Osteolipoma of the tongue

doi:10.1016/S1368-8375(00)00105-6

Oral Oncology

Volume 37, Issue 5, July 2001, Pages 468-470

https://doi.org/10.1016/S1368-8375(00)00105-6 Get rights and content

Abstract

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.

Introduction

Lipomas are common, benign tumours located in any part of the body in which fat is normally present [1], [2]. Lipomatous tumors are the most common soft tissue tumors [3]. The majority form in the upper half of the body, particularly the trunk and neck [1], and they are rarely reported in the oral cavity. Grossly, lipomas consist of bright yellow fat separated by fine fibrous trabeculae; microscopically, lipomas are constituted of mature adipose tissue with no cell atypia [1]. Variants of lipoma have been described according to the type of tissue present: fibrolipoma, myxolipoma, myolipoma, spindle-cell lipoma, angiolipoma, pleomorphic lipoma [1], [4]. The most common is the fibrolipoma [4]. A rare variant consists of a lipoma with osseous or cartilaginous metaplasia [1], [4], [5]. These lesions have been given a variety of names [4], [6], [7], [8], [9]. Osteolipomas of soft tissue seem to be much less common than chondrolipomas [6]. In the head and neck, osteolipomas have been reported in the central nervous system (tuber cinereum, hypothalamus, sellar region), submandibular space, parapharyngeal space, and skull [[6], [10], [11], [12], [13], [14], [15]]. Only five cases of this variant located in the oral cavity have been reported in the literature [4]. We report an additional case of osteolipoma in the tongue.

Section snippets

Case report

A 49-year-old female was referred for a painless mass located on the left lateral margin of the tongue. The patient had first noted the lesion about 8 years previously, but since it had caused only slight discomfort during chewing, she had not brought it to the attention of the attending physician. Intraoral examination showed an oval, well-circumscribed, non-tender, hard mass (Fig. 1). Under local anethesia, the lesion was completely excised. The lesion had a diameter of 0.8 cm.

Discussion

Osteolipomas have been reported in middle-aged or elderly patients with a very long history measured in years, as in our patient [1], [6]. These tumours tend to be large and to have origin from the deep soft tissues as well as from the subcutaneous plane [1], [6]. They are well-encapsulated, and the cut surface shows the presence of both adipose tissue and bone [6]. Some researchers consider such types of lipoma as benign mesenchymomas, because both adipose and chondroid or osseous components

Acknowledgements

This work was partially supported by the National Research Council (C.N.R.), Rome, Italy, and by the Ministry of University, Research, Science and Technology (M.U.R.S.T.), Rome, Italy

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Chondrolipoma of floor of the mouth: A case report
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Chondrolipoma is one of the less common variants of lipoma, showing mature hyaline cartilage in the underlying adipose tissue. We describe herein a rare case of chondrolipoma arising on the floor of the mouth. A 66-year-old woman was referred for close examination of a lingual mass on the anterior floor of the mouth. Intraoral examination revealed a spherical, well-defined, relatively soft mass, 2.0 cm in diameter, without adhesions to alveolar bone in the anterior floor of the mouth. The tumor was resected, and histopathologic examination diagnosed chondrolipoma. The postoperative course was uneventful and no recurrence within 1 year after surgery. Lipomas are also occasionally found on the floor of the mouth, where the chondrolipoma subtype can arise.
Intra-articular osteolipoma of the elbow: A case report and a review of the literature
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In an interesting series of 635 lipomas studied over a period of 05 years, only 6 cases with ossification were found (Allen, 1981). The head and neck are the most frequent localization of reported osteolipomas (Obermann et al., 1999; Piattelli et al., 2001; Lodwick et al., 1980; Allen, 1981; Jaiswal et al., 2005). Most cases of lipoma are with osseous tissue connected with bone (inside a bone or adjacent to it) (Friedman et al., 2013; Murphey et al., 2005; Wurlitzer et al., 1973).
Lipomas are the most common benign mesenchymal tumors. The intra-articular localization is exceptional.
We report the first case of an intra-articular osteolipoma at the elbow.
A 36-year-old patient with no pathological history, presented to the emergency room with a two weeks history of a painless, progressively left elbow swelling in a context of apyrexia.
Physical examination revealed a hot, edematous left elbow. The gentle mobilization of the joint was painless. Biologie was normal. Initial radiograph showed a well-defined lobular image. Ultrasound revealed an anechoic intra-articular collection associated to a synovium hyperaemia and the MRI shows an aspect of synovitis. An arthrotomy was done via an internal approach of the elbow. Joint fluid was red. A free ossified intraarticular mass was discovered. Bacteriological samples were sterile. Histological examination concluded to an osteolipoma with no histological signs of malignancy. At the last 3-year follow-up, the patient didn't report any pain or functional discomfort. Elbow mobility was complete, with the absence of recurrences.
Osteolipoma is defined as a histological variant of lipoma having undergone bone metaplasia. Allen found 06 cases in a series of 635 lipomas over five years. Pain has not been reported in the literature. In our case the pain was explained by the interposition of the tumoral mass between the articular surfaces. Histological examination confirms the diagnosis and recurrences are rare.
Osteolipoma is an extremely rare entity of mesenchymal tumors whose intra-articular location, although exceptional, does not worsen the prognosis.
Osteolipoma of head and neck – a review
2022, Brazilian Journal of Otorhinolaryngology
Due to the rarity of osteolipoma, current knowledge and understanding of its’ clinical presentation, management, radiological features, histological characteristics, and prognosis are lacking and can present a clinical conundrum to clinicians and histopathologist alike, given wide range of differential diagnoses. This paper aims to compile, analyse and present details to augment the available literature on osteolipoma in the head and neck.
A comprehensive literature search on PUBMED/MEDLINE, EMBASE, CINAHL and Science Citation Index, Google scholar and Cochrane database for osteolipoma in head and neck was performed up to the 1st May 2021. Reference lists from the relevant articles were then inspected and cross-referenced and any other pertinent publications were added to the review.
A total of 38 cases were identified from the literature. The commonest sites of involvement within the head and neck region were the oral cavity in 21 (56.8%) patients, followed by the neck in 7 (19.0%) patients. 29 (78.4%) patients presented with soft tissue swelling or mass making it the most common presenting feature. All patients had the tumour excised surgically; of which 18 (48.6%) were excised via transoral approach and 6 (16.2%) via open transcervical approach including 1 lateral pharyngotomy. 12 papers documented long-term follow-ups (median 12 months) with no recurrence. Only 1 regrowth was reported after 5-years.
Osteolipoma is a rare soft tissue neoplasm which has a wide range differential diagnosis including malignant processes. Recognising this benign tumour through an awareness of presenting sign and symptoms, radiological features and histopathology findings is important for patient reassurance as well as avoiding unnecessary radical treatment.
A rare intramuscular osteolipoma: A case report
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Osteolipoma independent of bone tissue has been reported in very few cases. Most of them occurred in the head and neck area [3,11–14]. There have been very few reports of ossifying lipomas arising either away from the head and neck or independently from bone [1,5] (Table 1).
Lipomas are frequently presented in adults and account for almost 50% of all soft-tissue tumors. Osteolipomas are rare and usually located in the intraosseous region or adjacent to bone. It is very unusual for osteolipomas with no connection to bony structures. We report a rare intramuscular osteolipoma independent of bone tissue.
We report a case of a 58-year-old man with painful and progressively enlarging mass in the right lower leg. A plain X-ray and computed tomography (CT) scans revealed a large homogeneous, low-fat density mass containing an oval shape calcification without bone connection. MRI showed a circumscribed mass in the peroneus muscle with a large calcified component. The patient underwent surgical excision of the mass. Histologically, benign osteolipoma was the final diagnosis. No recurrence was observed at six months follow-up.
Lipoma is a common benign soft tissue neoplasm but osteolipoma is rare. Most cases osteolipomas are connected with bone. independent of bone tissue has been reported in very few cases. Most of them occurred in the head and neck area. The pathogenesis of osteolipoma is still not clear. Although CT and MRI are useful for differential diagnosis, care should be taken because sometimes they are indistinguishable from well-differentiated liposarcomas. Excisional biopsy is useful for definitive diagnosis.
Although ossifying lipomas are very rare, it is important to keep them in mind when a lesion with adipose tissue in combination with ossification is encountered.
Firm, dome-shaped mass of lower lip
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Oral chondrolipomas have been diagnosed in individuals from 2 to 72 years of age, and most occur in the tongue,14,17-20 followed by the lower lip.21 Oral osteolipomas have been diagnosed in the buccal mucosa,5 tongue,3 and alveolar mucosa.22 Benign lipomas exhibiting both osseous and cartilaginous metaplasia, also known as osteochondrolipomas, have been observed in the subcutaneous and deep soft tissues, often in the parosteal region.16,23
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An intraosseous lipoma is a rare histologic variant of lipoma, accounting for only 0.1% of all primary bone tumors. This may not be the actual incidence because most of these lesions are frequently asymptomatic, but imaging modalities, such as computed tomography or magnetic resonance imaging (MRI) seem to have increased the detection rate. Lipoma occasionally undergoes osseous metaplasia and becomes an osseous lipoma. Although there are numerous papers discussing intraosseous lipoma and some authors have tried to differentiate lipomas from osseous lipomas, there is still a great deal of confusion with regard to characteristic radiologic features and the use of terms. Use of the mDixon sequence in MRI could be an effective, noninvasive method of lesion detection and differential diagnosis. Texture analysis is a useful technique for capturing intratumoral characteristics. We report what is possibly the first use of the mDixon MRI sequence in the measurement of tumoral texture in a case of the extremely rare inferior nasal turbinate intraosseous lipoma in a 58-year-old female. We conclude that mDixon and texture analysis are helpful methods for differentiating intraosseous lipomas from other masses and confirming the benign characteristics of lipoma. Our review of head and neck intraosseous lipoma could be of particular interest to head and neck surgeons and dental clinicians.

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Case reportOsteolipoma of the tongue

Abstract

Introduction

Section snippets

Case report

Discussion

Acknowledgements

J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Report of a case Oral Surg

Surg Neurol.

Lipomatous tumours of the soft tissues: an update

Virchows Arch

Soft tissue tumors. 3rd ed

Case report
Osteolipoma of the tongue