10.5005/jp-journals-10011-1256
Mahendra Raj et al
REVIEW ARTICLE
Intraoral Lipoma: Review of Literature and Case Report
Mahendra Raj, Thanuja Ramadoss, G Anuradha, Shobana Devi
ABSTRACT
Lipomas are benign mesenchymal neoplasms of soft tissue that
can be found in any part of the human body. Conversely, their
presence in the oral mucosa is rather uncommon, with
approximately 4% of the cases occurring in the oral cavity. The
aim of this paper is to present the importance of diagnosis and
treatment of intraoral lipoma. Clinicians must be able to
recognize rare lesions, like intraoral lipomas, to provide
appropriate treatment, thereby ensuring comfort and quality of
life for the patient.
Keywords: Benign mesenchymal neoplasm, Retromolar area.
How to cite this article: Raj M, Ramadoss T, Anuradha G,
Devi S. Intraoral Lipoma: Review of Literature and Case Report.
J Indian Aca Oral Med Radiol 2012;24(1):36-38.
Source of support: Nil
Conflict of interest: None declared
similar to that of the adjacent mucosa. On palpation, it was
soft, slippery and nontender (Fig. 1).
Based on the above findings, a provisional diagnosis of
fibroma was given. A differential diagnosis of lipoma was
given. The lesion was excised. On histopathological
examination, it was reported as lipoma where adult
adipocytes were seen interspersed with connective tissue
stroma and thinned epithelium (Fig. 2).
Correlating the clinical and histological findings, a final
diagnosis of intraoral lipoma of the retromolar area was given.
DISCUSSION
Lipoma was first described by Roux in 1848 in a review of
alveolar masses, where he referred it as ‘yellow epulis’. The
pathogenesis of lipoma is uncertain but they appear to be
more common in obese people. However, the metabolism
INTRODUCTION
Benign mesenchymal soft tissue neoplasms commonly occur
in the oral cavity. Lipoma is one such benign tumor which
occurs rarely in the oral mucosa. About 20% of the lipomas
occur in the head and neck region. Out of which oral lipomas
comprise only 1 to 4% of cases.1
Though the etiology of lipoma is unknown, possible
causes which have been postulated are trauma, infection,
chronic irritation, hormone alteration,2 metaphase of muscle
cells, lipoblastic embryonic cell nest in origin.3 Lipoma
appears to be more common in obese individuals.2 Lipomas
present clinically as slowly enlarging, smooth-surfaced soft
yellowish growth. Differentiating it from other
mesenchymal tumors is mandatory as it plays a major role
in treatment plan and diagnosis. This article presents a case
of a intraoral lipoma in a rare location.
Fig. 1: 1 × 1 cm well circumscribed, smooth, slippery,
nontender mass
CASE REPORT
A 55-year-old male patient reported to the department with
mobile teeth. On examination of the patient, a growth was
noted in the right retromolar area. History revealed that the
growth started 10 years back. It was initially small and has
grown to the present size. Patient did not give any history
of pain. Occassionally, the patient complained of discomfort
while eating.
Examination of the lesion revealed a 1 × 1 cm well
circumscribed, pedunculated, smooth surfaced growth in
the right retromolar area which was in proximity to the
posterior third of the tongue. The color of the growth was
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Fig. 2: Adult adipocytes seen with connective tissue
stroma in 5×
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JIAOMR
Intraoral Lipoma: Review of Literature and Case Report
of lipoma is completely independent of normal body fat.4
In few cases of lipoma, rearrangement of 12q, 13q, 6p
chromosomes have been observed.2
The accepted classification of benign lipomas includes
the categorics: Classic lipoma; lipoma variants, e.g.
angiolipoma, chondroid lipoma, myolipoma, spindle cell
lipoma, hamartomatous lesions; diffuse lipomatous
proliferation and hibernoma.5 Lipomas can occur in various
anatomic sites, including major salivary glands and various
parts of the mouth. The most common site of oral lipomas
is the buccal mucosa, a region rich in fatty tissue, followed
by the tongue, lips, floor of the mouth, palate and gingival.
This pattern corresponds to the quantity of fat deposits in
the oral cavity.3 Most patients with lipoma are above
40 years of age or older, lipomas are uncommon in children.6
Clinically, oral lipomas generally present as mobile,
painless, submucosal nodules, with a yellowish color.7 They
may be pedunculated or sessile. The consistency of the
lesion varies from soft to firm, depending on the quality
and distribution of fibrous tissue and depth of the tumor.2
The occurrence of multiple lipomas is associated with
Cowden’s syndrome or multiple hamartoma syndromes.7
Generalized lipomatosis has been reported to contribute to
unilateral facial enlargement in hemifacial hypertrophy.
Lipomas have the principal differential diagnosis of
fibromas, which is composed of fibrous tissue and much
more firm.8 In view of their similar clinical features, other
tumors, such as thyroglossal duct cysts, ectopic thyroid
tissue, pleomorphic adenoma, mucoepidermoid carcinoma,
and oral dermoid and lymphoepithelial cysts should also
be included in the differential diagnosis. 3 Oral
lymphoepithelial cyst’s clinical appearance is very similar
to oral lipomas but they usually occur in one-third decade
of life, and common sites are floor of mouth, soft palate
and mucosa of pharyngeal tonsils which is uncommon sites
for oral lipomas. Oral dermoid and epidermoid cysts also
present as submucosal nodules but commonly occur in
midline of floor of the mouth. Since, oral lipoma can also
present as a deep nodule with normal surface, color, salivary
gland tumor and benign mesenchymal neoplasms should
also be included in differential diagnosis.7
Lipomas may show alterations on conventional
radiographs. Similar features detected on occlusal
radiographs were only reported by Seldin et al. In this
respect, computed tomography, ultrasonography and MRI
are valuable tools in most cases.3 Lipomas have a less dense
and more uniform appearance than the surrounding
fibrovascular tissue when transilluminated. MRI scans are
very useful in the diagnosis which CT scans and
ultrasonography are less reliable.
The histopathology remains the gold standard in the
diagnosis of lipoma. Histologically, lipomas are classified
as simple lipoma or variants, such as fibrolipoma, spindle
cell lipoma, intramuscular or infiltrating lipoma,
angiolipoma, salivary gland lipoma (sialolipoma),
pleomorphic lipoma, myxoid and atypical lipomas.1 The
most frequent histological subtype in the oral cavity was
simple lipoma, followed by fibrolipoma. However, some
authors reported a similar incidence of lipomas and
fibrolipomas.3 Most oral lipomas are composed of mature
fat cells that differ little in microscopic appearance from
the surrounding normal fat as the fat cells in lipoma are
larger in size measuring up to 200 mm in diameter. The
tumor is well circumscribed and has a fibrous capsule.
The treatment of oral lipomas irrespective of histological
variant is simple surgical excision. Surgical resection is the
treatment of choice for this tumor. However, advantages of
suction-assisted lipectomy for medium sized (4 to 10 cm)
or large lipomas (>10 cm) have been reported.4 Recurrence
is rare.7 Intramuscular lipomas have a higher recurrence
rate because of their infiltrative growth pattern, but this
variant is rare in oral and maxillofacial region.9 Lesions,
outside the oral cavity, may show greater recurrence rates
after surgical excision.10
CONCLUSION
Clinicians must be able to recognize rare lesions like
intraoral lipomas to provide appropriate treatment, thereby
ensuring comfort and quality of life for the patients.
REFERENCES
1. Alvimar-Lima de Castro, Eni-Vaz-Franco-Lima de Castro,
Renata-Callestini, et al. Osteolipoma of the buccal mucosa. Med
Oral Patol Oral Cir Bucal 2010 1;15 (2):e347-49.
2. Kaur RP, Kler S, Bhullar A. Intraoral lipoma: Report of three
cases. Dent Res J (Isfahan) Winter 2011;8(1):48-51.
3. Eduardo-Costa Studart-Soares, Fábio-Wildson-Gurgel Costa,
Fabrício-Bitu Sousa. 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 Sep 1;15 (5):
e691-96.
4. 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;58:1113-17.
5. Waseem Ahmed, Muhammad Amin, Shafiullah. Intraoral
lipoma—an unusual site and size. PAFMJ 2009;2.
6. Sekar B, Dominic Augustine, Murali S. Lipoma, a rare
intraoral tumor–a case report with review of literature.
Oral and Maxillofacial Pathology Journal (OMPJ) 2011 JulyDec;2(2).
7. Matheus Coêlho Bandéca, Joubert Magalhães de Pádua, Michele
Regina Nadalin, et al. Oral soft tissue lipomas: A case series.
JCDA 2007 June;73:5.
Journal of Indian Academy of Oral Medicine and Radiology, January-March 2012;24(1):36-38
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Mahendra Raj et al
8. Gilberto Araujo Noro Filho, Bruno Vieira Caputo, Camila
Correia dos Santos, et al. Diagnosis and treatment of intraoral
lipoma: A case report. J Health Sci Inst 2010;28(2):129-31.
9. Neville Brad W, Dam, Allen, Bouquet. Oral and maxillofacial
pathology (3rd ed). Elseiver 2009;524.
10. Rafieiyan, Hamian N, Anbari M, Abdolsamadi F. Lipoma of
the tongue: A case report. DJH 2011;2(1).
ABOUT THE AUTHORS
Thanuja Ramadoss
Senior Lecturer, Department of Oral Medicine and Radiology, Madha
Dental College and Hospital, Chennai, Tamil Nadu, India
G Anuradha
Reader, Department of Oral Medicine and Radiology, Madha Dental
College and Hospital, Chennai, Tamil Nadu, India
Mahendra Raj (Corresponding Author)
Shobana Devi
Principal, Professor and Head, Department of Oral Medicine, Diagnosis
and Radiology, Madha Dental College and Hospital, Chennai, Tamil
Nadu, India, e-mail: drmahendraraj@yahoo.com
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Senior Lecturer, Department of Oral Medicine and Radiology, Madha
Dental College and Hospital, Chennai, Tamil Nadu, India
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