Rare Occurrence of Lip Spindle Cell Lipoma

Spindle cell lipoma (SCL) is a rare distinct variant of lipoma, which presents as a painless, circumscribed, slow-growing, superficial lesion on the lip and can mimic a minor salivary gland tumour. We present a slow growing lower lip lesion and its management.  A 38-year-old female gave an eight-year history of a slow-growing mass on her lower lip with intermittent change in size. She presented with a submucosal nodule and thin overlying mucosa adjacent to the vermilion border. Surgical excision was carried as the diagnostic and therapeutic approach.  Lip SCL is rare, and surgical excision is advocated in order to exclude underlying pathology and minor salivary gland tumours.

Related papers:

title: Oral soft tissue lipomas: a case series.
abstract: Lipomas are relatively uncommon tumours in the oral cavity; only 1% to 4% of cases occur at this site. In this study, we describe the clinical and histopathologic features of 6 cases of oral lipoma.



Between 1997 and 2005, the files for all cases of oral lipoma at the oral pathology division, University of Ribeirão Preto, São Paulo, Brazil, were retrieved for study. Clinical data were retrieved from patient records, and all cases were reviewed microscopically and classified.



Of the 6 cases, 3 occurred in males and 3 in females; their mean age was 50.2 years (range: 28-78 years). Most cases affected the buccal mucosa and the mean size of the tumours was 3.0 cm (range: 1.5-5.0 cm). Microscopically, 4 cases were classified as lipoma, 1 as fibrolipoma and 1 as intramuscular or infiltrative lipoma. All cases had been treated by simple surgical excision and there had been no recurrence after a mean treatment time of 50.3 months (range: 8-72 months).



Oral lipomas are uncommon tumours that predominantly affect the buccal mucosa and are associated with an excellent prognosis.

title: Benign tumors of adipose tissue of the oral cavity: a clinicopathologic study of 13 cases.
abstract: The purpose of this study was to determine the clinical and histologic features of 9 simple lipomas, 2 fibrolipomas, and 2 infiltrating lipomas of the oral cavity. In addition, 10 cases of infiltrating lipoma of the oral cavity previously reported in the literature were reviewed.



All cases were retrieved from the archives of the Department of Oral Medicine/Pathology of the University of Thessaloniki, Greece. Data on age, sex, location, clinical appearance, duration, recurrence, and histologic appearance were evaluated.



This study showed that the sex distribution of the simple lipomas was approximately equal, and the mean age of patients was 60.2 years. The buccal mucosa was the most frequent location of the tumors. Their size ranged from 0.2 to 1.5 cm, with an average rate 0.8 cm. In 3 cases, the tumor was not encapsulated. The sex distribution of the infiltrating lipomas was equal, and the mean age of the patients was 36.8 years. The most frequent location was the tongue.



Tumors of adipose tissue represent rare neoplasms of the oral cavity. The diagnosis is based on both the clinical and histologic characteristics. Caution is required during their surgical excision to avoid recurrence, especially with infiltrating lipomas.

title: Oral lipoma: analysis of 58 new cases and review of the literature.
abstract: Lipomas are common soft-tissue tumors but occur infrequently in the oral region. Here, we present 58 new cases of oral lipoma (OL), their clinical features, diagnostic workup, and management. The records of 58 patients with OL were reviewed. Demographic data, presenting symptoms, primary tumor site, histopathology, and clinical management were analyzed. Extraoral and intraosseous lesions were excluded. The patients were 29 men and 29 women with mean age of 59.7 years, range, 11 to 98 years. Tumor sites included the buccal mucosa (n = 31), tongue (n = 10), lip (n = 6), floor of the mouth (n = 6), and vestibule (n = 5). The mean tumor size was 2.1 cm (range, 0.3-5.0 cm). The mean tumor duration before excision was 2.6 years (31.2 months), ranging from 2 months to 12 years. Most common presenting symptom was an asymptomatic, circumscribed mass. Histologically, the tumors were classified as classic lipoma (n = 28), fibrolipoma (n = 19), intramuscular lipoma (n = 4), minor salivary gland lipoma (n = 2), angiolipoma (n = 2), and spindle cell lipoma (n = 3). A case of spindle cell lipoma affecting the lower lip that has not been described previously is presented. The provided treatment was surgical excision. Although uncommon, OL are most common in adults and very uncommon in children. No sex predilection was found. The buccal mucosa region is the most common site followed by the tongue. Classic lipomas are most common in the oral region and comprise 48% of the tumors. A case of spindle cell lipoma of the lower lip is reported. Its clinical, histologic, and cytogenetic workup is the first well-documented case. Further cytogenetic studies should be undertaken to learn more about the pathogenesis and tumorigenesis of OL.

title: Lipomas of the oral cavity: clinical findings, histological classification and proliferative activity of 46 cases.
abstract: Lipomas represent about 1 to 5% of all neoplasms of the oral cavity. Although relatively common, few large series of intraoral lipomas and its variants are seen in the literature. Therefore, the authors present the clinical, histological and immunohistochemical features of 46 cases of intraoral lipomas reviewed from the files of the University of Campinas Dental School from 1970 to 2001. Most of the cases affected adults, without gender predilection, and the main involved sites were the buccal mucosa (21 cases), tongue (six cases), lips (six cases) and floor of mouth (five cases). The histological analysis revealed 21 cases of lipoma, 18 fibrolipomas, four intramuscular lipomas, two minor salivary gland lipomas and one spindle cell lipoma. PCNA and ki-67 expression indexes were higher in spindle cell lipoma, intramuscular lipomas and fibrolipomas compared to common lipomas, but the differences were not statistically significant. All lesions were removed surgically and none showed recurrence, regardless of the various proliferative activities.

title: Spindle cell lipoma of the oral cavity: report of a case.
abstract: A true lipoma is an uncommon lesion intraorally and the spindle cell variant is extremely rare, with only four cases reported in the English language literature. A new case of spindle cell lipoma affecting the tongue of a 68-year old white woman is reported.

title: Spindle Cell Lipoma of the Oral Cavity
abstract: Spindle cell lipoma is typically seen in the neck/trunk region of middle-aged and older men. Rare cases of oral spindle cell lipoma have been reported. An entity described as myxoid lipoma of the oral cavity has rarely been reported but appears to be more properly classified as spindle cell lipoma. We describe the largest series yet of oral spindle cell lipoma involving the tongue (4), buccal mucosa (1), floor of mouth (1), and lip (1). The patients (3M; 4F) ranged from 31 to 88 years old. All presented with mass lesions. All were circumscribed and composed of mature adipocytes admixed with bland spindled cells. In two cases the adipocytes appeared atrophic, imparting a pseudo-lipoblastic appearance. No true lipoblasts were seen and none had the characteristic vasculature of a myxoid liposarcoma or the characteristic hyperchromatic cells of well-differentiated liposarcoma. The stromal background of all cases contained characteristic wiry collagen and myxoid ground substance. The myxoid ground substance was prominent in four cases. Immunohistochemical stains for CD34 highlighted the bland spindle cells in all cases. The combination of the histologic features and the immunoreactivity for CD34 confirmed the diagnosis. Spindle cell lipoma should be considered in the differential diagnosis of oral cavity mesenchymal tumors.

title: Spindle cell lipoma of the tongue: A case report of unusual occurrence
abstract: Spindle cell lipoma (SCL) is a benign lipomatous tumor predominantly occurring at the posterior neck and shoulder area. Face, forehead, scalp, cheek, perioral area, and upper arm are less common sites. In oral cavity, it is a relatively uncommon neoplasm, particularly in tongue, which is relatively devoid of fat cells. We present a case report of SCL located on the left lateral border of the tongue in a 64-year-old Caucasian female patient with diabetes mellitus type 2 and arterial hypertension.

title: Spindle cell lipoma
abstract: Spindle cell lipomas (SCLs) are a group of benign lipogenic tumours, typically arising in the posterior neck, upper back and shoulder of elderly male patients. Approximately 80% of these tumours arise in characteristic location, but 20% arise in unusual locations, thereby making these cases more difficult to diagnose. We present a case of SCL occurring in the right periorbital region of a 14-year-old boy. The MRI was suggestive of possible malignancy. Diagnosis of neurofibroma was made on incisional biopsy. However, the histopathological and immunohistochemical analyses of the excised lesion confirmed the diagnosis of SCL.

title: Spindle cell lipoma of the cheek: A case report and review of literature
abstract: Spindle cell lipoma is a benign tumour composed of mature fat cells, spindle cells, and a myxoid matrix separated by thick bands of birefringent collagen. Oral spindle cell lipoma is a very rare lesion. We report a case of spindle cell lipoma of the cheek. A 42-year-old woman was referred to our department because of a painless swelling on the left cheek. Clinical examination revealed a mobile, well-demarcated mass of the cheek. The tumour was removed surgically under general anaesthesia. A histopathological specimen revealed a spindle cell lipoma. Following surgery, no evidence of recurrence has been observed.

title: Intraoral lipoma: a rare clinical entity
abstract: Lipoma is a painless soft tissue tumour of the mesenchymal origin, which is slow growing and well circumscribed. The occurrence of lipoma is rare in the oral cavity (1–4%); however, the frequency is much higher in the head and neck region. The tumour is mostly present in the buccal mucosa, lips, tongue, palate, buccal sulcus and floor of the mouth. Sometimes the tumour becomes large enough to cause difficulty in speech and mastication. Histologically, lipoma is composed of mature fat cells, surrounded by normal fat. We present two cases of intraoral lipoma in two female patients.

title: Large oral lipoma: Case report and literature review in Iran
abstract: Lipoma is a benign mesenchymal tumor of fat with uncertain pathogenesis. Although the most common mesenchymal neoplasm in trunk and proximal portions of the extremities, it is rarely seen in the oral cavity. Oral lipomas are clinically soft, smooth-surfaced nodular masses that mostly are less than 3 cm in size. Typically the tumor is asymptomatic unless bitten or become noticeable because of their size. The buccal mucosa and buccal vestibule are the most common intraoral sites and account for 50% of all cases. Reported here is a relatively large lipoma of buccal mucosa that was treated surgically under local anesthesia. In an 18-month postsurgical follow up no complication or recurrence has occurred. This case will also be compared to intraoral lipomas reported in Iranian population. As lipomas are usually smaller than 3 cm in diameter, lipoma with the size reported, is of clinical importance. Since the large lipomas are in differential diagnosis with other, even malignant, mesenchymal, or salivary gland tumors. Thus, this case report recommends clinical awareness in diagnosis of large intraoral soft tissue lesions.

title: Lipomas of the oral cavity: clinical and histopathologic study of 41 cases in a Brazilian population
abstract: This study evaluated the clinical and histopathologic aspects of 41 cases of oral lipomas diagnosed in a Brazilian population. All records from patients diagnosed with oral lipoma between 1970 and 2008 were reviewed. Histological sections were evaluated by light microscopy. There was a predominance of females (2.4:1), with a peak incidence between the sixth and seventh decade. The buccal mucosa was the most affected site (53.7%), followed by the buccal sulcus (14.6%) and tongue (9.8%). Tumor size ranged from 0.5 to 10 cm and the mean reported duration was 48 months. Histologically, the following variants were identified: lipoma (41.5%), fibrolipoma (34.1%), spindle cell lipoma (9.8%), sialolipoma (9.8%), osteolipoma (2.4%), and chondrolipoma (2.4%). Most tumors were well delimited, irrespective of the variant. Lipomas are rare tumors of the oral cavity. The characterization of new variants, such as sialolipomas, and the identification of histological subtypes in already known variants, such as low-fat and fat-free spindle cell lipomas, highlight the importance for careful microscopic evaluation of these tumors, which might be combined with immunohistochemistry in some cases.

title: Intraoral lipomas: a study of 26 cases in a Brazilian population.
abstract: To analyze the clinical and histopathologic features of all cases diagnosed as lipomas in the oral cavity in a Brazilian population.



From 2002 to 2006, 26 cases of intraoral lipoma were studied. Clinical features obtained from biopsy records and microscopic slides were reviewed according to the World Health Organization and other cases previously described.



Mean age was 54.6 years (range, 29 to 91 years) with predilection for women. The buccal mucosa was the most common location (n= 9), followed by the tongue (n= 7), lower lip (n= 4), floor of the mouth (n= 3), retro-molar area (n= 2), and buccalsulcus(n= 1).Histologically, the lesions were defined as classic lipomas(n= 15),fibrolipomas(n= 7), intramuscular lipoma(n= 2), spindle-cell lipoma(n= 1), and sialolipoma(n= 1). Follow-up information was available in 20 cases. No case recurred during a 6- to 12-month period.



The benign nature of intraoral lipomas is supported by its bland histopathologic appearance and the absence of recurrences following complete local excision

title: Spindle cell lipoma
abstract: Spindle cell lipoma is a specific type of lipoma that is easily mistaken for a liposarcoma. An analysis of 114 cases of this tumor from the files of the Armed Forces Institute of Pathology reveals that it occurs chiefly in male patients between 45 and 70 years of age and affects the regions of the shoulder and posterior neck almost exclusively. Microscopically, it consists of an intricate mixture of lipocytes and uniform spindle cells within a matrix of mucinous material traversed by a varying number of birefringent collagen fibers. Ultrastructural studies in one case support the fibroblastic nature of the spindle cells. Followup information obtained in 63 patients with this lesion revealed a uniformly favorable clinical course, indicating that local excision is the treatment of choice, and that there is no need or reason for radical surgical procedures.

title: Spindle Cell Lipoma of the Oral Cavity: A Clinico-Pathologic Analysis of 35 Reported Cases
abstract: Spindle-cell lipoma (SCL) is a variant of lipoma, usually presenting in the neck or trunk. SCL of the oral cavity is rare. Some cases of oral SCL have been reported; however, the clinico-pathologic characteristics of oral SCL are still unknown. Here we report on 2 cases and review 33 cases of oral SCL published in the literature. The patients were 23 men and 12 women, with a mean age of 55 years (range 23 - 88 years); there were no children. Tumor sites included: tongue (n = 13), cheek/buccal mucosa (n = 11), floor of mouth (n = 5), lip (n = 2), hard palate (n = 2), alveolar ridge (n = 1), and maxilla (n = 1). The mean tumor size was 20.87 mm (range 3 - 50 mm), smaller than extra-oral lesions. Thirty-three patients (94%) presented with a single lesion that was circumscribed and composed of mature adipocytes admixed with bland spindle cells. The spindle cells were strongly immunoreactive for CD34, whereas the adipocytes were negative. The main differential diagnosis is atypical lipoma/well-differentiated liposarcoma. All lesions underwent local excision and recurrences are rare. Oral SCL do not seem to differ from their extra-oral counterpart, which are much more common and larger in size. SCL should be included in the differential diagnosis of oral cavity mesenchymal tumors.

title: Nerve sheath myxoma of the oral cavity: case report and review.
abstract: Nerve sheath myxoma is a benign peripheral nerve sheath tumor that rarely occurs in the oral cavity; approximately 12 cases have been reported to date. On histologic evaluation the lesions consist of closely aggregated fascicles that vary considerably in cellularity. Some of the lesions are predominantly myxoid with widely spaced, stellate-shaped cells. Other lesions consist of closely aggregated spindle cells in a matrix that appears fibrous yet stains strongly for acid mucopolysaccharides (extracellular mucin). Small numbers of mitotic figures may be observed. Because of their rarity and unusual histologic appearance, it is advisable that the pathologist be familiar with these lesions; they may be mistaken for other myxoid lesions of the oral mucosa. We describe a single case of nerve sheath myxoma that arose in the buccal mucosa in a woman.