Treatment off lypoma.

Dear friends, colleagues and curofians, Kindly find a small information about buccal Lipoma. Buccal Lipoma, A Rare Entity by Dr Sunil kumar ------------------------------------------- Figure 1: Lipoma being excised via an intra-oral incision Figure 2: Excised lipoma Figure 3: Photomicrograph showing aggregates of mature adipocytes with large clear cytoplasm and eccentric nuclei. Hematoxylin and eosin stain ×20. Discussion :- Lipomas are the most common benign adipose mesenchymal neoplasms that only rarely occur in the oral cavity with a reported incidence of 1% to 4% [3,4]. Roux, in 1848, described the first oral lipoma in literature and he referred to it as “Yellow Epulis”. Most lipomas occurring in the maxillofacial region are developmental and usually occur late in life. The peak incidence age for lipoma is 40 years and above. Generally, their prevalence does not differ with gender, although a male predilection has been recorded . A few of the lipomas show rearrangement of 12q, 13p, and 6p chromosomes. It has been suggested that trauma may, sometimes, acts as a trigger mechanism for the proliferation of the existing adipose tissue to convert into a lipomatous swelling. The classification for benign lipomas includes the following: classic lipoma; lipoma variants (for example angiolipoma, chondroid lipoma, myolipoma, spindle cell lipoma); hamartomatous lesions; diffuse lipomatous proliferations and hibernoma. In the oral cavity, the most common sites for lipomas are the cheek, tongue, palate, mandible and lip. They may occur as either sessile or encapsulated masses. Clinically, oral lipomas present as soft nodular swellings, usually of a long-standing nature based on them being slow growing tumors. They are almost always covered by normal appearing overlying mucosa. They are well defined masses clinically as well as radiologically using Ultrasonography and Computerized Tomographic scan and more recently, using Magnetic Resonance Imaging. A differential diagnosis is essential in these cases as they tend to have varying modes of presentation. The commonly made differential diagnosis besides that of a classic lipoma are those of an epidermoid cyst, dermoid cyst, lymphoepithelial cysts, and in rare cases aberrant lingual thyroid tissue. Oral dermoid and epidermoid cysts usually occur over the midline of the floor of the mouth but can also occur in other sites of the oral mucosa. Lymphoepithelial cysts are found in the floor of the mouth, soft palate and mucosa of the pharyngeal tonsil. Aberrant thyroid tissue can be easily ruled out using a combination of an Ultra sonogram of the neck to determine presence of normal functioning thyroid gland along with a Radioactive Thyroid Scan to detect presence of active thyroid tissue elsewhere in the body. FNAC of the swelling may be recommended in highly suspicious cases but is usually not necessary. Usually, it is cosmesis that brings a patient to the surgery in cases of asymptomatic swellings leading to a prolonged course beforehand. In rare cases, complications may ensue, for e.g. obstruction to airway in cases of pharyngeal / esophageal fibrolipomas , or in long standing cases malignant transformation to liposarcoma is a possibility . Adequate surgical excision is the treatment of choice for oral lipomas. The surgical approach is dependent on the site of the tumor and the proposed cosmetic result. Our patient's lipoma was approached intra-orally by a transverse 5 cm linear incision made directly over the mucous lining over it. Microscopically, it is difficult to differentiate between normal adipose tissue and lipomas, therefore, a clinician sending a surgical specimen to the pathologist for microscopic analysis must provide accurate clinical and surgical information in order to make a definitive diagnosis. The microscopic appearance of a circumscribed but not encapsulated aggregate of mature adipocytes with large clear cytoplasm in the absence of vascularity, atypia or metaplasia is diagnostic of a classical lipoma. Conclusion Buccal soft tissue lipomas are rare tumors. A high index of suspicion is required in making a diagnosis. Surgical excision is the ideal treatment with excellent outcome. Supported with the correct investigations, the entity can be tackled easily in a day care setting without the need for overnight hospitalistion. The importance of histological diagnosis cannot be overemphasized and the features of lipoma are usually straightforward and classical.

diagnosis?? age 25yr.,poor oral hygiene. soft in consistency.

1 and half year old boy with slow growing cervical mass for 8 months with recent Laryngeal stridor. USG neck showed a solid homogeneous retropharyngeal mass which pushed the trachea. FNAC was done and later Excised Images attached Diagnosis??

UNUSUAL PRESENTATION- Red fleshy, non tender, non ulcerated mass oral cavity of 2months duration. No trismus, slight difficulty in deglutition due to mass effect . Tongue movements full & free. On inv- Videolaryngoscopy- Arising from post cricoid region of hypopharynx. Case open for suggestions & discussion on diagnosis & plan of management. Adding Video laryngoscopy findings as a separate case as unable to add video file here.

A 75 yr old male with a huge swelling with ulcer in the parieto occipital region. the swelling was gradually progressing for the past 15 yrs. It was diagnosed and was found to be a liposarcoma without any metastasis. tumour was removed by surgery.