Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 7  |  Issue : 3  |  Page : 396-399  

Superficial intraoral lipoma in a geriatric edentulous male: A case report with review of literature


1 Department of Oral and Maxillofacial Pathology, Vyas Dental College and Hospital, KudiHaud, Pali Road, India
2 Department of Periodontics, Sri Aurobindo College of Dentistry and P.G Institute, Indore, Madhya Pradesh, India

Date of Web Publication18-Mar-2014

Correspondence Address:
Aanchal Sharma
Department of Oral and Maxillofacial Pathology, Vyas Dental College and Hospital, KudiHaud, Pali Road, Jodhpur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.129009

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  Abstract 

Lipoma is a common tumor of the soft tissues. Its location on the oral mucosa is infrequent, representing 1 to 5% of all benign oral tumors although it is the most frequently occurring mesenchymal tumor of the trunk and proximal portions of extremities. Lipoma of the oral cavity is seen mainly on the buccal mucosa, tongue, and floor of the mouth. The clinical presentation is typically as an asymptomatic yellowish mass. The overlying epithelium generally remains intact. The purpose of the present case report is to discuss a lipoma on the left buccal mucosa of an elderly male with a brief review of literature.

Keywords: Benign tumor, buccal mucosa, differential diagnosis, lipoma


How to cite this article:
Sahni P, Nayak MT, Sharma A, Kumar R. Superficial intraoral lipoma in a geriatric edentulous male: A case report with review of literature. Med J DY Patil Univ 2014;7:396-9

How to cite this URL:
Sahni P, Nayak MT, Sharma A, Kumar R. Superficial intraoral lipoma in a geriatric edentulous male: A case report with review of literature. Med J DY Patil Univ [serial online] 2014 [cited 2020 Oct 21];7:396-9. Available from: https://www.mjdrdypu.org/text.asp?2014/7/3/396/129009


  Introduction Top


Benign mesenchymal soft tissue neoplasms are common occurrences in the oral cavity. Lipoma is one such benign tumor that seldom occurs in the oral mucosa. [1] In the oral cavity, it comprises no more than 1-5% of all neoplasms. [2],[3],[4] The first description of oral lipomas was given by Roux in 1848, in a review of alveolar mass, wherein he referred to it as a "yellow epulis.'' [5] It presents as a solitary, slow growing, asymptomatic lesions with a characteristic yellowish color and soft, doughy feel. The surface is typically smooth and non-ulcerated except when traumatized. The buccal mucosa and the mucobuccal fold are the most common sites; followed by the tongue, floor of the mouth, and lip. [6] It occurs in the fourth and fifth decades and generally with no gender predilection. Although a male predilection has been reported in several studies, the etiology is unknown. However, it is thought that trauma may trigger proliferation of fatty tissue and cause a lipoma. [7],[8],[9] Although benign in nature, their continuous growth and large size may cause interference with speech and mastication. [2] The present case is of a superficial intra-oral lipoma in an elderly male treated by surgical excision.


  Case Report Top


A 65-year-old edentulous male, visited the OPD for replacement of missing teeth. He had noticed a swelling in the left mandibular posterior region of the cheek since 6 months. The patient was otherwise in good general health and his vital signs were well within the normal range.

On intra-oral examination, a solitary, round to oval, pedunculated, well-circumscribed swelling was observed on the posterior part of the left buccal mucosa, adjacent to the retromolar pad area. The mucosa over the swelling appeared normal. On palpation, the swelling was non-tender, fluctuant with a doughy consistency. The lesion measured 1.3 × 1.1 × 1.1 cm 3 in its greatest dimensions [Figure 1]. The excision of the lesion was planned before fabrication of a complete denture to avoid obstruction in the retention of the prosthesis. Following a thorough hematological examination, the lesion was completely excised under local anaesthesia.
Figure 1: Clinical presentation of swelling in the left posterior buccal mucosa

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Macroscopically, the lesion appeared creamish-brown in color, well-circumscribed with a smooth surface and was soft in consistency [Figure 2]a. Cut section revealed a smooth, shiny/greasy yellow colored inner surface [Figure 2]b.

Microscopic examination revealed the presence of parakeratinized stratified squamous epithelium covering a loose connective tissue stroma. Subepithelially, a thin fibrous capsule was present, which encapsulated mature adipose tissue containing variable sized adipocytes. The adipocytes were separated by thin fibrous connective tissue septae, which were visualized as large clear cell with eccentrically placed nucleus and no evidence of cellular atypia or metaplasia [Figure 3]a and 3b. On the basis of the histological findings, a diagnosis of lipoma was made. After an observation period of 3 months, a complete denture was fabricated for the patient.
Figure 2: (a) Gross appearance showing smooth, creamish-brown mass. (b) Cut section showing a smooth, well-circumscribed, shiny yellow colored surface

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Figure 3: (a) Photomicrograph showing stratifi ed squamous epithelium overlying a loose connective tissue stroma, which is encapsulating adipose tissue (H and E stain, 10x). (b) Photomicrograph showing aggregates of mature adipocytes with clear cytoplasm and eccentric nuclei (H and E stain 40x)

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  Discussion Top


Lipoma is defined as a benign, slow-growing neoplasm composed of mature fat cells. [10] They are the most common mesenchymal tumors especially in trunk and proximal portions of the extremities but are unusual tumors of oral cavity. [3] Many lipomas remain unrecorded or are brought to the notice of the clinicians only if they reach a large size or cause cosmetic problems or complications because of their anatomic site. [11]

Tumors in the oral cavity may become symptomatic earlier than those in other anatomic sites owing to interference in speech and mastication. Most tumors reported in the literature have been relatively asymptomatic. Several of them grow to a large size before patients seek medical advice. [12] The peak incidence age for this tumor is 40 years and above. Generally, their prevalence does not differ with gender although a male predilection has been recorded. [13] In the present case, the patient, aged 65 years gave a history of a slow growing painless swelling since 6 months.

Oral lipomas are slow-growing, soft compressible masses with doughy consistency commonly presenting a mean diameter between 2.0 and 2.2 cm at diagnosis. [14],[15],[16] The swelling reported here measured 1.3 cm. The buccal mucosa is the most common intra oral site. [17],[18] The site predilection is probably related to the availability of adipose tissue, which is high in the buccal mucosa because of the proximity of buccal fat pad. [19]

On gross appearance, lipomas usually manifest as a soft, well-circumscribed, thinly encapsulated, rounded mass varying in size. On cross section, lipomas are pale yellow to orange in color with a uniform greasy surface and an irregular lobular pattern. The lipomas of the deep structures vary in shape, and tend to be well-delineated from the surrounding tissue by a thin capsule. [11]

Microscopically, it is not possible to distinguish these lipomas from normal adipose tissue; however they are not used as an energy source as is normal adipose tissue because of their different metabolism. This is probably due to low lipoprotein lipase activity in the neoplastic lipoma cell. [15],[20] Based on their histopathologic features, lipomas can be classified as: Classic lipoma; lipoma variants, such as angiolipoma, chondroid lipoma, myolipoma and spindle cell/pleomorphic lipoma, all with specific clinical and histologic features; hamartomatous lesions; lipoblastoma/lipoblastomatosis; and hibernoma. [11] Cytogenetic analysis of adipose tissue tumors has shown that the various histopathologic subtypes are characterized by distinctive clonal chromosomal abnormalities. The CHOP gene, located on the long arm of chromosome 12 appears to be involved in adipocytic differentiation. [11] It has been shown that while classic lipomas typically harbor abnormalities involving 12q13-15 or 6p or 13q, spindle cell and pleomorphic lipomas typically display complete or partial loss of 13q and chromosome 16. [21] [Table 1].
Table 1: Cytogenic and histopathological fi ndings in variants of lipoma

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Occasionally, the lipoma may invade muscles or grow between them; the so-called infiltrating lipoma. Infiltrating lipoma is an uncommon mesenchymal neoplasm that tends to recur after excision. This type of lipoma is extremely unusual in the head and neck region, and its congenital type is uncommon. [22]

Multiple head and neck lipomas have been observed in neurofibromatosis, Gardner's syndrome, encephalocraniocutaneous lipomatosis, and Proteus syndrome. [10] The occurrence of multiple lipomas is also associated with Cowden's syndrome or multiple hamartoma syndrome. This condition is either familial or sporadic, resulting from mutations of the phosphatase and tensin homolog gene. [23]

Fregnani et al., demonstrated the proliferative activity of lipomas by the expression of proliferating cell nuclear antigen (PCNA) and Ki-67. The proliferation rate of fibrolipomas was greater than that of classic lipomas. Although the increased expression would suggest faster growth of the lesion, it was not reflected in the clinical behavior, as seen by the absence of recurrence in all the cases after surgical excision. [15]

Differential diagnosis of oral lipomas includes oral dermoid, epidermoid cysts, oral lymphoepithelial cysts, salivary gland cysts like mucocele. [8] Other benign connective tissue lesions like neurofibroma and traumatic fibroma should be considered in the differential diagnosis. [24] [Table 2].
Table 2: Differential diagnosis of Intra oral lipoma

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Surgical excision is the mainstay of the treatment. Recurrence is reduced by wide surgical excision at the same time preserving the surrounding structures. Well-encapsulated lipomas, easily shell out with no possibility of recurrence or damage to the surrounding structures. [3],[14] The patient was followed up for a period of 1 year, with no signs of recurrence.


  Conclusion Top


Lipoma of the oral cavity is considered as an unusual occurrence. It is a soft, asymptomatic, slow growing lesion for which complete excision is the treatment of choice, irrespective of its histological variant. The prognosis of this lesion is excellent with almost negligible chances of recurrence.

 
  References Top

1.Castro A, Castro E, Felipini R, Ribeiro AC, Soubhia AM. Osteolipoma of the buccal mucosa. Med Oral Patol Oral Cir Bucal 2010;15:e347-9.   Back to cited text no. 1
    
2.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. 2
    
3.Del Castillo Pardo de Vera JL, CebrianCarretero JL, Gomez GE. Chronic lingual ulceration caused by lipoma of the oral cavity. Case report. Med Oral 2004;9:166-7.  Back to cited text no. 3
    
4.Trandafir D, Gogãlniceanu D, Trandafir V, Cãruntu ID. Lipomas of the oral cavity--a retrospective study. Rev Med Chir Soc Med Nat Iasi 2007;111:754-8.   Back to cited text no. 4
    
5.Roux M. On exostosis: Their character. Am J Dent Sci1848;9:133-4.  Back to cited text no. 5
    
6.Venkateswarlu M, Geetha P, Srikanth M. A rare case of intraoral lipoma in a six year-old child: A case report.Int J Oral Sci 2011;3:43-6.  Back to cited text no. 6
    
7.Bandeca MC, de Padua JM, Nadalin MR, Ozorio ZE, 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. 7
    
8.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. 8
    
9.Lawoyin JO, Akande OO, Kolude B, Agbaje JO. Lipoma of the oral cavity: Clinicopathological review of seven cases from Ibadan. Niger J Med 2001;10:189-91.  Back to cited text no. 9
    
10.Rajenderan R, Sivapathsundharam B. Textbook of Oral Pathology. 7 th ed. New Delhi: Elsevier; 2012. p.141-3.  Back to cited text no. 10
    
11.Enzinger FW, Weiss SW. Soft tissue tumors. 4 th ed. St. Louis: Mosby; 2001. p. 429-52.  Back to cited text no. 11
    
12.Kacker A, Taskin M. Atypical intramuscular lipomas of the tongue. J Laryngol Otol 1996;110:189-91.  Back to cited text no. 12
    
13.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;58:1113-8.  Back to cited text no. 13
    
14.Furlong MA, Fanburg-Smith JC, Childers EL. Lipoma of the oral and maxillofacial region: Site and sub-classification of 125 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98:441-50.  Back to cited text no. 14
    
15.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. 15
    
16.Juliasse LE, Nonaka CF, Pinto LP, FreitasRde A, Miguel MC. Lipomas of the oral cavity: Clinical and histopathologic study of 41 cases in a Brazilian population. Eur Arch Otorhinolaryngol 2010;267:459-65.  Back to cited text no. 16
    
17.de Freitas MA, Freitas VS, de Lima AA, Pereira FBJr., 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. 17
    
18.Studart-Soares EC, Costa FW, Sousa FB, Alves AP, Osterne RL. Oral lipomas in a Brazilian population: A 10-year study and analysis of 450 cases reported in the literature. Med Oral Patol Oral Cir Bucal 2010;15:e691-6.   Back to cited text no. 18
    
19.Manor E, Sion- Vardy N, Joshua BZ, Bodner L. Oral lipoma: Analysis of 58 new cases and review of the literature. Ann Diagn Pathol 2011;15:257-61.  Back to cited text no. 19
    
20.Solvonuk PF, Taylor GP, Hancock R, Woods WS, Frohlich J. Correlation of morphologic and biochemical observations in human lipomas. Lab Invest 1984;51:469-74.  Back to cited text no. 20
    
21.Fletcher CD, Akerman M, Dal Cin P, de Wever I, Mandahl N, Mertens F, et al. Correlation between clinicopathological features and karyotype in lipomatoustumors. A report of 178 cases from the Chromosomes and Morphology (CHAMP) Collaborative Study Group.Am J Pathol 1996;148:623-30.  Back to cited text no. 21
    
22.Piattelli A, Fioroni M, Rubini C. Intramuscular lipoma of the cheek: A case report. J Oral Maxillofac Surg 2000;58:817-9.  Back to cited text no. 22
    
23.Woodhouse JB, Delahunt B, English SF, Fraser HH, Furguson MM. Testicular lipomatosis in Cowden's syndrom. Mod Pathol 2005;18:1151-6.  Back to cited text no. 23
    
24.Regezi JA, Sciubba JJ, Jordan RC. Oral pathology clinical pathological correlations. 6 th ed, USA: Elsevier Saunders; 2012. p.184-5.  Back to cited text no. 24
    


    Figures

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

  [Table 1], [Table 2]



 

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