Lipomas are benign mesenchymal neoplasms composed of mature adipocytes, usually surrounded by a thin fibrous capsule. They are uncommon intraoral tumors with 1% to 4% occurring in this region. The literature is scanty on lipomas occurring in the buccal soft tissue. Here, we present two rare cases of lipoma occurring in the cheek of a 35-year old and a 45 year-old male. These were excised extra-orally. Histopathologically, these lesions were composed of the mature adipocytes with clear cytoplasm. There has been no evidence of tumor recurrence postoperatively.
Initial description of Oral lipoma was provided by
Roux in 1848 and he referred it as “yellow epulis” .
Lipomas of maxillofacial region are supposed to be
neoplasms of adipocytes, occasionally associated
with trauma . Lipoma comprises 4-5% of all benign
tumors in the body whereas oral lipoma constitutes
2.2% of all lipomas and 2.4% of all benign tumors
of oral cavity . Lipomas are usually asymptomatic
unless they compress any neurovascular structure .
Commonest site of oral lipoma includes cheek,
tongue, palate, mandible and lip [5,6]. Superficial
lipomas impart yellow surface discolouration. Well
capsulated tumors are freely movable beneath
mucosa . MRI is helpful in clinical diagnosis but CT
and USG are unreliable. Multiple head and neck
lipomas have been observed in neurofibromatosis,
Gardner’s syndrome, Encephalocraniocutaneous lipomatosis, multiple familial lipomatosis and
proteus syndrome [7,8].
Report of Two Cases
First case - A 35 years-old male patient reported
to the Department of Otorhinolaryngology and Head
and neck surgery, with the chief complain of swelling
in the right cheek region. As per the patient, he
was alright 4 year back then he developed a small
swelling over right cheek which gradually increased
to present size. Extraoral examination revealed a
solitary swelling over right side of face approximately
4 cm × 4 cm in size. (Figure 1) On palpation, swelling
was soft in consistency. On clenching the teeth, the
swelling became firm and prominent; and soft and
diffused on relaxation. There was no skin ulceration
present. No abnormality detected on intraoral
examination and there was no mucosal swelling.
Second case - A 45 years male patient was reported
to the Department of otorhinolaryngology and head
and neck surgery UPRIMS and R, Saifai, with the
chief complain of swelling in the left cheek region
since 2 years. Extra-orally, a single swelling over left
side of face measuring approximately 3 cm × 2 cm
was present. The swelling was soft in consistency on
A provisional diagnosis of lipoma of cheek was
given for both cases.
For both cases, an excisional biopsy was done
under local anaesthesia; specimens were fixed
in formalin and then sent for histopathological
Surgical Specimens and Histopathology
Grossly, lesional tissue appeared as capsulated
fibro-fatty mass pale yellowish to greyish white in
colour, soft in consistency and greasy to touch (Figure
2). As with all fatty tissue, a lipoma will float on the
surface of formalin rather than to sink at the bottom
of jar. Formalin fixed tissues were processed followed
by sectioning and staining. Microscopic examination
of the excised soft tissue mass revealed capsulated
lesion composed of mature adipocytes containing
large clear cytoplasm and eccentric nuclei. They
were arranged in lobules separated by fibrous septa.
Few dilated and congested blood vessels were also
noted (Figure 3). These features are consistent with
a classic diagnosis of a lipoma.
Figure 3: Photo showing aggregates of mature adipocyte with large clear cytoplasm and eccentric nuclei. Hematoxylin and Eosin stain X20.
Lipoma is predominantly composed of mature
adipocytes admixed with collagen streaks and is
often well demarcated from surrounding connective
tissue. A thin, fibrous capsule may be seen and a
distinct lobular pattern can be present . Lipomas
are the most common soft tissue mesenchymal
neoplasms, with 15 to 20% of the cases involving
the head and neck region and 1 to 4% affecting the
oral cavity9. Several histological types of lipoma have
been described and reported in literature containing
glandular structure, cartilage, bone, vascular
component [10-13]. Ocassionally, lipoma cannot be
distinguished from a herniated buccal fat pad except
by lack of history of sudden onset after trauma . The peak age of incidence is usually in the 5th or
6th decade of life while the occurrence in children
is very uncommon. Generally there is no gender
Adequate surgical excision is the treatment for
oral lipomas. The surgical approach is dependent
on the site of the tumor and the proposed cosmetic
Lipomas of buccal mucosa are uncommon
and unusual tumors. Surgical excision is the ideal treatment with excellent outcome. Clinical course
is usually slow and asymptomatic until they get
larger in size and compress any neurovascular structures. Prognosis is considered good. Complete
surgical excision is mandatory to avoid postoperative
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