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Table of Contents   
SHORT COMMUNICATION  
Year : 2011  |  Volume : 22  |  Issue : 6  |  Page : 871-872
Intermuscular lipoma of the submandibular space


1 Department of Morphology, Stomatology and Physiology, Faculdade de Odontologia de Ribeirão Preto - USP, Brazil
2 Department of Oral and Maxillofacial Surgery, Hospital de Vila Penteado, SUS-SP, Brazil
3 Department of Oral Pathology, Araçatuba Dental School - UNESP, Brazil
4 Post Graduate Program, Oral and Maxillofacial Surgery Branch, Araçatuba Dental School - UNESP, Brazil

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Date of Submission22-Mar-2010
Date of Decision22-Oct-2010
Date of Acceptance08-May-2011
Date of Web Publication5-Apr-2012
 

   Abstract 

Deep lipomas, especially in the head and neck region, are uncommon. This report describes the case of a patient with a large intermuscular lipoma of the submandibular space, which had been present for 10 years and was diagnosed by computed tomography. The clinical, imaging, and histopathological features, as well as the management of the tumor, are described.

Keywords: Computed tomography, intermuscular lipoma, submandibular space

How to cite this article:
Adachi P, Kaba SP, Soubhia AP, Shinohara EH. Intermuscular lipoma of the submandibular space. Indian J Dent Res 2011;22:871-2

How to cite this URL:
Adachi P, Kaba SP, Soubhia AP, Shinohara EH. Intermuscular lipoma of the submandibular space. Indian J Dent Res [serial online] 2011 [cited 2014 Apr 20];22:871-2. Available from: http://www.ijdr.in/text.asp?2011/22/6/871/94691
Lipomas of the head and neck are relatively uncommon, and there have been only a few reports of lipomas of the submandibular space. [1] Although lipomas are generally diagnosed by clinical examination, imaging studies can aid in establishing the diagnosis in special situations. [2] This report describes a massive lipoma of the submandibular space, which was diagnosed by computed tomography (CT).


   Case Report Top


A 56-year-old man presented with a swelling of the right lower face. The swelling had been present for 10 years, without recent growth. Clinical examination revealed a soft, painless mass (10 × 5 cm) in the submandibular region [Figure 1].
Figure 1: Clinical aspect of the lipoma in the submandibular region

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A CT scan showed a well-circumscribed, bilobed mass measuring 14 cm in its largest diameter [Figure 2]. The mass was under the platysma muscle and had signal intensity characteristic of fat (-135 Hounsfield units).
Figure 2: CT demonstrating a well-circumscribed, bilobed mass with high signal intensity

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Fine-needle aspiration was negative for malignancy. After having given written informed consent, the patient underwent surgical exploration under general anesthesia. Dissection of the platysma revealed a well-circumscribed mass that was easily separated from the surrounding tissues [Figure 3].
Figure 3: Intraoperative view of the bilobed lesion easily separated from the surrounding tissues

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Histologically, the lesion consisted of mature adipocytes in a connective tissue stroma, surrounded by a thin fibrous capsule. No cellular atypia, mitotic activity, multinucleated cells, or lipoblasts was seen [Figure 4]. The lesion was diagnosed as intermuscular lipoma. The immediate postoperative period was uneventful, and no recurrence was observed during the five-year follow-up period.
Figure 4: Photomicrograph showing mature adipocytes surrounded by a fibrous capsule (hematoxylin and eosin stain, original magnification ×100)

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   Discussion Top


Lipomas are classified into various subtypes, depending on the clinical and microscopic features of the tumor. Deep-seated lipomas that arise within skeletal muscle fibers are designated intramuscular lipomas, whereas those that arise between skeletal muscle fibers are designated intermuscular lipomas. [3] Intramuscular lipomas account for 0 to 5.0% of all benign adipocytic tumors, whereas intermuscular lipomas account for 0.3 to 1.9%. [3] The clinical and histological features of the intermuscular lipoma described here were similar to those reported in the literature, which include greater frequency among males, greater frequency among patients aged 40 to 60 years, lobulated appearance, easy separation from the surrounding muscle tissue, presence of a fibrous capsule, and absence of muscle fibers in the mass. [4]

Regarding the diagnostic tools, sometimes clinical examination alone is not sufficient to identify the nature and exact location of the mass, particularly in cases of deep-seated tumor; in such situations, imaging tests can be useful. [5]

Ultrasound, [5] CT, and magnetic resonance imaging [4],[5],[6] can differentiate lipomas from other soft tissue tumors. These imaging methods can also contribute to the staging of the tumor (extent and structures involved). The soft tissue characterization provided by CT or magnetic resonance imaging is superior to that provided by ultrasound. [5] In the case reported here, CT was quite useful for the diagnosis of lipoma, which has signal intensity similar to that of subcutaneous fat (-50 to -150 Hounsfield units). The prognosis of intermuscular lipomas is good, and the risk of recurrence is low. [3],[4]

 
   References Top

1.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 Oral Radiol Endod 2004;98:441-50.  Back to cited text no. 1
    
2.de Freitas MA, Freitas VS, de Lima AA, Pereira FB Jr, dos Santos JN. Intraoral lipomas: A study of 26 cases in a Brazilian population. Quintessence Int 2009;40:79-85.  Back to cited text no. 2
    
3.Fletcher CD, Martin-Bates E. Intramuscular and intermuscular lipoma: Neglected diagnoses. Histopathology 1988;12:275-87.  Back to cited text no. 3
    
4.Nishida J, Morita T, Ogose A, Okada K, Kakizaki H, Tajino T, et al. Imaging characteristics of deep-seated lipomatous tumors: Intramuscular lipoma, intermuscular lipoma, and lipoma-like liposarcoma. J Orthop Sci 2007;12:533-41.  Back to cited text no. 4
    
5.Zhong LP, Zhao SF, Chen GF, Ping FY. Ultrasonographic appearance of lipoma in the oral and maxillofacial region. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98:738-40.  Back to cited text no. 5
    
6.Salvatore C, Antonio B, Del Vecchio W, Lanza A, Tartaro G, Giuseppe C. Giant infiltrating lipoma of the face: CT and MR imaging findings. AJNR Am J Neuroradiol 2003;24:283-6.  Back to cited text no. 6
    

Top
Correspondence Address:
Patrícia Adachi
Department of Morphology, Stomatology and Physiology, Faculdade de Odontologia de Ribeirão Preto - USP
Brazil
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DOI: 10.4103/0970-9290.94691

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    Figures

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

This article has been cited by
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