Oral Oncology EXTRA (2006) 42, 301–304

available at www.sciencedirect.com

journal homepage: http://intl.elsevierhealth.com/journal/ooex

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
Lipomatous tumours are the most common soft tissue tu-
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-
mely rare. Piattelli et al.1 reported that only 14 cases of
intraoral spindle cell lipoma had been reported in the liter-
ature. Clinically, SCL appears almost always as a solitary,
subcutaneous, circumscribed lesion.
* Corresponding author. Tel.: +81 95 849 7696; fax: +81 95 849
7737.
E-mail address: gkawa@net.nagasaki-u.ac.jp (G. Kawasaki).
Five cases of intraoral SCL have been reported in the Jap-
anese literature.2–6 We report a patient with spindle cell lipo-
ma in the buccal region, and conducted a literature review.
Case presentation
A 42-year-old woman was referred to the Division of Oral
and Maxillofacial Surgery, Nagasaki University Graduate
School of Biochemical Sciences, Nagasaki, Japan, in Febru-
ary 2005 because of a swelling of the left buccal region.
The patient noticed that the swelling had been slowly
increasing in size during the past two years. The patient’s
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
Figure 6 Well-demarcated tumour is seen in the submucosa.
The lobules of the tumour consist of predominant fat cells
(haematoxylin and eosin staining, low magnification).
Figure 7 Spindle cells are observed in the mucoid area including
sparse collagen fibers. Mature fat cells are also intermingled
(haematoxylin and eosin staining, high magnification).
aggregation of lobules mainly occupied with adipose tissue.
Narrow fibrous connective tissue including blood capillaries
is found among the lobules (Fig. 6). The tumour lobules
were composed of a mixture of predominant mature fat
cells and scattered foci of uniform spindle-shaped cells.
The spindle cells were associated with a mucoid matrix
and sparse collagen fibers. Mature fat cells are intermingled
in some mucoid areas (Fig. 7). There were no atypical cells
and lipoblasts in the tumour. No mitoses were found.
Histological diagnosis: spindle cell lipoma
Discussion
Lipomas are the most common soft tissue mesenchymal
neoplasms, with 15–20% of cases involving the head and
neck region and 1–4 % affecting the oral cavity.7 They rep-
resent 0.1–5% of all benign oral tumours. Oral lipomas pre-
dominantly affect the buccal mucosa, floor of the mouth,
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
in the literature. Enzinger and Harvey reported that it pre-
dominantly involved men between 45 and 70 years old.9
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
the areas of spindle cell formation.10 The microscopic fea-
tures of spindle cell lipomas range from tumours predomi-
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,
thick bundles of collagen, and a small number of mature
fat cells.9,10 The extent of replacement of fat cells by spin-
dle cells varies from one case to another. Spindle cells are
characterized by uniformity, having a single elongated nu-
cleus, bipolar cytoplasmic processes, and typically contain-
ing one or two vacuoles within the cytoplasm.11 No
lipoblastic activity is observed in spindle cell lipoma, and
mitotic figures are seldom seen.11
A histopathologic differential diagnosis appropriate to
the oral cavity would include ordinary lipoma if the spindle
cells are localized and fibrosarcoma if spindle cells are
numerous.16 Other lesions to consider would be schwan-
noma, myxoid neurofibroma, leiomyoma, nodular fasciitis,
myxolipoma, fibrolipoma, malignant fibrous histiocytoma,
myxoid liposarcoma, and myxoid solitary fibrous tumour.
A definitive diagnosis of SCL depends on an accurate cor-
relation between the histological and clinical features, and
it is important to recognize that this is a benign neoplasm
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.

the lesion as a myxoid liposarcoma with differing prognostic
implications.8
SCL is not usually encapsulated and may sometimes infil-
trate adjacent muscle.8 Generally, like other lipomas, intra-
oral SCL is thought to be a benign lesion and should be
treated by local excision.10 One case of recurrence has been
reported.8 Long-term follow-up is necessary.
References
1. Piattelli A, Perrotti V, Fioroni M, Rubini C. Spindle cell lipoma
of the floor of the mouth: report of a case. Auris Nasus Larynx
2005;32:205–7.
2. Yamagata K, Onizawa K, Namai T, Miyajima Y, Yusa H, Yoshida
H. A case of spindle cell lipoma of the cheek. Jpn J Oral
Maxillofac Surg 1999;45:838–40.
3. Donen M, Murakami Y, Takano M, Suzuki T, Iizuka T, Totsuka Y.
A case of spindle cell lipoma of the tongue. Jpn J Oral
Maxillofac Surg 2000;46:357–9.
4. Nagisa N, Hashiguchi N, Terai H, Ariyoshi Y, Shimahara S,
Shimahara M. A case of giant spindle cell lipoma extending
from the cheek to submandibular region. Jpn J Oral Maxillofac
Surg 2003;49:454–7.
5. Asoda S, Komiya Y, Uchida I, Yoshida S, Takaku Y. A case of
spindle cell lipoma of the tongue. Jpn J Oral Maxillofac Surg
2003;49:611–4.
6. Yamada K, Aiba T, Kubo T, Nakano T, Wada T, Uyama T. A case
of spindle cell lipoma of the cheek. Pract Oto-Rhino-Laryngol
2003;96:455–60.
7. Fregnani ER, Pire FR, Falzoni R, Lopes MA, Vargas PA. Lipomas
of the oral cavity: clinical findings, histological classification
and proliferative activity of 46 cases. Int J Oral Maxillofac Surg
2003;32:49–53.
8. Dutt SN, East DM, Saleem Y, Jones EL. Spindle-cell variant
intralingual lipoma-report of a case with literature review. J
Laryngol Otol 1999;113:587–9.
9. Enzinger FM, Harvey DA. Spindle cell lipoma. Cancer
1975;36:1852–9.
10. Darling M, Thompson I, Schneidaer J. Spindle cell lipoma of the
alveolar mucosa: a case report. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod 2002;93:171–3.
11. Said-Al-Naief N, Zahurullah FR, Sciuba JJ. Oral spindle cell
lipoma. Ann Diagn Pathol 2001;5:207–15.
12. McDaniel RK, Newland JR, Chiles DG. Intraoral spindle cell
lipoma: case report with correlated light and electron micros-
copy. Oral Surg Oral Med Oral Pathol 1984;57:52–7.
13. Christopoulos P, Nicolatou O, Patrikiou A. Oral spindle cell lipoma.
Report of a case. Int J Oral Maxillofac Surg 1989;18:208–9.
14. Levy FE, Goding GS. Spindle cell lipoma: an usual oral
presentation. Otolaryngol Head Neck Surg 1989;101:601–3.
15. Lombardi T, Odell EW. Spindle cell lipoma of the oral cavity:
report of a case. J Oral Pathol Med 1994;23:237–9.
16. Tosios K, Papanicolou SI, Kapranos N, Papadogeorgakis N.
Spindle cell lipoma of the oral cavity. Int J Oral Maxillofac Surg
1995;24:363–4.
17. Piattelli A, Fioroni M, Rubini C. Spindle cell lipoma of the oral
cavity: report of a case. J Oral Maxillofac Surg 1999;57:624–5.
18. Piattelli A, Rubini C, Fioroni M, Iezzi G. Spindle-cell lipoma of
the cheek: a case report. Oral Oncol 2000;36:495–6.
19. Agoff SN, Folpe AI, Grieco VS, Garcia RL. Spindle cell lipoma of
the oral cavity. Report of a rare intramuscular case with fine
needle aspiration findings. Acta Cytol 2001;45:93–8.
20. Khoo SP, Odell EW. Intraoral spindle cell lipoma: report of a
case and literature review. Ann Dent 1995;54:53–5.