Spindle Cell Lipoma of the Oral Cavity: A Clinico-Pathologic Analysis of 35 Reported Cases

Esther Manor, Netta Sion-Vardy, Peter A. Brennan, Lipa Bodner

3Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK.
Department of Oral and Maxillofacial Surgery, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Department of Pathology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Institute of Human Genetics, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

DOI: 10.4236/ss.2013.43037                

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.

Keywords

Lipoma; Spindle Cell Lipoma; Oral Cavity

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	E. R. Fregnani, F. R. Pires, R. Falzoni, et al., “Lipomas of the Oral Cavity: Clinical Findings, Histological Classification and Proliferative Activity of 46 Cases,” International Journal of Oral and Maxillofacial Surgery, Vol. 32, No. 1, 2003, pp. 49-53. doi:10.1054/ijom.2002.0317
[2]	M. A. Furlong, J. C. Fanburg-Smith and E. L. B. Childers, “Lipoma of the Oral and Maxillofacial Region: Site and Sub-Classification of 125 Cases,” Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, Vol. 98, No. 4, 2004, pp. 441-450. doi:10.1016/j.tripleo.2004.02.071
[3]	F. M. Enzinger and D. A. Harvey, “Spindle Cell Lipoma,” Cancer, Vol. 36, No. 5, 1975, pp. 1852-1859.
[4]	M. A. de Freitas, V. S. Freitas, A. A. de Lima, et al., “Intraoral Lipomas: A Study of 26 Cases in a Brazilian Population,” Quintessence International, Vol. 40, No. 1, 2009, pp. 79-85.
[5]	L. E. R. Julliasse, C. F. W. Nonaka, L. P. Pinto, et al., “Lipomas of the Oral Cavity: Clinical and Histopathologic Study of 41 Cases in a Brazilian Population,” European Archives of Otorhinolaryngology, Vol. 267, No. 3, 2010, pp. 459-465.
[6]	E. Manor, N. Sion-Vardy, B. Z. Joshua, et al., “Oral Lipoma: Analysis of 58 New Cases and Review of the Literature,” Annals of Diagnostic Pathology, Vol. 15, No. 4, 2011, pp. 257-261. doi:10.1016/j.anndiagpath.2011.01.003
[7]	R. K. McDaniel, J. R. Newland and D. G. Chiles, “Intraoral Spindle Cell Lipoma: Case Report with Correlated Light and Electron Microscopy,” Oral Surgery Oral Pathology Oral Radiology and Endodontology, Vol. 57, No. 1, 1984, pp. 52-57. doi:10.1016/0030-4220(84)90260-3
[8]	P. Christpoulos, O. Nicolatou and A. Partikiou, “Oral Spindle Cell Lipoma: Report of a Case,” International Journal of Oral and Maxillofacial Surgery, Vol. 18, No. 4, 1989, pp. 208-209. doi:10.1016/S0901-5027(89)80054-2
[9]	F. E. Levy and G. S. Goding Jr., “Spindle Cell Lipoma: An Unusual Oral Presentation,” Otolaryngology-Head and Neck Surgery, Vol. 101, No. 5, 1989, pp. 601-603.
[10]	T. Lombardi and E. W. Odell, “Spindle Cell Lipoma of the Oral Cavity: Report of a Case,” Journal of Oral Pathology & Medicine, Vol. 23, No. 5, 1994, pp. 237-239.
[11]	K. Tosios, S. I. Papanicolaoi, N. Kapranos and N. Papadogeorgakis, “Spindle Cell Lipoma of the Oral Cavity,” International Journal of Oral and Maxillofacial Surgery, Vol. 24, No. 5, 1995, pp. 363-364. doi:10.1016/S0901-5027(05)80493-X
[12]	S. P. Khoo and C. B. Lian, “Intraoral Spindle Cell Lipoma: Report of a Case and Literature Review,” Annals of Dentistry, Vol. 54, No. 1-2, 1995, pp. 53-55.
[13]	A. Piatteli, C. Rubini, M. Fioroni, et al., “Spindle-Cell Lipoma of the Cheek: A Case Report,” Oral Oncology, Vol. 36, No. 5, 2000, pp. 495-496. doi:10.1016/S1368-8375(00)00035-X
[14]	S. N. Dutt, D. M. East, Y. Saleen, et al., “Spindle-Cell Variant of Intralingual Lipoma-Report of a Case with Literature Review,” Journal of Laryngology and Otology, Vol. 113, No. 6, 1999, pp. 587-589. doi:10.1017/S0022215100144561
[15]	A. Piatteli, M. Fioroni and C. Rubini, “Spindle Cell Lipoma of the Oral Cavity: Report of a Case,” Journal of Oral and Maxillofacial Surgery, Vol. 57, No. 5, 1999, pp. 624-625.
[16]	S. N. Agoff, A. L. Folpe, V. S. Greico, et al., “Spindle Cell Lipoma of the Oral Cavity. Report of a Rare Intramuscular Case with Fine Needle Aspiration Findings,” Acta Cytologica, Vol. 45, No. 1, 2001, pp. 93-98.
[17]	N. Said-Al-Naief, F. R. Zahurullah and J. J. Sciubba, “Oral Spindle Cell Lipoma,” Annals of Diagnostic Pathology, Vol. 5, No. 4, 2001, pp. 207-215. doi:10.1053/adpa.2001.26973,
[18]	E. Atik, U. Usta and N. E. Aydin, “Pleomorphic Lipoma of the Tongue,” Otolaryngology-Head and Neck Surgery, Vol. 126, No. 4, 2002, pp. 430-431.
[19]	M. Darling, I. Thompson and J. Schneider, “Spindle Cell Lipoma of the Alveolar Mucosa: A Case Report,” Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, Vol. 93, No. 2, 2002, pp. 171-173. doi:10.1067/moe.2002.120520,
[20]	N. Kaku, K. Kashima, T. Daa, et al., “Multiple Spindle Cell Lipomas of the Tongue: Report of a Case,” Apmis, Vol. 111, No. 5, 2003, pp. 581-585.
[21]	A. Piatteli, V. Perrotti, M. Fioroni, et al., “Spindle Cell Lipoma of the Floor of the Mouth: Report of a Case,” Auris Nasus Larynx, Vol. 32, No. 2, 2005, pp. 205-207. doi:10.1016/j.anl.2005.01.013
[22]	G. Kawasaki, S. Yanamto, K. Hirata, et al., “Spindle Cell Lipoma of the Cheek: A Case Report and Review of Literature,” Oral Oncology Extra, Vol. 42, No. 10, 2006, pp. 301-304. doi:10.1016/j.ooe.2006.09.003,
[23]	F. Coimbra, J. M. Lopes, H. Figueiral, et al., “Spindle Cell Lipoma of the Floor of the Mouth: A Case Report,” Medicina Oral Patologia Oral y Cirugia Bucal, Vol. 11, No. 5, 2006, pp. E401-403.
[24]	S. D. Billings, J. D. Henely, D. J. Summerlin, et al., “Spindle Cell Lipoma of the Oral Cavity,” American Journal of Dematopathology, Vol. 28, No. 1, 2006, pp. 28-31.
[25]	T. Imai, M. Michizawa, H. Shimizu, et al., “Bilateral Multiple Spindle Cell Lipomas of the Tongue,” Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, Vol. 106, No. 2, 2008, pp. 264-269.
[26]	G. Vecchio, P. Amino, R. Catabrano, et al., “Spindle Cell/Pleomorphic Lipoma of the Oral Cavity,” Journal of Craniofacial Surgery, Vol. 20, No. 6, 2009, pp. 1992-1994.
[27]	S. M. Stokes, J. P. Wood and J. T. Castle, “Maxillary Intraosseous Spindle Cell Lipoma,” Journal of Oral and Maxillofacial Surgery, Vol. 69, No. 6, 2011, pp. e131-e134.
[28]	P. C. Caldiera, V. F. Bernardes and A. C. Miranda, “Oral Spindle Cell Lipomas,” Open Journal of Stomatology, Vol. 1, No. 4, 2011, pp. 202-206.
[29]	P. Chandrashekar, M. Jose, M. Dadhich, et al., “Spindle Cell Lipoma: A Case Report and Review of Literature,” Kathmandu University Medical Journal (KUMJ), Vol. 10, No. 2, 2012, pp. 92-95. doi: doi:10.3126/kumj.v10i2.7353
[30]	S. Cakarer, F. Selvi, S. C. Isler, et al., “Intraosseous Lipoma of the Mandible: A Case Report and Review of the Literature,” International Journal of Oral and Maxillofacial Surgery, Vol. 38, No. 8, 2009, pp. 900-902. doi:10.1016/j.ijom.2009.03.712
[31]	C. D. M. Fletcher and E. Martin-Bates, “Spindle Cell Lipoma: A Clinicopathological Study with Some Original Observations,” Histopathology, Vol. 11, No. 8, 1987, pp. 803-817.
[32]	L. Wood, T. J. Fountaine, L. Rosamilia, et al., “Cutaneous CD34+ Spindle Cell Neoplasms: Histopathologic Features Distinguish Spindle Cell Lipoma, Solitary Fibrous Tumor and Dermatofibrosarcoma Protuberans,” American Journal of Dermatopathology, Vol. 32, No. 8, 2010, pp. 764-766.
[33]	S. Suster, C. Fisher and C. A. Moran, “Expression of bcl-2 Oncoprotein in Benign and Malignant Spindle Cell Tumors of Soft Tissue, Skin, Serosal Surfaces and Gastrointestinal Tract,” American Journal of Surgical Pathology, Vol. 22, No. 7, 1998, pp. 863-872.
[34]	A. A. Sandberg, “Update on the Cytogenetics and Molecular Genetics of Bone and Soft Tissue Tumors: Lipoma,” Cancer Genetics and Cytogenetics, Vol. 150, No. 2, 2004, pp. 93-114.
[35]	J. C. Fanburg-Smith, M. A. Furlong and E. L. B. Childers, “Liposarcoma of the Oral and Salivary Gland Region: A Clinicopathologic Study of 18 Cases with Emphasis on Specific Sites, Morphologic Subtypes and Clinical Outcome,” Modern Pathology, Vol. 15, No. 10, 2002, pp. 1020-1031.
[36]	F. G. Bechara, M. Sand, D. Sand, et al., “Lipolysis of Lipomas in Patients with Familial Multiple Lipomatosis: An Ultrasonography-Controlled Trial,” Journal of Cutaneous Medicine and Surgery, Vol. 10, No. 4, 2006, pp. 155-159.