Year : 2004 | Volume
: 8 | Issue : 2 | Page : 96--98
Lipoma of the tongue
Rashmi S Metgud, Alka D Kale
Departmentof Oral Pathology and Microbiology, K.L.E.S's Institutes of Dental Sciences, Belgaum, India
Rashmi S Metgud
Departmentof Oral Pathology and Microbiology, K.L.E.S«SQ»s Institutes of Dental Sciences, Belgaum - 590 010
Lipomas are soft tissue tumors of adipose tissue origin. They may be single or multiple and may occur as superficial or deep-seated tumors. Solitary lipomas, consisting entirely of mature fat have stirred little interest in the past and have been largely ignored in the Literature. Approximately 15% to 20% of lipomas occur in the head and neck but the oral cavity is an unusual site. They represent 0.1-5% of all benign intraoral tumors with most lesions occurring in the buccal mucosa. Herewith is a rare case presentation of lipoma present on the tongue.
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Metgud RS, Kale AD. Lipoma of the tongue.J Oral Maxillofac Pathol 2004;8:96-98
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Metgud RS, Kale AD. Lipoma of the tongue. J Oral Maxillofac Pathol [serial online] 2004 [cited 2020 May 26 ];8:96-98
Available from: http://www.jomfp.in/text.asp?2004/8/2/96/40976
Lipoma is a very common benign moor of adipose tissue, but its presence in the oral and opharyngeal region is relatively uncommon. The first description of an oral lesion was provided in 1848, by Roux who referred to it as a"yellow epuli '. Although most lesions are considered as developmental anomalies, those that occur in the maxillofacial region usually arise late in life and are presumed to be neoplasms of adipocytes, occasionally associated with trauma  . Solitary lipomas can occur both subcutaneously or can be situated (feel) within the connective tissue 5% of lipomas are multiple and this tendency is sometimes inherited as an autosomal dominant trait and may be seen in neurofibromatosis, Gradner syndrome, Proteus syndrome.and multiple familial lipomatosis  .
A 17 years old male patient reported to K.L.E.S's. Institute of Dental Sciences. Belgaum with a chief complaint of swelling over the dorsum of the tongue, which was present since 1-1 ½ years. The swelling was not associated with pain or bleeding but caused discomfort while swallowing. The patient's medical history. drug history and systemic review were all noncontributory.
On clinical examination, a smooth surfaced, circumscribed mass, which was about 2 x 1.5 sq. cm in diameter, was present at the junction of anterior 2/3 rd and posterior 1/3 rd of the dorsum of tongue in the midline. This mass was pedunculated and free from the muscles of the tongue, firm in consistency and non-tender on palpation. A clinical diagnosis of benign tumor was given. An excisumal biopsy was done and the tissue was sent histopathological evaluation.
Gross specimen [Figure 1]: The biopsied mass of tissue appeared floating in formalin filled specimen jar. Specimen w'as yellowish in color and firm in consistency measuring about 3*3*2 cms. Specimen was dissected and processed.
Histopathology of soft tissue showed stratified squamous epithelium overlying fibro-fatty stroma. The stromal tissue consisted of well-encapsulated lunar mass, containing lobules of plump adipocytes. The lobules were interspersed by thin connective tissue stroma and the fat cells showed peripherally pushed darkly stained flattened nuclei. Deeper section showed presence of muscle bundles [Figure 2],[Figure 3].
A definitive diagnosis of lipoma was made.
Lipomas are benign, slow growing tumors composed of nature adipose cells. Approximately 15-20% a of lipomas occur in the head and neck region. Among the reported infra-oral lipomas, 50% occur in the buccal mucosal region without any gender predilection, contrary to the extra oral lipomas, which show a female predilection , . Lipomas usually occur in patients who are 40 years or older. They are uncommon in children. Clinically they are usually found as long standing. soft nodular. asymptomatic swellings covered by normal mucosa and can be sessile or pedunculated. The surface of the lesion is usually smooth but can at times show bosselations. When superficial, there is a yellow surface discoloration.
On palpation, the lesions that are situated deep within the connective tissue may feel fluid filled, leading to a mistaken diagnosis of a ''cyst". These tumors when well encapsulated are movable beneath the mucosa but less well-demarcated lesions are not movable  .
Lipomas of the oral cavity are rare. Grosch. in 1887 reported 716 cases of lipoma, none of which occurred in the oral cavity. Geschieter, in 1943. reported that only 3 of 460 lipomas were found in the mouth. Hatziotis reviewed the period from 1945 to 1967 and found 145 cases of oraI lipomas. Papanoyotou P et al reported I3 cases of lipomas, out of 156 cases of benign tumors during the period 1984 to 1998  .
Oral lipomus are relatively innocuous tumors involving the oral submucosa and are most commonly encountered in the check; less common sites include tongue, floor of the mouth and lips  . Lipomas of the tongue are very uncommon, comprising only 4-5% of all benign tumors in this location. Infrequent locations of orofacial lipomas include the mandible and parotid gland  .
Lipomas have a less dense and more uniform appearance than the surrounding fibrovascular tissue when transilluminated. Magnetic resonance imaging scans are very useful in the clinical diagnosis. C.T Scan and ultrasonography less reliable. Definitive diagnosis depends on correlation between the histological and cl inical features 
Occasional cases of intraosseous lipoma of the jaws are reported but these are difficult to separate from fatty marrow  .
The factors contributing for file etiology of lipoma as enumerated by Enzinger and Weiss include chromosomal abnormality viz, translocation of t (3; 12) (q127: q13) and I (3; 12) (q28; q14), diabetes mellitus, by hypercholesterolemia, and obesity  .
It has also been observed that adipocyte proliferation is sometimes seen as a result of trauma or radiation. This reactive proliferation is quite difficult to distinguish from true lipomas and is usually preceedcd by the formation hematoma  .
The Histopathology remains the gold standard in the diagnosis of liopoma. Lipomas differ little in microscopic appearance from the surrounding fat. Like fat they are composed of manure fat cells, but the cells vary slightly in size and shape and are somewhat larger, measuring upto 200m in diameter. Subcutaneous Iipomas are usually thinly encapsulated and have distinct lobular patterns. Deep-seated lipomas have a more Irregular configuration, largely depending on the site of origin. All are well vascularised.., but under normal conditions the vascular network is compressed by the distended lipocytes and is not clearly discernible.
Lipomas are occasionally altered by the admixture of other mesenchymal elements that comprise an intrinsic part of the tumor. The most common of these element, is fibrous connective tissue, which is often hyalinized and may or may not be associated with the capsule or the fibrous septa. Lipomas with these features are often classified as fibrolipomas  .
Quite often, however, lesional fat cells are seen to "infiltrate" into surounding tissues, perhaps producing long thin extensions of fatty tissue radiating from the central tumor mass. When located within striated muscle, this infiltrating variant is called intramuscular lipoma (infiltrating lipoma), but extensive involvement of a wide area of fibrovascular or stromal tissues aright best be termed Iipomatosis.
Occasional lesions exhibit excess numbers of small vascular channels (angiolipoma), a myxoid background stroma (myxoid lipoma, myxolipomaI, or areas with uniform spindle shaped cells interspersed between normal adipocytcs (spindle cell lipoma). When spindle cells appear somewhat dysplastic or mixed with pleomorphic gaint cells with or without hyperchromatic enlarged nuclei, the term pleomorphic lipoma is applied. When the spindle cells are of smooth muscle origin, the term myolipoma may be used, or angiolipoma when the smooth muscle appears to be derived from the walls of arterioles.
Rarely, chondroid or osseous metaplasia may be seen in a lipoma (osteolipoma, ossifying lipoma, chondroid lipoma. When bone marrow is present, the terns myclolipoma is used.
On occasions. lipoma of the buccal macosa cannot be distinguished front a herniated buccal fat pad, except by the lack of a history of sudden onset after trauma. Otherwise, lipomas of the oral and pharyngeal region are not difficult to differentiste front other lesions, although spindle cell and pleomorphic types must be distinguished front liposarcoma  .
Most of these microscopic variations do not affect the prognosis, which is usually good  .
Local excision of the tumor mass along with the surrounding capsule is the treatment of choice. Local recurrences although very rare, can occur, especially in case of intillraing lipomas that tend to invade surrounding muscles thus making radical surgery an extremely difficult task  .
Solitary lipomas, consisting entirely of mature fat have stirred little interest in the past and have been largely ignored in the literature. This continued neglect is not surprising, considering that most lipomas grow insidiously and cause few problems other than those ofa localised mass.
Approximately 15-20% of lipoma occurs in the head and neck region. Among the reported intra oral lipomas, 50% occur in the buccal mucosal region.
The occurrence of lipoma on the tongue is relatively uncommon comprising only4-5% of all benign tumors in this location and here is a report of such a case that occurred in a 17-year-old male patient for its rarity.
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