Lipoma

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This presentation is done by Dr. Abdel Rahman Sabsoob. Hope you enjoy it !!

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LIPOMA : 

LIPOMA

LIPOMA: 

Definition: It seldom occurs in oral cavity. It is a benign, slow growing, tumor composed of mature fat cells. LIPOMA

LIPOMA: 

Types: Encapsulated lipoma ____ It is the commonest tumor. Diffuse lipoma ____ It does not posses typical features of lipoma. It is also called as "Pseudolipoma". Lipomatosis ____ It has multiple lipomas. It refers to the symmetrical masses of fat, which sometimes occur around the neck in middle age aged man and occurs as painful deposits of fat in women in Dercum's disease. LIPOMA

LIPOMA: 

Clinical features: It occurs after 40 years of age with peak at 50 years, male to female ratio is 1:1. it usually occurs in upper parts of the trunk, neck and arms. In oral cavity, it occurs on buccal mucosa and mucobuccal fold followed by tongue, floor of the mouth and lip. It appears as a solitary lesion with sessile, pedunculated or submerged base. LIPOMA

LIPOMA: 

Size of lesion is approximately of 1 cm in diameter. Margins are well contoured and well defined. It grows as round or ovoid mass in oral cavity. It may be lobulated or may be broadly based or have narrow pedicle. Due to thinness of the overlying epithelium, yellow coloration of the fat can be seen. LIPOMA

LIPOMA: 

Most of the lesions are fluctuant and are not freely movable. Surface is smooth, non tender, soft and cheesy in consistency. The epithelium is usually thin and the superficial blood vessels are readily visible over the surface. Some lesions of lipoma are deep and feel fluctuant on palpation; may be mistaken as cysts. LIPOMA

LIPOMA: 

Slip sing, i.e. the edge of lipoma is soft, compressible and often slips away from the examining fingers, is positive in this case. Trans illumination test is also positive. LIPOMA

LIPOMA: 

Lipoblastomatosis is a variant of lipoma, but is not a true neoplasm. It is the continuation of the normal process of fetal fat development carried into the postnatal life. It is characterized clinically by the occurrence, in infants with solitary or multiple soft tissue masses, developing at various sites such as the buttocks, chest, axilla or neck. Hibernoma is developed as multivacuolated fat that is analogous to the brown fat of hibernating animals; however lesions in oral cavity are not reported. LIPOMA

LIPOMA: 

Histopathological features: It is made of circumscribed mass of mature fat cells. These cells are arranged in lobular pattern which is formed by connective tissue septae coursing through the tumor. These septae carry blood vessels and nerve fibers. Fat cells are large polygonal cells. They contain large amount of fat. This fat pushes the cytoplasm and nucleus to the periphery. Nucleus is flattened against the cell wall. LIPOMA

LIPOMA: 

Radiographic Features: The radiographic features of lipoma often parallel those of the histologic stage of the lesion. The Stage 1 lesions are lucent and represent viable, non-necrotic fat with resorption of bony trabeculae. LIPOMA

LIPOMA: 

Stage 2 lesions have lucent areas , which consist of viable fat and radio dense areas that consist of fat necrosis and dystrophic calcification. Stage 2 lesions can be expansile. LIPOMA

LIPOMA: 

Stage 3 lesions reflect resorption of normal bone, but they are more radio dense than stage 1 or 2 lesions. The radio density is a result of calcification and extensive fat necrosis. Stage 3 lesions also have thick sclerotic borders, presumably related to involution of these lesions. Radiologically, the differential diagnosis of intraosseous lipomas includes fibrous dysplasia, aneurysmal bone cysts, simple bone cysts, bone infarcts, chondroid tumors, and liposclerosing myxofibrous tumors. LIPOMA

LIPOMA: 

Treatment: Usually, treatment of a lipoma is not necessary, unless the tumor becomes painful or restricts movement. They are usually removed for cosmetic reasons, if they grow very large, or for histopathology to check that they are not a more dangerous type of tumor such as a liposarcoma . This last point can be important as the actual identity of a "bump" is not known until after it is removed and professionally examined . LIPOMA

LIPOMA: 

Lipomas are normally removed by simple excision. The removal can often be done under local anesthetic, and take less than 30 minutes. This cures the majority of cases, with about 1-2% of lipomas recurring after excision. Liposuction is another option if the lipoma is soft and has a small connective tissue component. Liposuction typically results in less scarring ; however, with large lipomas it may fail to remove the entire tumor, which can lead to re-growth. There are new methods being developed that are supposed to remove the lipomas without scarring. One of them is removal by the use of injection of compounds that trigger lipolysis , such as steroids or phosphatidylcholine . LIPOMA

LIPOMA: 

Management: Surgical excision and recurrence is uncommon. LIPOMA