Indian Journal of Dental Research

CASE REPORT
Year
: 2014  |  Volume : 25  |  Issue : 5  |  Page : 672--674

Oral fibrolipoma: A rare histological variant


Treville Pereira, Subraj Shetty, Swati Sapdhare, Avinash Tamgadge 
 Department of Oral and Maxillofacial Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Nerul, Navi Mumbai, Maharashtra, India

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

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.



How to cite this article:
Pereira T, Shetty S, Sapdhare S, Tamgadge A. Oral fibrolipoma: A rare histological variant .Indian J Dent Res 2014;25:672-674


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 Oct 21 ];25:672-674
Available from: http://www.ijdr.in/text.asp?2014/25/5/672/147123


Full Text

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



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}{Figure 2}{Figure 3}{Figure 4}{Figure 5}

 DISCUSSION



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.

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