|Year : 2015 | Volume
| Issue : 1 | Page : 11-14
Lipomas of Oral and Maxillofacial Region: A Case Series
Priya S Joshi, Madhuri Chougule, Mahesh P Dudanakar, Bhagyalaxmi P Hongal, Neha S Agnihotri
Department of Oral and Maxillofacial Pathology, Vasantdada Patil Dental College and Hospital, Sangli, Maharashtra, India
|Date of Web Publication||17-Jun-2015|
Priya S Joshi
Avani Appartment, Datta Nagar, Flat No B-3, 80 Feet Road, Vishrambag, Sangli - 416 416, Maharashtra
Source of Support: None, Conflict of Interest: None
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 2020 Jan 18];1:11-4. Available from: http://www.ijohr.org/text.asp?2015/1/1/11/158903
| Introduction|| |
Lipomas are benign soft tissue neoplasms of mature adipose tissue.  They most commonly involve proximal portions of the extremities and seldom the oro-maxillofacial region.  15-20% of the cases involve the head and neck region, whereas 1-4% cases affect the oral cavity which is very uncommon.  As lipomas are relatively rare in oral and maxillofacial region, very few case series have been published in the literature review. ,, 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|| |
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  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|| |
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|| |
Lipomas are benign mesenchymal neoplasms of mature adipocytes mostly occurring in subcutaneous tissue, rarely in deep tissues and oro-maxillofacial regions.  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). ,,
The etiology and pathogenesis of lipomas are unclear, although mechanical trauma, endocrine and inflammatory influences have been reported. ,, Most lipomas are developmental and the ones occurring in maxillofacial regions, usually, arise late in life and may present as a neoplasm. 
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.  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. , 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.  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.  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.  Multiple lipomas have been associated with certain syndromes like Neurofibromatosis, Gardner's syndrome, Decrum's disease, Proteus syndrome, Cowden's syndrome and Pai syndrome.  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. ,
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. 
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.  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. , 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  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 , 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  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.  In our case series, all the patients were treated surgically, with excellent outcome and no recurrence was noted in the follow-up.
| Conclusion|| |
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.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]