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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 3  |  Issue : 1  |  Page : 30-32

Oral lipoma: An uncommon case report with ultrasonographic finding


Department of Oral Medicine and Radiology, P.M.Nadagouda Memorial Dental College and Hospital, Bagalkot, Karnataka, India

Date of Submission10-Jul-2021
Date of Decision13-Jul-2021
Date of Acceptance15-Dec-2021
Date of Web Publication8-Feb-2022

Correspondence Address:
Misha Efney Fernandes
Department of Oral Medicine and Radiology, P.M.Nadagouda Memorial Dental College and Hospital, Bagalkot, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijofb.ijofb_1_21

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  Abstract 


Lipoma is most common tumor of mesenchymal origin and is rarely seen in the oral and maxillofacial region. The etiology is still unknown. Various theories are given explaining the pathogenesis of adipose tissue tumor. Intraoral lipoma is a rare entity, painless and mostly diagnosed on a routine dental check-up. We report a case of intraoral lipoma on the buccal mucosa of a 60-year-old female patient with its ultrasonographic appearance in detail.

Keywords: Benign neoplasm, lipoma, oral cavity, ultrasonography


How to cite this article:
Fernandes ME, Puranik SR. Oral lipoma: An uncommon case report with ultrasonographic finding. Int J Orofac Biol 2019;3:30-2

How to cite this URL:
Fernandes ME, Puranik SR. Oral lipoma: An uncommon case report with ultrasonographic finding. Int J Orofac Biol [serial online] 2019 [cited 2024 Mar 28];3:30-2. Available from: https://www.ijofb.org/text.asp?2019/3/1/30/337410




  Introduction Top


Lipoma is most common tumor of mesenchymal origin, comprising of mature adipocytes, mostly surrounded by a thin layer of fibrous capsule. They develop mostly in the subcutaneous tissues and in deep tissues too.[1] In the head and neck, lipomas are rare, accounting for 1%–4% of benign tumors. They present as long-standing, well-circumscribed, rubbery, nodular asymptomatic swelling covered by normal mucosa.[2] Most of the oral lipomas occur in the buccal mucosa and buccal vestibule, other sites including the major salivary glands, lip, tongue, palate, and floor of the mouth.[3] The etiology and pathogenesis are unclear, some stating mechanical, endocrinal, and inflammatory influences.[4] This case report describes the clinical, ultrasonographic, and histopathological findings.


  Case Report Top


A 60-year-old female patient visited the department with a chief complaint of swelling in the lower left front region of the mouth for the past 3 months. Not associated with pain, functional impairment, or any other difficulty in speech and deglutition. The lesion was well defined, solitary, sessile, dome swelling seen on the left buccal mucosa about 1 cm × 1 cm, yellowish in color, with smooth surface [Figure 1]. On palpation, the swelling was nontender, firm, superficial mucosa was intact with no ulceration or indentation. Ultrasonography was performed and the findings were hypoechoic ovoid to round-shaped areas seen in the submucosal structure of left cheek [Figure 2]. Excisional biopsy was planned under local anesthesia; the excised specimen was 1 cm × 1 cm in size [Figure 3] and was sent for histopathological examination. A review after 7 days showed uneventful healing; hence, the sutures were removed [Figure 4]. The histopathology revealed well-circumscribed capsulated lesional tissue consisting of lobules of round to oval-shaped plump cells with clear cytoplasm and eccentrically placed nucleus suggestive of mature adipocytes separated by thin fibrous septae along with scattered inflammatory cells.
Figure 1: Well-circumscribed, solitary nodular swelling

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Figure 2: Ultrasonograhy showing hypoechoic areas

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Figure 3: Excised specimen

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Figure 4: Histopathology showing aggregate of mature adipocytes with large clear cytoplasm and eccentric nuclei

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  Discussion Top


Lipomas are adipose mesenchymal tumors, statistics showing less frequency in the oral cavity, accounting for only 1%–4%.[5] The first case was reported by Roux in 1848, and he had referred it to as “yellow epulis.”[4] The etiology of lipoma is still unclear; hypertrophy theory suggests that obesity and inadvertent growth of adipose tissue lead to its formation. This theory is less convincing at the lesions that occur in areas lacking preexisting adipose tissue. The Metaplasia theory states that lipomatous development is due to aberrant differentiation of in situ mesenchymal cells into lipoblast. Other mechanisms such as trauma, infection, chromosomal abnormalities, or hormonal imbalances have been proposed.[4],[5],[6]

Lipoma is seen in adults mostly in the sixth and seventh decade of life and frequently seen in female patient. Intraoral lipoma most commonly seen on the buccal mucosa, followed by buccal vestibule, retromolar area, tongue, and other sites.[7] They occur more commonly in female patients than in male patients.[8] Lipoma clinically manifests as painless, sessile, slow growing, and size varies from 2 mm to 15 mm in diameter.[4] Lipomas can be superficial which are easily palpable and deep lipomas are not palpable usually and require imaging examination like ultrasonography.[8]

Imaging examination like ultrasonography helps to distinguish between the mass and adjacent tissue, also to delineate its boundary whether it is adherent to underlying muscle or salivary gland. Ultrasonography is noninvasive, quick, more economical and uses high frequency transducers, suitable for detecting superficial lesions. The echogenicity of lipoma is related to number of internal interfaces between fat and connective tissue; purer the fat tissue more hypoechoic the result.[7],[8] In our case, the ultrasonography showed hypoechoic areas similar to findings by Cole et al.[9] Other investigating modalities like computed tomography and magnetic resonance imaging (MRI) can also be used; but ultrasonography is quick, easy, uses high frequency transducer suitable for superficial lesions. However, when the mass is difficult to identify on ultrasonogram, computed tomography or MRI is advised.[9] The differential diagnosis of intraoral lipoma consists of oral dermoid and epidermoid cyst, oral lymphoepithelial cyst, benign salivary gland tumor, mucocele, benign mesenchymal neoplasm.[5] Complete surgical excision is the main treatment of lipoma. There is no recurrence after excision. Newer nonsurgical treatment modalities are still under trial which may come into practice in recent future.


  Conclusion Top


Intraoral lipomas are a rare entity which is often noticed on a routine dental check-up. Most of them rarely cause pain hence delay in seeking treatment. Adequate surgical excision is the choice and has a rare recurrence.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
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. 1
    
2.
Barca I, Faro CL, Cordaro R, Novembre D, Mignogna C, Cristofaro MG, et al. Intramuscular lipoma involving the masticator space: A case report. J Oral Maxillofac Surg Med Pathol 2019;31:208-11.  Back to cited text no. 2
    
3.
Naruse T, Yanamoto S, Yamada S, Rokutanda S, Kawakita A, Takahashi H, et al. Lipomas of the oral cavity: Clinicopathological and immunohistochemical study of 24 cases and review of the literature. Indian J Otolaryngol Head Neck Surg 2015;67:67-73.  Back to cited text no. 3
    
4.
Mehendirratta M, Jain K, Kumra M, Manjunatha BS. Lipoma of mandibular buccal vestibule: A case with histopathological literature review. BMJ Case Rep 2016;2016:bcr2016215586.  Back to cited text no. 4
    
5.
Kumar LK, Kurien NM, Raghavan VB, Menon PV, Khalam SA. Intraoral lipoma: A case report. Case Rep Med 2014;2014:480130.  Back to cited text no. 5
    
6.
Kumaraswamy S, Madan N, Keerthi R, Shakti S. Lipomas of oral cavity: Case reports with review of literature. J Maxillofac Oral Surg 2009;8:394-7.  Back to cited text no. 6
    
7.
Egido-Moreno S, Lozano-Porras AB, Mishra S, Allegue-Allegue M, Marí-Roig A, López-López J. Intraoral lipomas: Review of literature and report of two clinical cases. J Clin Exp Dent 2016;8:e597-603.  Back to cited text no. 7
    
8.
Zhong LP, Zhao SF, Chen GF, Ping FY. Ultrasonographic appearance of lipoma in the oral and maxillofacial region. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98:738-40.  Back to cited text no. 8
    
9.
Cole-Beuglet C, Schwartz GF, Kurtz AB, Patchefsky AS, Goldberg BB. Ultrasound mammography for male breast enlargement. J Ultrasound Med 1982;1:301-5.  Back to cited text no. 9
    


    Figures

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


This article has been cited by
1 Oral lipoma: A case report with comprehensive ultrasonographic features and treatment plan
Praveenkumar Ramdurg, E.G.Yog Naag Amaran, Saahil Ramesh, Surekha R Puranik
Journal of Dental Specialities. 2023; 11(2): 131
[Pubmed] | [DOI]



 

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