Abstract
Lipoma is the most common benign soft tissue tumor. Lipomas are relatively uncommon tumours in the oral cavity accounting only 1–4 %. Half of oral lipomas are in the cheek and the remaining is found in the tongue, floor of the mouth, lips, palate, and gingival mucosa. We are reporting a case of lipoma that occurred in the hard palate, which is extremely rare.
Electronic supplementary material
The online version of this article (doi:10.1007/s12070-015-0951-3) contains supplementary material, which is available to authorized users.
Keywords: Lipoma, Hard palate, Oral lipoma, Benign, Soft tissue tumour
Introduction
Intra-oral lipomas are benign and relatively rare tumors, although they occur with higher frequencies in other areas, most especially the back, abdomen and shoulders of adults [1, 2]. About 20 % occur in the head and neck region and only 1–4 % involve oral cavity [3, 4]. Half of oral lipomas are in the cheek and the remaining are found in the tongue, floor of the mouth, lips, palate [5, 6], and gingival mucosa [7]. Lipoma in the hard palate is rare. This case of lipoma at hard palate is presented for its rarity and lipoma should be considered as one of the rare possibility in differential diagnosis of various swellings of the palate.
Case Report
A 65 years-old lady reported to the Department of Surgery with a chief complaint of growth in mouth since 6 months. Patient noticed the growth 6 months years back after eating sago. The growth was gradual in onset, slowly increased in size over a period and attained to the present size causing difficulty in eating and speech problem. On inspection, a well-defined solitary growth was observed on hard palate. The growth was about 3 × 2 cm in size, sessile, non-tender, non fluctuant and rubbery in consistency. The color was yellowish. A provisional diagnosis of lipoma was given. The lesion was excised under local anesthesia and submitted for histopathological examination.
On gross examination, the specimen received by the department of oral pathology was 3 × 1.5 cm well circumscribed yellowish mass having a smooth surface and rubbery consistency. On cut section it was greasy. On microscopic examination of H&E stained slides show mature adipose tissue separated by thin fibrovascular septae (Fig. 1).Gross and microscopy examination confirmed the provisional diagnosis of lipoma.
Fig. 1.
Mature adipose tissue separated by thin fibrous septae (H&E 400X)
Discussion
Oral lipoma, a rarity in itself, is known to affect individuals in 4–6th decades, infrequently enlarges more than 25 mm and has slight male predilection [8].
Lipoma is benign slow growing tumour composed of mature adipose cells. Though lipoma contributes to 15–20 % of all benign tumours of head and neck, review of the literature shows that intraoral lipomas are relatively rare. Among the reported intraoral lipomas, 50 % occur in the buccal mucosal region. Other sites of common occurrence are the floor of mouth, buccal vestibule and lip. Palate, gingiva and retro molar area are the least favoured sites. Our patient had lipoma in hard palate, which is an unusual site of occurrence as reported in the literature.
Hatziotis et al. [9] found 145 cases of intraoral lipoma after reviewing the literature from 1945 to 1967; of which six cases occurred in hard palate. ER Fregnani and his associates reviewed 46 cases of lipoma and found none occurring in the palate [2]. Recently two cases of lipoma in palate are published one in soft palate [5] and one in hard palate [7].
The occurrence of multiple lipomas is associated with Cowden’s syndrome or multiple hamartoma syndrome and is associated with the predominantly post pubertal development of a variety of cutaneous, stromal and visceral neoplasms, resulting from mutations of the phosphatase and tensin homolog (PTEN) gene [10].
Though the etiology of lipoma is unknown, possible causes of which have been postulated are trauma, infection, chronic irritation, hormone alteration, metaphase of muscle cells, lipoblastic embryonic cell nest in origin.
The clinical differential diagnosis should consider are mucocele, fibroma, dermoid cyst, thyroglossal duct cyst, pleomorphic adenoma, angiolipoma, fibrolipoma, malignant lymphoma.
Simple lipomas are the most frequent histologic subtype, equal incidences of lipomas and fibrolipomas were observed. The other variants are Angiolipoma, Spindle cell lipoma, Pleomorphic lipoma Intramuscularlipoma, angiomyolipoma, osteolipoma, or ossifying chondromyxoid lipoma. However histological features have no prognostic significance.
Conclusion
We present this case for its rarity. Lipoma should be considered as one of the differential diagnosis while evaluating the lesions over palate as lipoma is curable completely after careful surgical resection with no recurrence.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Compliance with Ethical Standards
Funding
None.
Conflict of interest
None.
Ethical Approval
Informed consent was taken from the patient for this publication.
References
- 1.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;58:1113–1117. doi: 10.1053/joms.2000.9568. [DOI] [PubMed] [Google Scholar]
- 2.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. doi: 10.1054/ijom.2002.0317. [DOI] [PubMed] [Google Scholar]
- 3.De Visscher JG. Lipomas and fibrolipomas of the oral cavity. J Oral Maxillofac Surg. 1982;10:177–181. doi: 10.1016/s0301-0503(82)80036-2. [DOI] [PubMed] [Google Scholar]
- 4.Gnepp DR. Diagnostic surgical pathology of the head and neck. Philadelphia: WB Saunders; 2001. [Google Scholar]
- 5.Verma Neeraj, Srivastava Pooja, Priya Ratna, Kumar Amit, Tiwari Rakesh. Lipoma in soft palate: a rare presentation. J Res Adv Dent. 2015;4(1s):144–146. [Google Scholar]
- 6.Dhas PP, Ambika R, Arumugam A, Somasundaram J, Vindenes H. Lipomas of the oral cavity. Int J Oral Surg. 1978;7:162–166. doi: 10.1016/S0300-9785(78)80019-2. [DOI] [PubMed] [Google Scholar]
- 7.Dhas PP, Ambika R, Arumugam A, Somasundaram J. Lipoma in hard palate—a case report. Int J Otolaryngol Head Neck Surg. 2015;4:133–136. doi: 10.4236/ijohns.2015.42023. [DOI] [Google Scholar]
- 8.Daryani D, Gopakumar R. A large oral lipoma in a young patient: a rare combination. Contemp Clin Dent. 2015;25(5):236–239. doi: 10.4103/0976-237X.132363. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Hatziotis JC. Lipoma of the oral cavity. Oral Surg Oral Med Oral Pathol. 1971;31:511–524. doi: 10.1016/0030-4220(71)90348-3. [DOI] [PubMed] [Google Scholar]
- 10.Woodhouse JB, Delahunt B, English SF, Fraser HH, Ferguson MM. Testicular lipomatosis in Cowden’s syndrome. Mod Pathol. 2005;18(9):1151–1156. doi: 10.1038/modpathol.3800448. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.