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The Unseen Growth By Drs. Uzkelia Uzcategui Moncada, Alice Arroyo-Julia, Adrian Estopinales Paredes, Aaron Avila Lopez

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The Unseen Growth 

A case report on lipoma of the lower lip

by Drs. Uzkelia Uzcategui Moncada, Alice Arroyo-Julia, Adrian Estopinales Paredes and Aaron Avila Lopez

Introduction
Lipomas are common benign soft tissue tumors that originate from mesenchymal cells in connective tissue. Typically characterized by slow growth and a lack of pain, lipomas are among the most frequently encountered benign tumors in the body.1 However, their occurrence in the oral cavity is notably rare, with a reported incidence of 1–4%.2 These tumors are often asymptomatic and can remain undetected for years until they cause functional or aesthetic concerns. Intraoral lipomas, though uncommon, may present unique challenges due to their potential to interfere with speech, mastication and overall oral health.

The incidence of oral lipomas varies globally and within the United States. Although the exact global prevalence is difficult to ascertain due to underreporting and diagnostic challenges, studies suggest a low incidence in the oral cavity compared to other anatomical sites. In the United States, intraoral lipomas constitute a small fraction of all lipoma cases.3 This case report highlights a rare instance of an intraoral lipoma on the lower lip, emphasizing the importance of differential diagnosis, surgical management and histopathological evaluation in such cases.


Case report
Lipoma Case
Fig. 1: Soft mass on the mucous membrane of the lower lip.
Lipoma Case
Fig. 2: Soft mass during the procedure of excision.
Lipoma Case
Fig. 3: Excised specimen.

Lipoma Case
Fig.4: Pathology report by Dr. Danny Mora González, DMD, FAAOMP, MS.

A 60-year-old male presented to the dental clinic of the General Practice Residency program at the University of Puerto Rico with a complaint of a soft mass on the mucous membrane of his lower lip (Fig. 1). The patient reported noticing the lesion approximately two years earlier but did not seek medical attention due to the absence of symptoms. Over time, the mass began to cause discomfort, particularly during speaking and chewing, prompting the patient to seek evaluation.

During the clinical examination, a soft, mobile and well-defined mass was found on the mucosal surface of the lower lip. The lesion measured approximately 2.0 cm by 1.7 cm by 1.1 cm and was non-tender upon palpation. The overlying mucosa appeared intact, showing no signs of ulceration or inflammation. The clinical presentation suggested a benign lesion, leading to a provisional diagnosis of lipoma.

Differential diagnoses for this type of lesion include fibroma, mucocele, salivary gland tumors and benign mesenchymal tumors, such as neurofibroma or schwannoma. Imaging studies, such as ultrasound or MRI, were not considered necessary in this case due to the lesion’s superficial location and clinical characteristics.

Surgical excision of the lesion was performed under local anesthesia. The procedure was uneventful, and the excised specimen was sent for histopathological analysis (Fig. 2 and Fig. 3). Gross examination revealed a yellowish, encapsulated mass consistent with a lipoma. Microscopically, the lesion consisted of mature adipose tissue with no evidence of malignancy, confirming the diagnosis of a benign lipoma (Fig. 4).

Postoperative recovery was successful, and the patient reported significant improvement in speech and chewing functions during follow-up visits. No recurrence was observed after six months, underscoring the efficacy of complete surgical excision.


Discussion
Lipomas in the oral cavity, while rare, present unique diagnostic and therapeutic challenges. Their etiology remains unclear, though they are believed to arise from the proliferation of adipocytes caused by trauma, genetic factors or metabolic disturbances. The lower lip is an unusual site for lipomas, as these tumors more commonly occur in areas with abundant adipose tissue.

These tumors predominantly affect adults, with a slight predilection for males. Intraoral lipomas typically present as slow-growing, painless masses, often discovered incidentally during routine dental examinations or when they cause functional impairment.

The differential diagnosis of intraoral lipomas includes:
  • Fibroma: A common benign tumor arising from fibrous connective tissue, often associated with trauma or irritation.
  • Mucocele: A mucous retention cyst caused by the obstruction of minor salivary glands, typically presenting as a bluish, fluid-filled lesion.
  • Salivary gland tumors: Benign or malignant neoplasms originating from salivary gland tissue, requiring histopathological confirmation for definitive diagnosis.
  • Neurofibroma/schwannoma: Benign peripheral nerve sheath tumors, presenting as firm, well-circumscribed masses.4
Histopathological examination is crucial for confirming the diagnosis of lipoma and ruling out malignancy, such as liposarcoma. Imaging modalities, including ultrasound and MRI, may aid in the evaluation of larger or deeper lesions; however, they are rarely required for superficial lipomas.

Management of intraoral lipomas typically involves surgical excision, which is curative in most cases. Complete removal of the tumor, along with its capsule, minimizes the risk of recurrence. Patients should be reassured about the benign nature of the lesion, but regular follow-up is essential to monitor for any signs of recurrence.


Conclusions
Intraoral lipomas are rare but clinically significant entities that can impact oral function and quality of life. This case underscores the importance of considering lipoma in the differential diagnosis of soft tissue masses in the oral cavity. Prompt surgical intervention and histopathological evaluation are crucial for a definitive diagnosis and effective management.

Educating patients about the benign nature of lipomas and the benefit of surgical excision is essential. This case highlights the need for increased awareness among clinicians to ensure timely diagnosis and treatment of such lesions. By doing so, dentists can alleviate patient discomfort and improve overall oral health outcomes.


References
1. Fregnani, E. R., Pires, F. R., & Falzoni, R. (2003). Lipomas of the oral cavity: A study of 24 cases. International Journal of Oral and Maxillofacial Surgery, 32(1), 49-53.
2. Hamsi, G., Ozkan, A., & Yildirim, D. (2014). Intraoral lipomas: A comprehensive review of the literature. Clinical Oral Investigations, 18(2), 381-389.
3. Epstein, J. B., Villines, D., & Shariff, G. (1995). Lipomas of the oral cavity: A clinical review. Journal of Oral Pathology & Medicine, 24(4), 163-167.
4. Chandler, K., Smith, A., & Craig, G. (2006). Diagnostic Challenges in Oral Soft Tissue Tumors. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 101(5), 556-564.
Author Bios
Dr. Uzkelia Uzcategui Moncada Dr. Uzkelia Uzcategui Moncada graduated in 2002 with a degree in dental medicine from the University of Zulia. She completed her general practice residency at the University of Puerto Rico in 2006, followed by a degree in oral and maxillofacial surgery in 2010 at the same institution. In addition to her academic role, she currently serves as the director of the Dental Clinic at Hospital Federico Trilla. She is actively involved in patient care at both Hospital Federico Trilla and Hospital Universitario de Adultos.


Dr. Alice Arroyo Dr. Alice Arroyo-Juliá earned her DMD in 2017 and completed a general practice residency at the University of Puerto Rico in 2019. Arroyo-Juliá furthered her studies by obtaining a graduate certificate in gerontology in 2021 and a Master of Public Health in 2023. Currently, Arroyo-Juliá is a full-time faculty member at the University of Puerto Rico’s School of Dental Medicine, where she also serves as chief of the Community Section and director of the General Practice Residency (GPR) program.



Dr. Adrian Estopinales Paredes Dr. Adrian Estopinales Paredes graduated from the University of Cienfuegos in Cuba in 2013. Since 2019, he has worked in Florida as a dental hygienist. In 2023, Estopinales joined the GPR program at the University of Puerto Rico, where he is currently in his second year of residency and serves as the chief resident alongside Dr. Avila.




Dr. Aaron Avila Lopez Dr. Aaron Avila Lopez worked in his private practice in Mexico, where he specialized in endodontics. In 2023, he chose to advance his academic training by joining the GPR program in Puerto Rico, where he is currently in his second year and shares the responsibility of chief resident with Dr. Estopinales.
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