Fat-Containing Minor Salivary Gland Proliferation of the Supraglottis: Challenging the "Ectopic" Paradigm

Laryngeal lesions reported as "ectopic" salivary gland tissue are exceedingly rare, with fewer than 10 examples documented. The histogenesis of these lesions remains uncertain, and the terminology applied has not been critically reevaluated. A 63-year-old man presented with persistent throat discomfort. Laryngoscopy revealed a 9.5-mm left supraglottic nodule, which was excised microsurgically. Histopathologic examination demonstrated seromucous acini intimately admixed with lipomatous stroma, together with cystically dilated oncocytic ductal structures associated with lymphoid stroma. Review of previously reported lesions reveals a consistent pattern-seromucous acini associated with mature adipose tissue-occurring almost exclusively in the supraglottic region, where minor salivary glands are normally present. This architecture resembles the spectrum of fat-containing salivary gland lesions described in the major salivary glands. The absence of a well-defined capsule, together with preservation of native glandular architecture and associated reactive changes, favors interpretation as a localized adenolipomatous proliferation rather than a true heterotopia or hamartoma. We propose that these lesions represent part of a broader spectrum of fat-containing minor salivary gland proliferations of the supraglottis, within which nonencapsulated examples may be more appropriately regarded as adenolipomatous hyperplasia. Recognition of this pattern may help avoid diagnostic confusion and facilitate more consistent classification. Based on the limited available follow-up data, complete excision appears to be an adequate treatment.