CARTA AL DIRECTOR

Lingual Lipoma. A curiosity

Lipoma de lengua. Una curiosidad

Mr. Director

It is a well known phenomenon that lingual pathology is limited to scarce entities, predominately among epithelia lesions, leaving the rest of the semiotic delegated to infrequent cases. In the literature these cases are generally referred to as isolated or short series cases. In this last group we can include lingual fatty tumors. Although they deal with benign mesenchymes whose treatment is simple surgical abscission, the limited specificity of its symptoms and clinical presentations can present doubts to the doctor who is handling the case.

We mention this case after receiving a lingual lesion removed from a 79 year-old smoker. It was diagnosed as being a cyst however the doctor communicated his concern about discarding lesions of great concern especially when taking into special account the patient's age and pre-existing conditions. He received a mucous ellipse with a maximum dimension of 0.8 cm which was apparently non cystic, with epithelial inflammation at the surface. At the incision, the sub epithelial parenchyma was whitish-yellow and of a soft consistency. The histological study showed the lesion consisted of fatty cells without atypia and with a presence of a-cellular hyaline that defined fatty lobes. A strip of condensed connective tissue was found separating the lesion from the adjacent epithelium (Fig. 1-3).

With these facts they diagnosed it as lipoma. Even though the lipoma is the most frequent benign mesenchyme it is the least frequent in the tongue. If we remember the histology of the tongue the apposition brings attention to the mucous over thick skeletal muscle which leaves the lamina itself reduced to a fine layer of connective tissue more or less flaccid. Therefore it is more logical to think of leiomyomas and fibroids as lesions characteristically found in this site. The fatty tissue is scarce at the level of lamina however, unforeseen tumors can form. The most complete series of oral lipomas that we found¹ consists of 15 lipomas located on the tongue, the fourth most frequent oral site, coinciding with other projects that discuss the idea that a marked preference in kind does not exist and the most occurrence in elderly patients. Even though the majority of the lingual lipomas correspond to the classic phenotype, like the one we described, they have the same incidence as the lipoma of fusiform/pholymorphic cells and especially the chondroid.^2,3

The majority of the cases deal with discoveries that are not prognostically important. However caution must be used in their removal because the absence of encapsulation can lead to relapses. The diagnostic differential always needs to be established with the liposarcoma well differentiated (the subtypes of less differentiated liposarcoma differentiated are usually as similar to simple lipoma) in order to do this it is fundamental to observe the nuclear morphology: the presence of nuclear atypism which in the majority of cases is represented irregular contours of the karyotheca and hyperchromatism. This will define the diagnosis of liposarcoma. It is important not to confuse the presence of polymorphic cells of the polymorphic lipoma with the atypism seen in the liposarcomas. It shouldn't be considered an essential nor diagnostic requirement but rather it should be considered in the context of the histological changes that accompany the square. Finally, the most adequate treatment in those cases where the doctor has either doubts about diagnosis or bothering the patient is simple surgical abscission.

Francisco Javier Torres Gómez, Pilar Fernández Machín, Antonia Martínez Moyano
(TEAP). Unidad de Anatomía Patológica. Hospital de Alta resolución de Utrera. Sevilla, España

References

1. Furlong MA, Fanburg-Smith JC, Chelders EL. Lipoma of the oral and maxillofacial region: site and subclassification of 125 cases. Oral Surg Oral Med Oral Pathol Oral radiol Endod 2004; 98:441-50.        [ Links ]

2. Epivatianos A, Markopoulos AK, Papanayotou P. Benign tumors of adipose tissue of the oral cavity: a clinicopathologic study of 13 cases.        [ Links ]

3. Bándeca MC, de Padua JM, Nadalin MR, Ozorio JE, Silva-Sousa YT, da Cruz Perez DE. Oral Soft tissue lipomas: a case series. J Can Dent Assoc 2007; 73(5): 431-34.        [ Links ]