Intraoral lipoma with degenerative changes mimicking atypical lipomatous tumor: an immunohistochemical study
Keywords:Lipoma, Liposarcoma, Mouth, Immunohistochemistry
Lipomas are mesenchymal neoplasms relatively uncommon in the oral cavity. Lipomas can exhibit histopathological features mimicking atypical lipomatous tumors (ALT) or dysplastic lipoma (DL) in the presence of degenerative changes. Relevantly, immunohistochemistry assists in the correct diagnosis. Herein, we present the case of a 54-year-old male with a sessile nodule located on the dorsum of the tongue. The histopathological analysis showed a diffuse, non-circumscribed adipocytic proliferation constituted by cells of variable size containing cytoplasmic vacuoles and displaced nuclei, some resembling lipoblasts supported by fibrous connective tissue stroma. By immunohistochemistry, tumor cells were positive for vimentin, S100, FASN, CD10, and p16. Rb expression was intact. Moreover, CD34, p53, MDM2, and CDK4 were negative. After 2-year of follow-up, no alteration or recurrence was observed. In conclusion, MDM2, CDK4, p53, and Rb immunomarkers can be used reliably to differentiate benign lipoma with degenerative changes from ALT and DL.
Studart-Soares EC, Costa FWG, Sousa FB, Alves APNN, Osterne RLV. Oral lipomas in a Brazilian population: a 10-year study and analysis of 450 cases
reported in the literature. Med Oral Patol Oral Cir Bucal. 2010;15(5):e691-6. http://dx.doi.org/10.4317/medoral.15.e691. PMid:20383107.
Manor E, Sion-Vardy N, Joshua BZ, Bodner L. Oral lipoma: analysis of 58 new cases and review of the literature. Ann Diagn Pathol. 2011;15(4):257-61.
Santos JL, Ocamoto EA, Almeida LY, Teixeira LR, Ribeiro-Silva A, León JE. Low-fat plexiform spindle cell lipoma with prominent myxoid stroma: an unusual oral presentation and immunohistochemical analysis. J Craniofac Surg. 2017;28(2):e158-60. http://dx.doi.org/10.1097/SCS.0000000000003348. PMid:28045832.
Rocha AFL, Miotto LN, Ferrisse TM, et al. Low-fat and fat-free spindle cell lipomas in the oral cavity: immunohistochemical analysis and review of the literature. J Cutan Pathol. 2019;46(10):778-83. http://dx.doi.org/10.1111/cup.13512. PMid:31115930.
Furlong MA, Fanburg-Smith JC, Childers 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(4):441-50. http://dx.doi.org/10.1016/j.tripleo.2004.02.071. PMid:15472660.
Stojanov IJ, Mariño-Enriquez A, Bahri N, Jo VY, Woo SB. Lipomas of the oral cavity: utility of MDM2 and CDK4 in avoiding overdiagnosis as atypical lipomatous tumor.
Head Neck Pathol. 2019;13(2):169-76. http://dx.doi.org/10.1007/s12105-018-0928-0. PMid:29748845.
Michal M, Agaimy A, Contreras AL, et al. Dysplastic Lipoma: A distinctive atypical lipomatous neoplasm with anisocytosis, focal nuclear atypia, p53 overexpression,
and a lack of MDM2 gene amplification by FISH; a reportof 66 Cases demonstrating occasional multifocality and a rare association with retinoblastoma. Am J Surg
Pathol. 2018;42(11):1530-40. http://dx.doi.org/10.1097/PAS.0000000000001129. PMid:30001242.
Piperi E, Tosios KI, Nikitakis NG, et al. Well-differentiated liposarcoma/atypical lipomatous tumor of the oral cavity: report of three cases and review of the literature.
Head Neck Pathol. 2012;6(3):354-63. http://dx.doi.org/10.1007/s12105-011-0327-2. PMid:22234501.
Nili F, Baghai F, Aghai A, Etebarian A. Well-differentiated liposarcoma of the floor of the mouth: report of a rare case and review of the literature. J Oral Maxillofac Pathol.2016;20(2):312-5. http://dx.doi.org/10.4103/0973-029X.185984. PMid:27601829.
Ohta K, Yoshimura H, Matsuda S, Imamura Y, Sano K. Oral liposarcoma in elderly: case report and literature analysis. Medicine. 2020;99(6):e18985. http://dx.doi.
Nikitakis NG, Lopes MA, Pazoki AE, Ord RA, Sauk JJ. MDM2+/CDK4+/p53+ oral liposarcoma: case report and review of the literature. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod. 2001;92(2):194-201. http://dx.doi.org/10.1067/moe.2001.116815. PMid:11505267.
Laco J, Mentzel T, Hornychova H, Kohout A, Jirousek Z, Ryska A. Atypical lipomatous tumors of the tongue: report of six cases. Virchows Arch. 2009;455(4):383-
Clay MR, Martinez AP, Weiss SW, Edgar MA. MDM2 and CDK4 immunohistochemistry: should it be used in problematic differentiated lipomatous tumors? A new
perspective. Am J Surg Pathol. 2016;40(12):1647-52. http://dx.doi.org/10.1097/PAS.0000000000000713.PMid:27508976.
Kammerer-Jacquet SF, Thierry S, Cabillic F, et al. Differential diagnosis of atypical lipomatous tumor/well-differentiated liposarcoma and dedifferentiated liposarcoma: utility of p16 in combination with MDM2 and CDK4 immunohistochemistry. Hum Pathol. 2017;59:34-40. http://dx.doi.org/10.1016/j.humpath.2016.08.009.
Evans HL. Anisometric cell lipoma: a predominantly subcutaneous fatty tumor with notable variation in fat cell size but not more than slight nuclear enlargement
and atypia. AJSP Rev Rep. 2016;21(4):195-9.
Mayo Yáñez M, González Poggioli N, Álvarez-Buylla Blanco M, Herranz González-Botas J. Benign symmetric lipomatosis with lingual involvement: case report and
literature review. J Stomatol Oral Maxillofac Surg. 2018;119(2):148-50. http://dx.doi.org/10.1016/j.jormas.2017.11.006. PMid:29129710.
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