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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 6  |  Issue : 2  |  Page : 98-100

Intraoral lipoma at an unusual site: A rare presentation


1 Department of Oral Pathology and Microbiology, Mamata Dental College and Hospital, Khammam, Telangana, India
2 Department of Oral Medicine and Radiology, Mamata Dental College and Hospital, Khammam, Telangana, India

Date of Web Publication6-Dec-2017

Correspondence Address:
Dr. Moni Thakur
Department of Oral Pathology and Microbiology, Mamata Dental College and Hospital, Giriprasad Nagar, Khammam - 507 002, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdas.jdas_20_17

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  Abstract 


Lipomas are soft tissue benign mesenchymal tumors and are composed of mature adipocytes. They can occur anywhere on the human body where fat is found and thus called it is called “universal tumor” or “ubiquitous tumor.” However, its representation in the oral cavity is rare, i.e., 1%–4% only. Most of the patients affected are above 40 years of age with no gender predilection, but some studies reported male predilection and is uncommon in children. The size of the tumor rarely exceeds 25 mm in diameter and is mostly asymptomatic until secondarily infected or grow to a large size and interfere with mastication and speech. The most common site of occurrence intraorally is buccal mucosa, tongue, lips and floor of the mouth. Here, we report a case of intraoral lipoma occurring at an unusual site (retromolar area) in a 35-year-old female patient with a histopathologically confirmed diagnosis.

Keywords: Adipocytes, lipoma, soft tissue tumors


How to cite this article:
Thakur M, Reddy Kundoor VK, Maloth KN, Nayanala VA. Intraoral lipoma at an unusual site: A rare presentation. J Dent Allied Sci 2017;6:98-100

How to cite this URL:
Thakur M, Reddy Kundoor VK, Maloth KN, Nayanala VA. Intraoral lipoma at an unusual site: A rare presentation. J Dent Allied Sci [serial online] 2017 [cited 2019 Aug 19];6:98-100. Available from: http://www.jdas.in/text.asp?2017/6/2/98/219972




  Introduction Top


Lipoma is the most common benign slow growing mesenchymal tumor, composed of mature adipose tissue, and usually surrounded by thin fibrous capsule.[1] Roux, in 1848, was the first person to describe lipoma in his review of alveolar masses and referred to it as a “yellow epulis.”[1],[2],[3]

They are commonly seen on trunk and proximal portions of the extremities, but rare in the oral cavity.[1],[2] The incidence of lipoma varies between 15% and 20% in head and neck region and 1%–4% in the oral cavity.[1] The site of occurrence in the oral cavity is more common on buccal mucosa and mucobuccal fold followed by the tongue, floor of the mouth and lips.[2],[4] Lipomas are usually seen in patients above 40 years of age without any gender predilection, but some studies reported male predilection[2],[5] and uncommon in children.[6] The size of the tumor rarely exceeds 25 mm in diameter[7] and mostly asymptomatic until secondarily infected or grow to large size and interfere with mastication and speech.[8] The purpose of this report is to present a rare case of intraoral lipoma at an unusual site in a 35-year-old female patient.


  Case Report Top


A 35-year-old female patient reported to the department with a complaint of growth in her lower left back tooth region since 1 year. History revealed that she was apparently asymptomatic 1 year back, later she noticed a growth which was initially smaller in size and gradually increased to attain the present size and is not associated with pain or discharge but occasionally, associated with discomfort while eating. The patient has no history of trauma. Examination of the lesion revealed a well-defined, pedunculated, smooth surfaced growth in the left retromolar area measuring approximately 2 cm × 2 cm size [Figure 1]. On palpation, it was soft in consistency, slippery, nontender, and nonreducible. Diascopy was performed, which was negative [Figure 2]. Based on the above findings, a provisional diagnosis of lipoma was made, with a differential diagnosis of mucocele and irritational fibroma.
Figure 1: Soft tissue growth-retromolar region

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Figure 2: Diascopy-negative result

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Routine baseline blood investigations and radiological examinations were performed, which were noncontributory. Complete surgical excision was done [Figure 3], and specimen was sent for histopathological examination which revealed [Figure 4] the tumor mass was well circumscribed and encapsulated with adipocytes arranged in lobular pattern separated by fibrous septae, suggestive of lipoma (fibrolipoma). Based on clinical and histological findings, a final diagnosis of intraoral lipoma (fibrolipoma) of the retromolar area was given.
Figure 3: Excised specimen

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Figure 4: Histopathology showing mature fat cells separated by fibrous septae

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  Discussion Top


Lipoma is defined as a benign, slow-growing neoplasm composed of mature fat cells.[9] Lipoma can occur anywhere on the human body thus it is termed as “universal tumor” or “ubiquitous tumor.” It is rare in oral cavity representing 1%–4% of all benign oral tumors.[1] Intraorally, it commonly occurs on buccal mucosa, tongue, floor of the mouth, lips and mucobuccal fold.[1],[2] They occur most often in adult patients older than 40 years of age with no gender predilection, although some studies reported male predilection.[2],[5] In the present case, the site of occurrence was in the retromolar region in a 35-year-old female patient.

The exact etiology is unknown, but the possible causes are trauma, infection, chronic irritation, hormonal changes,[10] metaphase of muscle cells, and lipoblastic embryonic cell nest origin.[3] Furlong et al.[5] classified oral peripheral mesenchymal tumors into lipomas, myxomas, and peripheral nerve tumors. According to Rajendran and Sivapathasundaram[9] morphologically intraoral lipomas are classified into diffuse form affecting the deeper tissues, superficial form and encapsulated form.

Clinically, the lesion is pedunculated or sessile, nontender, mobile, and almost superficial in depth with yellowish color, but may infiltrate the surrounding tissue and become unmovable.[2],[3] The consistency of the lesion varies from soft to firm depending on the quality and distribution of fatty tissue and depth of the tumor.[10] The clinical features of the present case were in accordance with the literature.

Multiple lipomas are associated with neurofibromatosis, Gardner syndrome, Cowden's syndrome, encephalocraniocutaneous lipomatosis, multiple familial lipomatosis, and Proteus Syndrome.[2],[10] Based on the clinical features, other lesions such as fibroma, oral dermoid, epidermoid cysts, salivary gland tumors, benign mesenchymal tumors, and oral lymphoepithelial cysts can be considered as differential diagnosis.[11] Compared to lipomas, fibromas consist of fibrous tissue and are much more firm. Oral lymphoepithelial cysts clinically appear similar to oral lipomas, but usually occur in younger patients and commonly involving the floor of the mouth, soft palate, and mucosa of pharyngeal tonsils. Oral dermoid and epidermoid cysts present as submucosal nodules, but commonly occur in midline of floor of the mouth.[3] Although clinical findings are enough for diagnosis, the histopathology remains the gold standard. Most oral lipomas are composed of mature fat cells with fibrous components (fibrolipoma) which differ microscopically from normal fat cells that surround the tumor.[12] The case reported here is a fibrolipoma.

The other histopathological variants are angiolipoma, spindle cell lipoma, pleomorphic lipoma, ossifying lipoma, chondroid lipoma, ossifying chondromyxoid lipoma, hibernoma (benign neoplasm of brown fat), and intramuscular lipoma.[9],[12] The treatment of oral lipomas irrespective of the histological variant is simple surgical excision with good prognosis. No recurrence is observed, except intramuscular variant which is rare intraorally has higher recurrence rate, due to infiltrative growth behavior.[3],[12]


  Conclusion Top


Lipomas are common benign mesenchymal tumors, but their existence in the oral cavity is rare. In this article, we reported one such rare case in an unusual site in the oral cavity. Its diagnosis is mainly based on the clinical features. The treatment of these lesions is simple surgical excision under local anesthesia with good prognosis. Hence, every clinician should be aware of the clinical features for prompt diagnosis and proper treatment to prevent functional impairment for the patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Khadka R, Chaurasia NK. Intra oral lipoma – A case report. J Nepal Dent Assoc 2013;13:127-30.  Back to cited text no. 1
    
2.
Agarwal P, Patil S, Chaudhary M. A rare case of intraoral lipoma in a 33 months old child and a review. Dentistry 2014;4:215.  Back to cited text no. 2
    
3.
Raj M, Ramadoss T, Anuradha G, Devi S. Intraoral lipoma: Review of literature and case report. J Indian Acad Oral Med Radiol 2012;24:36-8.  Back to cited text no. 3
  [Full text]  
4.
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. 4
[PUBMED]    
5.
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. 5
[PUBMED]    
6.
Ahmed W, Amin M, Ullah S. Intraoral lipoma-an unusual site and size. Pak Armed Forces Med J 2009;59:137-9.  Back to cited text no. 6
    
7.
Rapidis AD. Lipoma of the oral cavity. Int J Oral Surg 1982;11:30-5.  Back to cited text no. 7
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8.
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. 8
[PUBMED]    
9.
Rajendran R, Sivapathasundaram B. Shafer's Textbook of Oral Pathology. 6th ed. India: Elsevier; 2009.  Back to cited text no. 9
    
10.
Kaur R, Kler S, Bhullar A. Intraoral lipoma: Report of 3 cases. Dent Res J (Isfahan) 2011;8:48-51.  Back to cited text no. 10
[PUBMED]    
11.
Tan MS, Singh B. Difficulties in diagnosing lesions in the floor of the mouth – Report of two rare cases. Ann Acad Med Singapore 2004;33 4 Suppl: 72-6.  Back to cited text no. 11
    
12.
Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial Pathology. 3rd ed. Philadelphia: Saunders; 2009.  Back to cited text no. 12
    


    Figures

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



 

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