Oral Oncology EXTRA (2006) 42, 301–304

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CASE REPORT

Spindle cell lipoma of the cheek: A case report

and review of literature
Goro Kawasaki a,*, Souichi Yanamto a, Kazunari Hirata a, Akio Mizuno a,
Shuichi Fujita b, Tohru Ikeda a

a
Department of Oral and Maxillofacial Surgery, Unit of Translational Medicine, Course of Medical and Dental
Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki 852-8588, Japan
b
Department of Oral Pathology and Bone Metabolism, Unit of Basic Medical Sciences, Course of Medical and
Dental Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, Japan

Received 23 May 2006; received in revised form 11 August 2006; accepted 18 September 2006

KEYWORDS Summary Spindle cell lipoma is a benign tumour composed of mature fat cells, spindle cells,
Spindle cell lipoma; and a myxoid matrix separated by thick bands of birefringent collagen. Oral spindle cell lipoma
Cheek; is a very rare lesion. We report a case of spindle cell lipoma of the cheek. A 42-year-old woman
Woman was referred to our department because of a painless swelling on the left cheek. Clinical exam-
ination revealed a mobile, well-demarcated mass of the cheek. The tumour was removed sur-
gically under general anaesthesia. A histopathological specimen revealed a spindle cell lipoma.
Following surgery, no evidence of recurrence has been observed.
c 2006 Elsevier Ltd. All rights reserved.

Introduction Five cases of intraoral SCL have been reported in the Jap-
anese literature.2–6 We report a patient with spindle cell lipo-
Lipomatous tumours are the most common soft tissue tu- ma in the buccal region, and conducted a literature review.
mours.1 Spindle cell lipoma (SCL) is a distinct histological
variant of lipoma derived from prelipoblastic mesenchymal
cells.1 SCL is a rare benign neoplasm, and oral SCL is extre- Case presentation
mely rare. Piattelli et al.1 reported that only 14 cases of
intraoral spindle cell lipoma had been reported in the liter- A 42-year-old woman was referred to the Division of Oral
ature. Clinically, SCL appears almost always as a solitary, and Maxillofacial Surgery, Nagasaki University Graduate
subcutaneous, circumscribed lesion. School of Biochemical Sciences, Nagasaki, Japan, in Febru-
ary 2005 because of a swelling of the left buccal region.
* Corresponding author. Tel.: +81 95 849 7696; fax: +81 95 849 The patient noticed that the swelling had been slowly
7737. increasing in size during the past two years. The patient’s
E-mail address: [email protected] (G. Kawasaki). medical and family histories were unremarkable.


1741-9409/$ - see front matter c 2006 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ooe.2006.09.003
302 G. Kawasaki et al.

Figure 1 Intraoral examination showed a soft swelling at the

left buccal mucosa.

Figure 4 The tumour was surrounded by normal oral mucosa

and it was elastic and soft.

mass with a low intensity signal on T1 (Figs. 2 and 3). The

clinical diagnosis was lipoma or benign tumour of the cheek.
The tumour was excised en block with oral mucosa under
general anaesthesia. The surgical margin was about 5 mm
around the tumour. The lesion was superficially located,
not infiltrating, uniformly hard, and presented a yellowish
colour. Clinically, the excised tumour was 50 · 40 · 20 mm
and had an elastic, soft covering with a connective tissue-
like capsule (Figs. 4 and 5). No recurrence has been de-
tected since surgery.

Figure 2 Axial MRI of the buccal lesion.

Histopathological findings
Clinical examination revealed an elastic firm mass mea-
suring 50 · 45 · 35 mm in the left buccal mucosa (Fig. 1). The submucous tumour was clearly demarcated from the
The surface of the swelling was smooth normal oral mucosa, surrounding connective and muscle tissues, and showed an
and the margin was clear. Erosion was noted at the lower
first molar tooth. MRI showed a well-circumscribed round

Figure 5 The surface of the divided mass was solid and

Figure 3 Coronal MRI of the buccal lesion. elastic soft.
Spindle cell lipoma of the cheek: A case report and review of literature 303

tongue, and lips. Histologically, they can be classified as

simple lipomas or its variant, such as spindle cell lipomas,
intramuscular or infiltrating lipomas, angiolipomas, salivary
gland lipomas, pleomorphic lipomas, myxoid lipomas, and
atypical lipomas.7
The spindle cell lipoma (SCL) is an uncommon lipoma var-
iant. SCL accounts for about 1.5% of all adipose tumours.8 It
was originally described by Enzinger and Harvey.9 They de-
scribed 114 cases with a range of microscopic features from
mature adipose tissue with mucoid material and scattered
spindle cells to a cellular mass of spindle cells with a small
number of mature adipocytes.
SCL usually occurs in the subcutaneous tissue of the
upper back, shoulders, and posterior neck, and is common
in men between the ages of 45 and 65 years.10 Oral SCL is
very rare. Piattelli et al.1 described in 2005 that only 14
cases of intraoral spindle cell lipoma had been reported
Figure 6 Well-demarcated tumour is seen in the submucosa. in the literature. Enzinger and Harvey reported that it pre-
The lobules of the tumour consist of predominant fat cells dominantly involved men between 45 and 70 years old.9
(haematoxylin and eosin staining, low magnification). Some other reports confirmed this finding.10 Our review
of the English and Japanese literature revealed twenty
previously reported cases of SCL in the oral
cavity.1–6,8,10–20 Of the 21 SCL including our case, 12 tu-
mours occurred in male patients and 9 in female patients
(Table 1). The overall average age was 55 years (range:
23–74 years). Specific anatomic locations within the oral
and maxillofacial regions included the cheek (n = 8), ton-
gue (n = 7), floor of the mouth (n = 3), gingiva (n = 2),
and hard palate (n = 1).
Typically, oral lipomas are encapsulated or well circum-
scribed with rare exceptions.11 They are composed of ma-
ture fat cells arranged in a lobular fashion, simulating
extraoral subcutaneous lipoma and normal surrounding
fat.11 SPL is histologically characterized by the presence
of an admixture of mature fat cells, uniform spindle cells,
and short bundles of collagen associated with the spindle
cells.11 Macroscopically, the tumour resembles a simple li-
poma except for gray–white gelatinous foci representing
Figure 7 Spindle cells are observed in the mucoid area including the areas of spindle cell formation.10 The microscopic fea-
sparse collagen fibers. Mature fat cells are also intermingled tures of spindle cell lipomas range from tumours predomi-
(haematoxylin and eosin staining, high magnification). nantly composed of mature fat cells, with a moderate
amount of myxoid material and widely scattered spindle
cells, to cellular lesions containing numerous spindle cells,
aggregation of lobules mainly occupied with adipose tissue. thick bundles of collagen, and a small number of mature
Narrow fibrous connective tissue including blood capillaries fat cells.9,10 The extent of replacement of fat cells by spin-
is found among the lobules (Fig. 6). The tumour lobules dle cells varies from one case to another. Spindle cells are
were composed of a mixture of predominant mature fat characterized by uniformity, having a single elongated nu-
cells and scattered foci of uniform spindle-shaped cells. cleus, bipolar cytoplasmic processes, and typically contain-
The spindle cells were associated with a mucoid matrix ing one or two vacuoles within the cytoplasm.11 No
and sparse collagen fibers. Mature fat cells are intermingled lipoblastic activity is observed in spindle cell lipoma, and
in some mucoid areas (Fig. 7). There were no atypical cells mitotic figures are seldom seen.11
and lipoblasts in the tumour. No mitoses were found. A histopathologic differential diagnosis appropriate to
the oral cavity would include ordinary lipoma if the spindle
Histological diagnosis: spindle cell lipoma cells are localized and fibrosarcoma if spindle cells are
numerous.16 Other lesions to consider would be schwan-
Discussion noma, myxoid neurofibroma, leiomyoma, nodular fasciitis,
myxolipoma, fibrolipoma, malignant fibrous histiocytoma,
Lipomas are the most common soft tissue mesenchymal myxoid liposarcoma, and myxoid solitary fibrous tumour.
neoplasms, with 15–20% of cases involving the head and A definitive diagnosis of SCL depends on an accurate cor-
neck region and 1–4 % affecting the oral cavity.7 They rep- relation between the histological and clinical features, and
resent 0.1–5% of all benign oral tumours. Oral lipomas pre- it is important to recognize that this is a benign neoplasm
dominantly affect the buccal mucosa, floor of the mouth, and avoid the potential diagnostic hazard of interpreting
304 G. Kawasaki et al.

Table 1 Clinical features of all reported cases of intra-oral spindle cell lipomas
Case no. Authors Year Age Gender Location of spindle cell lipoma Size (mm)
12
1 McDaniel et al. 1984 33 F Floor of mouth 10 · 10 · 8
2 McDaniel et al.12 1984 52 M Tongue NA
3 Christopoulous et al.13 1989 58 M Hard palate 20 · 20 · 20
4 Levy et al.14 1989 74 F Floor of mouth 43 · 35 · 15
5 Lombardi and Odell15 1994 68 F Tongue 15 · 13 · 10
6 Tosios et al.16 1995 55 M Cheek 40 · 20 · 12
7 Khoo et al.20 1995 23 M Cheek 50 · 25 · 15
8 Yamagata et al.2 1999 45 F Cheek 20 · 10
9 Piattelli et al.17 1999 75 M Cheek 20
10 Dutt et al.8 1999 42 F Tongue 30 · 20 · 10
11 Donen et al.3 2000 71 M Tongue 15 · 10 · 5
12 Piattelli et al.18 2000 63 M Cheek 25
13 Agoff et al.19 2001 61 F Gingiva 30
14 Said-Al-Naief et al.11 2001 66 M Tongue 30 · 25 · 17
15 Said-Al-Naief et al.11 2001 53 F Tongue 6·6·7
16 Darling et al.10 2002 69 M Alveolar ridge 8
17 Asoda et al.5 2003 56 M Tongue 35 · 30 · 20
18 Nagisa et al.4 2003 64 M Cheek 120 · 80
19 Yamada et al.6 2003 44 F Cheek 120 · 90
20 Piatteli et al.1 2005 50 M Floor of mouth 10
21 Kawasaki et al. 2006 42 F Cheek 50 · 40 · 20
Abbreviations: NA, data not available.

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