Intraoral lipoma of the tongue and submandibular space: report of a case

Fibrolipoma of the lower lip: A case report and review of the literature

BACKGROUND

Fibrolipoma of the lower lip is an uncommon condition with limited documentation in the literature. This paper provides updated insights into oral and maxillofacial lipomas through a detailed case report and comprehensive literature review, discussing clinical features, pathogenesis, diagnostic approaches, histopathology, and therapeutic strategies.

CASE PRESENTATION

A 54-year-old female presented with a painless, enlarging mass on the inner aspect of her right lower lip, first noticed 2 years prior. The mass, now the size of a peanut, interfered with her eating and speech. Physical examination revealed a 2.0 × 2.5 × 1.0 cm mass beneath the mucous membrane of the right lower lip. It was firm, well-demarcated, and mobile. Surgical excision was performed, and histopathological analysis confirmed the diagnosis of a lower lip fibrolipoma. The lesion was successfully removed without recurrence.

CONCLUSION

Lipomas in the oral and maxillofacial regions are rare, slow-growing benign tumors, particularly within the lips. Although their diagnosis is straightforward based on clinical presentation, histopathological confirmation is essential. Surgical resection remains the treatment of choice, with excellent prognostic outcomes.

Head and Neck Lipomas at Uncommon Subsites: A Series of Four Cases

Lipomas are benign soft tissue tumors; the most common ones present in subcutaneous planes distributed throughout the body. However, there are few sites which are unusual location for lipomas. Here, we discuss the presentation of 4 cases of head and neck lipomas at unusual subsites. Though its prevalence is high in the body, lipomas are rarely seen in upper aerodigestive tract and these lesions can cause severe deglutition and respiratory distress problems in addition to cosmetic deformities. In the head and neck, most common location of lipoma is the cheek, followed by the tongue. Tonsillar lipomas are very rare. The mainstay treatment for lipomas is complete surgical excision and recurrence following complete removal is rarely known. We are here discussing a series of 4 cases of lipomas, presenting at uncommon subsites in head and neck region. These include lesions over neck, tongue, palate and tonsillar fossa. Lipomas are benign mesenchymal tumors, that are initially non bothersome. However, with increasing size they can cause severe aerodigestive problems with functional compromise and need complete surgical excision.

Lipoma Rarely Involving Multiple Suprahyoid Fascial Spaces: A Large Lesion Removed With Bimanual Transcervical Finger Dissection Using a "Push-Pull Down" Maneuver

Lipoma involving multiple fascial spaces is extremely rare and poses a challenge to surgeons using less invasive procedures. Although blunt dissection using a finger is often used in excisional surgeries as a supplementary maneuver, few cases have been described using the bimanual technique for the removal of these extensive lesions.Herein, the authors present a large lipoma of the oral floor extending to the unilateral submandibular and parapharyngeal spaces, which was excised only via a submandibular approach using the "push-pull down" maneuver, blunt finger dissection of the tumor with counter-pushing on the overlying mucosa to the submandibular direction facilitated tumor separation. The tumor was consequently pulled down and removed without an additional intraoral incision.Based on accurate preoperative examinations, this maneuver, provides a less invasive surgery for well-encapsulated benign tumors involving multiple fascial spaces.

Atypical MRI and Histopathological Findings in Dermoid Cyst

On images, a dermoid cyst is often described as resembling a "sack of marbles" or "marbles in a bag". Typically, it comprises an inhomogeneity filled with multiple nodules in a fluid matrix on both computed tomography and magnetic resonance imaging (MRI). How it appears, however, will vary depending on its histological contents, which may cause confusion in arriving at a diagnosis. This report describes a dermoid cyst in the floor of the mouth of a 55 year-old woman that showed an atypical internal appearance on MRI. Most of the lesion showed homogeneous high signal intensity on T1 - and T2-weighted images, suggesting that it was derived from fat. A small area within the mass, however, showed moderate signal intensity almost equal to that of muscle on T1-weighted images and high signal intensity on fat-suppressed T2-weighted images. Given the location of the lesion, a dermoid cyst was one possible diagnosis. A lipoma or lipoma variants were also considered, however, based on signal intensity. Histopathological section of the excised specimen revealed a dermoid cyst with sebaceous glands in its walls and keratin in its cavity. Dermoid cysts show variation in their internal structures and contents. Since MRI can reflect such histological variation, signal intensity requires careful interpretation.

A rare presentation of lipoma on mandibular mucogingival junction

Lipoma is the most common tumor of mesenchymal tissues of body, but its occurrence in oral cavity is infrequent. Buccal mucosa is the most common intraoral site of lipoma followed by tongue, floor of the mouth, and buccal vestibule. The involvement of mucogingival junction is rare. We present a unique case report of oral lipoma occurring on mandibular mucogingival junction with review of literature which has emphasis on differential diagnosis.

Rare fibrolipoma of the tongue: a case report

INTRODUCTION

Lipoma is a benign tumor infrequent in the oral cavity, particularly in the tongue: indeed, lipomas only represent approximately 0.3% of all tongue neoplasia. Compared to conventional lipoma, fibrolipoma of the tongue is a very rare lesion that accounts for around 25-40% of tongue lipomas, and until now, to the best of our knowledge, only 14 cases have been described in which histological diagnosis of fibrolipoma was specifically confirmed. We report the case of a patient with a voluminous fibrolipoma of the tongue, treated by means of surgical excision. Fibrolipoma excision, like that described in this report, sometimes may be laborious, because fibrous bands appear to be focally infiltrating adjacent tissues, giving rise to some doubts about the nature of the lesion.

CASE PRESENTATION

We report the case of a voluminous fibrolipoma of the tongue in a 71-year-old Caucasian woman.

CONCLUSIONS

Because of its histological characteristics, abundance of connective and secondary changes/atrophy, fibrolipoma may appear as infiltrating adjacent tissues and may cause doubts of differential diagnosis with malignant infiltrating lesions. Surgical excision is the elective treatment. However, an accurate differential diagnosis, postsurgical histological examination and careful follow-up are required.

Intramuscular lipoma: a review of the literature

Lipomas are the most common type of soft tissue mesenchymal tumors. They are typically located subcutaneously and consist of mature fatty tissue. When they occur under the enclosing fascia, they are called deep-seated lipomas. Infrequently, lipomas can arise inside the muscle and are called intramuscular lipomas. Intramuscular lipomas have been commonly investigated and categorized in the same group as other deep-seated and superficial lipomatous lesions. Their clinical, histological and imaging characteristics may resemble well-differentiated liposarcomas, further adding to the difficulties in the differential diagnosis. This article summarizes the available literature and describes the typical epidemiological, pathological and clinical features of intramuscular lipomas, as well as delineating their treatment and prognosis.

Lipomas of the oral cavity: clinicopathological and immunohistochemical study of 24 cases and review of the literature

Although lipomas are common soft tissue tumors, few cases of lipoma or its variants have been reported in the oral cavity. We here described the clinical, histological, and immunohistochemical features of 24 cases of oral lipoma obtained from medical records at Nagasaki University Hospital between 1977 and 2010, and also retrospectively reviewed 603 cases of oral lipoma reported in the English literatures. The patients examined comprised 11 men and 13 women with a mean age of 59 years, ranging from 31 to 90 years. The main sites involved were the buccal mucosa (n = 9), followed by the tongue (n = 4), lip and retromolar area (n = 3), floor of the mouth (n = 2), and gingiva (n = 1). The mean tumor size was 2.0 cm, ranging from 0.2 to 5 cm. Histological analysis revealed 20 cases of lipoma, 2 cases of fibrolipoma, and one case each of intramuscular lipoma and spindle cell lipoma. Twenty-three cases were treated surgically while one case underwent biopsy and follow-up. Recurrence was not observed in any case. We reviewed the English literatures, and similar results were obtained. In immunohistochemical analysis, PCNA and ki-67 expression indices were higher in intramuscular lipoma cases than in its variants. Especially, it showed that a long time follow-up may be necessary in ki-67 positive cases.

A large oral lipoma in a young patient: A rare combination

Lipoma is a benign neoplasm of mature fat cells. Although a common mesenchymal neoplasm of trunk and extremities, its occurrence in the oral and oropharyngeal region is rather rare. Lipoma accounts for 1-5% of all benign oral tumors, occurring in patients above 40 years of age with slight male predilection. Oral lipoma presents as asymptomatic, slowly growing mass rarely exceeding 25 mm in diameter. Documented here is a rare case of a large size lipoma (>3 cm in diameter) occurring as an extraoral swelling in a girl aged 13 years, which was subsequently diagnosed and treated 4 years later. Furthermore discussed are the peculiarities in the clinical presentation, differential diagnosis, and investigations for this case.

Huge lipoma of tongue

Lipoma is the commonest benign tumor occurring at any anatomical site, where fat is present. In oral cavity and oropharynx, it is a relatively uncommon neoplasm. Tongue, which is totally devoid of fat cell is also a site for lipoma but very rarely. We report one such rare case of the universal tumor, of 20 years of duration and 9 cm in size, presenting at the lateral margin, dorsal and ventral surface of the tongue, for which complete tumor excision was done.

Lingual dermoid cyst with congenital discharging sinus: a rare entity

OBJECTIVE

There have been few reports of lingual dermoid cysts with a congenital discharging fistula. We report such a case, which mimicked lipoma on computed tomography, and we discuss relevant clinical and radiological features.

METHOD

We present a case report and a review of the English language literature concerning lingual dermoid cysts either mimicking lipoma or with a congenital discharging sinus.

RESULTS

A 35-year-old man presented with a lingual mass associated with a congenital fistula in the midline of the tongue dorsum, which discharged abnormal secretions. Computed tomography images showed that the lesion was well defined and contained homogeneous fatty tissue giving computed tomography attenuation values of -120 Hounsfield units.

CONCLUSION

Lingual dermoid cysts may develop with a midline discharging fistula, and may exhibit radiological similarity to lipomas on computed tomography.

Endolaryngeal lipoma: case report and literature review

Lipomas are the most common benign tumors affecting the soft tissues. They can occur at any age, but they typically appear in patients older than 40 years. They are found equally in men and women. Lipomas are uncommon in the head and neck, but when they do appear there, they can arise in any location, including the palate, tongue, tonsil, larynx, and parotid gland. We report the case of a 63-year-old man who presented to the emergency department with a large spindle-cell lipoma of the endolarynx. The patient was followed for 6 months, and he exhibited no snoring or breathing difficulties.

Oral lipoma in elderly saudi patient: a case report

Lipomas are relatively uncommon benign tumor occurring in the oral cavity with a prevalence rate of 1% to 4% of all oral lesions. They present as a slow growing, painless, asymptomatic submucosal mass and surgical excision is the treatment of choice. Oral lipomas have been known to grow to large sizes causing interference with speech, mastication and construction of denture. A case of 77 years old male patient with lipoma of buccal mucosa in oral cavity which exhibited a sudden growth after a lag time of 3 years with mastication and speech difficulties. The tumor excised in total with restoration of normal speech and mastication.

Oral lipoma: analysis of 58 new cases and review of the literature

Lipomas are common soft-tissue tumors but occur infrequently in the oral region. Here, we present 58 new cases of oral lipoma (OL), their clinical features, diagnostic workup, and management. The records of 58 patients with OL were reviewed. Demographic data, presenting symptoms, primary tumor site, histopathology, and clinical management were analyzed. Extraoral and intraosseous lesions were excluded. The patients were 29 men and 29 women with mean age of 59.7 years, range, 11 to 98 years. Tumor sites included the buccal mucosa (n = 31), tongue (n = 10), lip (n = 6), floor of the mouth (n = 6), and vestibule (n = 5). The mean tumor size was 2.1 cm (range, 0.3-5.0 cm). The mean tumor duration before excision was 2.6 years (31.2 months), ranging from 2 months to 12 years. Most common presenting symptom was an asymptomatic, circumscribed mass. Histologically, the tumors were classified as classic lipoma (n = 28), fibrolipoma (n = 19), intramuscular lipoma (n = 4), minor salivary gland lipoma (n = 2), angiolipoma (n = 2), and spindle cell lipoma (n = 3). A case of spindle cell lipoma affecting the lower lip that has not been described previously is presented. The provided treatment was surgical excision. Although uncommon, OL are most common in adults and very uncommon in children. No sex predilection was found. The buccal mucosa region is the most common site followed by the tongue. Classic lipomas are most common in the oral region and comprise 48% of the tumors. A case of spindle cell lipoma of the lower lip is reported. Its clinical, histologic, and cytogenetic workup is the first well-documented case. Further cytogenetic studies should be undertaken to learn more about the pathogenesis and tumorigenesis of OL.

Oral fibrolipoma-a rare histological entity: report of 3 cases and review of literature

Lipomas are rare benign soft tissue mesenchymal neoplasms in the oral cavity, representing 1% of all benign oral tumors. Fibrolipoma (FL), an uncommon, histological variant of the classic lipoma, mostly affects the buccal mucosa. Very few cases of FL have been reported in the English literature. To the best of our knowledge a review of the English literature showed 33 cases of FL affecting the oral cavity.The diagnosis and differentiation of FL with clinically similar lesions such as fibroma, mucocele and pleomorphic adenoma are very essential for a correct treatment plan and complete follow-up. Due to the rarity of oral cavity fibrolipoma reports, three cases and a review of literature is presented here.

Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial

BACKGROUND

Previous studies comparing low-carbohydrate and low-fat diets have not included a comprehensive behavioral treatment, resulting in suboptimal weight loss.

OBJECTIVE

To evaluate the effects of 2-year treatment with a low-carbohydrate or low-fat diet, each of which was combined with a comprehensive lifestyle modification program.

DESIGN

Randomized parallel-group trial. (ClinicalTrials.gov registration number: NCT00143936)

SETTING

3 academic medical centers.

PATIENTS

307 participants with a mean age of 45.5 years (SD, 9.7 years) and mean body mass index of 36.1 kg/m(2) (SD, 3.5 kg/m(2)).

INTERVENTION

A low-carbohydrate diet, which consisted of limited carbohydrate intake (20 g/d for 3 months) in the form of low-glycemic index vegetables with unrestricted consumption of fat and protein. After 3 months, participants in the low-carbohydrate diet group increased their carbohydrate intake (5 g/d per wk) until a stable and desired weight was achieved. A low-fat diet consisted of limited energy intake (1200 to 1800 kcal/d; <or=30% calories from fat). Both diets were combined with comprehensive behavioral treatment.

MEASUREMENTS

Weight at 2 years was the primary outcome. Secondary measures included weight at 3, 6, and 12 months and serum lipid concentrations, blood pressure, urinary ketones, symptoms, bone mineral density, and body composition throughout the study.

RESULTS

Weight loss was approximately 11 kg (11%) at 1 year and 7 kg (7%) at 2 years. There were no differences in weight, body composition, or bone mineral density between the groups at any time point. During the first 6 months, the low-carbohydrate diet group had greater reductions in diastolic blood pressure, triglyceride levels, and very-low-density lipoprotein cholesterol levels, lesser reductions in low-density lipoprotein cholesterol levels, and more adverse symptoms than did the low-fat diet group. The low-carbohydrate diet group had greater increases in high-density lipoprotein cholesterol levels at all time points, approximating a 23% increase at 2 years.

LIMITATION

Intensive behavioral treatment was provided, patients with dyslipidemia and diabetes were excluded, and attrition at 2 years was high.

CONCLUSION

Successful weight loss can be achieved with either a low-fat or low-carbohydrate diet when coupled with behavioral treatment. A low-carbohydrate diet is associated with favorable changes in cardiovascular disease risk factors at 2 years.

PRIMARY FUNDING SOURCE

National Institutes of Health.

Giant intramuscular lipoma of the tongue: a case report and literature review

We herein report a rare case of giant intramuscular lipoma of the tongue. A 75-year-old Italian male presented at our department with a large tumor at the tip of the tongue that had been present for over 30 years. Clinical examination revealed a yellowish lesion, measuring 10 cm in maximum diameter, protruding from lingual surface. Histological examination showed an unencapsulated lipomatous tumor composed of mature adipocytes, uniform in size and shape, diffusely infiltrating striated muscle fibers of the tongue. The patient is well with no local recurrence after a 15-month follow-up period.

Giant intramuscular lipoma of the tongue: a case report and literature review

We herein report a rare case of giant intramuscular lipoma of the tongue. A 75-year-old Italian male presented at our department with a large tumor at the tip of the tongue that had been present for over 30 years. Clinical examination revealed a yellowish lesion, measuring 10 cm in maximum diameter, protruding from lingual surface. Histological examination showed an unencapsulated lipomatous tumor composed of mature adipocytes, uniform in size and shape, diffusely infiltrating striated muscle fibers of the tongue. The patient is well with no local recurrence after a 15-month follow-up period.

Acute stridor caused by a previously asymptomatic large oropharyngeal spindle cell lipoma

Lipomas of the larynx, oropharynx and hypopharynx are rare, accounting for approximately 1% of benign laryngeal neoplasms. Spindle cell lipoma is a rarer histological variant characterised by mature adipocytes mixed with collagen-forming spindle cells. We present an unusual case of a 62-year-old lady who acutely presented to the emergency department with a large spindle cell lipoma arising from the vallecula. This lipoma was causing intermittent stridor unless traction was applied to it. Despite the size of the lesion, she had been completely asymptomatic prior to this single episode. To our knowledge, only one previous case of a spindle cell lipoma has been reported as specifically arising from the vallecula. This case also appears to be the largest reported from the oropharynx (17 cm length, 4 cm width). The tumour was completely removed endoscopically and the patient made an excellent recovery, returning home 3 days post-operatively. The histology, management and follow up of these lipomas are discussed.

Lipoma of the oral and maxillofacial region: Site and subclassification of 125 cases

OBJECTIVE

Lipomas and lipoma variants are common soft tissue tumors, but occur infrequently in the oral and maxillofacial region. In this study, we reviewed 125 lipomas in specific oral and maxillofacial locations. We wanted to examine and compare the clinicopathologic features of these tumors. Study design The records from the Oral and Maxillofacial Pathology Registry of the Armed Forces Institute of Pathology from 1970 to the present were searched for cases coded as "lipoma." This study included 125 cases based on location within the oral and maxillofacial region, benign histology, and available clinical information. Subcutaneous and intraosseous lipomas were excluded. The tumors were classified according to the most recent World Heath Organization classification for soft tissue tumors.

RESULTS

Of 125 lipomas, 91 tumors occurred in males, 33 in female patients, and 1 of unknown gender. The mean age was 51.9 years, range 9-92 years. Four tumors occurred in pediatric patients (age <18 years). Specific anatomic sites within the oral and maxillofacial region included the parotid region (n=30); buccal mucosa (n=29); lip (n=21); submandibular region (n=17); tongue (n=15); palate (n=6); floor of mouth (n=5); and vestibule (n=2). The mean size of tumors was 2.2 centimeters, range 0.5 to 8.0 centimeters. The mean duration of the tumors prior to excision was 3.2 years, range 6 weeks to 15 years. Most patients presented with an asymptomatic, circumscribed mass. Grossly, most tumors were described as pink and smooth, occasionally mucoid. Histologically, the tumors were subclassified as classic lipomas (n=62); spindle cell/pleomorphic lipomas (n=59); fibrolipoma (n=2), and chondroid lipoma (n=2). Fourteen tumors exhibited secondary changes, such as fat necrosis, atrophy, and prominent hyalinization; 23 tumors were histologically confirmed to be intramuscular.

CONCLUSIONS

Lipomas of the oral and maxillofacial region occur most commonly in adult males in the parotid region, followed closely by the buccal mucosa. These tumors are uncommon in children. Interestingly, spindle cell lipomas are common in this region and comprise the majority of our parotid and lip tumors. Angiolipomas were absent in this anatomic region in this study. Secondary changes and atrophy should not be confused with the malignant histologic features of a liposarcoma.