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      Osteolipoma of the palate – An unusual presentation

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          Abstract

          Sir, Although not common in the mouth, lipoma is the most common benign mesenchymal neoplasia of soft tissues in adults.[1] Around 20% of the cases involve the head and neck region and only 1–4% occur in the oral cavity.[1 2] Osteolipoma is very rare variant of lipoma accounts for less than 1% of all the cases.[3] Oral lipomas mostly occur in the buccal mucosa, floor of the mouth, tongue, and lips. Only two cases of osteolipoma of the palate have been reported in English literature: One was congenital osteolipoma associated with a cleft palate in a 6-year-old male child[4] and the second was reported in a 37-year-old female Nigerian patient.[5] We present a rare case of osteolipoma of the hard palate in a 55-year-old male patient. A 55-year-old male presented with a chief complaint of palatal swelling posterior to the incisive papilla from 4 years. Both the past medical history and systemic signs are not relevant with the case. Extraoral examination did not reveal any abnormality. On intraoral examination a yellowish pink firm-to-hard palatal swelling measuring about 1.5 × 1.5 cm was noted [Figure 1]. Figure 1 Yellowish pink firm-to-hard palatal swelling The swelling was nontender on palpation and overlying mucosa was normal in color without showing any signs of ulceration and erythema. On radiographic examination by oclusal radiographs, a patchy area of radiopacity was revealed. On the basis of clinical features, provisional diagnosis of ossifying fibroma was made. The lesion was surgically excised under local anesthesia by raising the mucoperiosteal flap and a soft yellowish white mass measuring 1.5 × 1 cm [Figure 2] was sent for the histopathological examination. Microscopical examination revealed normal bony trabeculae with the features of osteoblastic rimming, surrounded by mature adipocytes with compressed nuclei at the cell border [Figure 3]. Connective tissue septa were found intervening the adipocytes at places [Figure 4]. No dysplastic features were noted. On the basis of all the histopathological features, a final diagnosis of osteolipoma was established. Follow-up visits were uneventful. Figure 2 Gross tissue sent for histopathological examination Figure 3 Bony trabeculae surrounded by mature adipocytes Figure 4 Connective tissue septa intervening adipocytes Many benign histological variants of lipoma are known and described based on the type of tissue present and predominant in the lesion: Fibrolipoma, angiolipoma, myolipoma, myxolipoma, spindle cell lipoma, osteolipoma, and chondrolipoma.[1 2 3 4 5 6] Lipomas with osseous or cartilaginous metaplasia is a rare histological variant. Osteolipoma is a variant of lipoma that shows osseous metaplasia accounts for less than 1%[4] and is seen at many extra-oral sites including scapula, vertebral spine, neck, skull, suprasellar region, and tuber cinereum.[4 6] A differential diagnosis suggesting osteolipoma primarily depends on its location. Because of the various anatomic sites reported for this lesion, a very wide range of lesions can be included in the differential diagnosis, such as other benign tumors that may contain bone including teratoma[2] In addition, tumor calcinosis, ossifying fibroma, central hemangioma, and myositis ossificans should also be considered.[2 6] Soft-tissue sarcomas that can show calcification or ossification include liposarcoma, synovial sarcoma, osteosarcoma, and chondrosarcoma. Soft-tissue chondromas, which are also rare, are frequently mineralized. Also some series showed that osteolipoma mimicked well-differentiated liposarcoma.[4] The diagnosis of oteolipoma is easy, and surgical excision is the treatment of choice. The prognosis of osteolipoma is favorable like conventional lipomas, but lesions should be monitored carefully and postoperative follow-up is also required as not much information is available pertaining to this rare tumor.

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          Lipomas of the oral cavity: clinical findings, histological classification and proliferative activity of 46 cases.

          Lipomas represent about 1 to 5% of all neoplasms of the oral cavity. Although relatively common, few large series of intraoral lipomas and its variants are seen in the literature. Therefore, the authors present the clinical, histological and immunohistochemical features of 46 cases of intraoral lipomas reviewed from the files of the University of Campinas Dental School from 1970 to 2001. Most of the cases affected adults, without gender predilection, and the main involved sites were the buccal mucosa (21 cases), tongue (six cases), lips (six cases) and floor of mouth (five cases). The histological analysis revealed 21 cases of lipoma, 18 fibrolipomas, four intramuscular lipomas, two minor salivary gland lipomas and one spindle cell lipoma. PCNA and ki-67 expression indexes were higher in spindle cell lipoma, intramuscular lipomas and fibrolipomas compared to common lipomas, but the differences were not statistically significant. All lesions were removed surgically and none showed recurrence, regardless of the various proliferative activities.
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            Lipoma of the oral and maxillofacial region: Site and subclassification of 125 cases.

            Lipomas and lipoma variants are common soft tissue tumors, but occur infrequently in the oral and maxillofacial region. In this study, we reviewed 125 lipomas in specific oral and maxillofacial locations. We wanted to examine and compare the clinicopathologic features of these tumors. Study design The records from the Oral and Maxillofacial Pathology Registry of the Armed Forces Institute of Pathology from 1970 to the present were searched for cases coded as "lipoma." This study included 125 cases based on location within the oral and maxillofacial region, benign histology, and available clinical information. Subcutaneous and intraosseous lipomas were excluded. The tumors were classified according to the most recent World Heath Organization classification for soft tissue tumors. Of 125 lipomas, 91 tumors occurred in males, 33 in female patients, and 1 of unknown gender. The mean age was 51.9 years, range 9-92 years. Four tumors occurred in pediatric patients (age <18 years). Specific anatomic sites within the oral and maxillofacial region included the parotid region (n=30); buccal mucosa (n=29); lip (n=21); submandibular region (n=17); tongue (n=15); palate (n=6); floor of mouth (n=5); and vestibule (n=2). The mean size of tumors was 2.2 centimeters, range 0.5 to 8.0 centimeters. The mean duration of the tumors prior to excision was 3.2 years, range 6 weeks to 15 years. Most patients presented with an asymptomatic, circumscribed mass. Grossly, most tumors were described as pink and smooth, occasionally mucoid. Histologically, the tumors were subclassified as classic lipomas (n=62); spindle cell/pleomorphic lipomas (n=59); fibrolipoma (n=2), and chondroid lipoma (n=2). Fourteen tumors exhibited secondary changes, such as fat necrosis, atrophy, and prominent hyalinization; 23 tumors were histologically confirmed to be intramuscular. Lipomas of the oral and maxillofacial region occur most commonly in adult males in the parotid region, followed closely by the buccal mucosa. These tumors are uncommon in children. Interestingly, spindle cell lipomas are common in this region and comprise the majority of our parotid and lip tumors. Angiolipomas were absent in this anatomic region in this study. Secondary changes and atrophy should not be confused with the malignant histologic features of a liposarcoma.
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              Osteolipoma of the tongue.

              Lipomas are common, benign tumours located in any part of the body in which fat is normally present. Some variants of lipoma have been described according to the type of tissue present. A rare variant consists of a lipoma with osseous or cartilaginous metaplasia. These lesions have been called chondrolipoma, osteolipoma, lipoma with chondroid or osseous metaplasia, lipoma with cartilaginous or osseous change, or ossifying lipoma. We present the case of an osteolipoma of the tongue in a 49-year-old female who was referred for a painless mass on the left lateral margin of the tongue, and present for about 8 years. Osteolipomas have been reported in middle-aged or elderly patients with a very long clinical history. These tumours tend to be large and to arise from the deep soft or subcutaneous tissues. The cartilage and bone is probably produced by metaplasia of fibroblasts in chondroblasts or osteoblasts. These lesions are benign and do not recur.
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                Author and article information

                Journal
                Natl J Maxillofac Surg
                Natl J Maxillofac Surg
                NJMS
                National Journal of Maxillofacial Surgery
                Medknow Publications & Media Pvt Ltd (India )
                0975-5950
                2229-3418
                Jul-Dec 2014
                : 5
                : 2
                : 250-251
                Affiliations
                [1]Department of Oral and Maxillofacial Pathology, NIMS Dental College, Jaipur, Rajasthan, India
                [1 ]Department of Prosthodontics, Crown and Bridges, NIMS Dental College, Jaipur, Rajasthan, India
                [2 ]Department of Endodontics, NIMS Dental College, Jaipur, Rajasthan, India
                [3 ]Department of Orthodontics and Dentofacial Orthopaedics, K.D Dental College, Mathura, India
                [4 ]Department of Oral and Maxillofacial Pathology, Career Institute of Dental Sciences, Lucknow, Uttar Pradesh, India. E-mail: dr.manasbajpai@ 123456gmail.com
                Article
                NJMS-5-250
                10.4103/0975-5950.154856
                4405983
                25937752
                23a0a114-8414-4162-8037-5059dcc28357
                Copyright: © National Journal of Maxillofacial Surgery

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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