Liposarcoma circumscriptum (lipoma-like) of the tongue: report of a case

Oral liposarcoma in elderly: Case report and literature analysis

RATIONALE

Oral liposarcoma is an extremely rare lesion that is often clinically misdiagnosed as a benign lesion because of its asymptomatic and indolent clinical course. we report a case of atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) of buccal mucosa, provisionally diagnosed as lipoma.

PATIENT CONCERNS

A 97-year-old female was referred to dentistry and oral surgery department with an asymptomatic mass on the right buccal mucosa which had been present for an unknown period of time.

DIAGNOSIS

Magnetic resonance imaging demonstrated a well-circumscribed lesion at the right buccal mucosa, and a lipoma was suspected.

INTERVENTIONS

Surgical removal was performed, and a diagnosis of ALT/WDL was made. She and her family refused additional treatment due to her age.

OUTCOMES

At the 10 months follow-up, the patient remained free of disease.

LESSONS

The indolent clinical course and small size of oral liposarcoma can lead to provisional clinical diagnosis of benign lesion.

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.

Well-differentiated liposarcoma/atypical lipomatous tumor of the oral cavity: report of three cases and review of the literature

Atypical Lipomatous Tumor/Well Differentiated Liposarcoma (ALT/WDLS) is a soft tissue sarcoma of intermediate malignant behavior, most frequently affecting the retroperitoneum and lower extremities. Oral liposarcomas are very rare neoplasms, the most common histological subtype being ALT/WDLS. In this study, three additional cases of ALT/WDLS located on the tongue (2 cases) and the lower lip (1 case), respectively, are described. Analysis of the salient clinicopathologic features of 63 oral ALT/WDLS cases previously reported in the English language literature, as well as of the 3 cases presented in this study, indicates that the indolent biologic behavior of this tumor justifies its designation as a locally spreading malignant neoplasm, affording a rather conservative surgical approach.

Diode laser excision of chondroid lipoma of the tongue with microscopic (conventional and confocal laser scanning) analysis

OBJECTIVE

We describe a case of chondroid lipoma of the oral mucosa, which represents an unusual histological type of oral lipoma. Though its use is still debated, we used a diode laser to perform complete excision of the lesion, and histologically analyzed the specimen.

BACKGROUND DATA

Lipomas represent 0.1-5% of all benign oral neoplasms. Chondroid lipoma is a rare histological type first described in 1993; only a few cases have been described in the literature. Its clinical diagnosis is difficult because the clinical appearance is not specific.

METHODS

The lesion was excised by diode laser and the specimen was histologically evaluated using both conventional and confocal laser scanning microscopy.

RESULTS

The final diagnosis was lipoma (chondroid variant). Diode laser had several benefits in the clinical application and in the histological evaluation due to the lack of morphological and structural alterations of the surgical specimen.

CONCLUSION

We maintain that the diode laser is a useful electromedical device for surgery on both benign and malignant oral lesions, though good practice is mandatory in order to apply the best parameters to the clinical situation. When the preoperative biopsy is not performable because of small dimension, as in the reported case, surgical excision of all nodular lesions of the oral mucosa should be performed with lateral and deep margins distant from the central lesion. This prevents possible complications related to a possible final diagnosis of malignant neoplasm; in fact, the differential diagnosis in the reported case also included liposarcoma.

Atypical lipomatous tumors of the tongue: report of six cases

The occurrence of liposarcoma in the tongue is rare with only 34 cases published so far. We report six new cases of atypical lipomatous tumor (ALT) of the tongue, and detection of mdm-2 and CDK4 expression by immunohistochemistry and fluorescence in situ hybridization (FISH), respectively, was performed. The series comprised three males and three females, aged 11-78 years. The tumors arose at the lateral side of the tongue, and in one case, multiple tumor nodules were noted. Follow-up information in five cases (range from 4 to 159 months) revealed one local recurrence at 6 months. Microscopically, four cases had features of lipoma-like ALT, whereas two cases displayed patterns of sclerosing ALT. Immunohistochemically, tumor cells revealed expression of vimentin (five of five), S100 (five of five), mdm-2 (three of five), and CDK4 (four of five). Two cases were also examined by FISH; amplification of mdm-2 gene was found in both cases, whereas amplification of CDK4 gene was present in one case only. To the best of our knowledge, this is the third largest series reporting occurrence of ALT in the tongue and the first one where analysis of mdm-2 and CDK4 proteins/genes expression/amplification was performed. Both these markers may be of help in the differential diagnosis of ALT versus lipoma. Although most ALTs of the tongue behave in the nonaggressive fashion, they may recur locally. Based on current data, the term ALT is strongly recommended for tumors occurring in the tongue to prevent inadequate treatment.

Fibrolipoma of the lip treated by diode laser surgery: a case report

Introduction

Several neoplasms of the adipose tissue can involve the soft tissues of the head and neck region. These neoplasms are mainly treated surgically and an accurate histological examination is mandatory for a precise diagnosis.

Case presentation

We report a case of fibrolipoma involving the lower lip of a 43-year-old man, which was successfully treated by diode laser surgery. This approach allowed adequate resection of the neoplasm with minimal damage to the adjacent tissues, thus reducing post-surgical scarring.

Conclusion

Diode laser surgery for the treatment of benign lesions of the oral mucosa appears to be a convenient alternative to conventional blade surgery and has proved to be effective for the excision of fibrolipoma of the lip. The possibility of avoiding direct suture after excision is surely helpful when aesthetic areas, such as the lip, are surgically treated. For these reasons, and also considering the lower histological alteration of the specimen obtained with diode laser surgery if adequately used, the diode laser is undoubtedly a good alternative to conventional surgery.

Giant gluteal lipoma-like liposarcoma: a case report

BACKGROUND

Liposarcoma is the second most common soft tissue sarcoma in adults with a peak incidence between the 4th and 6th decade of life and slight preponderance to the male gender. It originates from multipotential primitive mesenchymal cells, rather than mature adipose tissue.

CASE PRESENTATION

An unusual case of a rapidly growing giant lipoma-like liposarcoma of the left gluteal and perineal areas in a young male was presented. The patient was managed by wide local excision of the lesion and coverage with split thickness skin graft. The key issues surrounding the treatment of lipoma-like liposarcoma and literature review is discussed.

CONCLUSION

For such unusual case of this particular rapidly growing tumor, a longer follow-up is needed to evaluate the outcome in these cases.

Gingival liposarcoma: An unusual polyp

Liposarcomas account for up to 20% of all soft tissue tumours. They are uncommon in the head and neck. Sarcomas of the oral region (excluding lymphoma) account for 5% of all oral cancers, of which 10% are liposarcomas. Fewer than 80 cases have been reported in the world literature, most of which presented as expansile masses. The prognosis of liposarcoma is dependant on the histopathologic type, location, and adequacy of surgical treatment. Well-differentiated types have a good prognosis and minimal metastatic potential. We report a case of well-differentiated liposarcoma (lipoma-like subtype), that presented as a gingival polyp.

Liposarcoma of the Tongue: Case Report and Review of the Literature

Liposarcoma is the most common soft-tissue malignancy in adults, but the appearance of a liposarcoma in the head and neck region is distinctly unusual. Intraoral liposarcomas represent a particularly interesting subset of this tumor in that (1) they are exceedingly rare and (2) affected patients tend to have a better prognosis than do patients with a similar lesion located elsewhere in the head and neck. An understanding of the histologic subtypes and corresponding clinical behavior of liposarcomas will assist physicians in appropriately managing these patients. Most of these tumors can be effectively treated with conservative surgery. We report the rare case of a well-differentiated liposarcoma arising in the tongue of a 55-year-old man. We also discuss the typical pathologic findings in these malignancies and review the diagnosis, associated controversies, management, and prognosis.

Liposarcoma of the tongue: case report and review of the literature

Background

Liposarcoma most commonly arises in the retroperitoneum and lower extremities. Liposarcoma of the head and neck is rare, with only 12 previously reported cases of liposarcoma in the tongue.

Case presentation

We present a case of well-differentiated liposarcoma of the tongue occuring in a 39 year old man, treated with surgical excision. At 14 years of follow-up, the patient remains free of disease.

Conclusion

Liposarcoma of the head and neck is rare, and may easily be misdiagnosed clinically. The diagnosis is made histologically. Clinical behavior is related to histopathologic subtype. Wide surgical excision is the treatment of choice, with limited data to support the use of radiation or chemotherapy. Our case represents the longest follow-up period for a tongue liposarcoma, with 14 years disease-free following surgical extirpation.

Liposarcoma of the tongue: Clinico-pathologic correlations of a possible underdiagnosed entity

Liposarcoma (LS), one of the most common malignant tumors, is considered as a rarity in the oral cavity, the tongue being the most frequent site for its occurrence. The purpose of the present study was to review and analyze the clinico-pathologic correlations of 32 cases of LS of the tongue, including four new cases from the files of our department. A total of 32 cases of LS of the tongue were collected, 29 from a MEDLINE search of the English language literature (1966-2004). Since the histopathologic features of one of the four new cases have been presented previously, this case was counted only once. LS of the tongue is a tumor of adult and old age, with a mean age of approximately 62 years and a peak incidence in the seventh and eighth decades. Clinically, it is a long-standing tumor that commonly presents as a solitary nodular mass, but can also present as a multi-nodular lesion. The most common histopathologic type is that of atypical lipomatous tumor (ALT)/well-differentiated LS (75%). LS can be easily misdiagnosed with both benign and malignant lipomatous and non-lipomatous tumors. LS of the tongue was commonly treated by local excision, however, there were cases of (multiple) recurrences and dedifferentiation. When a lipomatous lesion is encountered in the oral cavity, and especially in the tongue, LS should certainly be among the lesions that top the list of differential diagnosis. The follow-up must be on a long-term basis since this tumor can recur years after initial surgical treatment and can also undergo dedifferentiation.