Acta Scientific Otolaryngology (ASOL) (ISSN: 2582-5550)

Case Report Volume 3 Issue 4

Lipoma of Tongue: A Common Lesion at an Uncommon Location

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.

References

  1. Egido-Moreno S., et al. “Intraoral lipomas: review of literature and report of two clinical cases”. Journal of Clinical and Experimental Dentistry5 (2016): e597.
  2. Baonerkar HA., et al. “The lipoma of tongue-A rare site for a tumor: Case report and review of the literature”. Indian Journal of Dentistry4 (2015): 207.
  3. Magadum D., et al. “Classic tongue lipoma: a common tumour at a rare site”. Case Reports (2013).
  4. Fregnani ER., et al. “Lipomas of the oral cavity: clinical findings, Histological classification and proliferative activity of 46 cases”. International Journal of Oral and Maxillofacial Surgery 32 (2003): 49-53.
  5. Baonerkar HA., et al. “The lipoma of tongue-A rare site for a tumor: Case report and review of the literature”. Indian Journal of Dentistry4 (2015): 207.
  6. Bajpai M., et al. “Prevalence of oral lipomas in Indian population: An institutional retrospective study of 12 years and analysis of 49 published cases from 1976–2017 reported in Indian patients”. Electronic Journal of General Medicine 3 (2016): 42-46.
  7. Chun-Kit Chung J and Wai-Man Ng R. “A huge tongue lipoma”. Otolaryngology–Head and Neck Surgery 137 (2007): 830-831.
  8. Chidzonga MM., et al. “Gigantic tongue lipoma: A case report”. Medicina Oral, Patologia Oral Y Cirugia Bucal 11 (2006): 437-439.
  9. Chandak S., et al. “Huge lipoma of tongue”. Contemporary Clinical Dentistry4 (2012): 507-509.
  10. Colella G., et al. “Giant intramuscular lipoma of the tongue: a case report and literature review”. Cases Journal 2 (2009): 7906.
  11. Kumar LK., et al. “Intraoral lipoma: a case report”. Case Reports in Medicine (2014): 141-144.
  12. Studart-Soares EC., et al. “Oral lipomas in a Brazilian population: A 10-year study and analysis of 450 cases reported in the literature”. Medicina Oral, Patologia Oral Y Cirugia Buccal 15 (2010): e691-e696.
  13. Garavaglia J and Gnepp DR. “Intramuscular (infiltrating) lipoma of the tongue”. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology 3 (1987): 348-350.
  14. Moore PL., et al. “Atypical lipoma of the tongue”. The Journal of Laryngology and Otology: JLO10 (2001): 859-861.

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.




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