differential
diagnosis and prognosis before surgical planning.
Case presentation
An eight-year-old male neutered boxer and a nine-
year-old female neutered lurcher were presented
for investigation of a soft mass ventral to the right
horizontal ear canal. The masses had been identified
approximately three weeks and four weeks (respec-
tively) before presentation. Neither mass had been
noted to have substantially increased in size in this
time. On examination, the masses were relatively
moveable and were non-painful on palpation. All
palpable lymph nodes were of normal size. The rest
of the physical examination was unremarkable in
Veterinary Record Case Reports
both cases. Fine needle aspirates (FNA) performed
by the referring veterinarian of case 2 revealed the
presence of blood, adipose cells and normal salivary
gland epithelium; however, no neoplastic cells were
identified.
Investigations and differential
diagnosis
Haematology and biochemistry results performed
as a baseline were within normal limits in both
cases. FNA from both masses revealed the presence
of adipose cells and normal salivary epithelium,
with no neoplastic cells identified.
Both cases were anaesthetised to facilitate biopsy
and imaging. Computed tomography (CT) was
performed with a dual-slice CT scanner (Siemens
Somatom Spirit; Siemens, Erlangen, Germany). The
dogs were positioned in sternal recumbency, with
the head and neck extended. In each case, the head
and neck was imaged, along with the thorax as part
of clinical staging.
Acquisition scan mode was helical with tube
voltage: 130 kVp, tube current: 50–240 mAs, tube
rotation time: 1–1.5 seconds, beam pitch: 1–1.5,
slice thickness: 1.5–3 mm, matrix size: 512 x 512.
Images were reformatted with bone and soft tissue
filters for the head, and with bone, lung and soft
tissue filters for the thorax; and window viewings
could be adjusted for both patients.
A non-ionic iodine-based contrast agent was
administered intravenously to assess the cervical
mass lesions (2 ml/kg ioversol, Optiray 300;
Mallinckrodt Pharmaceuticals, UK) with the use
of a pressure injector (Injektron 82M; Medtron,
Germany), at a rate of 5 ml/s. Postcontrast images
were acquired at 30 seconds and three minutes
post injection and were reconstructed in soft tissue
window.
Case 1
In the right parotid region, a moderately hetero-
geneous mass lesion was identified ventral to the
right horizontal canal, and lateral to the border of
the right digastricus muscle (Fig 1). This lesion was
extending from the level of the caudal aspect of the
mandibular ramus, caudally to the right masseter
muscle, until the level of the wing of the atlas.
The mass appeared to have an identifiable capsule
on the lateral aspect and the centre was a mixed
attenuation between fat and fluid (Hounsfield
units (HU) ranging from −75 for the fat compo-
nent to 31 for the soft tissue component). It was
heterogeneously moderately enhancing with rim
enhancement. There was neither obvious attach-
ment to the overlying platysma muscle or skin
1
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Veterinary Record Case Reports
FIG 1: Transverse CT images immediately caudal to the tympanic
bullae (A) soft tissue window pre contrast, (B) soft tissue window post
contrast (WL 50, WW 350). The right side of the patient is displayed
on the left. The heterogeneous mass in the right parotid region does
not appear to infiltrate the adjacent structures, shows a capsule that
is thin ventrally and slightly thicker laterally. This mass lesion is mixed
fat and soft tissue attenuating and is heterogeneously moderately
enhancing with rim enhancement. The right retromandibular vein (star)
is intimately associated with its ventral aspect. No right parotid salivary
gland is identified. The left parotid salivary gland is within normal limits
(open arrowhead). WL, Window level; WW, Window width.
nor obvious invasion of the medial tissues; however, the right
maxillary and retromandibular veins were intimately associated
with its medioventral aspect. This mass was compressing and
displacing the right mandibular salivary gland medially. The
right parotid salivary gland was not visible. The mandibular and
medial retropharyngeal lymph nodes were not associated with
any substantial anomaly on either side.
Needle core biopsies were collected from the mass and yielded
six irregular fragments of biopsied tissue. These were composed
of a mix of mature adipose tissue and multifocal aggregates of
normal mixed salivary tissue. Acini were histologically normal,
as were the occasional ducts that were scattered throughout the
regions of salivary tissue. Neither inflammation nor necrosis was
noted and a small amount of acute haemorrhage was believed
to be associated with biopsy collection. The histology was
consistent with a sialolipoma; however, it was difficult to differ-
entiate from lipomatous infiltration based solely on histology of
the submitted samples. Identification of a surrounding fibrous
capsule is necessary to confirm the diagnosis and it was recom-
mended that the entire mass was excised.
Case 2
A heterogeneous lesion was seen in the right parotid region,
lateral to the right digastricus muscle (Fig 2). This mass was
underneath the right platysma muscle and ventral to the right
horizontal external ear canal. It was extending from the caudal
aspect of the mandibular ramus, caudally until the level of the
wing of the atlas. The mass was well delineated with smooth
slightly irregular outline, was predominantly fat attenuating with
some soft tissue attenuating areas (HU ranging from −95 for the
fat component to 21 for the soft tissue component), and was
heterogeneously minimally contrast enhancing. It did not seem
to invade the surrounding tissues, although the right retroman-
dibular vein was in close association with its ventral aspect. This
2 Rodiño Tilve V, et al. Vet Rec Case Rep 2017;5:e000376. doi:10.1136/vetreccr-2016-000376
FIG 2: Transverse CT images at the level of the tympanic bullae (A)
soft tissue window pre contrast, (B) soft tissue window post contrast
(WL 40, WW 400). The right side of the patient is displayed on the
left. The mass in the right parotid region is mixed fat and soft tissue
attenuating and is heterogeneously minimally enhancing. It does
not appear to infiltrate the adjacent structures although the right
retromandibular vein (star) is intimately associated with its ventral
aspect. No right parotid salivary gland is identified. A normal left parotid
salivary gland is identified (open arrowhead). WL, Window level; WW,
Window width.
mass lesion was compressing and displacing the right mandibular
salivary gland medially. A normal right parotid salivary gland
was not identified. Bilaterally, the mandibular and medial retro-
pharyngeal lymph nodes were within normal limits.
In both cases, imaging differential diagnoses for the right
cervical fatty mass with lack of normal right parotid salivary
gland identification were sialolipoma, infiltrative lipoma,
liposarcoma and less likely solitary lipoma. The three last
differentials were considered less likely because they would not
explain the absence of ipsilateral parotid salivary gland. Severe
compression and displacement of the salivary gland, hypoplasia
or agenesis of the right parotid salivary gland would then have to
be considered. A lipoma would typically be expected to show a
more homogeneous fat attenuation. An atypical soft tissue mass
with some fat infiltration was considered unlikely, as more soft
tissue attenuation would have been expected. None of the cases
did show any substantial thoracic anomaly.
As part of the staging process, both cases also underwent
abdominal ultrasound examination. No evidence of metastasis
or any other substantial anomaly was identified in either dog.
Treatment
Surgical excision of the masses was considered the treatment
of choice as well as allowing for definitive histopathological
examination of the entire mass. Both dogs were anaesthetised
and placed in left lateral recumbency. A right parotid gland
sialoadenectomy was performed in both cases; visualising and
preserving the facial nerve and other vital structures by means of
gentle blunt and sharp dissection.
In case 1, the right parotid salivary gland was grossly enlarged
and lobulated with a well-demarcated fibrous capsule. A marginal
excision of the gland was attempted, trying to remove the gland
with the capsule as a whole; however, this proved challenging
around the entire gland, due to intimate association between this
and the surrounding structures.
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Veterinary Record Case Reports

FIG 3: Parotid salivary gland. Haematoxylin and eosin stain, x 1.25 FIG 4: Parotid salivary gland. Haematoxylin and eosin stain, x 10
magnification. Sialolipoma highlighting the presence of mature magnification. Sialolipoma highlighting the presence of oncocytic
adipocytes admixed with foci of salivary tissue composed of both metaplasia in occasional abnormal ducts lined by large epithelial cells
ductular and acinar elements. with voluminous and eosinophilic cytoplasm.

In case 2, the right parotid salivary gland was excised. No

ducts were dilated with occasional intraductal mineralised mate-
major structures were infiltrated by the mass, although some
rial and surrounded by mild lymphocytic inflammation. The
dissection had to be performed around the jugular, maxillary
mass was surrounded by a thin, fibrous capsule that bordered
and linguofacial veins in order to remove it.
adjacent non-neoplastic connective and adipose tissue (Fig 5).
The defects were closed in three layers and both abnormal
The capsule of the mass was within less than 1 mm of the inked
parotid glands were submitted for histopathological analysis.
surgical margins. The presence of a capsule in this instance was
consistent with a diagnosis of sialolipoma of the parotid gland.
Outcome and follow-up No recurrence was identified 16 months postoperatively.
Case 1
Surgical site swelling developed on day 1 postoperatively, this
Discussion
was believed to be a haematoma caused by excessive head
Sialolipoma is a rare lipomatous tumour of the salivary glands.
shaking. This was managed with meloxicam (Metacam 1.5 mg/
In humans, it accounts for less than 0.5% of all parotid gland
ml oral suspension for dogs; Boehringer Ingelheim) at 0.1 mg/
tumours (Nagao and others 2001) with 52 cases reported
kg every 24 hours orally and resolved within two to three weeks
(Eldamati 2016). The parotid salivary gland is the most common
without further treatment. There were no other postoperative
location, with 50 per cent of all sialolipomas reported in this
complications.
location (Eldamati 2016). To date, there is one report of recur-
Histopathology revealed the presence of mature adipocytes
rence following partial removal of the parotid salivary gland in
admixed with foci of salivary tissue composed of both ductular
the human literature (Lee and others 2014). Microscopically,
and acinar elements (Fig 3). The mass was partially surrounded
sialolipoma was first characterised by Nagao and others (2001)
by a fibrous capsule and there was normal salivary gland and
a linear area of fibroplasia admixed with neovascularisation
(granulation tissue). These findings were most consistent with
the presumptive diagnosis of sialolipoma of the parotid gland.
Complete excision could not be confirmed in this case due to
the mass often extending close to the margins and the fibrous
capsule was occasionally missing. No recurrence had occurred
seven months postoperatively.

Case 2
There were no postoperative complications. The dog was
discharged home on oral meloxicam (Metacam 1.5 mg/ml oral
suspension for dogs; Boehringer Ingelheim) administered at
0.1 mg/kg every 24 hours orally for five days to aid with postop-
erative inflammation.
Histopathology revealed a multilobular, encapsulated
neoplastic mass composed of approximately 60% adipose tissue
that entrapped normal-appearing salivary tissue with a scant to
moderate fibrovascular supporting stroma. Normal ducts were
present within islands of salivary tissue with occasional abnormal FIG 5: Parotid salivary gland. Haematoxylin and eosin stain, x 10
ducts lined by large epithelial cells with voluminous, eosinophilic magnification. Sialolipoma surrounded by a thin, fibrous capsule that
cytoplasm (oncocytic metaplasia) (Fig 4). Frequently abnormal borders adjacent non-neoplastic connective and adipose tissue.

Rodiño Tilve V, et al. Vet Rec Case Rep 2017;5:e000376. doi:10.1136/vetreccr-2016-000376 3

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Veterinary Record Case Reports
as a well-circumscribed proliferation of mature adipose tissue
and entrapped normal salivary glandular elements surrounded
by a fibrous capsule. This differentiates sialolipoma from adeno-
lipoma, lipomatosis, true lipoma, fibrolipoma and spindle
cell lipoma of the parotid salivary gland. Histopathology of
the masses reported here revealed adipose tissue entrapped in
normal-appearing salivary tissue surrounded by a well-defined
fibrous capsule.
It has been hypothesised by Akrish and others (2011) that
sialolipoma may result from salivary gland dysfunction due
to the replacement of salivary gland parenchyma with mature
adipose tissue and varying stages of acinar atrophy; with the
presence of salivary duct long-standing changes, such as ectasia,
periductal fibrosis and/or oncocytic metaplasia; and moderate
to severe chronic inflammatory infiltrate, as it is described in
case 2.
In the veterinary literature, there has been only one published
case report of a sialolipoma of a minor salivary gland in a dog
that was surgically excised and did not recur after six months
of follow-up. Radiographic features were described in this case,
the sialolipoma appeared as a soft tissue opacity in the caudal
oropharynx (Clark and others 2013). To the authors’ knowl-
edge, the cases reported here are the first two sialolipomas of
the parotid salivary gland described in the veterinary literature
and the first with CT features described.
Advanced imaging plays the major role in the preoperative
diagnosis of sialolipoma in human medicine; CT and magnetic
resonance imaging (MRI) are the cornerstones for establishing
the diagnosis (Eldamati 2016), proving to be superior to ultra-
sonography in defining exact location and texture of the lesion
(Qayyum and others 2013). However, they cannot differentiate
sialolipomas from other benign neoplasms such as lipomas (Lee
and others 2014): sialolipomas are characterised by a well-cir-
cumscribed tumour with a low CT attenuation and high MRI
intensity (Nagao and others 2001), as would be lipomas or
other fat infiltrated masses. CT was performed in both cases in
this report to assess the extent, the structure and the degree of
contrast enhancement of the tumours. It was also possible to
stage the disease, obtaining CT images of the thorax under the
same anaesthetic procedure. CT showed mixed fat attenuating
masses in the region of the right parotid salivary gland in both
dogs. However, differentiation between sialolipoma and other
lipomatous tumours is not feasible by means of CT alone.
FNA has been reported in the human literature to be of
little value in giving a final diagnosis of sialolipoma, due to the
inability to confirm the presence of the characteristic fibrous
capsule (Eldamati 2016), and the lesion containing mature
adipose tissue and non-neoplastic salivary gland tissue (Khazaeni
and others 2013). FNA can confirm the lipomatous origin and
benign behaviour of the mass (Tomo and others 2016), espe-
cially if advanced imaging is not available. The presence of fat
and/or salivary gland epithelium from an FNA of this site should
not be dismissed as non-diagnostic and should alert the clinician
to the possibility of a sialolipoma.
In human medicine, superficial parotidectomy with complete
excision of the tumour is the treatment of choice. As specified
above, surgical excision and histopathology are necessary to get a
definitive diagnosis of sialolipoma (Eldamati 2016). This partial
(superficial) parotidectomy aims to preserve the facial nerve and
4 Rodiño Tilve V, et al. Vet Rec Case Rep 2017;5:e000376. doi:10.1136/vetreccr-2016-000376
has been performed in the majority of cases (Tomo and others
2016) with only one reported case of recurrence in the human
literature. In this case, excisional margins were clear on histo-
pathology and it was thought to be a novel and independent
sialolipoma rather than recurrence from residual sialolipoma
tissue (Lee and others 2014). Therefore, marginal excision of
the tumour with the affected parotid salivary gland is expected
to be curative and to have a very good prognosis. In the two dogs
reported here, marginal surgical excision was performed and
neither tumour had recurred after 7 and 16 months, respectively.
To the authors’ knowledge, these are the first cases of parotid
salivary gland sialolipoma reported in dogs. A similar presenta-
tion of a painless, mandibular swelling was seen in both cases
and fine needle and needle core biopsies were consistent with
sampling both fat and salivary tissue. The CT findings of a fat
attenuating mass in the region of a salivary gland may raise
suspicion of this tumour. Definitive diagnosis is made on histo-
pathology showing a well-delineated mass of mature adipocytes
with islands of salivary gland parenchyma surrounded by a char-
acteristic fibrous capsule. Therefore, sialoadenectomy is vital
from a diagnostic point of view and is expected to be curative
with a favourable prognosis.
Contributors All authors listed have contributed significantly to the work,
have read the manuscript, attest to the validity and legitimacy of the data and
its interpretation, and agree to its submission to Veterinary Record Case Reports.
Detailed contributorship statement: VRT: Collating clinical information, literature
review, and writing and revising the manuscript. MF: Interpreting and reporting the
imaging studies, revising the manuscript. JDGL: Histopathological interpretation and
reporting, revising the manuscript. MJM: Performing diagnostic testing and clinical
management, literature review and revising the manuscript.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All available data can be obtained from the corre-
sponding author.
© British Veterinary Association (unless otherwise stated in the text of the article)
2017. All rights reserved. No commercial use is permitted unless otherwise expressly
granted.
References
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Rodiño Tilve V, et al. Vet Rec Case Rep 2017;5:e000376. doi:10.1136/vetreccr-2016-000376 5

 Downloaded from http://vetrecordcasereports.bmj.com/ on May 29, 2017 - Published by group.bmj.com

Sialolipoma of the parotid salivary gland in

two dogs
Verónica Rodiño Tilve, Marlene Finck, Joshua DG Leach and Michael J
Macfarlane

Vet Rec Case Rep 2017 5:

doi: 10.1136/vetreccr-2016-000376

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http://vetrecordcasereports.bmj.com/content/5/2/e000376

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References This article cites 8 articles, 0 of which you can access for free at:
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