Gingival Lipoma: A Rare Case Report

Abstract

Lipomas are benign tumours of mesenchymal origin (mature adipocytes) that are comparatively uncommon in the oral cavity corresponding to less than 4.4% of all benign oral soft tissue tumors. Clinically, they present as slow growing, soft, asymptomatic masses. Histopathologically, they appear as thinly encapsulated lesion composed of mature adipocytes with inconspicuous vascularity. The pathogenetic mechanisms of oral lipomas are still unclear. They are usually treated by surgical excision and bear excellent prognosis. Here we report a case of intraoral lipoma in 54 year old male patient in the left lower lingual alveolar mucosal region that was treated by surgical excision using electrocautery without any postsurgical complication. One-year follow-up showed no evidence of recurrence.

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Journal of Nepalese Society of Periodontology and Oral Implantology : Vol. 1, No. 1, Jan-Jun, 2017
Gingival Lipoma: A Rare Case Report
Case Report
ABSTRACT
Lipomas are benign tumours of mesenchymal origin (mature adipocytes) that are comparatively uncommon in the oral cavity corresponding
to less than 4.4% of all benign oral soft tissue tumors. Clinically, they present as slow growing, soft, asymptomatic masses. Histopathologically,
they appear as thinly encapsulated lesion composed of mature adipocytes with inconspicuous vascularity. The pathogenetic mechanisms of
oral lipomas are still unclear. They are usually treated by surgical excision and bear excellent prognosis. Here we report a case of intraoral
lipoma in 54 year old male patient in the left lower lingual alveolar mucosal region that was treated by surgical excision using electrocautery
without any postsurgical complication. One-year follow-up showed no evidence of recurrence.
Key Words: Lipoma, adipocytes, neoplasm, gingiva
INTRODUCTION
Lipomas are the most common benign mesenchymal
tumors surrounded by a thin fibrous capsule.
1
Oral lipomas
represent only 1-4% of all benign oral soft tissue tumors. The
most common intraoral site for lipoma is buccal mucosa and
buccal vestibule. Intraoral lipomas show equal predilection
for involvement of men and women. Lipoma commonly occur
in the 5
th
or 6
th
decades of life and are usually asymptomatic
until they grow to large size and may interfere with speaking
and mastication.
2
The diagnosis is mainly based on clinical
findings with histopathology to rule out other lesions in the
same site.
The accepted classification of benign lipomas includes:
classic lipoma; lipoma variants (e.g. angiolipoma. chondroid
lipoma, myolipoma, spindle cell lipoma); hamartomatous
lesions; diffuse lipomatous proliferations; and hibernoma.
3
The etiology suggested are endocrine, traumatic, and
hereditary causes.
1
The diagnosis is made by pathology of
Dr. Sweta Shrestha,1 Dr. Shaili Pradhan,2 Dr. Ranjita Shrestha Gorkhali3
1Resident, 2Professor, 3Asst. Professor, Periodontology and Oral Implantology Unit,
Department of Dental Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
an incisional or excisional specimen. An important feature
is that the tumor tends to float when placed in a 10%
formaldehyde solution.
2
CASE REPORT
A 54 year old male patient reported to Department of Dental
Surgery, Periodontology and Oral Implantology unit with a
chief complaint of painless swelling in the lower left region
which interfere with tongue movement and had increased in
size for the past 10 years to the present size. No relevant
medical history was reported by the patient.
On intraoral examination, solitary, soft, sessile, lobulated
mass is seen in the left lingual gingival region extending to
alveolar mucosa round in shape, 1.8x1.3 cm in size located
in relation to 33, 34 and 35. The surface was smooth, non-
tender, mobile and fluctuant (Figure 1).
Radiographically, (Figure 2) the alveolar bone in the region
of the growth appeared normal. Routine hematological
Figure 1: Pre-operative view of mass Figure 2: Intraoral periapical
radiographs
J Nep Soc Perio Oral Implantol. 2017;1:37-9
Correspondence:
Dr. Sweta Shrestha
Periodontology and Oral Implantology Unit,
Department of Dental Surgery, National Academy of Medical Sciences,
Bir Hospital, Kathmandu, Nepal
email: stonasweta@gmail.com
Citation
Shrestha S, Pradhan S, Gorkhali RS. Gingival lipoma: a rare case
report. J Nep Soc Perio Oral Implantol. 2017;1:37-9.

38 Journal of Nepalese Society of Periodontology and Oral Implantology : Vol. 1, No. 1, Jan-Jun, 2017
Figure 4: Follow up after 1 year
Figure 5: Histopathological section of excised mass
Figure 3: Excision of mass using electrocautery
analyses were found to be normal. A provisional diagnosis of
lipoma was made. The differential diagnoses were ranulae,
epidermoid cysts, pleomorphic adenomas, and fibromas.
After nonsurgical therapy an excisional biopsy was carried
out with electrocautery under local anesthesia, followed by
curettage (Figure 3). Periodontal dressing was placed and the
patient was recalled after 1 week for removal of the pack and
checkup. Specimen was placed in 10% formalin and send for
histopathological examination.
Histopathological examination (Figure 5) revealed normal
appearing parakeratinized stratified squamous epithelium.
The underlying connective tissue reveals numerous
benign looking mature adipocytes in the deeper areas with
extravasations of RBC at places .A final diagnosis of lipoma
was made. The patient is currently being monitored and so
far no recurrence has occurred (Figure 4).
DISCUSSION
Roux in 1848 was the first to describe the intra-oral lipoma,
referring it as yellow epulis.
4
Lipoma is the most common
neoplasm arising from fat tissue. However presenting as
intraoral masses is an uncommon intraoral finding.
1
Studart-Soares et al. (2010) investigated the development
site in 450 cases of intraoral lipoma reported between 1966
and 2009, with lesions arising from the buccal mucosa
(n = 174; 38.7%), vestibule (n = 35; 7.8%), retromolar area (n =
21; 4.7%), gingiva (n = 4; 0.9%), and others (n = 216; 48.0%).
5
Greer et al. (1973) found that the etiology of the lipoma is
obscure. Chronic irritation, trauma, heredity and spontaneous
development have been mentioned. Embryonic rests of
lipoblasts, fatty degeneration of fibroblasts or metaphase of
muscle cells may be responsible for the formation of mature
fat cells.
7
Histologically lipomas consist of mature fat cells arranged
into lobules that are separated by septa of fibrous connective
tissue. Although morphologically indistinguishable from
normal fat, lipomas differ from normal body fat by the fact
that their lipid is not available for metabolism and that they
are usually surrounded by a thin fibrous capsule.
4
Sometimes
the capsule may be missing or broken.
6
Bendeca et al. (2007) suggested removal of lipomas because
of concerns regarding growth, cosmetic aspects or symptoms
resulting from the compression of local structures. In this
case mass was surgically removed using electrocautery and
no esthetic, functional or neurological abnormalities were
observed. The treatment of oral lipomas irrespective of
histological variant is simple surgical excision.
8
Shrestha et al : Gingival Lipoma - A Rare Case Report

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Journal of Nepalese Society of Periodontology and Oral Implantology : Vol. 1, No. 1, Jan-Jun, 2017
REFERENCES
1. 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.
2. Hoseini AT, Razavi SM, Khabazian A. Lipoma in Oral Mucosa: Two Case Reports. Dent Res J Dent Res J. 2010;7(1):41-43.
3. Fletcher C, Unni K, Mertens F. Adipocytic tumors. World Health Organization classification of tumours: pathology and genetics of
tumours of soft tissue and bone. Paul Kleihues MDLHS, MD. editor. IARC Press; IARC Press International Agency for Research on Cancer
(IARC) 69008 Lyon, France; 2002.
4. Rajendran R. Shafer’s Oral Pathology. 5th ed. Amsterdam: Elsevier; 2006. 194-5 p.
5. 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(5):691-6.
6. Juliasse LE, Nonaka CF, Pinto LP, Freitas Rde A, Miguel MC. Lipomas of the oral cavity: clinical and histopathologic study of 41 cases in
a Brazilian population. Eur Arch Otorhinolaryngol. 2010;267:459-65.
7. Greer RO, Richardson. The nature of lipomas and their significance in the oral cavity. A review and report of cases. Oral Surg Oral Med
Oral Pathol. 1973;36(4):551-7.
8. Bandéca MC, de Pádua JM, Nadalin MR, Ozório JE, Silva-Sousa YT, da Cruz Perez DE. Oral soft tissue lipomas: A case series. J Can Dent
Assoc. 2007;73:431-4.
9. Azma E, Safavi N. Diode laser application in soft tissue oral surgery. J Lasers Med Sci. 2013;4(4):206-11.
10. De Castro AL, De Castro EV, Felipini RC, Ribeiro AC, Soubhia AM. Osteolipoma of the buccal mucosa. Med Oral Patol Oral Cir Bucal.
2010;15:347-9.
11. Cawson RA, Binnie RH, Speight PM, Bareett AW, Wright JM . - Lucas’s Pathology of tumors of the oral tissues: Tumors of adipose tissue.
5th ed: Churchill Livingstone; 1999. 35-69 p.
Shafer et al. (2006) found electrosurgery (ES) has the ability
to control bleeding and ensure greater visibility. Other
advantages are electrode cuts on its side as well as on its
tip, cuts are made with ease when the device is set correctly,
the wound is nearly painless and the tip is self disinfecting.
However, it has been suggested that ES use results in low
tactile sensitivity for cutting, unavoidable burning flesh
odor, and poor postoperative healing in the early stages.
Using ES, the lateral-heat accumulation should be minimized,
and high-speed suction for odor control to facilitate patients’
comfort which was effectively accomplished in this case.
4
Azma et al (2013) studied that diode laser can be used as
a modality for oral soft tissue surgery. Excision with laser
would reduce bleeding and also lower swelling and scarring
of the surgical site, comparing to the simple surgeries. The
diode laser can be applied for excision of oral soft tissue.
9
De Castro et al. (2010) found no recurrence except
intramuscular lipomas which has been reported to be 3 to
6.5%. Intramuscular lipomas have a higher recurrence rate
because of their infiltrative growth pattern, but this variant
is rare in oral and maxillofacial region.
10
Studarts-Soars et al (2010) found no recurrence in their study
series over the 3 years of follow-up.
5
The present case was
followed up for a period of 1 year and no recurrence was
observed.
Although rare, malignant transformation of oral lipomas
to liposarcomas has been reported.
1
However Enzinger
and Weiss stated that malignant change has never been
encountered in a lipoma.
11
CONCLUSION
Lipomas are common benign tumours of mature adipocytes
however their intraoral occurrence is relatively rare. The
histopathologic features should lead to a confirmatory
diagnosis of lipoma. Treatment by careful and complete
surgical excision is the treatment of choice and recurrence
is reported rarely.
Shrestha et al : Gingival Lipoma - A Rare Case Report