Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 8  |  Issue : 5  |  Page : 656-658  

Intramuscular lipoma of tongue: A common tumor at an uncommon site


1 Department of Pathology, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, Telangana, India
2 Department of Oncology, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, Telangana, India

Date of Web Publication10-Sep-2015

Correspondence Address:
Shailaja Prabhala
H. No. 8-14/1, Ravindranagar Colony, Street No. 8, Habsiguda, Hyderabad - 500 007, Telangana
India
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Source of Support: Nil., Conflict of Interest: None declared.


DOI: 10.4103/0975-2870.164958

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  Abstract 

Lipomas are common benign soft tissue tumors and usually occur in the back, neck and shoulder regions. Intraoral lipomas are infrequent, and its occurrence in the tongue is uncommon. Owing to the unusual site and a possible correlation to traumatic etiology, we report a case of lingual lipoma in a 75-year-old male.

Keywords: Intramuscular lipoma, tongue, trauma


How to cite this article:
Prabhala S, Jayashankar E, Reddy MS, Tanikella R. Intramuscular lipoma of tongue: A common tumor at an uncommon site. Med J DY Patil Univ 2015;8:656-8

How to cite this URL:
Prabhala S, Jayashankar E, Reddy MS, Tanikella R. Intramuscular lipoma of tongue: A common tumor at an uncommon site. Med J DY Patil Univ [serial online] 2015 [cited 2020 May 26];8:656-8. Available from: http://www.mjdrdypu.org/text.asp?2015/8/5/656/164958


  Introduction Top


Lipomas are common soft tissue tumors. Almost 20% cases involve head and neck regions.[1] Lipomas of the oral cavity are uncommon, contributing to less than 5% of all neoplasms in this location.[1] The common intraoral sites are cheek, tongue, lips, and floor of the mouth. Lipoma accounts for 0.3% of all lingual tumors.[1] Lipoma of the tongue is infrequent and hence we present a case report.


  Case Report Top


A 75-year-old male presented to the Department of Oncology, with a relatively rapidly growing painless swelling in the left side of the tongue since 2 months.

He noticed difficulty in speech as well as masticatory problems since 1-month for which he sought the present consultation. He is a nondiabetic and hypertensive on regular oral medication. He did not have any dental problems or history of use of dentures. He had sustained a road traffic accident 14 years ago and at that time he had multiple rib fractures and laceration of the tongue at the same site where the present lesion was situated.

On local clinical examination: A soft tissue mass 2 cm diameter was seen on the left lateral border of the tongue [Figure 1]. The mucosa was normal, without any inflammation or ulceration. The mass was soft to firm, nontender and nonfluctuant. The free border of the tongue showed slightly yellowish areas. The cervical lymph nodes were nonpalpable. Considering the history of a painless mass that was soft and yellowish, a clinical diagnosis of lipoma of the tongue was entertained despite of it being an uncommon entity in this location.
Figure 1: Preoperative clinical photograph of the lesion on the left lateral border of tongue

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The surgical profile was within normal limits. Magnetic resonance imaging images were not available as it was done at an outside hospital. The report read as a 1.8 cm × 1.5 cm well-circumscribed lesion within the muscles of the tongue in anterior two-thirds area on the left side. The findings were reported as consistent with lipoma.

Local excision with a surrounding rim of normal tissue was done under general anesthesia. The raw area was reconstructed by primary closure with interrupted vicryl sutures. The postoperative period was uneventful, and he was discharged on the 5th day.

The gross specimen showed a well-circumscribed soft mass covered by pink lingual mucosa superiorly and by muscle fibers in other areas. The specimen was tagged for margins. Its cut sections revealed a well-delineated, nonencapsulated, yellowish, solid, greasy, spherical mass 1.8 cm × 1.7 cm × 1 cm in size. Tiny yellowish areas were seen on the free/lateral margin of the specimen [Figure 2].
Figure 2: The cut surface shows well-circumscribed yellowish mass

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The bits were fixed in 10% buffered formalin, processed routinely, embedded in paraffin, and the sections were stained with Hematoxylin–Eosin.

The microscopy revealed lobules of mature adipocytes separated by thin fibrovascular septa. The lesion was well-circumscribed with entrapped striated muscle fibers some of which showed atrophic changes. Inflammation, atypia, mitoses, necrosis or lipoblasts were absent and hence, well-differentiated liposarcoma was ruled out. It was reported as "intramuscular lipoma of the tongue."[Figure 3] and [Figure 4]. The deeper excised plane showed involvement by the lipoma.
Figure 3: Section shows normal stratified squamous epithelium with underlying lesion composed of mature adipocytes (H and E, ×40)

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Figure 4: Section shows mature adipocytes and entrapped striated muscle fibers. No atypia seen (H and E, ×100)

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  Discussion Top


Roux gave the first description of an intraoral lipoma in 1848 and he referred to it as a "yellow epulis."[2] Lipomas are benign neoplasms of mature fat cells.[3] They arise most commonly from the subcutaneous tissue and have a wide anatomic distribution. However, the trunk and the proximal limbs are the most frequent sites.[4] The tongue is said to be a mucomuscular organ relatively devoid of fat cells and hence occurrence of lipomas at this site is intriguing.[5] They, usually, occur in the fourth and fifth decades whereas our patient was 75 years old.[6] The oral lipomas range in size from 0.5 to 8 cm.[3] However, they can grow huge up to 10 cm size as reported by Chandak et al.[7] Lipomas of the tongue are, usually, solitary, but they can also be multiple as encountered by Keskin et al.[8] Sometimes, they may cause muscle dysfunction or sensory changes as they may exert pressure on the nerve trunks.[9] These features were not seen in the present case.

Some of the possible etiologic factors for oral lipoma are origin from embryonic cell rests, fatty degeneration, infection, recurrent trauma, infarction, chronic irritation as in use of dentures or hormonal alterations.[3],[5] Our patient had none of these risk factors. However, he gave a history of having sustained a laceration in that area 14 years ago and which had healed adequately without any complications. Lipomas can arise in traumatized areas. The proposed hypothesis is that after a soft tissue injury and hematoma formation there are various cytokines involved in the repair process which probably play a role in the preadipocytic differentiation and proliferation leading to a lipoma.[10] In the present case, the duration between the injury and the appearance of lipoma at the injured site is fairly long, of 14 years. But considering the fact that lingual lipomas are very uncommon, we propose that this is an unusual case of a lipoma occurring posttrauma after a long latent period. Further studies are required in this regard.

Surgical removal is the treatment of choice for oral lipomas and recurrence is not expected.[6]

However, intramuscular lipomas of the tongue are known to recur with a range of 3-62.5%.[11] And also, in our case as the deeper margin was involved, a close observation was advised. The patient is under follow-up since 4 months (postoperative) and does not have any complaints.


  Conclusion Top


Intramuscular lipomas can present as relatively rapidly growing soft tissue tumors within the tongue and have to be considered in the differential diagnoses, especially in elderly individuals even though they are uncommon in this site. Clinically, visible yellowish areas in the lesion strongly favor a diagnosis of lipoma. Local trauma, irrespective of the duration, may play an important role in the causation of lingual lipomas.

 
  References Top

1.
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. 1
    
2.
Rapidis AD. Lipoma of the oral cavity. Int J Oral Surg 1982;11:30-5.  Back to cited text no. 2
[PUBMED]    
3.
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. 3
    
4.
Fletcher CD. Soft tissue tumors. In: Fletcher CD, editor Diagnostic Histopathology of Tumors. 3rd ed. China: Elsevier; 2007. p. 1529.  Back to cited text no. 4
    
5.
Srinivasan K, Hariharan N, Parthiban P, Shyamala R. Lipoma of tongue — A rare site for a rare site for a common tumour. Indian J Otolaryngol Head Neck Surg 2007;59:83-4.  Back to cited text no. 5
    
6.
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. 6
    
7.
Chandak S, Pandilwar PK, Chandak T, Mundhada R. Huge lipoma of tongue. Contemp Clin Dent 2012;3:507-9.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.
Keskin G, Ustundag E, Ercin C. Multiple infiltrating lipomas of the tongue. J Laryngol Otol 2002;116:395-7.  Back to cited text no. 8
    
9.
Cicconetti A, Guttadauro A, Mascioli PA. Rapidly growing infiltrating lipoma of the oral cavity and the mental region. Oral Surg 2010;3:140-2.  Back to cited text no. 9
    
10.
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. 10
    
11.
Colella G, Biondi P, Caltabiano R, Vecchio GM, Amico P, Magro G. Giant intramuscular lipoma of the tongue: A case report and literature review. Cases J 2009;2:7906.  Back to cited text no. 11
    


    Figures

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



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
Introduction
Case Report
Discussion
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