|Year : 2020 | Volume
| Issue : 2 | Page : 65-68
An unusual presentation of an intraoral lipoma
Apurva Mohite Khator, Mukta Bhagwandas Motwani
Department of Oral Medicine and Radiology, VSPM'S Dental College, Nagpur, Maharashtra, India
|Date of Submission||27-Jul-2020|
|Date of Acceptance||10-Aug-2020|
|Date of Web Publication||31-Oct-2020|
Dr. Apurva Mohite Khator
25 Daga Layout, Shilpak Apartments, Nagpur, Maharashtra
Source of Support: None, Conflict of Interest: None
Intraoral lipomas are a rare entity and they usually cause no discomfort. Therefore, patients are unable to notice them or tend to neglect them as they are painless in nature. This makes it mandatory for oral physicians to perform a meticulous examination of the oral cavity and accurately diagnose intraoral lipomas for early management. Lipomas are benign, slow-growing tumors of mesenchymal origin composed of fat. Intraorally, buccal mucosa, lip, and tongue are the common sites of occurrence as they have ample fat tissue but, the hard palate is a rare site. They usually occur in older individuals with no gender predilection. This case report describes a case of a 22-year-old female with a lipoma on the hard palate which was surgically excised and reported no recurrence after 1 year of follow-up.
Keywords: Hard palate, lipoma, surgically excised
|How to cite this article:|
Khator AM, Motwani MB. An unusual presentation of an intraoral lipoma. Indian J Oral Health Res 2020;6:65-8
| Introduction|| |
Lipomas are common tumors in the human body but are less frequent in the oral cavity, comprising no >1%–5% of all neoplasms. They are asymptomatic, slowly growing, and benign tumors of mesenchymal origin consisting of fat. They usually occur in individuals >40 years of age. They may present in various forms, as sessile or pedunculated, and single or lobulated tumors of variable sizes but mostly below 3 cm in diameter. Lipomas could be superficial or deep. The deeper ones are more diffuse and on palpation may give the feeling of a fluid-filled cyst. Hence, meticulous clinical evaluation should be done to avoid any misdiagnosis.
Histologically, lipomas are classified as simple lipomas or variants such as fibrolipoma, spindle cell lipoma, intramuscular or infiltrating lipoma, angiolipoma, salivary gland lipoma (sialolipoma), pleomorphic lipoma, myxoid, and atypical lipomas. Of these, the simple lipomas and fibrolipomas are the most common. Intraoral lipomas can cause discomfort, difficulty in chewing, dysphagia, and dyspnea. They are nontender. They generally have well-defined margins, so surgical excision is recommended in such cases.
The present case report describes a case of intraoral lipoma occurring in a young female on the palate.
| Case Report|| |
A 22-year-old female patient came to the Department of Oral Medicine and Radiology with a chief complaint of growth on the left side of palate for the past 4 months [Figure 1]. She noticed the growth while eating as she felt it with her tongue. The growth was initially small in size and gradually increased to attain a size of 1.5 cm × 1 cm. There was no history of pain or any kind of discomfort associated with the growth. Furthermore, there was no history of any discharge from the growth or trauma to the palate.
Intraoral examination revealed a single pedunculated growth at the junction of the hard and the soft palate on the left side, distal to the maxillary tuberosity. The growth was roughly oval in shape, pale pink in color having well-defined margins. The surface texture was smooth with no ulceration or inflammation and the consistency was soft with no discharge on palpation.
Excision biopsy was planned under local anesthesia after obtaining patients hemogram reports. The excised specimen was pale yellow in color and measured 2 cm × 1 cm in size [Figure 2] and [Figure 3]. It was sent for histopathological examination. A follow-up visit after 7 days showed uneventful healing and 1 year of follow-up did not reveal any recurrence [Figure 4].
The histopathology of the soft-tissue section showed the parakeratinised stratified squamous epithelium and focal entrapment of connective tissue at places. Acanthosis was also seen at some places. The underlying connective tissue was fibro cellular showing predominantly mature adipocytes present within the collagen fiber bundles, fibroblasts, and endothelial lined blood capillaries, some of which were dilated along with mild chronic inflammatory cell infiltrate chiefly composed of lymphocytes [Figure 5] and [Figure 6].
| Discussion|| |
Lipomas are benign tumors of mature fat cells. Clinically, these tumors appear as yellowish masses with thin epithelium showing a delicate pattern of blood vessels. They are usually slow growing, asymptomatic subcutaneous nodules. Approximately 13% of lipomas occur in the head and neck, but the oral cavity is an unusual site. Oral lipomas account for 2.2%–4.4% of all benign intraoral tumors with most lesions occurring in the buccal mucosa. They generally occur in individuals over 40 years of age with no gender predilection.
Hatziotis et al. had reviewed the literature from 1945 to 1967 and had found 145 cases of intraoral lipomas of which only six cases occurred in the hard palate. Fregnani et al. reviewed 46 cases of lipomas and found none occurring in the palate. Review of a few large reported series of intraoral lipoma and its variants seen in the literature did not show any case of oral lipoma occurring in the hard palate.
In the present case, both the age of the patient and the site of occurrence are unusual and hence we believe that it is a rare case.
The etiology of oral lipomas is unclear. Some studies have mentioned that mechanical factors, endocrine system, inflammation, obesity, chromosomal abnormalities, radiation, trauma, mucosal infections, and chronic irritation can contribute to the development of oral lipomas. The most common type is fibrolipoma, which is characterized by the presence of the fibrous components adjacent to the fat cells. Osteolipoma, chondrolipoma, intramuscular or infiltrating lipomas, salivary gland lipomas, pleomorphic lipomas, angiolipomas, myxoid lipomas, spindle cell lipomas, and atypical lipomas are rare.
The diagnosis of lipoma can be made clinically by identifying its pathognomonic features like Yellowish color due to fat cells, smooth surface, extremely soft consistency, and inability to hold in between the fingers (positive slip sign). Even then, there are a variety of lesions to be considered while diagnosing a case of intraoral lipoma, owing to similarities in their presentation [Table 1].
In the present case, the first differential diagnosis considered was a fibroma since it is the most common benign tumor occurring in the oral cavity, and its color is pink. However, the consistency of the lesion in the present case was very soft, and hence fibroma was ruled out. The second differential diagnosis considered was a dermoid cyst since it is mobile, slow growing, and painless which is similar to lipoma. However, the dermoid cyst is a developmental anomaly and is congenital, whereas in the present case the patient had the growth for 4 months hence dermoid cyst was ruled out. The third differential diagnosis was a lymphoepithelial cyst because it appears as a yellowish-white nodule with a smooth surface having very soft fluctuant consistency. However, as opposed to our case, it is more common in men and almost exclusively limited to the floor of the mouth or the lateral border of the tongue.
The treatment of choice for intraoral lipoma is complete surgical excision. No recurrence has been described after local excision. The diode laser can also be used for excision as it has an added advantage of reduced bleeding and lesser chances of swelling and scarring of the surgical site, as compared to the simple surgeries.
Recurrence is reduced by wide surgical excision. Infiltrating lipomas are more liable to recurrence as they are not encapsulated such as simple lipomas.
Medical management of lipomas can be done by steroid injections that result in local fat atrophy, thus, shrinking the tumor size. They are best done on lipomas that are <1 inch in diameter. A monthly repeated injection of 1:1 mixture of lidocaine and triamcinolone acetonide into the central region of the tumor may be useful in the regression of the lesion. The average volume of steroids used may range from 1 to 3 mL depending on the size of the tumor. Liposuction using a 16-gauge needle and large syringe is useful in small or large lipomatous growths where scarring needs to be avoided.
| Conclusion|| |
The lipoma is a benign, slow-growing tumor composed of adipose cells occurring particularly in the subcutaneous tissues of the neck. It is relatively rare in the oral cavity and even rarer on the palate as seen in the present case. Even though lipomas show some classic clinical features, histopathological evaluation is the gold standard for diagnosing them. Surgical excision is the treatment of choice and recurrence is rare.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]