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 Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 4  |  Issue : 4  |  Page : 148-150

Infiltrating lipoma of oral cavity: A rare entity


1 Department of Periodontology and Oral Implantology, Sebha University, Sebha, Libya
2 Department of Oral Pathology and Microbiology, Sebha University, Sebha, Libya
3 Faculty of Dentistry, Sebha University, Sebha, Libya
4 Department of Periodontics, Faculty of Dentistry, Arab Medical University, Benghazi, Libya

Date of Web Publication4-Dec-2013

Correspondence Address:
Karthikeyan Ramalingam
Department of Oral Pathology and Microbiology, Faculty of Dentistry, Sebha University, Sebha
Libya
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2155-8213.122679

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  Abstract 

Introduction: Lipomas are rare in the oral cavity comprising less than 5% of benign neoplasms in head and neck region. Infiltrating lipomas are much less common than other variants. Case Report: We report a rare case of infiltrating/intra-muscular lipoma in the retro-molar region of a 28-year-old male. Discussion: To the best of our knowledge, this is the first case report from Libyan population and in the Middle East & North Africa region (MENA). Surgical excision is curative but, regular follow-up is needed to identify recurrences of this unusual variant.

Keywords: Infiltrating lipoma, libyan origin, oral cavity, retro-molar region


How to cite this article:
Peeran SW, Ramalingam K, Alsaid FM, Mugrabi MH. Infiltrating lipoma of oral cavity: A rare entity. Dent Hypotheses 2013;4:148-50

How to cite this URL:
Peeran SW, Ramalingam K, Alsaid FM, Mugrabi MH. Infiltrating lipoma of oral cavity: A rare entity. Dent Hypotheses [serial online] 2013 [cited 2019 May 26];4:148-50. Available from: http://www.dentalhypotheses.com/text.asp?2013/4/4/148/122679


  Introduction Top


Lipomas are defined as benign neoplasms of mature fat tissue. [1] Despite being the most common mesenchymal neoplasm in adults, the occurrence of lipomas in the oral cavity is uncommon, representing only 1-5% of all oral neoplasms. Lipomas may occur in any intra-oral location, but the most commonly reported sites are the buccal mucosa, tongue, floor of mouth, buccal vestibule, lip, palate, gingival, and retromolar area. [2],[3] They usually present as painless, well-circumscribed, slow-growing submucosal or superficial lesions. [2] There are a number of microscopic subtypes of lipoma, such as angiolipoma, fibrolipoma, myolipoma, chondroid lipoma, spindle cell lipoma, myxoid lipoma, and pleomorphic lipoma. Lipomas can be classified as classic or simple lipoma which could be heterotopic like intra-muscular and inter-muscular location. [4]

There are less than 10 reported cases in literature about the infiltrating variant of lipoma in head and neck region. [4],[5],[6],[7],[8],[9] We report this case of infiltrating lipoma because of its rarity and the atypical features. To the best of our knowledge, this is the first case report in Libyan population and to be reported from the MENA region. The purpose of presenting this case is to highlight the distinctive manifestation of this lipoma variant.


  Case Report Top


A 28-year-old, apparently healthy male patient of Libyan origin was referred to the outpatient department, Faculty of Dentistry, Sebha University, Sebha, Libya for examination of swelling in the oral cavity. History revealed that the patient had noticed the swelling few months earlier. It started as a small swelling and grew slowly to attain the present size. The swelling was asymptomatic but interfered with mastication. Medical, surgical, and dental histories were non-contributory. Family history was irrelevant.

Clinical examination revealed a pedunculated swelling arising from the left buccal mucosa in the retromolar region, approximately 3 × 2 cms in size and covered by apparently normal mucosa. There was evidence of occlusal trauma in few areas. On palpation, the swelling was soft to fibro-elastic in consistency with diminished mobility at the base of the swelling [Figure 1]. Provisionally, it was diagnosed as lipoma.
Figure 1: Intra-oral picture showing the swelling in the left retro-molar region

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The lesion was surgically excised with a margin of normal tissue under local anaesthesia, fixed in formalin and sent for histopathological assessment.

Grossly, the tumor was a round, well-circumscribed mass about 2.5 cms in diameter [Figure 2]. The colour of the mass varied from predominantly yellowish-brown and soft to firm consistency on palpation. Histopathology of the tumor revealed mature adipocytes with thin, fibrous connective tissue septa [Figure 3]. Deeper sections revealed infiltration of the muscle without any evidence of degeneration [Figure 4].
Figure 2: Gross picture of the specimen

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Figure 3: Photomicrograph showing mature adipocytes separated by thin fibrous connective tissue septa (H and E, ×10)

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Figure 4: Photomicrograph showing the adipocytes infiltrating the muscle bundles (H and E, ×10)

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Correlating the history, clinical examination, and biopsy report, the lesion was diagnosed as infiltrating lipoma.

The patient is remaining disease-free on follow-up for the past one year after surgical excision.


  Discussion Top


The common inter-muscular type or the rarer intra-muscular form is considered a heterotopic variant of the classic lipoma, if it grows between two or more distinct muscles or any other known histological type of lipoma, which exhibits inter-digitations with the muscle fibres. [10],[11] There are doubts regarding their existence, as simple lipomas may be entrapped between muscle fibers. [2] The tendency to infiltrate muscle fibers could lead to recurrence of these variants. [10]

The infiltrating behavior of these variants should be excluded from liposarcoma. However, well-differentiated liposarcomas are usually encapsulated and they have the tendency to lose the connective sheath as they gain a more aggressive behavior. Infiltrating lipomas infiltrate the muscular bundles from the periphery. [12] Histologically, the presence of intact muscular fiber in the context of the lesion and the absence of cellular atypia and lipoblasts should confirm the diagnosis of an infiltrating lipoma. [13]

The superficial lipomas can be accurately diagnosed with clinical examination. The differential diagnosis of superficial lesions includes Schwannoma, neurofibroma, vascular malformation, sebaceous cyst, and lymphangioma. The deeper lipomas should be assessed by magnetic resonance imaging (MRI) or computed tomography (CT) with appropriate contrast. [14]

Our case correlated with literature exhibiting a slow growth, being larger in size and deeply localized than simple lipomas. Our case did not have any sensory disturbances due to pressure or tension on nerve trunks. [4] The most common reported location for intra-muscular lipomas in the oral cavity is the tongue, [15] but our case presented in the retro-molar region.

In addition to the oral cavity, this variant of infiltrating lipoma usually affects the large muscles of the extremities in adult men; it is usually painless and characterized by infiltrating adipose tissue and muscle atrophy. At these sites, the recurrence rate after surgical resection is higher, [16] whereas, it rarely recurs in the oral cavity after complete removal. [15],[16] Surgical excision of the lipoma is curative and recurrence is rare. However, infiltrating lipomas have a high recurrence rate and the patients must be followed-up at regular intervals. [14] But our patient is remaining disease-free on follow-up.

The exact pathogenesis of lipomas is still controversial. There are reports on the presence of chromosomal abnormalities translocations involving 12q13-15, locus interstitial deletions of 13q and rearrangements involving 8q11-13 locus. [17] It could also arise by pre-adipocyte differentiation and proliferation mediated by cytokines following soft tissue damage when blunt trauma and hematoma formation occurs. Further studies are needed for clarification. [15]


  Conclusion Top


The lipoma is an extremely rare tumor of the head and neck region. We report a rare case of infiltrating lipoma involving the retro-molar region. Surgical excision is curative but, regular follow-up is needed to identify recurrences of this unusual variant.

 
  References Top

1.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. 1
    
2.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. 2
    
3.de Visscher JG. Lipomas and fibrolipomas of the oral cavity. J Maxillofac Surg 1982;10:177-81.  Back to cited text no. 3
    
4.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. 4
    
5.Amirzadeh A, Klaustermeyer W. Intramuscular lipoma of the tongue masquerading as angioedema. Ear Nose Throat J 2013;92:E4-5.  Back to cited text no. 5
    
6.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. 6
    
7.Mandal RV, Duncan LM, Austen WG Jr, Nielsen GP. Infiltrating intramuscular spindle cell lipoma of the face. J Cutan Pathol 2009;36:70-3.  Back to cited text no. 7
    
8.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. 8
    
9.Usta U, Türkmen E, Mizrak B, Yildiz D, Güzel Z. Spindle cell lipoma in an intramuscular lipoma. Pathol Int 2004;54:734-9.  Back to cited text no. 9
    
10.Colella G, Lanza A, Rossiello L, Rossiello R. Infiltrating lipoma of the tongue. Oral Oncol 2004;40:33-5.  Back to cited text no. 10
    
11.Goodwin RW, O'Donnell P, Saifuddin A. MRI appearances of common benign soft-tissue tumours. Clin Radiol 2007;62:843-53.  Back to cited text no. 11
    
12.Kind M, Stock N, Coindre JM. Histology and imaging of soft tissue sarcomas. Eur J Radiol 2009;72:6-15.  Back to cited text no. 12
    
13.Donato M, Vanel D, Alberghini M, Mercuri M. Muscle fibers inside a fat tumor: A non-specific imaging finding of benignancy. Eur J Radiol 2009;72:27-9.  Back to cited text no. 13
    
14.Navaneetham A, Rao A, Gandhi A, Jeevan CA. Lipoma involving the masticator space. Ann Maxillofac Surg 2011;1:93-4.  Back to cited text no. 14
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15.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. 15
    
16.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. 16
    
17.Benign lipomatous tumors. In: Weiss SW, Goldblum JR, editors. Enzinger and Weiss's Soft Tissue Tumors, 4 th ed. St. Louis: Mosby; 2001. p. 571-39.  Back to cited text no. 17
    


    Figures

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



 

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