Sanika Kulkarni¹, Dinshaw Hormuzadi², Jaydeep Pol³, Himanshu Soni⁴* and Shivani S Desai⁵

¹Fellow, Head and Neck Oncosurgery, Mahatma Gandhi Cancer Hospital, Miraj, Maharashtra, India
²Consultant, Head and Neck Oncosurgery, Mahatma Gandhi Cancer Hospital, Miraj, Maharashtra, India
³Consultant, Pathology, Mahatma Gandhi Cancer Hospital, Miraj, Maharashtra, India
⁴Fellow Cranio-Maxillo-Facial Trauma Surgery, Fellow, Head and Neck Oncosurgery, Mahatma Gandhi Cancer Hospital, Miraj, Maharashtra, India
⁵General Dentist, Mahatma Gandhi Cancer Hospital, Miraj, Maharashtra, India

*Corresponding Author: Himanshu Soni, Fellow Cranio-Maxillo-Facial Trauma Surgery, Fellow, Head and Neck Oncosurgery, Mahatma Gandhi Cancer Hospital, Miraj, Maharashtra, India.

Received: February 15, 2021; Published: March 06, 2021

Abstract

  Though lipoma is a most common benign tumour its incidence in oral cavity is very rare. These lesions are usually slow growing and painless hence go unnoticed for years. Because of the rarity of this tumour, here we are discussing a case of very large and long standing lipoma of tongue and its surgical management.

Keywords: Lingual Lipoma; Intraoral Lipoma; Wide Excision; Tongue Lipoma

Introduction

  Lipoma is a benign mesenchymal tumour composed of mature adipocytes. Incidence of lipoma in head and neck region is about 15 - 20% and in the oral cavity only 1 - 4% of all benign tumors [1]. Lipoma of tongue occurs in 0.3% of all tongue tumors [2]. Clinically all the lipomas are slow growing and asymptomatic. Intraoral lipomas with significantly large size may hamper routine masticatory functions and phonetics. Large lipomas present of ventral surface of tongue or palate may cause respiratory difficulty hence excision of these lesions is mandatory.

Here, we are documenting a case of excessively large lipoma present over ventral surface of tongue and its surgical management.

Case Report

  A 37 year male patient reported to department of head and neck oncosurgery with complain of large painless growth over the tongue since last 7 to 8 years. The lesion was gradually increasing. Patient had mild difficulty in speaking and swallowing but not in breathing.

  On examination, there was about 8 * 8 cm sized pedunculated growth present on ventral and right lateral surface of tongue extending up to floor of mouth. Surface of Lesion was smooth and shiny and yellowish red in colour with multiple engorged blood vessels over its surface. Overlying mucosa was thin without any ulceration or inflammation. The remaining tongue and the oral mucosa didn’t show any other abnormalities on inspection (Figure 1). There was sensory or functional impairment noticed. On palpation the lesion was non-tender, soft, rubbery, nonpulsatile and compressible. Venous congestion was noted at the bottom of the lesion. There was no induration on palpation of tongue. There were no palpable cervical nodes. The clinical diagnosis made was benign mesenchymal tumour with a differential diagnosis of Lipoma, fibroma, haemangioma and neurofibroma. Looking at the size of lesion, the patient was advised to undergo MRI before any surgical intervention. But patient was reluctant to undergo imaging because of financial constraints. FNAC of the lesion was carried out and diagnosis made was lipoma.

Figure 1: Clinical photograph showing large polypoidal mass involving right lateral and ventral surface of tongue.

  Wide excision of lesion was planned under general anaesthesia. Circumferential incision was given at the junction of the lesion and the tongue mucosa. During dissection it was noted that the tumour was firmly fixed to the underlying tongue muscles and there was no plane between the lesion and tongue muscles. The tumour was excised completely together with a thin margin of part of genioglossus and intrinsic muscle tissue in the inferior part (Figure 2). Around 4 to 5 large feeding vessels were present at surgical bed. All the feeding vessels were identified and ligated and excision of the lesion was done. Tongue defect closed with interrupted vicryl sutures. Excised specimen was sent for histopathological examination.

Figure 2: Intraoperative photograph of lesion showing thin margin of attached tongue musculature.

  Grossly, the tumour was polypoid measuring about 8 x 8 cm. On cut section, it was partially encapsulated and had yellowish greasy lobulated appearance (Figure 3). On histopathological examination, the tumour was covered by an intact squamous epithelium of tongue mucosa. Beneath the epithelium was seen a partially encapsulated tumour composed of mature adipocytes arranged in lobules and admixed with delicate vasculature. No nuclear atypia, necrosis or mitosis was noted (Figure 4a and 4b). Hence, a histopathology diagnosis of lipoma of tongue was made.

Figure 3: Gross specimen showing polypoidal mass with thinned out intact mucosa.

Figure 4: Microphotograph showing (a) intact squamous epithelium overlying the tumour composed of mature adipocytes with delicate vasculature x10 (b) x40.

On one month follow up, there was good healing of tongue and no functional disability to the patient.

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Citation

Citation: Himanshu Soni., et al. “Lipoma of Tongue: A Common Lesion at an Uncommon Location”. Acta Scientific Otolaryngology 3.4 (2021): 02-05.

Copyright

Copyright: © 2021 Himanshu Soni., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.