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Case Report

Fibrolipoma: A rare entity ‑ Case series

Kavita A Amale, Narendra T Chaudhari1, Sweety S Bafna1, Hemant R Umarji
Departments of Oral Medicine, Diagnosis and Radiology and 1Oral Pathology and Microbiology, Government
Dental College and Hospital, Mumbai, Maharashtra, India

ABSTRACT

Lipomas are benign soft tissue neoplasms of mature adipose tissue usually seen in the head and neck region. Intraoral
lipomas are rare lesions, which may be discovered during routine dental examinations since they present as a slow‑growing,
painless, and asymptomatic yellowish mass. Fibrolipoma is one of the rare variants of the lipoma, and very few cases
have been reported in the oral cavity. These lesions infrequently cause pain, but may grow to large size causing difficulty
in speech and mastication. Surgical excision is the treatment of choice, and the prognosis is generally good as recurrence
rate is very less. Here, we present two cases of fibrolipoma and a brief review of literature.
Key words: Excision, fibrolipoma, neoplasm, recurrence

Introduction About 15–20% of lipomas occur in the head and neck

region, but only 1–4% occurs in the oral cavity. They

L
ipomas are benign mesenchymal neoplasms are seen in patients belonging to fourth or fifth decade
consisting of mature adipocytes, generally with equal gender predisposition, although a male
enclosed by a thin fibrous capsule.[1] Intraoral predilection is also seen. [1] Lipomas are commonly
lipoma was first described by Roux in 1848, to which located on buccal mucosa (53.7%), buccal sulcus (14.6%),
he referred to as “yellow epulis.”[2] Classic lipomas are and tongue (9.8%). They are encapsulated, but may
the most common, followed by fibrolipomas among present an infiltrating growth if capsule is absent. These
the intraoral lipomas.[3] Lipomas can be attributed to are slow‑growing, painless, and asymptomatic lesions,
mechanical, endocrine, and inflammatory influences, which may interfere with speech and mastication.[5]
which may lead to the differentiation of multipotent Few lesions become ulcerated which leads to difficulty
mesenchymal cells in fat tissue, cartilage, and bone. in diagnosis.[6] Intra‑osseous lipomas may arise from
Systemic and local influences such as local trauma the soft tissue adjacent to the bone or may occur in an
or prolonged ischemia may cause modification of intramedullary location.[7]
mesenchymal cells. The pathogenesis of fibrolipoma
remains unclear. It may be congenital due to an The histological variants seen are classic lipoma (41.5%),
endocrinal imbalance, product of a degenerated fibrolipoma (34.1%), spindle cell lipoma (9.8%),
fibromatous tumor, or arise from the maturation of
lipoblastomatosis.[4] This is an open access article distributed under the terms of the
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DOI: How to cite this article: Amale KA, Chaudhari NT, Bafna SS,
10.4103/0972-1363.188769
Umarji HR. Fibrolipoma: A rare entity - Case series. J Indian Acad
Oral Med Radiol 2015;27:588-92.

Address for correspondence: Dr. Narendra T Chaudhari, Nirman Park Phase 3, A‑6, Room No: 4, Santoshi Mata Road,
Kalyan West ‑ 421 301, Mumbai, Maharashtra, India. E‑mail: naren.njoi@gmail.com
Received: 19‑08‑2015  Accepted: 24‑05‑2016  Published: 19-08-2016

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Amale KA et al.: Fibrolipoma ‑ Case series

sialolipoma (9.8%), osteolipoma (2.4%), and chondrolipoma

(2.4%).[8] Histologically, the tumor is composed of adult
fat cells that are sub‑divided into lobules by fibrous
connective tissue septa. The histological pattern may
show varied features such as dense fibrous connective
tissue septa, spindle cell components, mitotically active
atypical cells, mature blood vessels, myxoid stroma, or
even salivary acinar structures are seen along with mature
adipose tissue depending on each variant.[2]

Intraoral lipomas are managed by conservative local

excision without any recurrence, but intramuscular
lipomas due to their infiltrating nature and when
multiple,[6] show recurrence rate of as high as 62.5%.[5]
Oral fibrolipomas are uncommon in the oral cavity with
few cases documented so far. As the proliferative activity
Figure 1:  Extraoral view: No facial asymmetry; Intraoral view:
of fibrolipoma is greater than the other variants, the need Pink‑colored, exophytic, pedunculated growth on the right buccal
for accurate diagnosis is important.[9] Hence, we present mucosa (Case 1)
here two cases and a brief review on fibrolipomas.

Case Reports
Case report 1
A 19‑year‑old female patient reported with a complaint
of gradually increasing intraoral swelling on the right
cheek. The patient was apparently alright when she
noticed a growth of about 0.5 cm in diameter 6 years ago
and since it was asymptomatic; she did not report to the
dentist. However, the growth gradually increased to its
present size and caused difficulty in mastication which
prompted the patient to visit the hospital. There was
no history of bleeding and discharge from the swelling,
and no treatment was taken for the lesion. Extraoral
examination showed no facial asymmetry. There was
no associated lymphadenopathy.
Figure 2: Thin, atrophic epithelium and dense collagen fibers along with
adipose tissue (Case 1) (H and E, ×4)
Intraoral examination showed pink‑colored, exophytic,
pedunculated growth of 4 cm × 3 cm in size on the right
buccal mucosa opposing crowns of 15 and 16. The growth
was well‑circumscribed, with keratotic bite markings on
the surface. The surface was smooth and glossy with
intact mucosa. On palpation, it was soft in consistency,
nontender with no bruit, and slightly mobile. Slip sign
was not demonstrated. The swelling was fluctuant with
no bleeding [Figure 1]. Provisional diagnosis of lipoma
and differential diagnosis of fibroma and neurofibroma
were considered. The lesion was completely excised and
subjected to histopathological examination. Microscopic
examination revealed thin atrophic surface epithelium
and dense connective tissue. The stroma consisted of
adipose tissue interspersed between numerous collagen
fiber bundles [Figures 2 and 3]. Based on the above
features, a final diagnosis of fibrolipoma was given.
Postoperative follow‑up of the patient after 6 months Figure 3: Mature adipocytes surrounded by numerous collagen fibers
showed no signs of recurrence [Figure 4]. (Case 1) (H and E, ×10)

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Amale KA et al.: Fibrolipoma ‑ Case series

Case report 2 prevented the teeth from complete occlusion [Figure 5].

A 41‑year‑old male patient visited our outpatient Provisional diagnosis of fibroma and differential
department with a complaint of swelling in the left back diagnosis of lipoma and neurofibroma were given.
region of jaw since 3 years. The patient did not feel any The lesion was completely removed and sent for
discomfort as the swelling initially was small about histopathological examination. Microscopic examination
0.2 cm in size, but as it increased slowly over the years, it showed surface epithelium and dense, mature
affected patient’s chewing ability. There was no bleeding connective tissue. The stroma predominantly consisted
and discharge from the swelling, and no significant of collagen fiber bundles. Deeper areas of stroma
medical or family history. The patient had no deleterious showed mature adipocytes surrounded by collagen fiber
habit history. There was no facial asymmetry and bundles consistent with fibrolipoma [Figures 6 and 7].
associated lymphadenopathy on external examination. Postoperative follow‑up of the patient after 4 months
showed no signs of recurrence [Figure 8].
A well‑defined, round, pedunculated, pinkish‑white
growth on the left pterygomandibular raphe distal to 38,
Discussion
measuring about 2 cm × 2 cm in size was seen. Surface
of the growth appeared smooth and shiny. Overlying The metabolism of fat cells in a lipoma is different from
mucosa was intact with superficial blood vessels seen. It normal fat cells, as during starvation, there will be a
was soft‑to‑firm in consistency, pedunculated, no bruit, loss of fat from normal fat deposits in the body, but
slightly mobile, and nontender on palpation. Slip sign
was negative, and bleeding was not seen. The lesion

Figure 5:  Extraoral view: No facial asymmetry; Intraoral view: Round,

pedunculated, pinkish‑white growth on the left pterygomandibular
Figure 4: Postoperative view after 6 months (Case 1) raphe (Case 2)

Figure 6: Thin, atrophic epithelium and dense collagen fibers showing

adipose tissue in deeper areas (Case 2) (H and E, ×4) Figure 7: Mature collagen fibers with few interspersed matured
adipocytes (Case 2) (H and E × 10)

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Amale KA et al.: Fibrolipoma ‑ Case series

lipomatosis, multiple familial lipomatosis and Proteus

syndrome, Cowden’s syndrome, multiple hamartoma
syndrome, and Dercum’s disease are associated with
multiple head and neck lipomas.[4] As the clinical course
of fibrolipoma is usually asymptomatic, the lesion grows
to a large size, leading to cosmetic problems that prompt
the patient to take treatment. A few complications such
as obstruction of upper airway leading to asphyxial
death in case of esophageal fibrolipoma and liposarcoma
in long‑standing cases can also occur.[11,15] The Ki‑67
and proliferating cell nuclear antigen expression are
increased in fibrolipomas than in other variants, which
suggest a greater proliferative rate and faster growing
pattern, but this feature does not affect the prognosis
of the lesion.[14] The cases we presented were of young
female and a middle‑aged male showing soft‑to‑firm
Figure 8: Postoperative view after 4 months (Case 2)
growth suggestive of lipoma. The lesions were confirmed
as fibrolipoma on histopathological examination.
not from a lipoma. Furthermore, fatty acid precursors
are incorporated rapidly into lipoma fat than into
normal fat. Basically, the lipid present in lipoma is not Conclusion
available for metabolism.[10] Fibrolipoma according to
the WHO classification is a rare microscopic variant of Fibrolipoma may resemble many lesions clinically
lipoma, which is characterized by mature adipose tissue and pose a diagnostic challenge to general dentists.
interspersed by dense fibrous connective tissue.[7,11] Histopathological examination is advised for the
confirmation of diagnosis. This would be helpful in
The various factors attributed for the etiology of providing treatment and prevention of complications
fibrolipoma are congenital, endocrine imbalances, such as malignant transformation. Fibrolipoma is a rare
degeneration of fibromatous tumor, or from the lesion, so more cases should be documented to make
maturation of lipoblastomatosis. [10] The growth rate dental professionals aware of its features.
of fibrolipomas is faster than the classic variants. Even
though fibrolipomas are benign tumors, few cases of Declaration of patient consent
conversion to liposarcoma are also reported.[12] The The authors certify that they have obtained all appropriate
consistency is soft‑to‑firm, which depends on the patient consent forms. In the form the patient(s) has/
quantity and distribution of fibrous tissue and the depth have given his/her/their consent for his/her/their
of the tumor. It is most commonly seen in the buccal images and other clinical information to be reported in
mucosa and buccal vestibule,[11] and it also shows a slight the journal. The patients understand that their names
predominance in females.[4] and initials will not be published and due efforts will
be made to conceal their identity, but anonymity cannot
Fibrolipoma is the most frequent microscopic variant be guaranteed.
of oral lipomas. Microscopically, the fibrolipoma is
composed of lobules of “chicken‑wire” appearing, benign Financial support and sponsorship
adipocytes with a component comprising broad bands of Nil.
dense collagen. It is mostly well circumscribed and maybe
thinly encapsulated like the classic lipoma.[13] Differential Conflicts of interest
diagnosis includes many benign mesenchymal tumors There are no conflicts of interest.
such as fibromas, simple lipomas, and minor salivary
gland tumors either benign or malignant.[14] Magnetic References
resonance imaging is a very helpful tool for the diagnosis
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