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

A large cheek lipoma misdiagnosed as a dental infection: a rare case report

The most frequent benign tumor is lipoma. About 1-4% of people have intraoral lipomas. This uncommon case report shows a large cheek lipoma misinterpreted as dental infection. A 14-year-old girl with a right cheek tumor was diagnosed and treated for a dental infection. Multiple imaging examinations complete the diagnosis. A benign lipoma, common in subcutaneous tissues but unusual in the mouth, created the lesion. A histological investigation confirmed lipoma after extraoral excision under general anesthesia utilizing an external flap. The edema did not return after surgery, which restored face symmetry. This case study shows that diagnosing and treating oral and maxillofacial edema requires extensive clinical and radiographic testing. Lipomas should be evaluated in the differential diagnosis of mouth swelling even without usual risk markers to prevent excessive treatments and delays. Surgery is recommended for lipomas since it has a low recurrence and fewer risks.

A review of oral pathology in orthodontics. Part 1: Soft-tissue pathology

Orthodontists are well placed to detect soft-tissue disease of the oral cavity and associated structures because of the frequent repeat examinations of their patients. This review describes the clinical manifestations, pathologic features, and treatment of the soft-tissue pathology most likely to be encountered by the orthodontist and uncommon soft-tissue disease with significant implications for the patient. The recognition of soft-tissue disease will allow reassurance, referral, and early intervention when required.

Bilateral intraosseous lipoma of the maxillary tuberosity: A challenging entity

Lipomas can occur anywhere in the body where fat cells are present; however, intraosseous lipomas are rare. Although solitary lesions have already been reported in the gnathic bones, to the best of our knowledge, this is the first case of bilateral intraosseous lipoma. A 62-year-old woman was referred for evaluation of a swelling on both maxillary tuberosities. The radiographic examination showed a mixed radiolucent-radiopaque image with ill-defined borders on the right side of the maxilla, and an ill-defined radiolucency on the left side. Histologically, both sides revealed numerous mature adipocytes surrounded by immature bone and dystrophic calcification. The patient remains under follow-up and free of disease for 8 months. Due to the rarity of the intraosseous lipomas in the jaws, a literature review of the published cases was performed jointly with this unique case report.

Large Sublingual Lipoma: A Case Report

Lipomas are benign soft tissue tumors frequently observed throughout the body. Lipomas rarely cause health concerns; however, when symptomatic, it is often related to their location and size. A 65-year-old male patient presented with a non-tender, enlarging mass in the anterior floor of the mouth, which was otherwise asymptomatic. Computed tomography evaluation revealed an unusually large hypolucent mass, posterior to the inner table of the right anterior mandible. Surgical excision was uncomplicated. Upon follow-up, the right anterior floor of the mouth wound healed without compromise of the lingual or hypoglossal nerves or Wharton's duct. This discussion highlights the infrequent occurrence of lipomas in the oral cavity, particularly in the floor of the mouth, including patient presentation, preoperative evaluation, and surgical planning.

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.

Chondroid lipoma that may mimic malignancy: A case report

Chondroid lipoma is rare benign lipomatous lesion could mimic other soft tissue tumor.

Spindle cell lipoma of the buccal mucosa: Uncommon finding in an older adult

OBJECTIVE

This article reports a case of a longstanding, slowly enlarging intraoral spindle cell lipoma (SCL) that had become increasingly painful during mastication.

BACKGROUND

The SCL represents an uncommon variant of the conventional lipoma. There is limited information regarding this lesion in the gerodontologic literature.

MATERIALS AND METHODS

A 68-year-old patient underwent an excisional biopsy of a 9-mm slightly yellow papule along the buccal mucosa.

RESULTS

The surgical specimen was composed of mature adipocytes with abundant spindle cell populations and was diagnosed as a SCL.

CONCLUSIONS

Timely removal of the SCL may reduce the incidence of clinical and surgical complications, particularly in older adults. The management of a SCL is complete excision, and recurrence is rare. Lesions must be carefully distinguished microscopically from its malignant counterpart, the spindle cell liposarcoma.

Lipoma in Parotid Gland: A Rare Case Report

Lipoma is a benign, rare, mesenchymal tumor found in the head and neck region, especially in the parotid gland. It thus requires a careful and precise examination to establish a diagnosis. A surgical procedure of the parotid gland is challenging due to the associated risk factor of facial nerve injury. We report a rare case of head and neck region lipoma between the superficial and deep lobe of the parotid gland. A 44-year-old female patient was presented with the chief complaint of a painless lump on the left front ear to the left cheek for about 1 year. There were no complaints of tooth pain before the lump appeared, and there were no lumps in other regions. A fine-needle aspiration biopsy, ultrasonography, and magnetic resonance imaging were all performed to establish the preoperative diagnosis and to plan the correct surgical approach. Lipoma was the initial clinical diagnosis, and a surgical excision with superficial parotidectomy and facialis nerve preservation was performed. Follow-up examinations were conducted to assess any facial nerve injury complications. Conclusion Lipoma rarely grows in the parotid gland. Careful diagnosis should be performed to establish a precise surgery for parotid dissection and facial nerve preservation.

Deep Frontal Lipoma With Frontal Bone Invasion: Report of a Rare Case

Lipomas are benign masses of fatty tissue, and in the forehead, they may develop in the subcutaneous or deep fat tissue. While subcutaneous lipomas are common, deep forehead lipomas are unusual and rarely invade the underlying bone. Only a few cases have been reported in the literature, and even fewer cases are reported in children. We present a case of a slowly growing frontal mass corresponding to a deep lipoma responsible for frontal bone invasion, resulting in a bony defect reaching the dural space. Through this case, we aim to emphasize forehead lipomas' clinical and surgical characteristics.

Spindle cell lipoma of the floor of mouth

The patient was a man in his 60s with the gradually increasing mass in his mouth. A well-defined, elastic soft mass with a major diameter of 60 mm was found on the right floor of mouth. The magnetic resonance imaging findings showed a well-defined mass with high signal on both T1 and T2-weighted image in the right sublingual space. The mass was slightly heterogeneous inside and had a septum-like appearance. The tumor was resected with care not to damage the capsule. Histopathological findings showed mature adipocytes, spindle-shaped cells, and collagenous components. Spindle cells were CD34-positive. The tumor was diagnosed as spindle cell lipoma. The patient was followed up for 6 months with no recurrence. Spindle cell lipoma is a rare entity and this is the largest case in the oral cavity. Because there are wide variety of adipocytic tumors, the careful examination of their imaging and histopathological findings is essential.

Atraumatic intraoral buccal fat pad herniation in a neonate

An approximately 2-day-old neonate was brought with a fleshy intraoral mass and an inability to suckle adequately, without a preceding history of trauma. Contrast-enhanced CT revealed a fat density mass-like lesion occupying and partially filling the oral cavity. Following detection of a defect in the buccinator muscle with associated herniation of the buccal pad of fat into the mouth, a surgical approach was adopted to tackle the condition. Intraoperatively, the defects in the buccinator muscle and buccal mucosa were repaired after excision of the prolapsed fat pad. Age-appropriate feeding practices were initiated following surgery without residual anatomical or functional limitation. Early radiological diagnosis directing surgical intervention was helpful in management of a benign but functionally impeding lesion.

EGFR, VEGF, and angiogenesis promote the development of lipoma in the oral cavity

This study aimed to detect, quantify and compare the immunohistochemical expression of EGFR and VEGF and microvessel count (MVC) in oral lipomas, and to correlate the findings with clinical and morphological characteristics of the cases studied. The sample consisted of 54 oral lipomas (33 classic and 21 non-classic) and 23 normal adipose tissue specimens. Cytoplasmic and/or nuclear immunohistochemical staining of EGFR and VEGF was analyzed. The angiogenic index was determined by MVC. Cells were counted using the Image J® software. The Statistical Package for the Social Sciences was used for data analysis, adopting a level of significance of 5% for all statistical tests. A statistically significant difference in EGFR immunoexpression (p=0.047), especially, between classic lipomas and normal adipose tissue. There was a significant difference in MVC between non-classic lipomas and normal adipose tissue (p=0.022). In non-classic lipomas, only VEGF immunoexpression showed a significant moderate positive correlation (r=0.607, p=0.01) with MVC. In classic lipomas, the number of EGFR-immunostained adipocytes was directly proportional to the number of VEGF-positive cells, demonstrating a significant moderate positive correlation (r=0.566, p=0.005). The results suggest that EGFR, VEGF, and angiogenesis participate in the development of oral lipomas but are not primarily involved in the growth of these tumors.

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.

Intraoral lipoma with degenerative changes mimicking atypical lipomatous tumor: an immunohistochemical study

Lipomas are mesenchymal neoplasms relatively uncommon in the oral cavity. Lipomas can exhibit histopathological features mimicking atypical lipomatous tumors (ALT) or dysplastic lipoma (DL) in the presence of degenerative changes. Relevantly, immunohistochemistry assists in the correct diagnosis. Herein, we present the case of a 54-year-old male with a sessile nodule located on the dorsum of the tongue. The histopathological analysis showed a diffuse, non-circumscribed adipocytic proliferation constituted by cells of variable size containing cytoplasmic vacuoles and displaced nuclei, some resembling lipoblasts supported by fibrous connective tissue stroma. By immunohistochemistry, tumor cells were positive for vimentin, S100, FASN, CD10, and p16. Rb expression was intact. Moreover, CD34, p53, MDM2, and CDK4 were negative. After 2-year of follow-up, no alteration or recurrence was observed. In conclusion, MDM2, CDK4, p53, and Rb immunomarkers can be used reliably to differentiate benign lipoma with degenerative changes from ALT and DL.

Intraosseous lipoma of the jaws: Review of the literature and rare case report

BACKGROUND

Lipoma is a benign tumor that arises at the expense of mature adipose tissue, it can occur anywhere in the body that contains adipose tissue. However, the intraosseous lipoma is considered a rare bone tumor, that affects the long and flat bones, but it is uncommon in the jaws. Usually, diagnosis based on clinical and radiographic features is insufficient and histopathology analysis is of utmost importance for the final diagnosis.

CASE PRESENTATION

In this article, we present a case report of a 28-year-old female patient who visited the dentist with the intention of extracting an impacted tooth. She had no medical history with medications or genetic diseases. The tooth was extracted with a small soft mass that was subjected to histological analysis and it was found to be an intraosseous lipoma.

DISCUSSION

Intraosseous lipoma is a rare tumor of the oral cavity, and it can be difficult to diagnose when only clinical and radiographic features are based, and the definitive diagnosis is based on histological examination. The treatment is complete surgical excision.

CONCLUSIONS AND LITERATURE REVIEW

30 cases were discovered and archived since 1948 until now, most of them were in the posterior region of mandibular, and the infection of females is higher than males with different final sub-diagnosis of types of intraosseous lipoma.

Intraosseous Lipoma Mimicking Periapical Lesion: A Rare Presentation

Lipoma is one of the benign soft-tissue tumors in the adipose tissue. Oral lipomas comprise 1%-5% of benign oral tumors. They are slow-growing, soft, asymptomatic, solitary tumors. In this case report, a 45-year-old female patient having swelling on the upper right arch for 2 months has been reported. Clinically, the right upper second premolar and first molar were grossly carious, with diffuse swelling on the adjacent vestibule. A provisional diagnosis of the periapical abscess was rendered. Radiological evaluation and routine blood tests were performed. After the tissue was obtained, following teeth extraction and socket curettage, it was sent for histopathological evaluation, and findings suggested intraoral intraosseous lipoma. Clinically, they are asymptomatic, and therefore, if it was not curetted and histopathologic evaluation not done, and only thought to be just a swelling or a periapical abscess, proper treatment could not have been established. This paper will surely bring out the importance of histopathology in routine dentistry and the role of histopathological evaluation of periapical soft tissues.

A “V”-Shaped Intraoral Lipoma on the Floor of the Mouth: A Case Report

A benign soft tissue tumor of mature fat cells is called a lipoma (adipocytes). Lipoma can develop anywhere on the body, although it is uncommon in the mouth. Lipomas that are superficially positioned are often yellowish in color, painless, soft, and non-fluctuating with a thin epithelial surface. As a result, a delicate pattern of blood vessels is frequently seen on the surface. Deeper lesions might not exhibit this finding and, as a result, are not as clinically recognized. Since the patients do not report any subjective clinical symptoms, the dentist often diagnoses such lipomas by accident. Deep-seated lipomas require specialist imaging procedures, such as contrast-enhanced computed tomography, magnetic resonance imaging, or ultrasound to determine their extent. Lipomas can range in size from tiny to large to enormous. Large lipomas typically feature a "slip sign" and a nodular surface. Giant-sized lipomas can have a diameter of up to 10 cm. Lipomas can be single or multicellular. Dercum's disease, Proteus syndrome, neurofibromatosis, and familial adenomatosis polyposis all exhibit lipomas in various locations. The preferred course of treatment for these oral lipomas is surgical removal. Such lipomas do not recur again. Lipoma comes in a number of tiny varieties. The traditional description is of a well-defined tumor made up of lobules of uniformly sized and shaped mature fat cells. The term "fibrolipoma" refers to lipomas that contain a sizable amount of fibrous connective tissue, "angiolipoma" refers to lipomas that contain numerous tiny blood vessels, "myxolipoma" refers to lipomas with a background of myxoid cells, and "spindle cell lipoma" refers to lipomas that contain a mixture of uniform spindle cells. When compared to a pleomorphic liposarcoma, the pleomorphic lipoma exhibits spindle cells and strange, hyperchromatic large cells, making it challenging for the pathologist to tell them apart. An intramuscular lipoma is a lipoma that invades skeletal muscle bundles. Because they are harder to entirely eradicate, intramuscular lipomas are more likely to reoccur.

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.

Osteochondrolipoma of the Hand

Lipoma is the most common type of benign soft tissue tumor and is composed of mature adipose tissue. A neoplasm of adipose tissue with admixed mature bone and cartilage, or osteochondrolipoma, is an extremely rare histologic variant. Most documented osteochondrolipomas have occurred in the soft tissues of the head and neck related to the oral cavity, and the tumor is seen involving the extremities. A fatty mass with nonlipomatous elements can present a diagnostic challenge. We present a rare case of osteochondrolipoma involving the wrist. The clinical presentation, radiographic images, histologic findings, and treatment are discussed in this case report.

Oral Lipoma Resembling Popeye's Pipe: A Case Report

Lipomas are benign neoplasms of mesenchymal origin. Although they are frequently seen in other parts of the body, they are rare in the oral cavity. In the oral cavity, they most often develop from buccal mucosa. They tend to grow slowly, so they may remain asymptomatic for a long time and go unnoticed. Lipomas in the oral cavity may cause deterioration in chewing-speaking and esthetic problems over time, depending on the increase in their size. The most reliable imaging method for differential diagnosis is magnetic resonance imaging. Complete excision of the lipoma is essential for treatment. In this study, a case of an unusual oral lipoma, causing nutrition-speaking difficulties in a geriatric male patient is presented.

Giant lipoma of the tongue: A case report and review of the literature

This report presents the case of a 49-year-old man who presented with giant masses that had recently grown on the bilateral sides of the tongue. A clinical examination revealed rubbery yellowish lesions protruding from the tongue. A panoramic radiograph showed an enlarged soft tissue shadow of the tongue. Computed tomography showed well-defined circumscribed mass exhibiting a homogeneous low density on the bilateral sides of the tongue. On magnetic resonance images, the masses showed a high signal intensity on T1-weighted images and iso-signal intensity with partially hyperintense margin on fat-suppressed T2-weighted images. Surgical excision was performed, and a histopathologic examination confirmed the diagnosis of lipoma. The patient recovered well with no sign of recurrence. A giant lipoma is defined as a lipoma larger than 5 cm in diameter. A literature review of giant lipomas of the tongue is also presented herein.

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.

Review of Head and Neck Masses in the Indian Population Based on Prevalence and Etiology With an Emphasis on Primary Diagnostic Modalities

Head and neck masses are classified as sebaceous cysts (epidermoid cysts), cervical lymphadenopathy, benign lipomas, lymph nodes, thyroid swellings, or tuberculosis lymphadenitis that may be painful or painless, adherent or fluctuant. In spite of this, they have distinct prognoses and pathological features. The anatomical location of the swelling and other demographic manifestations of the patient provide valuable information about the cause and type of swelling. Computed tomography (CT), magnetic resonance imaging, positron emission tomography-CT, and ultrasonography are the gold standard imaging methods for the head and neck examination. These methods are used according to the region considered for the study. Fine-needle aspiration cytology of lymph nodes is known to be effective, simple, and sometimes the only tool for the diagnosis of lymph node malignancies. This review highlights the epidemiological aspect of head and neck masses in the Indian population.

Sialolipoma of the Floor of the Mouth with Immunohistological Analysis

Lipomas are relatively rare in the head and neck, and sialolipoma was described as an entity about 20 years ago as lipoma that entraps salivary gland tissue. Less than 10 cases have been described in the floor of the mouth not related to the major salivary glands. Here, we report a case of sialolipoma affecting the floor of the mouth in a 47-year-old patient and reviewed the clinical, histologic, and immunohistochemical characteristics of the lesion.

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.

Tumors of the labial mucosa: a retrospective study of 1045 biopsies

BACKGROUND

To investigate the relative frequency of localized mucosal swellings of the upper and lower labial mucosa, the clinical-pathological diagnosis agreement and whether patient's age and gender and tumor's site and size may raise the suspicion of neoplasm.

MATERIAL AND METHODS

Retrospective analysis was performed on upper or lower labial mucosal tumors, histopathologically diagnosed between 2009-2018. The diagnostic categories developmental/reactive tumors, benign and malignant neoplasms were associated with patient's age and gender and tumor's site and size; clinical-pathological diagnosis agreement was, also, evaluated.

RESULTS

Overall, 1000 (95.7%) developmental/reactive tumors, 35 (3.3%) benign and 10 (1%) malignant neoplasms were found. Upper/lower lip tumor ratio was 0.14:1. The diagnostic category was significantly associated with age (p<0.0001), site (p<0.0001) and diameter (p<0.0001). Age ≥60 years, tumor's location on the upper lip and diameter >1cm were independent predictors for neoplasms. Patients presenting 2 or 3 of these variables were 20.2 times (p < 0.0001) or 33.6 times (p < 0.0001), respectively, more likely to have a neoplasm. Complete/partial agreement between clinical and pathological diagnosis was seen in 96.3% of the cases.

CONCLUSIONS

Most lip tumors involve the lower lip and are reactive, but upper lip tumors measuring >1cm in patients≥60 years have significantly higher probability to be neoplasms.

Benign connective and soft-tissue neoplasms of the oral and maxillofacial region: Cross-sectional study of 1066 histopathological specimens

BACKGROUND

Benign connective and soft-tissue neoplasms (CSTNs) are unusual in the head and neck region. The aim of the present study was to evaluate the demographic and clinicopathological features of these neoplasms.

METHODS

A cross-sectional study was conducted of cases diagnosed as benign CSTNs, with data collected from biopsy records. The chi-square test was used. A p-value <0.05 was considered indicative of statistical significance.

RESULTS

Among the 38 119 specimens, 1066 (2.79%) were benign CSTNs: 369 fibroblastic/myofibroblastic, 250 adipocytic, 179 vascular, 130 neural, 94 osseous/cartilaginous, 19 muscular, and two fibrohistiocytic. Most patients were female (62.8%) and white-skinned (45.8%). Mean age was 42 years. The tongue (25.2%) was the most affected site for extraosseous neoplasms.

CONCLUSION

This study had the largest sample of benign oral and maxillofacial CSTNs. Although these tumors have similar clinical features, the characterization and differentiation detailed here may help clinicians with regards to the correct diagnosis.

Intraoral Lipoma of the Cheek - A Case Report With a One-Year Follow-up and Review of Literature

Lipomas are mesenchymal adipose tumors that are most common in the human body. However, they are rare in the oral cavity at an occurrence rate of 1% to 4% with male gender predilection. The case presented is of a 37-year-old male who presented with a large painless swelling on the right cheek region. The swelling was present for the past year and had aggravated in the previous one month, causing discomfort during mastication and speech. On clinical examination, a solitary non-fluctuating circumferential swelling on the right cheek was observed. A provisional diagnosis of lipoma was made based on the history and clinical examination, and it was decided to treat by surgical excision. A final diagnosis of lipoma was made based on histopathological analysis of the excised specimen. The patient at a one-week follow-up had recovered from his speech and chewing problems, and no recurrence was reported at a one-year follow-up.

Transoral floor of mouth lipoma resection: A technical multimedia analysis

Lipomas are common benign mesenchymal tumors that originate from mature adipocytes throughout the body, with 13-20% occurring in the head and neck region, however only 1-4.4% affect the oral cavity, where they are found predominately in the cheek, followed by the tongue, lips, palatal mucosa, gingiva, and floor of the mouth. Herein, we present a multimedia analysis of transoral floor of mouth lipoma resection in a 58-year-old female. Learning points include (1) Identification and stenting of Wharton's ducts in order to facilitate their functional preservation and to minimize risk of postoperative sialocele; (2) postoperative observation with airway monitoring due to expected floor of mouth edema; (3) utilization of a midline incision to minimize injury to Wharton's ducts and maximize bilateral access to the floor of mouth.

Angiolipoma in the Head and Neck: Imaging, Diagnosis and Management

Angiolipoma, distinguishable from other lipomas by its excessive degree of vascular vessels, are rare in the head and neck and require unique management. A slow growing mass, located underneath the inferior border of the right mandibular angle of a 51-year-old female, was excised under general anesthesia. Unexpected excessive bleeding during the excision was observed and the histological specimen was diagnosed as angiolipoma. As shown in this case report, pre-operative imaging modalities have a crucial influence and are sufficient to diagnose and manage angiolipomas. The “Gold standard” treatment is excision with clear margins and bleeding management should be taken into account according to appropriate differential diagnosis.

Osteolipoma: An Extremely Rare Hard Palate Tumor

Lipoma and its variants rarely involve the oral cavity. Osteolipoma of the hard palate is extremely uncommon with only a few cases reported worldwide. It is important to recognize and give comprehensive diagnosis of this entity, so as to prevent unwarranted medical interventions. Here, in this report, we describe a rare case of osteolipoma arising in the hard palate of a 35-year-old male and the diagnostic conundrum associated with it. The approach to such a case, differential diagnosis, and review of the literature are also presented.

A Case of Fibrolipoma of the Hard Palate

An extremely rare case of fibrolipoma in the hard palate is presented and discussed with reference to the literature. An 85-year-old woman visited the Tokyo Dental College Chiba hospital in September 2016 with the chief complaint of a mass in the hard palate. The patient had first become aware of this mass several years earlier. An examination at another hospital in June 2009 resulted in a clinical diagnosis of lipoma. Regular examinations followed every 6 months until September 2014, at which time she stopped attending these appointments because there was no change. In August 2016, however, the patient realized that the tumor was increasing in size. Although there was no pain, awareness of a foreign body in the oral cavity when eating or talking was increasing, so she decided to visit our clinic for detailed examination and treatment. At this point, the mass extended from the center to the left side of the hard palate. It measured 15 mm along the major axis, and had a clear border; nearly spherical, its surface was smooth and glossy, and was of a slightly yellowish color. The mass was painless, elastic, and soft. Computed tomography and magnetic resonance imaging revealed a tumorous lesion. Based on a clinical diagnosis of lipoma, it was subsequently excised under general anesthesia in January 2017. The tumor lay under the palatal mucosa, extending from the center to the left side of the hard palate. It was surrounded by a single-layered membranous structure, and had not adhered to the surrounding tissues. Healthy palatal mucosa and periosteum were also removed en bloc with the tumor within a safety margin of approximately 5 mm. No pressure absorption of palatine bone was seen. Histopathologically, proliferation of mature adipose tissue was observed. This was surrounded by a thin, single-layer membrane within the subepithelial connective tissue, which was covered by stratified squamous epithelium. Proliferation of fibrotic connective tissue was seen between the adipocytes. The final diagnosis was fibrolipoma. To date, at 18 months postoperatively, no recurrence has been observed and progress has been satisfactory.

A 37 mm Spindle Cell Lipoma on the Floor of the Mouth

Spindle cell lipoma (SCL) is a rare variety of lipoma that mostly arises in male patients and rarely affects the oral cavity. The floor of the mouth is an uncommon site for SCL, and very few cases have been reported in this location. A case of SCL is reported in a 70-year-old woman who had noticed a swelling of the floor of the mouth without any functional consequence. Both ultrasonography and RMI suggested a diagnosis of ranula, whereas clinical palpation showed a nonfluctuant mass. The lesion was excised under local anesthesia. A 37 × 32 mm encapsulated yellow mass was removed. Histological features (mature adipocytes and CD34+ spindle cells) led to a diagnosis of SCL. Medical imaging assessment of this lesion could have been influenced by the high frequency of the ranulas in the floor of the mouth. This case appears to be quite infrequent because of its location (floor of the mouth), its size (over 3.5 cm), and the patient's gender (female).

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.

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

BACKGROUND

The aim of this study was to describe the clinicopathological characteristics of 43 intraoral lipomas and classify them according to their microscopic variants.

MATERIAL AND METHODS

All the cases of intraoral lipomas diagnosed at an Oral Pathology service were selected for the study. Clinical data, such as age, gender, location, time of evolution, clinical presentation, clinical hypothesis of diagnosis, and treatment, were collected from the clinical files.

RESULTS

Of the 43 cases analyzed, 24 (55.8%) occurred in women. The mean age was 77.4 years. The most affected site was the buccal mucosa (22 cases, 51.1%). The mean lesion size was 1.7 cm. Twenty-three cases (53.5%) were classified as simple lipoma, 14 (32.6%) as fibrolipoma, four (9.3%) as spindle cell/pleomorphic lipoma (SC/PL), one (2.3%) as lipoma of the salivary glands, and one (2.3%) as intramuscular lipoma. In one case of SC/PLs, lipoblasts were observed. No atypical lipoblasts or mitoses were noted. Lipoma was considered more often than other tumor histological subtypes among the clinical hypotheses of diagnosis when the final diagnosis was simple lipoma (p=0.01).

CONCLUSIONS

Intraoral lipomas present different clinical presentation depending on the histological subtype. In SC/PLs, lipoblasts with vacuolated cytoplasm may be found and the presence of mature adipocytes is essential for diagnosis.

Oral lipoma: Case report and review of literature

Lipoma is a benign neoplasm that primarily affects the middle-aged individuals and has a rare oral cavity occurrence. Given its noninvasive behavior and low recurrence rate, surgical conservative management should be regarded as the best therapeutic option. This paper highlights two patients along with their improved conditions following the treatment.

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.

Laryngeal Spindle Cell/Pleomorphic Lipoma: A Case Report. An In-Depth Review of the Adipocytic Tumors

Spindle cell and pleomorphic lipomas (SC/PLs) are a rare form of lipomatous tumors. They typically occur as a slow-growing localized mass in the subcutaneous fatty tissue of the posterior neck, back, and shoulders. This benign variant represents less than 1.5% of all lipomas and is relatively uncommon in the head and neck area. A manifestation in the larynx is even rarer. Unlike other anatomic locations, laryngeal lipomas can pose life-threatening symptoms secondary to acute obstruction of the upper aerodigestive tract. This report presents a case of a large SC/PL of the larynx associated with hoarseness, dysphagia, globus sensation, and neck fullness. The tumor was successfully removed through an anterior transcervical approach with infrahyoid myotomy. The authors review the literature concerning head and neck adipocytic tumors with spindle cells and discuss the difficulties in distinguishing SC/PLs from liposarcomas. To the best of the authors' knowledge, this is the first case to be reported in the oral and maxillofacial surgery literature.