口腔病理科 On-Line KMU Student Bulletin
- 1 -
原文題目(出處)： Angiolipoma of the cheek: A case report with a literature review. 2011;23:35-7.
原文作者姓名： Shigeaki Yanase, Jouji Nomura, Yoshihiko Matsumura, Hideharu Kato, Takashi Takeoka, Hiroko Imura, Rina Matsuura, Ko Nakanishi, Toshiro Tagawa
通訊作者學校： Department of Dentistry and Oral Surgery, Mie-chuo Medical Center, National Hospital Organization, Mie, Japan 報告者姓名(組別)： 陳信佑 Intern B組
報告日期： 100/10/07
內文：
A. Abstract
The case of an angiolipoma of the cheek in a 76-year-old man
Angiolipoma is a benign tumor which is very rare in the soft tissue of the oral region, with only 21 reported cases
microscopically, the mass consisted of mature adipose cells intermixed with scattered vascular components.
The tumor had a low proliferative capacity (增生能力)and the capsule was present, indicating a noninfiltrating type.
After surgical treatment, the patient has done well with no sign of recurrence for 3 months.
B. Introduction
Angiolipoma (AL), a subtype of lipoma, is a benign tumor in which adipose tissue and vascular components are intermingled.
commonly in the trunk and extremities, especially in the forearm
AL is very rarely found in the soft tissue of the oral region, with only 21 reported cases, including our case.
C. Case report
76-year-old Japanese male with a chief complaint of a mass in the left buccal mucosa
medical history
hypertension and lumbago(腰痛)
unremarkable family history.
good physique and good nutritional status, with no abnormalities in the trunk and extremities.
A head and neck examination showed a symmetrical facial configuration, no abnormal sensation or motor palsy of the cheek, and no significant cervical lymph node enlargement.
A non-tender, well-defined, soft mass measuring 20mm×20mm was noted in the left cheek below the buccal mucosa.
口腔病理科 On-Line KMU Student Bulletin
- 2 -
slightly moveable and no abnormalities of the overlying mucosa such as changes of thickness or color
clinical diagnosis of benign tumor of the buccal mucosa,
surgical excision under local anesthesia.
surrounded by a thin capsule and was not adherent to the surrounding tissue, detachment was easy and the mass was removable as a lump.
The specimen was
15mm×15mmin size
surface was smooth and red-yellow
solid
cross section was yellowish
Microscopically
H-E staining -the mass consisted of mature adipose cells intermixed with scattered vascular components
immunohistochemical staining-the vascular element was positive for
CD34 (細胞表面蛋白) -vascular endothelial cells
smooth muscle actin( 肌 動 蛋 白 ), consistent blood vessel smooth muscle
proliferative activity
proliferating cell nuclear antigen (PCNA)- 5.3%
Ki-67- less than 1%
Based on these results, the final diagnosis was AL.
After surgical treatment, the patient has done well with no sign of recurrence for 3 months.
D. Discussion
AL is a subtype of lipoma that was first reported by Bowen in 1912
口腔病理科 On-Line KMU Student Bulletin
- 3 -
Most ALs occur just below the surface of the skin in the
extremities
abdomen
chest and back
especially in the forearms,
and tend to be multiple .
ALs can occur at any age, but are relatively common in adolescence and the twenties
Histologically，ALs- classified into a noninfiltrating type with a capsule and an infiltrating type
AL in the oral cavity was first reported by Davis et al.- hard palate.
AL in the oral cavity
systemic AL Other common
lipomas in the oral cavity Onset age 29 years 21 to 24 years 51.9–60.2 years overlying skin or
mucosa (yellow and pink)
7/21 rare
pain and discomfort
4/21 >50%
family history not associated 11/248
multiple tumor - 197 /248
place Cheek: 13 cases
(61.9%)
buccal mucosa (36.4–45.7%)
size 3.0cm (0.5–8.0
cm)
0.8–2.2 cm.
infiltrating AL pain
3/7 7/23 -
noninfiltrating AL tenderness
3/12 >50% -
口腔病理科 On-Line KMU Student Bulletin
- 4 -
ALs in oral soft tissues appear to occur in younger patients.
This may be because vascular components grow more rapidly than lipoma tissues.
Other common lipomas in the oral cavity are painless.
Howard and Helwig- lipoma caused by adolescent hormones is subsequently stimulated by trauma, resulting in angioproliferation in the lipoma.
However, AL occurs several years after birth in some cases
History of trauma was found only in one patient with AL in the oral region, continuous slight stimulation is involved in the onset of AL in the oral region, particularly since stimulation by food in the mouth can occur easily.
Most ALs are originally diagnosed as lipoma, but case reports since 1990 have used MRI, CT, sonography and aspiration biopsy to distinguish between hemangioma, lipoma and AL
definite diagnosis in most literature cases has been made by histopathology
In our patient, the clinical diagnosis was lipoma, but AL was diagnosed histopathologically.
PCNA and Ki-67 immunohistochemical staining can be performed to evaluate the proliferative capacity of a tumor.
Regnani et al. found mean labeling indexes of
PCNA- 13.2% andKi-67 -2.8% for all lipomas
PCNA-17.3% and Ki67-4.8% fibrolipomas in the oral cavity
In our case, PCNA and Ki-67 immunohistochemical staining gave labeling indexes of 5.3% and less than 1%, which suggests that the proliferative capacity of the tumor was relatively low
The appropriate treatment for noninfiltrating ALs is surgical Excision
excision including the surrounding tissues recommended for an infiltrating AL
There has been no report of malignant transformation and recurrence of AL in the oral region[average follow-up duration: 17.5 months (range: 3–36 months)]
but the recurrence rate of infiltrating AL is high, ranging from 35% to 50%.
To prevent recurrence of AL, it is important to remove the tumor and surrounding tissues
diagnosis of the infiltrating type of the tumor is difficult preoperatively.
題號 題目
1
下列關於在口腔內的angiolipoma何者為非?(A) 分infiltrating和 noninfiltrating兩種型態 (B) 是一種血管增生的lipoma
(C) 切除方法為excision
(D) 復發率極高
答案(D) 出處：Oral and maxillofacial Pathology Third edition p524.
題號 題目
2
下列關於口腔內的angiolipoma何者為非?(A) 通常大於3公分
(B) 好發位置在buccal mucosa
(C) 男女發生機率大致相同
(D) 表面光滑(smooth)
答案(A) 出處：Oral and maxillofacial Pathology Third edition 523
