|Year : 2017 | Volume
| Issue : 9 | Page : 31-33
Lipoma of the hard palate: A ubiquitous lesion in a rare location
Adebayo Aremu Ibikunle1, Abdurrazaq Olanrewaju Taiwo1, Ramat Oyebunmi Braimah1, Kabir Abdullahi2
1 Department of Surgery/Dental and Maxillofacial Surgery, Usmanu Danfodiyo University, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
2 Department of Histopathology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
|Date of Web Publication||2-Aug-2017|
Adebayo Aremu Ibikunle
Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto
Source of Support: None, Conflict of Interest: None
Lipoma is a frequently diagnosed lesion in clinical practice. However, they are rarely seen in the oral cavity. When they occur intraorally, the buccal mucosa is the most frequent site of occurrence, with the hard palate being a rare intraoral site. They are often asymptomatic although functional impairment may occur with large lesions. Few cases of lipoma of the hard palate have been reported in English literature. Excisional biopsy was performed under local anesthesia and histological diagnosis of lipoma was made. A case of intraoral lipoma in an atypical location and pertinent literature review pertaining to this condition are here presented.
Keywords: Benign tumor, lipoma, palate
|How to cite this article:|
Ibikunle AA, Taiwo AO, Braimah RO, Abdullahi K. Lipoma of the hard palate: A ubiquitous lesion in a rare location. N Niger J Clin Res 2017;6:31-3
|How to cite this URL:|
Ibikunle AA, Taiwo AO, Braimah RO, Abdullahi K. Lipoma of the hard palate: A ubiquitous lesion in a rare location. N Niger J Clin Res [serial online] 2017 [cited 2022 Jan 27];6:31-3. Available from: https://www.mdcan-uath.org/text.asp?2017/6/9/31/212000
| Introduction|| |
Lipomas are benign mesenchymal tumors which typically is a proliferation of mature adipocytes and frequently, other mesenchymal derivatives.,, They are slow growing, oftentimes asymptomatic, classically yellowish, and soft or doughy in consistency., Lipomas are common benign neoplasms, which occur in 1%–2% of the population constituting 50% of all musculoskeletal soft tissue tumors., Although as much as 13%–20% of lipomas occur in the head and neck region, intraoral lipomas are not commonly seen, accounting for only 1%–4% of lipomas.,,
When seen intraorally, they are frequently located in the cheeks, tongue, and floor of the mouth. It is most prevalent among patients in the fourth and fifth decades of life., Lipomas of the palate are very rarely seen.,, Perez et al. in a review of 2270 cases of oral lesions over a period of 8 years reported 6 cases of intraoral lipoma, none of which was on the hard palate. Here presented, is a rare case of intraoral lipoma of the hard palate.
| Case Report|| |
A 47-year-old male nonsmoker presented at our clinic with a 5-year history of an exophytic, painless palatal swelling, which increased gradually in size. There was no positive history of fluid discharge, swallowing ability impairment, or ulceration. However, speech was slightly impaired. The lesion was a pedunculated swelling with its stalk attached to the right half of the palate adjacent to the premolars, oval in shape, and measuring about 2.6 by 2.1 cm [Figure 1]. The mucosal covering of the lesion appeared clinically normal. It was doughy in consistency, not tender, and no pulsations were felt on palpation. The medical, dental, and family histories were not contributory. Review of systems was also satisfactory. Differential diagnoses of salivary gland neoplasm, lipoma, neurofibroma, and fibrolipoma were made. A fine-needle aspiration cytology indicated a benign lesion.
Excisional biopsy of the lesion was performed under local anesthesia with adequate margins and curettage of the base was done under copious irrigation with normal saline [Figure 2]. The specimen was subjected to histopathology and a diagnosis of lipoma was arrived [Figure 3].
|Figure 3: Photomicrograph showing mature fat cells arranged in lobules separated by fibrous septae|
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| Discussion|| |
Lipomas are ubiquitous slow-growing lesions, which belong to the lipomatous group of tumors. They are seen commonly in the trunk, extremities, and head and neck region but relatively rarely seen intraorally.,, Intraoral lipoma was first described by Roux in 1848., Despite having been recognized over a century ago as a possible intraoral neoplasm, few reports of intraoral lipoma have been reported in literature. Lipomas are metabolically distinct from fat cells as they are not utilized for energy production during periods of starvation as seen in normal adipose tissue.,
The etiology of lipomas is still uncertain although rearrangement of chromosome 12 has been identified in solitary lipomas. It may occur sporadically or as a component of familial disorders, such as familial multiple lipomatosis and benign symmetric lipomatosis., Several factors have been implicated in its etiopathogenesis, including the hypertrophy theory, metaplasia of surrounding muscle cells, trauma, heredity, presence of residual embryonic fat cells, and fatty degeneration.,,
Lipomas may be histologically categorized as classic lipoma, fibrolipoma, intramural lipoma, spindle cell lipoma, angiolipoma, sialolipoma, pleomorphic lipoma, myxoid lipoma, and atypical lipoma. Furthermore, the intraosseous, intramuscular, and congenital types have also been described., They may also be seen in association with congenital malformations, such as the description by Mahabir et al. who reported lipoma seen in a patient with cleft palate. Syndromic types, which are often multiple, have also been described. Such syndromes include, Proteus, Pai, and Gardner's syndromes. Although they are often encapsulated, the capsules may be missing or deficient.
De Freitas et al. in a study of 26 cases of intraoral lipomas reported an age range of 29–91 years with a mean age of 54.6 years, and a predilection for females. The buccal mucosa was the most common location, which accounted for 34.6% of the cases reviewed by them. Manor et al. in an analysis of 58 cases reported similar findings. In addition, they reported equal sex prevalence, an age range of 11–98 years, and mean of 59.7 years. Significantly, no case of hard palatal lipoma was reported by them, which further underlines the rarity of lipoma at this site.
The buccal mucosa is the most common intraoral site for lipomas, perhaps because of the relative availability of adipose tissue at this site., In contrast, palatal lipoma is rarely reported, perhaps because of the limited amount of adipose tissue in the region. When found on the hard palate, they often present as pedunculated masses with the stalk attached to the anterolateral aspect of the hard palate., This was also observed in this case. This may be because the midline is relatively thin and tightly bound to the underlying bone.
The intraoral lipomas are often asymptomatic although when large, it may interfere with function such as speech, mastication, and swallowing., The 5-year history recorded in this report is not surprising because of the indolent nature of the lesion. Surgical excision of lipoma has a good prognosis as the potential for recurrence is low.,, The differential diagnosis of intraoral lipoma includes benign salivary gland tumors, submucosal mucoceles, lymphangioma, fibroepithelial polyp, and benign nerve sheath tumor., Histopathology is the most reliable mode of diagnosis though clinical examination and imaging techniques such as ultrasound, magnetic resonance imaging, and computed tomographic scan have been utilized. Imaging is particularly important when the lesion is in an obscure location and when the infiltrating type of lipoma is encountered as it aids in determining the extent of the lesion and thus, presurgical planning. In this case, the lesion was in the anterolateral aspect of the hard palate, easily visualized, and attached by a stalk, making its complete excision straight forward.
The mainstay of treatment is surgical excision. However, other modes of treatment such as intralesional steroid injection and liposuction have been described. Recurrence is rare following surgical excision, except in cases of intramuscular/infiltrating lipoma, which may be linked to the complete or partial absence of encapsulation, permeating property, and deep location of this particular type, thus making complete excision challenging.
| Conclusion|| |
Although lipoma of the hard palate is a rarity, it should be considered as a differential when slow-growing, benign, soft tissue neoplasms of the palate are encountered. Careful, histological evaluation is important to exclude other sinister lesions such as liposarcoma.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Tettamanti L, Azzi L, Croveri F, Cimetti L, Farronato D, Bombeccari G, et al
. Oral lipoma: Many features of a rare oral benign neoplasm. Head Neck Oncol 2014;6:21.
Hoseini AT, Razavi SM, Khabazian A. Lipoma in oral mucosa: Two case reports. Dent Res J (Isfahan) 2010;7:41-3.
Noro Filho GA, Caputo BV, Santos CC, Souza RS, Giovani EM, Scabar LF, et al
. Diagnosis and treatment of intraoral lipoma: A case report. J. Health Sci. Inst 2010;28.
Kumar LK, Kurien NM, Raghavan VB, Menon PV, Khalam SA. Intraoral lipoma: A case report. Case Rep Med 2014;2014:1-4.
Kaeser MA, Smith LW, Kettner NW. A case report of an intermuscular lipoma: presentation, pathophysiology, differential diagnosis. Journal of Chiropractic Medicine, 2010;9:127-131.
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.
Agarwal R, Kumar V, Kaushal A, Singh RK. Intraoral lipoma: A rare clinical entity. BMJ Case Rep 2013;2013. pii: Bcr2012007889.
Nayak S, Nayak P. Lipoma of the oral mucosa: A case report. Arch Orofac Sci 2011;6:37-9.
Pattipati S, Kumar MN, Ramadevi B, Kumar BP. Palatal lipoma: A case report. J Clin Diagn Res 2013;7:3105-6.
Bakshi SS, Priya M, Coumare VN, Vijayasundaram S, Karanam L. A common tumor in an uncommon location: Lipoma of the palate. Ann Maxillofac Surg 2015;5:237-9.
] [Full text]
Dhas PP, Ambika R, Arumugam A, Somasundaram J. Lipoma in hard palate – A case report. Int J Otolaryngol Head Neck Surg 2015;4:133.
Weiss SW. Lipomatous tumors. Monogr Pathol 1996;38:207-39.
Steger CM. Intrapericardial giant lipoma displacing the heart. Int Sch Res Notices (ISRN Cardiol). 2011;2011:e243637.
Naruse T, Yanamoto S, Yamada S, Rokutanda S, Kawakita A, Takahashi H, et al
. Lipomas of the oral cavity: Clinicopathological and immunohistochemical study of 24 cases and review of the literature. Indian J Otolaryngol Head Neck Surg 2015;67 Suppl 1:67-73.
Mahabir RC, Mohammad JA, Courtemanche DJ. Lipoma of the cleft soft palate: A case report of a rare congenital anomaly. Cleft Palate Craniofac J 2000;37:503-5.
de Freitas MA, Freitas VS, de Lima AA, Pereira FB Jr., dos Santos JN. Intraoral lipomas: A study of 26 cases in a Brazilian population. Quintessence Int 2009;40:79-85.
Manor E, Sion-Vardy N, Joshua BZ, Bodner L. Oral lipoma: Analysis of 58 new cases and review of the literature. Ann Diagn Pathol 2011;15:257-61.
Hançer A, Özbay C, Karaarslan S, Balaban M. Spindle cell lipoma of the soft palate. Case Rep Otolaryngol 2015;2015:1-3.
[Figure 1], [Figure 2], [Figure 3]