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Table of Contents   
CASE REPORT  
Year : 2014  |  Volume : 25  |  Issue : 5  |  Page : 672-674
Oral fibrolipoma: A rare histological variant


Department of Oral and Maxillofacial Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Nerul, Navi Mumbai, Maharashtra, India

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Date of Submission10-Feb-2014
Date of Decision24-Feb-2014
Date of Acceptance24-May-2014
Date of Web Publication16-Dec-2014
 

   Abstract 

Lipomas are benign soft tissue mesenchymal neoplasms. Fibrolipoma is a histological variant of lipoma that mostly affects the buccal mucosa and causes functional and cosmetic disabilities. The diagnosis and differentiation of fibrolipoma with clinically similar lesions such as fibroma and pleomorphic adenoma is very essential for a correct treatment plan and complete follow-up. This article presents a case of a 35-year-old female with a fibrolipoma on the lingual marginal gingiva of the mandibular left third molar.

Keywords: Adipocytes, fibrolipoma, gingiva

How to cite this article:
Pereira T, Shetty S, Sapdhare S, Tamgadge A. Oral fibrolipoma: A rare histological variant . Indian J Dent Res 2014;25:672-4

How to cite this URL:
Pereira T, Shetty S, Sapdhare S, Tamgadge A. Oral fibrolipoma: A rare histological variant . Indian J Dent Res [serial online] 2014 [cited 2019 Dec 15];25:672-4. Available from: http://www.ijdr.in/text.asp?2014/25/5/672/147123
Lipoma is a common benign neoplasm of the adipose tissue, but it has been considered as an unusual growth in the oral and oropharyngeal region. The first description of an oral lipoma was published by Roux in 1848 in a review of alveolar masses and he referred to it as a "yellow epulis". [1]

The etiology of lipomas is uncertain and the tumor mainly affects the region of the trunk, shoulders, neck and axilla. Involvement of the oral cavity is rare with lipomas accounting for <4.4% of the benign oral tissue tumors. [2]

Fibrolipoma is an uncommon histological variant of the classic lipoma, in which neoplastic fat cells are embedded along with dense collagen. Most patients are 40 years of age or older. [3] It may occur at various anatomic sites including the buccal mucosa, lips, tongue, palate, and floor of the mouth. Although benign in nature, their progressive growth can cause interference with speech and mastication due to the tumor's dimension. [4]


   Case report Top


A 35-year-old female patient visited our dental clinic at Airoli, Navi Mumbai, Maharashtra, India, with the chief complaint of a long standing growth on the lingual marginal gingiva of the mandibular left third molar. The patient gave a history of a toothbrush injury about 1-year back after which she noticed a small growth near the third molar. The growth showed a slow and continuous enlargement over the past 1-year, causing discomfort on occluding the teeth. Past medical history of the patient was noncontributory.

Intra-oral examination revealed a pinkish, well-defined, oval, pedunculated growth measuring 1.5 × 2 cm present on the lingual side of third molar [Figure 1]. The overlying mucosa was normal without any evidence of inflammation and ulceration. On palpation, the growth was firm to soft in consistency, nontender, mobile and margins were slippery under the palpating finger. On the basis of the patient's history and clinical examination, a provisional diagnosis of traumatic fibroma was made along with differential diagnosis of lipoma, pyogenic granuloma and neurofibroma. Routine blood examination was found to be normal. The lesion was excised under local anesthesia and the excised tissue was sent for histopathological examination.

Macroscopic examination revealed one soft tissue, creamish-white colored mass, firm in consistency and measuring 1 × 0.8 × 0.5 cm. The cut surface of the tissue revealed a yellow colored mass at the center surrounded by white areas at the periphery [Figure 2].

Microscopic examination revealed an overlying epithelium, which was 8-10 layers thick, atrophic, parakeratinized and stratified squamous type. The underlying connective tissue revealed adipose tissue with compressed blood vessels embedded within dense collagen fibers [Figure 3] and [Figure 4]. Correlating with the clinical and histopathological examination, the excised lesion was diagnosed as a fibrolipoma. The postoperative course was uneventful. There has been no recurrence of the lesion after 6 months [Figure 5].
Figure 1: Preoperative intraoral view showing smooth, pink colored pedunculated mass on the lingual marginal gingiva of left mandibular molar

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Figure 2: Gross cut specimen of tissue showing yellowish colored mass surrounded by pink colored areas at the periphery

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Figure 3: Microphotograph showing stratified squamous parakeratinized epithelium with an underlying connective tissue consisting of dense collagen fibers admixed with adipose tissue (H and E, ×4)

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Figure 4: Microphotograph showing mature adipose tissue interspersed by broad bands or fascicles of dense connective tissue (H and E, ×10)

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Figure 5: Postoperative intraoral view (after 6 months) showing complete healing after excisional biopsy

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   Discussion Top


Lipoma is a common benign tumor of adipose tissue, but its presence in the oral and oropharyngeal region is relatively uncommon with a prevalence rate of only 1/5000 adults. [5] No consensus exists regarding the pathogenesis of oral lipomas. Hereditary, fatty degeneration, trauma, hormonal basis, infection, infarction and chronic irritation are probable representative theories to elucidate the pattern of lipoma. [2] In most cases, they represent a developmental anomaly, but they can arise as a result of trauma and rearrangement of chromosomes no. 12q, 13q and 6p. [1],[6] It may also arise by preadipocyte differentiation and proliferation mediated by cytokines following soft tissue damage when blunt trauma and hematoma formation occurs. [7] In this case, trauma may be the cause for the presence of the lesion on the mandibular lingual gingiva. Lipomas usually present as slow growing asymptomatic lesions with a characteristic yellow color and soft doughy feel in the buccal mucosa, floor of the mouth and tongue, in the fourth and fifth decades, and generally with no gender predilection. [8]

Fibrolipoma is a benign soft tissue tumor which rarely occurs in oral and maxillofacial regions, and is classified as a variant of the conventional lipoma. It differs histologically from the classic variant, in that it is posed with mature adipose tissue interspersed by bands of connective tissue. [9] The tumor has been reported to be more frequently occurring in the buccal mucosa and buccal vestibule and it also shows a slight predominance in females. [10] In the present case the lesion occurred on the lingual marginal gingiva of the mandibular left third molar area which is a relatively rare site for occurrence.

According to the literature, it is difficult to value the real incidence of this neoplasm because it appears painless and slow growing in clinical appearance. In reality, the patient reports to the clinician only when it becomes symptomatic and for aesthetic and functional reasons. In 2003, Fregnani et al. collected several cases and diagnosed 45.7% as lipomas and 39.1% as fibrolipomas. [4] Several variants have been described, including angio-lipoma, fibrolipoma, chondrolipoma, osteolipoma/chondrolipoma, adenolipoma, perineural lipoma, and myxoid lipoma. [6]

Histopathologically, the fibrolipoma 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 usually well-circumscribed and may be thinly encapsulated. [5] The lesion in the present case showed similar features.

Furthermore, liposarcoma of the oral cavity is exceedingly rare, but this entity cannot be distinguished from its benign counterpart on clinical examination. [11] Therefore, accurate histological examination is mandatory, and the differential diagnosis is based on the detection of lack of lobular architecture, areas of prominent fibrosis and most importantly, on the presence of multivacuolated adipose cells with indented nuclei (lipoblasts), which are typically present in liposarcoma in variable proportion. The lesion in this case was surgically excised without any complications. Postoperative follow-up of 6 months showed no recurrence.

Fibrolipoma represents a distinct clinico-pathologic and biologic entity with an increased growth potential and a low recurrence rate. The clinical course is usually asymptomatic until they attain larger size. The knowledge and prompt treatment of tumors in this region is important. Complete resection should be emphasized, which is the key factor to avoid recurrence.

 
   References Top

1.
Shafer WG, Hine MK, Levy BM. A Textbook of Oral Pathology. 4 th ed. Philadelphia: WB Saunders; 1983.  Back to cited text no. 1
    
2.
Studart-Soares EC, Costa FW, Sousa FB, Alves AP, Osterne RL. 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. 2
    
3.
Enzinger FM, Weiss SW. Soft Tissue Tumors. 2 nd ed. St. Louis: Mosby; 1988.  Back to cited text no. 3
    
4.
Fregnani ER, Pires FR, Falzoni R, Lopes MA, Vargas 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.
Neville BW, Damm DD, Allen CM, Bouquot JE. Soft tissue tumors. Oral and Maxillofacial Pathology. 2 nd ed. Philadelphia: WB Saunders; 2002.  Back to cited text no. 5
    
6.
Gnepp DR. Diagnostic Surgical Pathology of the Head and Neck. Philadelphia: WB Saunders; 2000.  Back to cited text no. 6
    
7.
Peeran SW, Ramalingam K, Alsaid FM, Mugrabi MH. Infiltrating lipoma of oral cavity: A rare entity. Dent Hypotheses 2013;4:148-50.  Back to cited text no. 7
  Medknow Journal  
8.
Hoseini AT, Razavi SM, Khabazian A. Lipoma in oral mucosa: Two case reports. Dent Res J (Isfahan) 2010;7:41-3.  Back to cited text no. 8
    
9.
Manjunatha BS, Pateel GS, Shah V. Oral fibrolipoma-a rare histological entity: Report of 3 cases and review of literature. J Dent (Tehran) 2010;7:226-31.  Back to cited text no. 9
    
10.
Epivatianos A, Markopoulos AK, Papanayotou P. Benign tumors of adipose tissue of the oral cavity: A clinicopathologic study of 13 cases. J Oral Maxillofac Surg 2000;58:1113-7.  Back to cited text no. 10
    
11.
Capodiferro S, Maiorano E, Scarpelli F, Favia G. Fibrolipoma of the lip treated by diode laser surgery: A case report. J Med Case Rep 2008;2:301.  Back to cited text no. 11
    

Top
Correspondence Address:
Treville Pereira
Department of Oral and Maxillofacial Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Nerul, Navi Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.147123

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]

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