|Year : 2023 | Volume
| Issue : 1 | Page : 171-174
Fibrolipoma of the buccal mucosa: A rare case report
DR Keerthana, Punnya V Angadi
Department of Oral Pathology, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
|Date of Submission||18-Oct-2022|
|Date of Acceptance||04-Nov-2022|
|Date of Web Publication||21-Jan-2023|
Dr. Punnya V Angadi
Department of Oral Pathology, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research, Belagavi, Karnataka
Source of Support: None, Conflict of Interest: None
Fibrolipoma is a benign neoplasm categorized as a histopathological variant of classical lipoma. The occurrence of fibrolipoma in the oral cavity is extremely rare. When present, it manifests as a pedunculated or sessile, soft, smooth-surfaced nodular mass. Although it may vary, the majority of lesions are <5 cm in size. There may be association between functional and aesthetic limitations related to anatomical sites. Hence, it is crucial to properly examine lipomas histopathologically for better treatment modalities. Here is a case report of fibrolipoma occurring in buccal mucosa.
Keywords: Buccal mucosa, fibrolipoma, lipoma, oral cavity
|How to cite this article:|
Keerthana D R, Angadi PV. Fibrolipoma of the buccal mucosa: A rare case report. Indian J Health Sci Biomed Res 2023;16:171-4
| Introduction|| |
Lipomas are the most common benign tumor of adipose cells of mesenchymal origin. Lipomas have not been given much importance in the literature due to their insidious nature and they do not cause much problems or symptoms other than issues related to location and associated vital structures. For this reason, many lipomas are not reported and patients fail to get it to the doctor's attention unless they grow to a large size or result in problems due to their anatomical site.
Lipomas are defined as subcutaneous tumour composing adipose cells and are often encapsulated by a thin layer of fibrous tissue. They usually range from 1 cm to 10 cm and can be found anywhere in the body. They are clinically present as yellowish, asymptomatic, and slow-growing lesions. The common sites for occurrence of lipoma include the back, arm, shoulder, breast, thigh, abdominal wall, legs, forehead and face, in decreasing order of frequency.
Lipomas are uncommon occur in the head and neck and especially in the oral cavity region. In 1848, Raux gave first description of oral lipoma in a review of alveolar mass where he found that the excised lesions were slow-growing, soft, doughy, and yellow-colored tissue with normal overlying mucosa and called it as yellow epulis.
The objective of this paper is to present a rare case of fibrolipoma, a histopathological variant occurring in the left buccal mucosa of the oral cavity region of an adult male and to explain histopathological features of the same.
| Case Report|| |
A 29-year-old male patient from Belagavi presented to the outpatient department with a chief complaint of growth or mass of tissue on his left buccal mucosa for 3 months. No previous medical or surgical history was available. Clinically, the lesion was oval in shape, soft on palpation, measuring approximately 2 cm × 1 cm in diameter. Covering mucosa appeared normal in texture without ulceration [Figure 1]. Other findings included sharp distal cusp with respect to mandibular left third molar and decayed tooth, i.e., maxillary left 3rd molar. Clinical diagnosis of traumatic fibroma was considered and surgical excision of the lesion was performed under local anesthesia [Figure 2]. Excised specimen was 2 cm × 1 cm in diameter and sent for histopathological evaluation.
|Figure 1: Intraoral examination reveal solitary smooth surfaced yellowish swelling on left buccal mucosa|
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|Figure 2: (a) Surgical excision was performed under local anesthesia, (b) Gross examination reveals a tissue that appears pinkish in color with hemorrhage, soft to firm in consistency|
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| Results|| |
The gross details revealed a pinkish brown colored specimen, soft in consistent measuring 1.5 cm × 1 cm in diameter. The excised tissue was fixed and processed, and sections were cut and stained with hematoxylin and eosin. On microscopic examination, the H and E-stained sections showed stretched-out stratified squamous parakeratinized epithelium with underlying loose to dense connective tissue stroma. Numerous cells with clear cytoplasm and eccentrically placed nucleus suggesting adipocytes were seen to be interspersed with thick bundles of collagen fibers and blood capillaries [Figure 3]. Sections of muscle bundles were also noted in the deeper part of connective tissue. Van Gieson staining of the lesional tissue revealed the interspersed collagen bundles taking up red color [Figure 4]. A histopathological diagnosis of fibrolipoma, a variant of lipoma, was given.
|Figure 3: (a) Microscopic examination reveals homogenous adipocytes interspersed with fibrous tissue are observed, (b) Higher magnifications reveal adipocytes interspersed with hick collagen bundles|
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|Figure 4: Van Gieson special stain showing the collagen bundles interspersed between the adipocytes taking up red color|
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| Discussion|| |
Abnormal neoplastic growth of adipocytes as subcutaneous soft mass is termed lipoma. Even though they are common in other body parts such as the neck, shoulder, and extremities, the oral cavity is an uncommon site. Lipomas account for 4%–5% of all benign tumors arising throughout the entire body, while those occurring in the oral region account for 0.7%–2.2% of all lipomas., They occur most commonly in children and young adults, most often in darkly pigmented patients. Clinically, they present as a soft, nodular, sessile, or pedunculated tissue mass usually encapsulated by a thin fibrous capsule. They appear yellowish and glistening with the typical texture of the overlying surface. Complications depend primarily on location and size. They may cause difficulty in chewing, speech, dysphagia, and dyspnea. The most common sites affecting the oral cavity are buccal mucosa, followed by uncommon areas such as the tongue, lip, palate, gingiva, salivary glands, and floor of the mouth.
Etiological factors proposed for lipomas are hereditary, HMG-I-C gene relation, trauma, fatty generation, hormonal basis, infection, and chronic irritation. Other conditions, even though rare, associated with lipoma are familial multiple lipomatosis, adipose Dolorosa, Gardner's syndrome, Madelung disease encephalocraniocutaneous lipomatosis, and Pai syndrome.
The pathogenesis of lipoma is still unclear, however, few reasons and theories have been put forward. These could be due to cytogenetic abnormalities seen in chromosome 12 commonly as the DDIT3 gene present on its long arm is associated with adipocytic differentiation. Lin et al. stated that these “benign entities are congenital lesions arising from multipotent cells of an embryo that remain clinically dormant until they differentiate into fat cells under the hormonal influence during adulthood.” Specific theories, such as the hypertrophic and metaplasia theory, have also been proposed for the induction of lipoma. Hypertrophic theory states that excessive growth of adipose tissue and obesity could result in the formation of lipoma. The metaplasia theory states that lipomatous growth may be due aberrant differentiation of in situ mesenchymal cells into lipoblast almost anywhere in the body.
Oral lipomas can occur in two morphological forms, superficial and diffused. Gross pathology reveals a soft, well-encapsulated, and round mass. The cut section presents with pale yellow to orange color, homogeneous fat mass, and greasy surface. The histopathologic finding in lipomas reveals abundant, mature, homogeneous adipocytes arranged in lobular architecture separated by fibrous connective tissue septa.
Histopathological variants are based on the microscopic features and presence of other components along with adipocytes such as thick collagen fibers, spindle cells, muscle bundles, blood capillaries, myxoid component, osteoid, chondroid, and bone marrow components. These variants are termed fibro-lipoma, spindle cell lipoma, intramuscular lipoma, angiolipoma, pleomorphic lipoma, myxoid lipoma, and atypical lipoma. The present case contains significant fibrous component intermixed with adipocytes, hence we called it as fibrolipoma.
In histological reports, occurrence in the oral region is said to be simple/classical oral lipomas (46%–91%) as the most common type, followed by fibrolipomas (8%–38%). Fibrolipoma is said to have slight female predominance in the oral cavity region, even though lipomas have no sex-based difference. However, the present case is seen in a male adult patient.
Lipomas are common in the age above 40 years and show no gender predominance. However, slight female predominance is seen in fibrolipomas. The current case is 29 years male patient who presents with swelling on the left buccal mucosa.
Microscopically, fibrolipomas contains an evident fibrous component interspersed with adipocytes, which is also observed in the microscopic examination of the present case.
Standard management of lipomas is surgical excision, and sometimes diffuse lipomas pose a challenge to the operating surgeon in terms of adjacent vital structures. However, recurrence is infrequent in these benign neoplasms. The present case is treated with surgical excision and follow-up after 7 days for suture removal.
The lesions such as herniation of buccal pad of fat, traumatic fibroma, cysts like dermoid/epidermoid cysts, mucocele, and neurofibromas can be considered in the differential diagnosis for lipoma occurring in the buccal mucosa.
| Conclusion|| |
Lipomas are rare tumors of the oral cavity. Fibrolipomas are a common histopathological variant to occur in the oral cavity after classical lipomas. Fibrolipomas could be considered a differential diagnosis in the buccal mucosa for lesions like traumatic fibromas, which occur most commonly in buccal mucosa regions.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
The authors would like to acknowledge the Department of Oral Surgery, KLE VK Institute of Dental Sciences, Belagavi, Karnataka, India, for providing the clinical and surgical photographs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kaur R, Kler S, Bhullar A. Intraoral lipoma: Report of 3 cases. Dent Res J (Isfahan) 2011;8:48-51.
Rajeev R, Beena VT, Indu G, Choudhary K, Devu A. Fibrolipoma of floor of the mouth of 20 years of duration. Clin Can Invest J 2014;3:394-7. [Doi: 10.4103/2278-0513.138058].
Charifa A, Azmat CE, Badri T. Lipoma Pathology. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.
Medina CR, Schneider S, Mitra A, Spears J, Mitra A. Giant submental lipoma: Case report and review of the literature. Can J Plast Surg 2007;15:219-22.
Lin JJ, Lin F. Two entities in angiolipoma(A study of 459 cases of lipoma with review of literature on infiltrating angiolipoma). Cancer 1974;34:720-7.
Hayashi K, Yamada S, Onda T, Shibahara T. A case of fibrolipoma of the hard palate. Bull Tokyo Dent Coll 2020;61:53-60.
Egido-Moreno S, Lozano-Porras AB, Mishra S, Allegue-Allegue M, Marí-Roig A, López-López J. Intraoral lipomas: Review of literature and report of two clinical cases. J Clin Exp Dent 2016;8:e597-603.
Gnepp DR, Bishop J. Gnepp's Diagnostic Surgical Pathology of the Head and Neck E-Book. Philadelphia, US: Elsevier Health Sciences; 2020.
Azzouz Y, Abidi S, Zidane FZ, Chbicheb S. An unusual intraoral lipoma: Case report and review of the literature. Pan Afr Med J 2022;41:336.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]