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【前言】

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原文題目(出處): Osteolipoma: a rare tumor in the oral cavity 原文作者姓名: Sheyla Viana Omonte, Rosana Maria Leal,

Bruno Augusto Benevenuto de Andrade, Hermínia Marques Capistrano,

Paulo Eduardo Alencar Souza, Martinho Campolina Rebello Horta

通訊作者學校: Pontifícia Universidade Católica de Minas Gerais 報告者姓名(組別): 劉怡伶(C)

報告日期: 106/10/05

【前言】

Lipoma:

1. benign mesenchymal neoplasms of soft tissue

2. 20% of cases occur in the head and neck region, with only 1% to 4% occurring in the oral cavity: buccal mucosa, floor of the mouth, and lips

3. Histologic variants: fibrolipoma, angiolipoma(血管), myolipoma(肌細胞), leiomyolipoma(平滑肌), myxolipoma(黏液), spindle cell lipoma, osteolipoma, chondrolipoma(軟骨), and sialolipoma(唾液腺).

Osteolipoma:

1. less than 1%, only 13 cases was presented

2. classified as intraosseous when located in bone and as parosteal or periosteal when located adjacent to bone

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【Case report】

1. 29-year-old female with a painless mass in the left buccal mucosa with an 8- month evolution. The patient had no history of trauma in that region.

2. Physical intraoral examination showed a 1.5 x 1.5 cm, well-defined, movable submucosal mass in the left posterior buccal mucosa, near the retromolar triangle. The lesion had a yellowish appearance and hard consistency. The overlying mucosa showed telangiectasia but no ulceration or erythema.

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3. Imaging findings revealed a round area of radiopacity, with an irregular pattern of trabeculae, and no evidence of influence on the surrounding structures was found.

4. With the patient under local anesthesia, the lesion was completely excised, and it was not attached to any adjacent structures, such as the mandibular bone.

5. Specimen :

(1) consisted of a mass measuring 1.8 x 1.5 x 1.2 cm

(2) Yellowish with various intermixed thin lamellar bony structures and a fibrous capsule.

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6. Microscopically:

(1) Abundant mature adipose tissue, with no atypia, and was separated by thin fibrous connective tissue septa.

(2) Randomly distributed irregular trabeculae of immature bone, with osteoblastic activity, were found throughout the tumor.

(3) No foci of hematopoietic cells were observed

(4) Surrounded by a thin osseous layer and a fibrous capsule.

7. A final diagnosis of osteolipoma was established. The recovery course was uneventful, and no recurrence was detected after a 5-year long follow-up.

【Clinical differential diagnosis】

Oral osseous choristoma (soft tissue osteoma), cartilaginous choristoma,

osteolipoma, chrondrolipoma, pleomorphic adenoma with ossification, and other salivary gland or connective tissue tumors with dystrophic calcification.

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【Discussion】

1. Above table

(1) no clear gender preponderance

(2) except for one case of a young boy, most patients were adults (3) slow progression

(4) occur in various anatomic sites: buccal mucosa(4), buccal vestibule(4), hard palate(3), mouth floor(2), lateral tongue(1)

(5) clinical and radiographic features (hard or soft peripheral mass generally associated with a radiopaque area), as well as the histopathologic appearance of mature fatty tissue with diffuse bone trabeculae, usually

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2. However, these features are also found in oral osseous choristoma:

(1) Krolls et al. in 1971 to describe benign bone formations in oral soft tissue, previously referred to as soft tissue osteomas.

(2) A mass of dense lamellar bone, which is easily differentiated from an osteolipoma

(3) Some of these lesions can display a cancellous pattern: Hodder and MacDonald in 1988, display spongy bone trabeculae containing abundant bone marrow spaces filled with fatty tissue

(4) Foci of hemopoietic marrow are encountered in osseous choristomas but not in osteolipomas

(5) Treated by conservative surgical excision and exhibit similar prognoses 3. Pathogenesis of osteolipomas:

(1) Has not yet been clarified

(2) May originate from two types of undifferentiated mesenchymal cells that separately form adipose and bone cells

(3) Multipotent adipose-derived stem cells within adipose tissue may be involved in osteolipoma development

(4) Repetitive trauma, metabolic changes, or ischemia may lead to metaplasia of pre-existing fibrous elements within lipomas, which then develop into osteoblasts

【Conclusion】

Osteolipomas:

1. Very rare

2. Clinical: hard consistency on palpation 3. Image examinations: radiopacity

4. Histopathological: mature adipose tissue associated with bone trabeculae 5. Same prognosis as a simple lipoma:

(1) Surgical excision

(2) Recurrences have not been reported

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題號 題目

1

下列關於 lipoma 之敘述何者有誤?

(A) may occur after local trauma

(B) most common intraoral sites : buccal mucosa and buccal vestibule(about 50%)

(C) treated by conservative local excision (D) recurrence is common

答案 (D)

出處:Oral and Maxillofacial Pathology , 4th edition, Ch.12

說明:Lipoma 本身以及各種變異中, 只有 Intramuscular lipomas 有較高 的復發率

題號 題目

2

下列 lipoma 的變異中何者最常見?

(A) fibrolipoma (B) angiolipoma (C) sialolipoma

(D) intramuscular (infiltrating) lipomas 答案

(A )

出處:Oral and Maxillofacial Pathology , 4th edition, Ch.12

參考文獻

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