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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 5  |  Issue : 7  |  Page : 18-20

Intramuscular lipoma associated with frontalis muscle: A rare case report


1 Department of Periodontology, Career P. G. Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
2 Department of Oral and Maxillofacial Surgery, Government College of Dentistry, Indore, Madhya Pradesh, India

Date of Web Publication28-Jul-2016

Correspondence Address:
Mohammad Arif Khan
H. N. 25, Dak Bangla Road, Ghosi, Mau, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2250-9658.187184

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  Abstract 

Lipomas are the most common benign neoplasm of mesenchymal origin, composed of adipose tissue, which comprises almost 50% of all the soft tissue neoplasm. Lipomas can occur at any age and more frequently located on chest, arm, the trunk, shoulder, and thigh but rarely found on head and neck region. Lipomas are most frequently encountered in the subcutaneous tissues but very rarely may be intermuscular or intramuscular. This case report presents an unusual case of lipoma associated with frontalis muscle in a 65-year-old male patient.

Keywords: Forehead swelling, frontalis muscle, head and neck, lipoma


How to cite this article:
Tripathi AK, Priyanka, Khan MA, Saimbi CS. Intramuscular lipoma associated with frontalis muscle: A rare case report. N Niger J Clin Res 2016;5:18-20

How to cite this URL:
Tripathi AK, Priyanka, Khan MA, Saimbi CS. Intramuscular lipoma associated with frontalis muscle: A rare case report. N Niger J Clin Res [serial online] 2016 [cited 2020 Aug 15];5:18-20. Available from: http://www.mdcan-uath.org/text.asp?2016/5/7/18/187184


  Introduction Top


Lipomas are most common, slow-growing, benign neoplasm of soft tissue's that composed of adipocyte. [1] It is most commonly found on the trunk and lower limbs because of these tumors are more commonly found where abundant amount of adipose tissue has been present but rarely found within the muscle (i.e., intermuscular or intramuscular). Fregnani et al. reported that lipomas are rare in the oral and maxillofacial region, and it accounts for 1-4.4% of all soft tissue benign neoplasm and it is mesenchymal in origin. [2]

On clinical examination, lipomas are presented as nontender, soft, immobile masses. Most subcutaneous lipomas may be diagnosed with a high degree of accuracy on clinical examination.

We report, due to its rarity, an unusual case of lipoma associated with frontalis muscle in a 65-year-old male patient.


  Case Report Top


A 65-year-old male presented with a single asymptomatic swelling on the right side of the forehead since 3-4 years. On clinical examination revealed, a 3 cm × 3.5 cm, firm, nontender, slightly mobile subcutaneous nodule on the right side of the forehead [Figure 1]. Clinically, these findings suggested as a differential diagnosis of epidermoid cyst, sebaceous cyst, and lipoma or osteoma. All the routine investigations were found within normal limit, and complete surgical excision under local anesthesia was planned.
Figure 1: Preoperative-incision line marked

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Before surgery, local anesthesia was first administered then the skin was incised transversely through forehead. After incising the skin and superficial fascia, the extension of swelling was found intramuscular [Figure 2] then frontalis muscle was dissected to reveal a well-circumscribed yellowish mass, the lesion was popped out from surrounding tissues [Figure 3] and [Figure 4] which was completely excised [Figure 5] and sent for histopathological examination. Flap was approximated with subcuticular suturing [Figure 6] and [Figure 7].
Figure 2: Exposed lipoma after blunt dissection

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Figure 3: Pooped out lipoma

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Figure 4: Hold lipoma with tissue holding forcep

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Figure 5: En bloc resection of the forehead lipoma

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Figure 6: Excised lipoma

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Figure 7: After subcuticular suturing

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On the basis of histopathological examination, which showed a circumscribed lesion covered by a thin fibrous capsule, composed of mature adipocytes infiltrating muscle in a diffuse pattern which confirmed it to be an intramuscular lipoma. No evidence of malignancy was noted [Figure 8].
Figure 8: Histopathological view

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There were no postoperative complications created, and healing was found satisfactory and uneventfully. The patient was followed up regularly, and there were no signs of recurrence at the end of 2-year.


  Discussion Top


Lipomas are commonly seen in the superficial fascia, whereas the intramuscular lipomas arise from deep investing fascia. Fletcher and Martin-Bates demonstrated that only 1.8% of fatty tumors are intramuscular lipomas and occur predominantly in the middle to late adult life. [3] Uriburu was first reported the occurrence of lipoma in areas other than subcutis in 1943. [4]

The term "frontalis-associated lipoma" was first introduced by Salasche et al. in 1989. [5] Frontalis-associated lipoma was originated from deeper tissue as compared to traditional lipoma which is originate from subcutaneous tissue. They may arise in one of the four following locations: Within the frontalis muscle, between the frontalis muscle and the deep investing fascia, in the loose areolar tissue between the deep investing fascia of the frontalis muscle and the periosteum also called as "subgaleal lipomas," and beneath the periosteum. [5],[6],[7] Lipoma of forehead also can occur in temporalis muscle as infiltrating type of lipoma. [8] Lipomas are rarely located within the muscles and between the muscles. Among intramuscular lipomas, frontalis-associated lipoma is rarer. Intramuscular lipomas were first reported by Regan et al. in 1946 and they account for a very small number among tumors which is originate from adipose tissue. [9]

To differentiate the frontalis-associated lipoma from other subcutaneous nodular swelling, it is very important to have good skill and the knowledge of different subcutaneous nodules of the forehead such as epidermoid cyst, sebaceous cyst, liposarcoma, tumors such as osteoma, desmoids, and other fibrous tumor along with frontalis-associated lipoma in a subcutaneous forehead swelling which have a similar clinical appearance because of deeper lipoma requires deeper incision onto fascia or muscle for complete excision than subcutaneous lipoma. [10]

Histopathologically, intramuscular lipoma can be classified into two types; first one is well-circumscribed and second one is infiltrative types. Circumscribed type shows the presence of fibrous capsule and consists of mature adipocytes such as superficial lipoma, whereas infiltrative type of lipoma is associated with the muscle atrophy and degenerative changes. [3]

The prognosis of lipoma associated with frontalis muscle is good, and chances of recurrence are less because of forehead lipomas are generally benign with no malignant potential, and complete surgical excision is considered curative.


  Conclusion Top


Forehead lipomas are rare benign tumors with no sex predilection. In differential diagnosis, other lesions such as epidermoid cyst and sebaceous cyst, with similar clinical features can be considered, and hence there is need to make right diagnosis. Complete surgical excision of forehead lipomas is the best treatment of choice.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Weiss SW. Histological Typing of Soft Tissue Tumors. 2 nd ed. Berlin, Germany: Springer Verlag; 1994. p. 23.  Back to cited text no. 1
    
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.  Back to cited text no. 2
    
3.
Fletcher CD, Martin-Bates E. Intramuscular and intermuscular lipoma: Neglected diagnoses. Histopathology 1988;12:275-87.  Back to cited text no. 3
    
4.
Uriburu JV. Lipoma de frente. Prensa Med Argent 1943;30:2451-2.  Back to cited text no. 4
    
5.
Salasche SJ, McCollough ML, Angeloni VL, Grabski WJ. Frontalis-associated lipoma of the forehead. J Am Acad Dermatol 1989;20:462-8.  Back to cited text no. 5
    
6.
Grosshans E, Fersing J, Marescaux J. Subaponeurotic lipoma of the forehead. Ann Dermatol Venereol 1987;114:335-40.  Back to cited text no. 6
[PUBMED]    
7.
Sewell LD, Adams DC, Marks VJ. Subcutaneous forehead nodules: Attention to the button osteoma and frontalis-associated lipoma. Dermatol Surg 2008;34:791-8.  Back to cited text no. 7
    
8.
Ban M, Kitajima Y. Intramuscular lipoma within the temporal muscle. Int J Dermatol 2002;41:689-90.  Back to cited text no. 8
    
9.
Regan JM, Bickel WH, Broders AC. Infiltrating benign lipomas of the extremities. West J Surg Obstet Gynecol 1946;54:87-93.  Back to cited text no. 9
[PUBMED]    
10.
Zitelli JA. Subgaleal lipomas. Arch Dermatol 1989;125:384-5.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

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