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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 1  |  Issue : 1  |  Page : 11-14

Lipomas of Oral and Maxillofacial Region: A Case Series


Department of Oral and Maxillofacial Pathology, Vasantdada Patil Dental College and Hospital, Sangli, Maharashtra, India

Date of Web Publication17-Jun-2015

Correspondence Address:
Priya S Joshi
Avani Appartment, Datta Nagar, Flat No B-3, 80 Feet Road, Vishrambag, Sangli - 416 416, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2393-8692.158903

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  Abstract 

Objective: Lipomas are the most common soft tissue tumors in the human body, but only 15-20% of cases occur in the oral and maxillofacial region. Hence in this study, we describe the clinical and histopathologic features of eight cases of lipomas in the oro-facial region. Materials and Methods: The cases reported during the period 2009-2014 to the Department of Oral and Maxillofacial Pathology were retrieved for the study as none of the cases of lipomas reported before. Clinical data were collected from patient's records, and cases were reviewed and classified microscopically. Results: Of the eight cases, six were female patients, and two were males; their mean age was 47 years (ranges: 22-76 years). In the present case series, lipomas showed multiple site involvement in the oral and maxillofacial region with the mean size of tumor being 3 cm (ranges 1.5-4.5 cm). Microscopically, three cases were classic lipomas, four were fibrolipomas and one was intramuscular or infiltrating lipoma. All cases had been treated by simple surgical excision, were followed, and no recurrence was reported. Conclusion: Lipomas of oral and maxillofacial region are relatively uncommon tumors. They have no gender as well as the site predilection for occurrence. The most common histological variant was found to be fibrolipoma. Surgical excision is the treatment of choice with a good prognosis.

Keywords: Benign tumor, fibrolipoma, intramuscular, intraoral site


How to cite this article:
Joshi PS, Chougule M, Dudanakar MP, Hongal BP, Agnihotri NS. Lipomas of Oral and Maxillofacial Region: A Case Series. Indian J Oral Health Res 2015;1:11-4

How to cite this URL:
Joshi PS, Chougule M, Dudanakar MP, Hongal BP, Agnihotri NS. Lipomas of Oral and Maxillofacial Region: A Case Series. Indian J Oral Health Res [serial online] 2015 [cited 2019 May 23];1:11-4. Available from: http://www.ijohr.org/text.asp?2015/1/1/11/158903


  Introduction Top


Lipomas are benign soft tissue neoplasms of mature adipose tissue. [1] They most commonly involve proximal portions of the extremities and seldom the oro-maxillofacial region. [2] 15-20% of the cases involve the head and neck region, whereas 1-4% cases affect the oral cavity which is very uncommon. [3] As lipomas are relatively rare in oral and maxillofacial region, very few case series have been published in the literature review. [4],[5],[6] Therefore, the aim of this study was to assess the clinical behavior, histopathologic features and differential diagnosis of eight cases of lipomas located in oral and maxillofacial region.


  Materials and Methods Top


Registry of the Department of Oral and Maxillofacial Pathology of the institution during the period 2009-2014 was analyzed for benign soft tissue tumors. We found eight cases of lipoma amongst 205 cases of benign soft tissue tumors reported as none of the cases of lipomas reported before 2009. All lipoma cases were retrieved for this case series. Clinical data, such as age and gender of the patient, site and size of the tumor, origin, progress, duration of the lesion, treatment and follow-up were obtained from the patient's records. Hematoxylin and eosin stained slides of each case was reviewed microscopically and classified according to Gnepp [7] as follows: Simple lipoma, other variants: fibrolipoma, spindle cell lipoma, intramuscular or infiltrating lipoma, angiolipoma, salivary gland lipoma (sialolipoma), pleomorphic lipoma, myxoid and atypical lipomas.


  Results Top


The clinical features, origin, progress and duration, histological subtypes, treatment with follow-up of the eight cases of lipomas is summarized in [Table 1]. Out of eight cases, six patients were females, and two were men, with a mean age of 47 years (ranges: 22-76 years). In six cases, the reported duration of the complaint varied from 12 to 48 months (mean 28 months). The exact history of duration was not reported in the remaining two cases. Considering the site of lesion amongst the total eight cases, there was one case each on buccal mucosa, labial mucosa, floor of mouth, anterior palate, vermilion border of lower lip, tongue, buccal vestibule and attached gingiva. The size of the tumors varied from 1.5 to 4.5 cm (mean 3.0 cm). Clinically all cases presented as painless, well-circumscribed, submucosal nodules, with yellowish discoloration and fibro-elastic consistency [Figure 1]. All lipomas were freely movable except intramuscular type that exhibited diminished mobility. All patients were treated by surgical excision without any recurrence in the follow-up period (ranges: 6-48 months).
Figure 1: Intraoral picture showing submucosal nodule at the attached gingiva

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Table 1: Lipomas of oral and maxillofacial region: Clinico-pathologic features with follow-up

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Microscopically, three cases were classified as classic lipomas (28.5%), four were fibrolipomas (57.1%), and one was intramuscular lipoma (14.3%). Mature adipose cells without atypia and necrosis, formed the classic lipomas [Figure 2]. The fibrolipoma was composed of the mature adipose cells and was surrounded by dense fibrous connective tissue [Figure 3]. Intramuscular lipoma showed mature adipocytes with infiltrating growth pattern extending in between skeletal muscle bundles [Figure 4].
Figure 2: Classic lipoma: Lobules of mature adipocytes and overlying epithelium (H and E, ×4); (Inset) Mature adipocytes surrounded by well circumscribed thin fibrous connective tissue capsule (H and E, ×10)

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Figure 3: Fibrolipoma: Mature adipocytes intermixed with significant fibrous component (H and E,×40)

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Figure 4: Intramuscular lipoma: Mature adipocytes with infiltrating growth pattern extending in between skeletal muscle bundles (H and E, ×40)

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  Discussion Top


Lipomas are benign mesenchymal neoplasms of mature adipocytes mostly occurring in subcutaneous tissue, rarely in deep tissues and oro-maxillofacial regions. [1] The first reported case of oral lipoma was described by Roux in a review of alveolar masses, and he referred it to as "yellow epulis" (Roux 1848). [8],[9],[10]

The etiology and pathogenesis of lipomas are unclear, although mechanical trauma, endocrine and inflammatory influences have been reported. [11],[12],[13] Most lipomas are developmental and the ones occurring in maxillofacial regions, usually, arise late in life and may present as a neoplasm. [14]

Hypertrophy theory suggests that the obesity and inadvertent growth of adipose tissue are contributory to the formation of these lesions. The fat from lipomas is not used up in general metabolism during periods of starvation like fat from normal adipose tissue. Another theory known as "metapalsia theory" suggests that lipomatous development occurs due to aberrant differentiation of mesenchymal cell-lipoblast. Lin and Lin suggest that lipomas are congenital lesions arising from embryonic multipotent cells. The factors contributing for etiology of lipomas as enumerated by Enzinger and Weiss include chromosomal abnormality like translocation of t (3:12) (q127:q13) and I (3:12) (28:q14), diabetes mellitus, hypercholesterolemia and obesity. [15] In our case series, four cases gave a history of trauma, two were obese with high lipid profile, while others had unknown etiology.

The peak incidence of age for lipomas is fourth to fifth decades of life. [16],[17] However in our case series, we had two cases each in the range of second to third decade and sixth to seventh decade. The prevalence does not differ with gender, although a male predilection has been recorded for oral lipomas in the literature that is not in accordance with our case series. [18] Clinically lipomas are sessile, painless, solitary, well circumscribed yellowish lesion with soft doughy consistency and occur in various anatomic sites including buccal mucosa, lip, tongue, palate, vestibule, floor of mouth, mandible and major salivary glands. [4] Our case series does not report intraosseous lesion. Interestingly, we report one uncommon case on the attached gingiva. Signs and symptoms may include feeling of fullness and discomfort with functional problems like dysphagia, difficulty in speech and mastication. [3] Multiple lipomas have been associated with certain syndromes like Neurofibromatosis, Gardner's syndrome, Decrum's disease, Proteus syndrome, Cowden's syndrome and Pai syndrome. [19] Due to the diverse modes of presentation some other lesions should be considered in the differential diagnosis and these include oral lymphoepithelial cysts, epidermoid and dermoid cysts, mucocele, ranula, benign salivary gland tumor, benign mesenchymal neoplasms. [3],[16]

Superficial lipomas in oro-maxillofacial regions can be clinically diagnosed with the help of palpation, but deep lesions adherent to muscle or salivary gland require imaging techniques such as computerized tomography, magnetic resonance imaging and ultrasonography. [2]

Interesting criteria considered for diagnostic purpose is that after removal of the lesion, the soft tissue specimen should float when placed in a water pot. [11] All cases reported to our department fulfilled the same criteria.

Microscopically, it is difficult to differentiate between normal adipose tissue and lipomas, therefore, accurate clinical and surgical information must be provided by the clinician to the pathologist for making definitive diagnosis. [4],[16] Based on microscopic features lipomas are classified into classic lipoma, fibrolipoma, angiolipoma, spindle cell lipoma, pleomorphic, myxoid, sialolipoma and intramuscular lipoma. Histologically, classic lipomas are composed of adult fat cells that are subdivided into lobules by thin fibrous connective tissue septa, whereas the fibrolipomas consist of adipose cells surrounded by dense fibrous connective tissue. Classic lipomas are the most frequent histologic subtype [4] but the incidence of fibrolipoma was more in our case series as compared to classic lipomas. But, the equal incidences of classic lipomas and fibrolipomas have been reported in the literature [4],[14] that probably may be due to subjective variation in the diagnosis. One histologic variant in our study was an intramuscular or infiltrative lipoma. These lipomas generally present as a noncircumscribed nodule and is, usually, seen on the tongue [2] but in our case series it was found on lower labial mucosa which is rare.

The treatment for lipomas in oral and maxillofacial region is adequate surgical excision. The surgical approach is dependent on the site of the tumor and the proposed cosmetic result. [16] In our case series, all the patients were treated surgically, with excellent outcome and no recurrence was noted in the follow-up.


  Conclusion Top


Lipomas of oral and maxillofacial region are relatively uncommon tumors although they are reported to be most common soft tissue tumors. Lipomas can occur at any intra-oral site, and there is no gender predilection. Most common histologic type in our case series is the fibrolipoma. Surgical excision is the treatment of choice, with no recurrence on follow-up.

 
  References Top

1.
Annibali S, Cristalli MP, Monaca GL, Giannone N, Testa NF, Russo LL, et al. Lipoma in the soft tissues of the floor of the mouth: A case report. Open Otorhinolaryngol J 2009;3:11-3.  Back to cited text no. 1
    
2.
Epivatianos A, Markopoulos AK, Papanayotou P. Benign tumors of adipose tissue of the oral cavity: A clinicopathologic study of 13 cases. J Oral Maxillofac Surg 2000;58:1113-7.  Back to cited text no. 2
    
3.
Kumar LK, Kurien NM, Raghavan VB, Menon PV, Khalam SA. Intraoral lipoma: A case report. Case Rep Med 2014;2014:480130.  Back to cited text no. 3
    
4.
Bandéca MC, de Pádua JM, Nadalin MR, Ozório JE, Silva-Sousa YT, da Cruz Perez DE. Oral soft tissue lipomas: A case series. J Can Dent Assoc 2007;73:431-4.  Back to cited text no. 4
    
5.
Fregnani ER, Pires FR, Falzoni R, Lopes MA, Vargas PA. Lipomas of the oral cavity: Clinical findings, histological classification and proliferative activity of 46 cases. Int J Oral Maxillofac Surg 2003;32:49-53.  Back to cited text no. 5
    
6.
Weiss SW, Goldblum JR, editors. Benign lipomatous tumors. In: Enzinger and Weiss′s Soft Tissue Tumors. 4 th ed. St. Louis: Mosby; 2001. p. 571-639.  Back to cited text no. 6
    
7.
Gnepp DR, editor. Diagnostic Surgical Pathology of the Head and Neck. Philadelphia: WB Saunders; 2001.  Back to cited text no. 7
    
8.
Ikram R, Rehman Al-Eid AA. Oral lipoma in elderly Saudi patient: A case report. Int J Health Sci (Qassim) 2012;6:97-103.  Back to cited text no. 8
    
9.
Fomete B, Amalimeh B, Rowland A, Uche OA. Lipoma of the floor of the mouth: Case report and review of the literature. Case Study Case Rep 2013;3:65-70.  Back to cited text no. 9
    
10.
Chidzonga MM, Mahomva L, Marimo C. Gigantic tongue lipoma: A case report. Med Oral Patol Oral Cir Bucal 2006;11:E437-9.  Back to cited text no. 10
    
11.
Filho GN, Caputo BV, Santos CC, Souza RS, Giovani EM, Scabar LF, et al. Diagnosis and treatment of intraoral lipoma: A case report. J Health Sci Inst 2010;28:129-31.  Back to cited text no. 11
    
12.
Aust MC, Spies M, Kall S, Gohritz A, Boorboor P, Kolokythas P, et al. Lipomas after blunt soft tissue trauma: Are they real? Analysis of 31 cases. Br J Dermatol 2007;157:92-9.  Back to cited text no. 12
    
13.
de Freitas MA, Freitas VS, de Lima AA, Pereira FB Jr, dos Santos JN. Intraoral lipomas: A study of 26 cases in a Brazilian population. Quintessence Int 2009;40:79-85.  Back to cited text no. 13
    
14.
Rehani S, Bishen KA. Intraoral fibrolipoma - A case report with review of literature. Indian J Dent Adv 2010;2:215-6.  Back to cited text no. 14
    
15.
Metgud RS, Kale AD. Lipoma of the tongue. J Oral Maxillofac Pathol 2004;8:96-8.  Back to cited text no. 15
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16.
Adoga AA, Nimkur TL, Manasseh AN, Echejoh GO. Buccal soft tissue lipoma in an adult Nigerian: A case report and literature review. J Med Case Rep 2008;2:382.  Back to cited text no. 16
    
17.
Hoseini AT, Razavi SM, Khabazian A. Lipoma in oral mucosa: Two case reports. Dent Res J (Isfahan) 2010;7:41-3.  Back to cited text no. 17
    
18.
Furlong MA, Fanburg-Smith JC, Childers EL. Lipoma of the oral and maxillofacial region: Site and subclassification of 125 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98:441-50.  Back to cited text no. 18
    
19.
Larsen K, Juul A, Kristensen S. Intraoral lipoma. A rare cause of dysphagia. J Laryngol Otol 1984;98:1041-2.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]



 

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