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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists


 
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CASE REPORT  
Year : 2017  |  Volume : 21  |  Issue : 1  |  Page : 129-131
 

Massive noninfiltrating angiolipoma of the buccal mucosa: Report of an extremely rare case


1 Department of Oral and Maxillofacial Surgery, Malla Reddy Institute of Dental Sciences, Hyderabad; Department of Oral and Maxillofacial Surgery, Mamata Dental College, Khammam, Telangana, India
2 Department of Oral and Maxillofacial Surgery, Mamata Dental College, Khammam, Telangana, India; Department of Biomedical Dental Sciences, College of Dentistry, University of Dammam, Dammam, Kingdom of Saudi Arabia

Date of Submission15-May-2016
Date of Acceptance26-Jan-2017
Date of Web Publication5-Apr-2017

Correspondence Address:
Nagaraju Tanneru
Department of Biomedical Dental Sciences, College of Dentistry, University of Dammam, P. O. Box 1982, Dammam 31441, Kingdom of Saudi Arabia

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jomfp.JOMFP_62_16

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   Abstract 


We present an extremely rare case of noninfiltrating angiolipoma (AL) of the buccal mucosa in a 90-year-old patient reaching a size of 14 cm × 10 cm. AL is rare in the soft tissues of oral cavity, and till date, only 22 cases have been reported, including our case. If size be taken into consideration, our case can be considered to be the first in literature to reach this massive size. Surgical excision of the tumor mass was performed. The histopathological findings confirmed the diagnosis of noninfiltrating AL. Follow-up for 1 year revealed no signs of recurrence.


Keywords: Angiolipoma, buccal mucosa, lipoma, noninfiltrating


How to cite this article:
Dhanala S, Tanneru N. Massive noninfiltrating angiolipoma of the buccal mucosa: Report of an extremely rare case. J Oral Maxillofac Pathol 2017;21:129-31

How to cite this URL:
Dhanala S, Tanneru N. Massive noninfiltrating angiolipoma of the buccal mucosa: Report of an extremely rare case. J Oral Maxillofac Pathol [serial online] 2017 [cited 2019 Sep 17];21:129-31. Available from: http://www.jomfp.in/text.asp?2017/21/1/129/203790





   Introduction Top


Angiolipoma (AL) is a variant of lipoma with marked degree of vascularization. It was first reported by Bowen in 1912.[1] ALs are differentiated into noninfiltrating (encapsulated) and infiltrating (nonencapsulated) types. The common occurrence of these tumors is prevalent among males in their second or third decades of life with site predilection toward trunk and extremities, especially in the forearm.[2] However, the incidence of AL is extremely rare in the intraoral region, with only 21 reported cases in English literature.[3] This case report presents the 22nd case of intraoral AL of massive size.


   Case Report Top


A 90-year-old woman with no significant medical history was referred to our department for evaluation of painless mass arising from oral cavity. The tumor was noticed by the patient 20 years ago as a small nodule on the right buccal mucosa and since then it gradually increased in its size. The growth reached a size, which could not accommodate in mouth, and due to constant irritation from the tumor, the patient coughed the growth for 5 years. Since then, there was a rapid growth of the tumor. On extraoral examination, a solitary, smooth, nontender and nonpulsatile pedunculated growth of size 14 cm × 10 cm with variable consistency was evident with intraoral origin [Figure 1].
Figure 1: Clinical image shows preoperative tumor

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On intraoral examination, single, smooth, firm and nontender stalk-like pedicle of diameter 2 cm was seen originating from the right buccal mucosa. Based on the history and clinical examination, we provisionally diagnosed it as a benign growth. Surgical excision of the tumor was done under general anesthesia [Figure 2] and [Figure 3].
Figure 2: Clinical image shows excised tumor mass

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Figure 3: Clinical image shows postoperative frontal view

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Histopathology confirmed it as noninfiltrating AL [Figure 4],[Figure 5],[Figure 6]. One-year follow-up of the patient revealed no evidence of recurrence. Ethical approval from the Institutional Review Board was obtained for the publication, and patient release form was signed by the patient.
Figure 4: Clinical image shows histopathology section (×4 magnifications)

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Figure 5: Clinical image shows histopathology section (×10 magnifications)

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Figure 6: Clinical image shows histopathology section (×40 magnifications)

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   Discussion Top


Lipomas are the most frequently found soft-tissue benign tumors, but their occurrence in head and neck region is rare.[4] AL, in the oral cavity, was first documented by Davis et al. as a growth on the hard palate.[5] History of trauma, lipomatous differentiation by hormones during puberty, vascular proliferation of a congenital lipoma and fatty degeneration of a central hemangioma have been implicated as possible etiological factors.[6] Based on the studies by Gonzalez-Crussi et al., these ALs have been classified into two histologic types: Infiltrating and noninfiltrating.[7] The noninfiltrating ALs are encapsulated and common in young patients.[8] The infiltrating types are poorly encapsulated and usually diagnosed in elder patients. The mean diameter at the largest portions of all the 21 documented ALs occurring in oral region was 3 cm, and the mean onset age of the patients was about 29 years old.[4]

Although diagnostic modalities such as magnetic resonance imaging, computed tomography, ultrasonography and aspiration biopsy have been used to differentiate between hemangioma, lipomas and AL, the diagnosis of these tumors is confirmed only by histopathology.[9] The standard treatment of choice is surgical excision for the noninfiltrating ALs and complete surgical excision with a clear surgical margin for poorly encapsulated infiltrating ALs to avoid recurrence. There is no report of malignant transformation or recurrence of noninfiltrating ALs in literature.[10]

The case we have presented showed the typical clinical and histological findings of a noninfiltrating AL. Its most striking and unique features were its occurrence in a 90-year-old female with a 20-year long history and pedunculated mass of 14 cm × 10 cm. With regard to the size and its typical pedunculated appearance, our present case can be considered to be the first of its kind in literature.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Bowen JT. Multiple subcutaneous hemangiomas, together with multiple lipomas, occurring in enormous numbers in an otherwise healthy, muscular subject. Am J Med Sci 1912;144:189-92.  Back to cited text no. 1
    
2.
Pfannenstiel TJ, Boseley M, Roach L. A case of paranasal sinus angiolipoma. Laryngoscope 2003;113:1080-1.  Back to cited text no. 2
    
3.
Yanase S, Nomura J, Matsumura Y, Kato H, Takeoka T, Imura H. Angiolipoma of the cheek: A case report with a literature review. Asian J Oral Maxillofac Surg 2011;23:35-7.  Back to cited text no. 3
    
4.
Mesolella M, Di Martino M, Laguardia M, Galera F, Galli V. Angiolipoma of the larynx. Otolaryngol Head Neck Surg 2007;136:142-3.  Back to cited text no. 4
    
5.
Davis GB, Stoelinga PJ, Tideman H, Bronkhorst F. Angiolipoma of the hard palate: A case report and review of the literature. J Maxillofac Surg 1976;4:242-4.  Back to cited text no. 5
    
6.
El-Monem MH, Gaafar AH, Magdy EA. Lipomas of the head and neck: Presentation variability and diagnostic work-up. J Laryngol Otol 2006;120:47-55.  Back to cited text no. 6
    
7.
Gonzalez-Crussi F, Enneking WF, Arean VM. Infiltrating angiolipoma. J Bone Joint Surg Am 1966;48:1111-24.  Back to cited text no. 7
    
8.
Sánchez Aniceto G, Salván Saez R, García Peà±in A. Angiolipoma of the cheek: Report of a case. J Oral Maxillofac Surg 1990;48:512-5.  Back to cited text no. 8
    
9.
Ali MH, el-Zuebi F. Angiolipoma of the cheek: Report of a case. J Oral Maxillofac Surg 1996;54:213-5.  Back to cited text no. 9
    
10.
Lopez-Cedrun JL, Urtasun Fernandez J, Melendez Baltanas J, Lopez Garcia JA. Hemangioma of the temporalis muscle: A case report and review of the literature. J Oral Maxillofac Surg 1996;54:1130-2.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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