Intraoral lipomas: A clinicopathological study of 43 cases, including four cases of spindle cell/pleomorphic subtype

Large Buccal Space Lipoma Excised Through an Intraoral Approach

Lipomas are benign tumors of adipose tissue. They represent the most common mesenchymal neoplasm but are relatively rare in the oral and maxillofacial regions. The purpose of this study is to present an unusual case of a large lipoma of the buccal space and its excision by an intraoral approach. A 38-year-old male patient presented with an otherwise asymptomatic swelling of the right cheek that had first been noticed four years earlier and had subsequently exhibited gradual, continuous enlargement with stable dimensions over the last year. The patient was obese but otherwise healthy. Examination revealed a movable, well-circumscribed, non-fluctuant, soft-elastic large swelling of the right buccal and parotid-masseteric region with normal overlying skin and no bruit. Ultrasound and MRI findings, as well as fine needle aspiration, were suggestive of lipoma. The lesion was excised under general anesthesia through an intraoral approach. The tumor measured 7.0 cm × 5.3 cm × 1.6 cm and was separated from the surrounding tissues by a thin capsule. Histopathologic examination rendered a final diagnosis of lipoma. No signs of recurrence were noted. Although lipomas are the most common mesenchymal neoplasm, they do not usually occur in the oral and maxillofacial region, especially as large lesions are located in the buccal space, and may pose diagnostic and therapeutic challenges.

Fine needle aspiration of spindle cell lipoma-Lochkern cells as a clue for diagnosis: A case arising in the parotid gland

Spindle cell lipoma (SCL) is a rare form of lipoma, typically occurring as a mass in the back, shoulder or posterior neck of adult males. Most cases present little diagnostic difficulty on fine needle aspiration (FNA), but can be problematic when the SCL is in an unusual location. The authors report a case in the parotid gland in a 75-year-old man. FNA was paucicellular and showed loose collections of spindle cells with mild to moderate atypia, admixed with ropy collagen fibers on a myxoid background. The nuclei showed occasional angulation, interpreted on FNA as suspicious for myoepithelial tumor or low-grade sarcoma. The subsequent excisional specimen was diagnosed as SCL. On retrospective review of the FNA, an additional finding was recognized: 'naked' nuclei with intranuclear lipid vacuoles and positive immunostaining for S100 protein, consistent with Lochkern cells of mature adipocytes. This case highlights the challenges of diagnosing SCL on cytology when no fat-containing cells are apparent on the smear, and stresses the significance of Lochkern cells as a clue for diagnosis.

Oral medicine considerations for the older patient

With the proportion of the world population aged over 60 years expected to nearly double to 22% by 2050, health care professionals are faced with the challenge of ensuring they are ready to address this demographic shift. As people age, they are more likely to develop comorbidities which have implications for their oral health. The effects of polypharmacy used to address these underlying health problems can also influence the oral health of older-aged patients. From a clinician's perspective, an awareness of the variety of conditions associated with old age, such as oral-mucosal disease, swellings and manifestations of underlying health conditions, are required to ensure appropriate referral, investigation and management, both in primary and secondary care settings. This article aims to provide the practitioner with an overview of orofacial and oral mucosal conditions commonly encountered with the older patient.

Spindle cell lipoma of the tongue: First case report from the Gulf region and review of the literature

Spindle cell lipoma is a histological variant of oral lipomas. In this report, we present the first case from the Gulf region with the most comprehensive literature review. Clinicians should consider rare tumors in the differential diagnoses of oral masses.

A 14-year retrospective study focusing on clinical and morphological features of oral cavity lipomas: A review of main topics

BACKGROUND

Lipomas are benign soft tissue neoplasms frequently found in the human body. Head and neck lipomas are relatively uncommon, accounting for 1 to 4% of benign lesions at this location. This 14-year retrospective study analyzed the clinical-pathological features of cases of oral cavity lipomas and their histopathological variants seen at a single oral pathology referral center.

MATERIAL AND METHODS

Data on age, sex, anatomical location, clinical diagnosis, and histological subtypes were collected from all cases microscopically diagnosed as lipoma. Three previously trained oral pathologists re-evaluated hematoxylin/eosin-stained slides of all selected cases.

RESULTS

Among 7,861 oral and maxillofacial lesions diagnosed at the service, 95 (1.2%) were lipomas or their histopathological variants. There was a predominance of female patients (n = 65; 68%); the mean age at diagnosis was 58.8 years (±13.56). We found the following histological subtypes: conventional lipoma, fibrolipoma, spindle cell lipoma, sialolipoma, osteolipoma, chondrolipoma, and intramuscular lipoma. The buccal mucosa was the most affected site. Conventional lipoma and fibrolipoma were the most commonly diagnosed histological variants. Although most lipomas are asymptomatic, large lipomas can occur, reaching a diameter of 4 cm.

CONCLUSION

The present study reinforces the importance of careful clinical and histopathological examination in order to obtain an accurate diagnosis and to ensure appropriate treatment.

Spindle Cell Lipoma Occurring in the Submandibular Space: Fifth Case Reported along with a Concise Review of the Literature

Spindle cell lipoma (SCL) is an uncommon histological variant of lipoma that accounts for 1.5% of all adipose tumors. It rarely occurs in the oral cavity. The most common sites of involvement are the buccal mucosa, tongue, lip, alveolar mucosa, gingiva, and palate. Submandibular space is a very rare site of occurrence for SCL. When occurs in this site, SCL mainly involves the 4th-7th decade with a female predominance. Due to wide communications of submandibular space, the actual extent and appearance of the lesions present here gets masked up especially those involving the deeper tissues leading to an inaccurate diagnosis. Wide overlap of clinical and histopathological features of SCL to other clinical pathologies leads to a challenging task for the clinicians to reach an accurate diagnosis. To our knowledge, only four cases of intraoral SCL involving the submandibular region directly or indirectly have been reported in the literature. Here we represent another rare case of SCL in an 18-year-old male patient along with a concise review of the literature. This case appears to be quite rare due to its location (submandibular space), age, and sex of the patient (18/M).

Large Lipoma of the Mouth Floor

Lipomas are one of the most common benign connective tissue masses in the human body. They rarely cause issues and are typically removed for cosmetic reasons. They rarely appear in the oral cavity though they are common. Thus, only a few sublingual lipoma cases have been reported. We present a case of a male in his 60s who came to our clinic complaining of dysphagia and dysarthria caused by an oral swelling from a right sublingual simple lipoma. It was decided to be removed surgically under general anesthesia, with neuromonitoring of the right hypoglossal nerve. The patient tolerated the surgery without complications and fully recovered with complete resolution of his mass effect symptoms. This case demonstrated the importance of having a wide differential diagnosis of oral lesions, especially in a patient with a complicated medical history. Though it is not used often, the case also demonstrated the neuroprotective effect of intraoperative hypoglossal nerve monitoring during sublingual surgeries.

Large intraoral spindle cell lipoma

Lipomas are relatively common benign neoplasms composed by mature fat cells. Apart from conventional lipomas, several other subtypes have been described in the oral cavity, including fibrolipoma, myxoid lipoma, angiolipoma, myolipoma, chondrolipoma, osteolipoma and spindle cell lipoma (SCL). Intraoral SCL is rare, representing from 1.4% to 9.8% of all intraoral lipomas. The aim of the present study is to report a case of a large intraoral SCL of the buccal mucosa affecting a 46-year-old male, calling attention to its clinical and histological features and to its successfull surgical conservative management. Key words:Lipoma, spindle cell, oral, buccal mucosa.

Intraoral soft tissue lipomas: clinicopathological features from 91 cases diagnosed in a single Oral Pathology service

Background

intraoral soft tissue lipomas are relatively uncommon mesenchymal neoplasms. Few papers have been published comparing the clinicopathological features of these tumors in different populations. The aim of the present study was to analyze the clinicopathological features from intraoral soft tissue lipomas diagnosed in a Brazilian population.

Material and Methods

all cases diagnosed as intraoral soft tissue lipomas in an Oral Pathology laboratory from 2005 to 2019 were retrieved and descriptively analyzed; statistical analysis was performed for comparison of the clinical and demographic parameters.

Results

91 intraoral lipomas were retrieved, including 56 lipomas, 30 fibrolipomas, 2 spindle cell lipomas, 2 angiolipomas, and 1 chondrolipoma. Mean age of the patients was 62.2 years and females represented 57.1% of the sample. Mean time of complaint was 45.4 months and mean size of the lesions was 16.2 millimeters. Buccal mucosa (38.8%), lower lip (18.8%) and tongue (16.5%) were the most commonly affected locations. Fibrolipomas were more common in females (p=0,037) and presented as smaller lesions (p=0,011) in comparison to lipomas.

Conclusions

report of clinicopathological data from intraoral lipomas aid in establishing their differential diagnostic criteria and clinical profile in this specific location.

Key words:Lipoma, fibrolipoma, oral, mouth, spindle cell lipoma, angiolipoma, chondrolipoma.