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CORRESPONDENCE
Year : 2019  |  Volume : 15  |  Issue : 8  |  Page : 173-176

Intraosseous lipoma of the maxillary tuberosity: A rare entity with diagnostic challenge


1 Department of Oral and Maxillofacial Pathology, Pushpagiri College of Dental Sciences, Tiruvalla, Kerala, India
2 Department of Oral and Maxillofacial Surgery, Pushpagiri College of Dental Sciences, Tiruvalla, Kerala, India

Date of Web Publication22-Mar-2019

Correspondence Address:
Dr. Sharlene Sara Babu
Department of Oral and Maxillofacial Pathology, Pushpagiri College of Dental Sciences, Tiruvalla, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.187234

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 > Abstract 


Lipoma is called the “universal tumor” or the “ubiquitous tumor” as it occurs anywhere in the body where fat is found. Intraosseous lipoma is a rare lesion that constitutes not more than 0.1% of bone tumors. There are only a few reported cases of intraosseous lipoma of the maxilla in the literature. The diagnosis of intraosseous lipoma of the maxilla may be a challenge, due to its rarity and clinical similarity with many other radiolucent lesions. Therefore, histopathological examination is mandatory. The radiolucent nature and mature adipose tissue admixed with the bony trabeculae confirms the diagnosis of intraosseous lipoma. Here, we report a case of intraosseous lipoma of the left maxillary tuberosity in a 52-year-old male patient.

Keywords: Intraosseous, lipoma, tumor


How to cite this article:
Babu SS, Sunil S, Pratap N, Thomas E. Intraosseous lipoma of the maxillary tuberosity: A rare entity with diagnostic challenge. J Can Res Ther 2019;15, Suppl S1:173-6

How to cite this URL:
Babu SS, Sunil S, Pratap N, Thomas E. Intraosseous lipoma of the maxillary tuberosity: A rare entity with diagnostic challenge. J Can Res Ther [serial online] 2019 [cited 2019 May 19];15:173-6. Available from: http://www.cancerjournal.net/text.asp?2019/15/8/173/187234




 > Introduction Top


Lipomas, though predominantly located in subcutaneous sites, are also found in intramuscular, retroperitoneal, and intraosseous location.[1] Despite the large amount of bone marrow in the human skeleton, intraosseous lipoma is considered infrequent accounting for <0.1% of all primary tumor of the bone. Oral lipomas represent 0.5–5% of all benign oral neoplasms.[1],[2]

Oral lipomas can occur at any site including the major salivary glands, buccal mucosa, lip, tongue, palate, vestibule, and floor of the mouth.[3],[4] The occurrence of multiple lipomas is associated with Cowden's syndrome or multiple hamartoma syndrome.[3],[5]

Lipomas are considered as infrequent primary intraosseous tumors, even though adipocytes are distributed throughout the bone marrow of the human skeleton.[1] A search for the available literature on maxillary intraosseous lipoma revealed only a limited number reported cases. Brault described the first intraosseous lipoma in 1868, involving the diaphysis of the femur.[1] The first intraosseous lipoma of the mandible was reported by Mauric Oringer in 1948,[1],[6] and in the maxilla by Selzer in 1965.[7],[8]


 > Case Report Top


A 52-year-old male reported with a complaint of painful swelling on the left back region of the upper jaw since 1½ years. General and extraoral examination findings were within normal limits. Intraoral examination revealed a swelling on the left maxillary tuberosity with well-defined margin, flat base, and a smooth intact overlying mucosa of 3 cm × 2 cm in size, which was tender and firm on palpation [Figure 1] and [Figure 2]. There was no cervical lymphadenopathy. No history of trauma was reported. Extraction of 26, 27, 28 was done earlier due to periodontal disease.
Figure 1: Intraoral clinical photograph showing swelling in the left maxillary tuberosity region

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Figure 2: Intraoral photograph showing swelling in the buccal aspect of left maxillary posterior alveolar ridge area

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Intraoral periapical (IOPA) [Figure 3], occlusal [Figure 4] radiographs, and orthopantomograph [Figure 5] showed an ill-defined radiolucency over the tuberosity area.
Figure 3: Intraoral periapical radiograph showing ill-defined radiolucent lesion

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Figure 4: Preoperative occlusal radiograph showing poorly defined radiolucent lesion in the left maxillary posterior region

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Figure 5: Orthopantomograph showing ill-defined radiolucent lesion in the left maxillary posterior region

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The differential diagnosis included odontogenic cyst and tumor, benign fibro-osseous lesion, simple bone cyst, osteoporotic bone marrow defect, and central giant cell granuloma. Based on the clinical and radiographic presentations, a provisional diagnosis of odontogenic cyst/tumor was made.

After routine blood investigation, an incisional biopsy was done under local anesthesia. Buccal mucoperiosteal flap was raised, and the buccal cortex was found to be thin and adherent to the mucoperiosteal flap. The lesion consisted of some peripheral shell such as cancellous bone and a central semisolid yellowish structure, which was excised and send for histopathological examination. Decalcified hematoxylin and eosin stained sections revealed a mature adipose tissue surrounded by an outer rim of cortical bone [Figure 6]. The lesion was excised under local anesthesia, and the excisional biopsy confirmed the findings.
Figure 6: Photomicrograph showing a mature adipose cells surrounded by an outer rim of cortical bone (H and E, ×10)

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Histopathologic finding of a mature adipose tissue surrounded by an outer rim of cortical bone excluded the abovementioned pathologies. Histopathological differential diagnosis included intraosseous lipoma and liposarcoma. Intraosseous liposarcoma was excluded by the lack of adipocytic atypia.[8],[9] Therefore, a final diagnosis of intraosseous lipoma was made.

Surgical excision with buccal cortical bone contouring was done to facilitate the patient to wear denture in future. The patient was under regular follow-up for the postoperative 6 months [Figure 7]. Postoperative IOPA and occlusal radiographs were evaluated. The patient was asymptomatic and is able to wear partial denture.
Figure 7: Postoperative clinical photograph

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 > Discussion Top


The incidence of intraosseous lipoma is reported as <0.1% of all bone tumors and in the maxilla only four cases have been reported till date.[6],[7],[9],[10] [Table 1] shows the reported cases of intraosseous lipoma of the jaws, which revealed a slight female predilection (1.4:1) with the age ranging from 20 to 65 years.[11],[12],[13],[14]
Table 1: Clinical features of intraosseous lipoma in reported cases

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A significant number of cases are asymptomatic, being incidentally found on routine radiographs. However, swelling, pain, hypoesthesia are frequent symptoms of intraosseous lipoma,[15],[16] depending mainly on the location and tumor size. Radiographically, intraosseous lipoma appears as a well-defined lytic lesion frequently with large sclerotic borders,[9],[12],[16] and eventually presenting some mixed radiolucent and radiopaque areas.[13] Intraosseous lipoma is classified and subdivided by Milgram into three stages, depending on the degree of involution.[9],[14]

  1. Stage 1: Tumors of viable fat cells
  2. Stage 2: Transitional cases composed partly of viable fat cells but also demonstrating fat necrosis and calcification
  3. Stage 3: Lesions demonstrating necrotic fat, calcification of necrotic fat, variable degrees of cyst formation, and reactive woven bone formation.


The clinical, radiological, and histopathological features of the present case can be reconciled within the range of intraosseous lipoma of the left maxillary tuberosity area (Stage 1) and the etiology due to trauma during extraction of 26, 27 and 28 or due to simple conglomeration of fatty marrow as part of normal ageing process or due to genetic change.

Four cases of malignant transformation of intraosseous lipoma have been reported.[8],[9] However, to the best our knowledge, no case of malignant transformation of intraosseous lipoma arising in the jaws has been documented.

Surgical enucleation is the treatment of choice for these lesions, and no recurrence has been reported in the literature.

A surgeon should keep in mind the possibility of an intraosseous lipoma when dealing with a radiolucent jaw lesion.[10]


 > Conclusion Top


Intraosseous lipomas are considered to be one of the rarest benign, primary tumors of bone. These benign tumors are composed of adipose tissue and can arise, either from the bone marrow cavity or from just below the bone surface. When present, pain in the affected bone is the most common symptom, otherwise the tumors are usually asymptomatic. A diagnosis suspected on radiological study of the affected jaw bone can be confirmed by biopsy of the tumor. Treatment modalities include conservative and surgical methods.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

1.
González-Pérez LM, Pérez-Ceballos JL, Carranza-Carranza A. Mandibular intraosseous lipoma: Clinical features of a condylar location. Int J Oral Maxillofac Surg 2010;39:617-20.  Back to cited text no. 1
    
2.
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.  Back to cited text no. 2
    
3.
Hemavathy S, Roy S, Kiresur A. Intraosseous angiolipoma of the mandible. J Oral Maxillofac Pathol 2012;16:283-7.  Back to cited text no. 3
  [Full text]  
4.
Furlong MA, Fanburg-Smith JC, Childers EL. Lipoma of the oral and maxillofacial region: Site and subclassification of 125 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98:441-50.  Back to cited text no. 4
    
5.
Polte HW, Kolodny SC, Hooker SP. Intraosseous angiolipoma of the mandible. Oral Surg Oral Med Oral Pathol 1976;41:637-43.  Back to cited text no. 5
    
6.
Buric N, Krasic D, Visnjic M, Katic V. Intraosseous mandibular lipoma: A case report and review of the literature. J Oral Maxillofac Surg 2001;59:1367-71.  Back to cited text no. 6
    
7.
To WH, Yeung KH. Intra-osseous lipoma of the maxillary tuberosity. Br J Oral Maxillofac Surg 1992;30:122-4.  Back to cited text no. 7
    
8.
Sakashita H, Miyata M, Okabe K. Intraosseous lipoma of the maxilla. A case report. Int J Oral Maxillofac Surg 1998;27:63-4.  Back to cited text no. 8
    
9.
Milgram JW. Malignant transformation in bone lipomas. Skeletal Radiol 1990;19:347-52.  Back to cited text no. 9
    
10.
Barker GR, Sloan P. Intraosseous lipomas: Clinical features of a mandibular case with possible aetiology. Br J Oral Maxillofac Surg 1986;24:459-63.  Back to cited text no. 10
    
11.
Morais AL, Mendonça EF, de Alencar AH, Estrela C. Intraosseous lipoma in the periapical region of a maxillary third molar. J Endod 2011;37:554-7.  Back to cited text no. 11
    
12.
Darling MR, Daley TD. Radiolucent lesion of the anterior mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98:441-50.  Back to cited text no. 12
    
13.
Manganaro AM, Hammond HL, Williams TP. Intraosseous angiolipoma of the mandible: A case report and review of the literature. J Oral Maxillofac Surg 1994;52:767-9.  Back to cited text no. 13
    
14.
Colella G, Strocchi R, Lanza A, Piattelli A. ZEBRA XXVI part 2. Intraosseous lipoma. J Endod 2003;29:535-7.  Back to cited text no. 14
    
15.
Silva BS, Yamamoto FP, Pontes FS, Fonseca FP. Intraosseous lipoma of the mandible: A diagnostic challenge. Rev Odontol Cienc 2011;26:182-6.  Back to cited text no. 15
    
16.
Cakarer S, Selvi F, Isler SC, Soluk M, Olgac V, Keskin C. Intraosseous lipoma of the mandible: A case report and review of the literature. Int J Oral Maxillofac Surg 2009;38:900-2.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1]



 

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