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 Table of Contents  
CASE REPORT
Year : 2012  |  Volume : 3  |  Issue : 1  |  Page : 39-41

Intraoral fibro-lipoma: A rare histological variant


1 Department of Oral Pathology & Microbiology, Purvanchal Institute of Dental Sciences, Gorakhpur, India
2 Department of Oral Pathology & Microbiology, Darshan Dental College & Hospital, Udaipur, India

Date of Web Publication27-Sep-2012

Correspondence Address:
Pramod Kumar
House No. 1, Shakti Nagar, Mal Godam Road,Etawah (U.P.) 206 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-6944.101675

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  Abstract 

Lipomas are benign neoplasm of adipocytes, but are rarely seen in oral cavity, representing 1% of all benign tumors. Hence, correct histopathological examination of lipomas is important. Fibro-lipoma is one of the rare variant of the lipoma, and very few cases have been reported in the oral cavity. This article describes a case of 60-year-old female with fibro-lipoma of the buccal mucosa. The diagnosis and differentiation of fibro-lipoma with clinically similar lesions such as fibroma, mucocele, and pleomorphic adenoma are very essential for a correct treatment plan and complete follow-up.

Keywords: Adipocytes, buccal mucosa, lipoma


How to cite this article:
Kumar P, Naraniya A. Intraoral fibro-lipoma: A rare histological variant. Indian J Oral Sci 2012;3:39-41

How to cite this URL:
Kumar P, Naraniya A. Intraoral fibro-lipoma: A rare histological variant. Indian J Oral Sci [serial online] 2012 [cited 2017 Jul 25];3:39-41. Available from: http://www.indjos.com/text.asp?2012/3/1/39/101675


  Introduction Top


Lipomas are the common benign neoplasm of adipose tissue, but they have been considered very unusual growths in the oral and oropharyngeal region. The first description of oral lipoma was provided by roux in 1848 in a review of alveolar masses, and he referred to it as a 'yellow epulis.' [1]

Oral lipoma occurs with a prevalence rate of 1/5,000 adults. [2] Most of the time, they represents a developmental anomaly, but they can also arise as a result of trauma and rearrangement of chromosomes no. 12q, 13q, and 6p. [1],[3]

They are benign mesenchymal neoplasms, composed of fat cells, usually surrounded by a thin fibrous capsule. [4] Histologically, there are many variants of lipoma; fibro-lipoma is one of the rare variants of lipoma in which neoplastic fat cells are embedded within dense collagen bundles. [5] We report a case of fibro-lipoma in a 60-year-old male.


  Case Report Top


A 60-year-old male patient+ was referred to Department of Oral Pathology and Microbiology, Purvanchal Institute of Dental Sciences, with the chief complaint of long standing growth of left buccal mucosa near the corner of mouth. The growth was first noticed approximately 18 months back, which showed slow and continuous enlargement over past one and half year. The swelling interferes while eating, speaking, and swallowing. There was no past history of trauma. Past medical history, past dental history of the patient was non-contributory. Patient gave a history of bidi smoking occasionally since 20 years.

On General examination, patient was of normal built and height. Vital signs were normal, and there was no abnormality detected on systemic examination. Extraoral examination of the patient revealed that there was no facial asymmetry, and there was no lymph node enlargement.

Intraoral examination revealed that patient was edentulous, except for the presence of 23. A well-circumscribed, pink-colored, ovoid, smooth, pedunculated growth was present on buccal mucosa, close to the corner of mouth at the level of occlusal plane, measuring about 1.0 ×1.2 ×1.5 cm 3 size [Figure 1]. The Overlying mucosa was normal without any evidence of inflammation and ulceration. On palpation, the lesion was firm to soft in consistency and non-mobile in nature. There was no tenderness present. On the basis of patient's history and clinical examination, a provisional diagnosis of traumatic fibroma and a differential diagnosis of intraoral lipoma were made.
Figure 1: Preoperative Intraoral view showing smooth, pink coloured, nodular mass on the left buccal mucosa

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The lesion was superficial, small, and appeared benign clinically; therefore, an excisional biopsy was planned. After obtaining an informed and written consent, an incisional biopsy was performed, and the tissue was taken for histopathological examination. The area of biopsy healed uneventfully without any complications [Figure 2]
Figure 2: Postoperative Intraoral view showing complete healing after excisional biopsy

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Macroscopic examination revealed one soft tissue of creamish-white colored, firm in consistency, smooth surface, and measuring 0.9 × 1.0 × 1.5 cm. 3

Microscopic examination of hematoxylin- and eosin-stained section revealed a stratified squamous non-keratinized epithelium with absence of rete pegs in most of the areas. The underlying connective tissue stroma consisting of dense collagen fibers arranged in bundles and adiposites with connective tissue saptae are also seen without any cellular atypia. Connective tissue also shows numerous proliferating fibroblasts with mild chronic inflammatory cells infiltrate. The blood vessels in connective tissue stroma were compressed and engorged with red blood cells [Figure 3] and [Figure 4]. The above features were suggestive of fibro-lipoma.
Figure 3: Microphotograph shows stratified squamous nonkeratinized epithelium with absence of rete pegs & the connective tissue consisting of collagen fibers arranged in bundles. (H & E Stain, ×100 magnification)

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Figure 4: Microphotograph showing round to oval shaped adipocytes admixed with dense collagenous fibers and fibroblasts. (H & E Stain, ×100 magnification)

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  Discussion Top


Lipomas are adipose mesenchymal neoplasms; they are relatively uncommon in the oral cavity, representing not more than 1.0% to 5% of all neoplasms. [6],[7] No consensus exists regarding the pathogenesis of oral lipomas today. Heredity, fatty degeneration, hormonal basis, trauma, infection, infarction, metaphase of muscle cells, lipoblastic embryonic cell nest in origin, and chronic irritation are probable representative theories to elucidate the pattern of a lipoma. [8]

Intraorally, they present as a slow-growing painless mass with a characteristic yellowish color and soft, doughy feel. [9],[10] The most affected anatomical sites in the oral cavity include the buccal mucosa, lips, and tongue. [4],[11],[12]

Rajendran et al, has classified intraoral lipomas into three types, depending upon its morphology. [1]

  • Diffuse form affecting deeper tissues.
  • Superficial form.
  • Encapsulated form.
They often present in adults in the 5 th to 7 th decade and are rare in children. [13] The lipoma usually occurs as a solitary lesion that may be sessile or pedunculated. It ranges in size from 1 cm in diameter to a massive tumor 5 cm. The surface is typically smooth and non-ulcerated, except when traumatized. The histopathology remains the gold standard in the diagnosis of lipoma.

Histologically, classic lipomas are composed of mature adipose tissue with true lipoblasts showing no cellular atypia. Several histologic variants described include angio-lipoma, chondroid lipoma, myo-lipoma, spindle cell lipoma, pleomorphic lipoma, fibro-lipoma, osteolipoma/chondrolipoma, mylelipoma, adenolipoma, perineural lipoma, myxoid lipoma. [3]

The most common microscopic variant of oral lipomas is the fibro-lipoma. Microscopically, the fibro-lipoma is composed of lobules of "chicken-wire" appearing, benign adipocytes with a component comprised of broad bands of dense collagen. Like the classic lipoma, it is often well-circumscribed and maybe thinly encapsulated. The definitive treatment for lipomas including fibro-lipoma is surgical excision with rare recurrence. [14] Malignant transformations or recurrences in the oral and maxillofacial regions are rare. [9]

The fibro-lipoma, the lesion in our case, also shows similar feature and after surgical excision of the lesion, there was no recurrence of the lesion.


  Conclusion Top


Microscopic / histological findings provided by oral pathologists should always be combined with clinical features for accurate diagnosis. Fibro-lipoma represents a distinct clinico-pathologic and biologic entity with an increased growth potential compared with the classic lipoma.

There are very few reported cases of intraoral fibro-lipoma in literature. There are many lesions, which appear similar clinically, but have diverse and overlapping histopathological features and in such cases, they pose a diagnostic challenge for general dentists. Therefore, we recommend that histopathological examination of excised tissue is a gold standard investigative procedure along with consultation with an oral pathologist for correct diagnosis, treatment, and prognosis.

 
  References Top

1.Rajendran R, Shivapathasundharam B, editors. Shafer's Textbook of Oral Pathology. 6 th ed. Noida: Elsevier; 2009. p. 137.  Back to cited text no. 1
    
2.Rapidis AD. Lipoma of the oral cavity. Int J Oral Surg 1982;11:263-75.   Back to cited text no. 2
    
3.Gnepp Dr. Diagnostic surgical pathology of the head and neck. Phialdelphia; WB Saunders; 2000. p. 192-3.  Back to cited text no. 3
    
4.Fregnani ER, Pires FR, Falzoni R, Lopes MA, Var gas PA. Lipomas of the oral cavity: Clinical findings, histological classification and proliferative activity of 46 cases. Int J Oral Maxillofac Surg 2003;32:49-53.  Back to cited text no. 4
    
5.Enzinger FM, Weiss SW. Soft tissue tumors. 2 nd ed. St. Louis: Mosby; 1988. p. 303-40.  Back to cited text no. 5
    
6.Del Castillo Pardo de Vera JL, Cebrian Carretero JL, Gomez GE. Chronic lingual ulceration caused by lipoma of the oral cavity. Case report. Med Oral 2004;9:166.  Back to cited text no. 6
    
7.Trandafir D, Gogalniceanu D, Trandafir V, Caruntu ID. Lipomas of the oral cavity - a retrospective study. Rev Med Chir Soc Med Nat Iasi 2007;111:754-8.  Back to cited text no. 7
    
8.Costa E, Soare S, Costa FWG. Oral lipomas in a Brazilian population: A 10-year study and analysis of 450 cases reported in the literature. Med Oral Patol Oral Cir Bucal 2010;15:e691-6.  Back to cited text no. 8
    
9.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 Reports 2008;2:382.  Back to cited text no. 9
[PUBMED]    
10.Lawoyin JO, Akande OO, Kolude B, Agbaje JO. Lipoma of the oral cavity: Clinicopathological review of seven cases from Ibadan. Niger J Med 2001;10:189-91.  Back to cited text no. 10
[PUBMED]    
11.Said-Al-Naief N, Zahurullah FR, Sciubba JJ. Oral spindle cell lipoma. Ann Diagn Pathol 2001;5:207-15.  Back to cited text no. 11
[PUBMED]    
12.Bandéca MC, Pádua JM, Nadalin MR, Ozório JEV, Silva-Sousa YTC, Perez DEC. Oral soft tissue lipomas: A case series. J Can Dent Assoc 2007;73:431-4.  Back to cited text no. 12
    
13.Furlong MA, Fanburg-Smith JC, Childers EL. Lipoma of the oral and maxillofacial region: Site and subclassification of 125 cases. Oral Surg Oral Med Oral Pathol Radiol Endod 2004;98:441-50.  Back to cited text no. 13
    
14.Neville BW, Damm DD, Allen CM, Bouquot JE. Soft tissue tumors. Oral and Maxillofacial Pathology. 3 rd ed. St. Louis: Saunders; 2009. p. 452-4.  Back to cited text no. 14
    


    Figures

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



 

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