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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 12  |  Issue : 2  |  Page : 95-98

Multiple intraoral lesions in a male patient with smoker's palate: A rare case report


1 Department of Oral and Maxillofacial Surgery, Baba Jaswant Singh Dental College Hospital and Research Institute, Ludhiana, Punjab, India
2 Department of Oral Pathology, Baba Jaswant Singh Dental College Hospital and Research Institute, Ludhiana, Punjab, India

Date of Submission05-Oct-2022
Date of Acceptance07-Oct-2022
Date of Web Publication19-Dec-2022

Correspondence Address:
Dr. Paramjot Kaur
1558, Sector 32-A, Chandigarh Road, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijohs.ijohs_27_22

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  Abstract 


It is rare to find peripheral intraoral tumors in a male patient. In this case report, a 60-year-old comorbid male patient presented with three intraoral lesions in the buccal mucosa on the left side and also smoker's palate. Excision of three lesions was suggestive of lipoma, giant cell fibroma, and leukoplakia on the histopathological report. Long-term follow-up was advised following excision of the lesions.

Keywords: Multiple oral lesions, peripheral oral tumors, smoker's palate


How to cite this article:
Kaur P, Singh I. Multiple intraoral lesions in a male patient with smoker's palate: A rare case report. Int J Oral Health Sci 2022;12:95-8

How to cite this URL:
Kaur P, Singh I. Multiple intraoral lesions in a male patient with smoker's palate: A rare case report. Int J Oral Health Sci [serial online] 2022 [cited 2023 Feb 1];12:95-8. Available from: https://www.ijohsjournal.org/text.asp?2022/12/2/95/364224




  Introduction Top


Multiple[1],[2] lesions in a single patient have only very seldom been reported in publications. We present the case report of a 60-year-old diabetic, hypertensive male patient with intraoral lipoma, giant cell fibroma, and leukoplakia in the buccal mucosa on the left side and also smoker's palate. He was advised long-term follow-up following excision of the lesions.


  Case Report Top


A 60-year-old male patient came to the department of oral and maxillofacial surgery with a chief complaint of a growth in the left side of oral cavity for the past 3 months. He also gave a history of cigarette smoking 10–15 times a day for the past few years. On examination, he had a localized growth in left buccal mucosa with a history of superficial bleeding surface for the past 4 days. There was pigmented swelling present on his left retromolar region which was firm on palpation. He had a grayish white patch on hard palate with pinpoint petechiae extending to the junction of hard and soft palate. He also had a nonscrapable white lesion on both sides of oral mucosa at the angles of the mouth. His medical history revealed that he was suffering from diabetes and hypertension. Under aspetic conditions under local anesthesia, excisional biopsy of the lesions was done. Histopathological evaluation revealed the presence of giant cell fibroma in left buccal mucosa, fibrolipoma in the left alveolar mucosa, and leukoplakia in the left oral mucosa at the angle of the mouth. The patient was advised long-term follow-up along with maintenance of blood sugar and hypertension under control by regular medical consultation and to stop smoking on his recall visit after 7 days.


  Discussion Top


Peripheral odontogenic tumors are uncommon lesions.[3] In this case report, we present a male patient with triple intraoral lesions as described below.

Peripheral giant cell fibroma [Figure 4]

Intraoral peripheral giant cell fibroma presents as a distinct lesion that originates from the connective tissue of the submucosa. It manifests clinically by a painless, soft, nodular, sessile, or pedunculated mass, usually red to reddish-blue in color, occasionally ulcerated surface, and located on the tongue and gingiva. Giant cell fibroma usually occurs in female patients in gingiva-associated lower anterior teeth.[3] However, in this case report, a 60-year-old male patient had a tender, pedunculated lesion in the buccal mucosa with a superficial bleeding surface. Lesions are usually 1 cm in size as reported in this case.[2],[3],[4]

Histologically, the stroma was highly fibrous and was composed of plump as well as stellate fibroblasts. In few areas, the fibroblasts were giant with dendritic processes. Underlying patchy inflammation was seen with few areas of melanin pigmentation was also present.[2],[4] Although these lesions are harmless and benign, biopsy was confirmatory of the lesion and ruled out suspicion of cancer.[2],[4],[5]

Lipoma

Fibrolipoma [Figure 5] are clinicopathologically distinct, usually asymptomatic, slow-growing tumors, with an increased growth potential and a low recurrence rate. The etiology of lipomas is unknown. According to one hypothesis, multipotential fibroblasts may differentiate into fat cells and create a lipoma. An alternative explanation is that lipomas can arise from lipomatous tissue.[1],[6],[7],[8],[9],[10],[11],[12] In concurrence to this case report, these lipomas usually occur in old, obese, and mostly male patients with a chronic history of smoking.[1],[9] However, Naruse et al.[11] revealed that male-to-female ratios is equal in classic lipomas and fibrolipomas. There study also mentioned that ki-67 expression may indicate recurrence or malignant transformation, and a long-term follow-up is necessary.[11],[12],[13],[14],[15],[16],[17] Several studies[9],[10],[16],[18] have reported the occurrence of well-defined swelling in retromolar region that was lipoma on histopathological examination. However, our case presented with asymptomatic brownish-white pigmented retromolar mucosa. It was differentially diagnosed as melanoma and was found to be lipoma on histopathological examination.[1] There have been many case reports of lipomas involving the submandibular and parapharyngeal spaces[6],[7] and also of the masticatory space.[8]

The knowledge and prompt treatment of tumors in this region is important. Complete resection should be emphasized, which is the key factor to avoid recurrence.

Hyperkeratosis [Figure 6]

In this case, a 60-year-old male also had a white lesion bilaterally on the buccal mucosa and on the palate. It was clearly related to patient's history of smoking 15–20 cigarettes per day. It was differentially diagnosed as tobacco-associated leukoplakia” (leukoplakia in smokers) on the buccal mucosa and tobacco-induced lesion (leukokeratosis nicotina palate) on the palate. Histopathological report of the biopsy specimen taken from the left buccal mucosa confirmed the diagnosis of leukoplakia. Some of these lesions may transform into cancer. Nevertheless, several studies report that oral leukoplakia may regress or disappear after cessation of smoking.[19]

Triple lesions [Figure 4],[Figure 5],[Figure 6]

It is very unusual to find three locoregional pathologies with morphologically and histopathologically different characteristics involving the left buccal mucosa of the same patient. Most of these intraoral focal overgrowths are reactive chronic inflammatory hyperplasias, with minor trauma or chronic irritation being the etiologic factors.[2] Studies reveal that high frequency of lesions found in men aged between 51 and 60 years of age are dysplastic and buccal mucosa is the commonest site in smokers.[13],[17] Wang et al. in their study performed a large-scale retrospective analysis in a representative sample of the Chinese population diagnosed with oral leukoplakia and encouraged all their patients to quit smoking and drinking, but it was found that dysplastic lesions were more frequent in nonsmoker women around 50 years of age.[14],[20]


  Conclusion Top


Anatomical site, gender, and presence of epithelial dysplasia should be considered when treating a lesion due to the possibility of a malignant transformation.[5] The histologic assessment[16] remains the gold standard for detecting epithelial dysplasia as it carries a significant risk of transformation to oral cancer even when treated by surgical excision. Long-term follow-up and expert opinion from head and neck oncosurgeons is mandatory. Therefore, the patient in this case report with three intraoral lesions was referred to a cancer hospital as long-term follow-up and surveillance is mandatory.[14],[15],[16],[17]

It is important to stop the personal habits of patients which are an offending etiology to prevent dysplastic and irreversible changes in the lesions.

[Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5] are shown below.
Figure 1: Left Buccal Mucosa

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Figure 2: Nonscrapable white lesion on the oral mucosa at the right angle of the mouth

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Figure 3: Retromolar region

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Figure 4: Fibrolipoma

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Figure 5: Giant cell fibroma

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Figure 6: Hyperkeratosis

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Cheng J, Liu X, Shuai X, Deng M, Gao J, Tao K. Synchronous triple colorectal carcinoma: A case report and review of literature. Int J Clin Exp Pathol 2015;8:9706-11.  Back to cited text no. 1
    
2.
Sangle VA, Pooja VK, Holani A, Shah N, Chaudhary M, Khanapure S. Reactive hyperplastic lesions of the oral cavity: A retrospective survey study and literature review. Indian J Dent Res 2018;29:61-6.  Back to cited text no. 2
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3.
Brierley DJ, Crane H, Hunter KD. Lumps and bumps of the gingiva: A pathological miscellany. Head Neck Pathol 2019;13:103-13.  Back to cited text no. 3
    
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Ramesh A, Asok A, Bhandari R. Giant cell fibroma – A case report. J Cont Med A Dent 2016;4:49-51.  Back to cited text no. 4
    
5.
Lima JS, Pinto Ddos S Jr., Sousa SO, Corrêa L. Oral leukoplakia manifests differently in smokers and non-smokers. Braz Oral Res 2012;26:543-9.  Back to cited text no. 5
    
6.
Calhoun NR. Lipoma of submandibular space. Report of a case. Oral Surg Oral Med Oral Pathol 1964;17:815-7.  Back to cited text no. 6
    
7.
Rogers J, Patil Y, Strickland-Marmol L, Padhya T. Lipomatous tumors of the parapharyngeal space: Case series and literature review. Arch Otolaryngol Head Neck Surg 2010;136:621-4.  Back to cited text no. 7
    
8.
Navaneetham A, Rao A, Gandhi A, Jeevan CA. Lipoma involving the masticator space. Ann Maxillofac Surg 2011;1:93-4.  Back to cited text no. 8
[PUBMED]  [Full text]  
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Haranal S, Naresh N, Vinuth DP, Aggarwal P, Chandrashekhar KT. Lipoma in the retromolar area. Int J Dis Disord 2013;1:053-4.  Back to cited text no. 9
    
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Hatziotis JC. Lipoma of the oral cavity. Oral Surg Oral Med Oral Pathol 1971;31:511-24.  Back to cited text no. 10
    
11.
Naruse T, Yanamoto S, Yamada S, Rokutanda S, Kawakita A, Takahashi H, et al. Lipomas of the oral cavity: Clinicopathological and immunohistochemical study of 24 cases and review of the literature. Indian J Otolaryngol Head Neck Surg 2015;67:67-73.  Back to cited text no. 11
    
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Pereira T, Shetty S, Sapdhare S, Tamgadge A. Oral fibrolipoma: A rare histological variant. Indian J Dent Res 2014;25:672-4.  Back to cited text no. 12
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Venkat A, Sathya Kumar M, Aravindhan R, Magesh KT, Sivachandran A. Analysis of oral leukoplakia and tobacco-related habits in population of Chengalpattu district – An institution-based retrospective study. Cureus 2022;14:e25936.  Back to cited text no. 13
    
14.
Wang T, Wang L, Yang H, Lu H, Zhang J, Li N, et al. Development and validation of nomogram for prediction of malignant transformation in oral leukoplakia: A large-scale cohort study. J Oral Pathol Med 2019;48:491-8.  Back to cited text no. 14
    
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Odell E, Kujan O, Warnakulasuriya S, Sloan P. Oral epithelial dysplasia: Recognition, grading and clinical significance. Oral Dis 2021;27:1947-76.  Back to cited text no. 15
    
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Jalili Sadrabad M, Sohanian S, Behrad S. Oral fibrolipoma: A report of two cases. Middle East J Rehabil Health Stud 2020;7:e98307.  Back to cited text no. 16
    
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Shah M, Rathod CV, Shah V. Peripheral giant cell fibroma: A rare type of gingival overgrowth. J Indian Soc Periodontol 2012;16:275-7.  Back to cited text no. 17
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Shetty L, Kshirsagar K, Kulkarni D. Lipoma in the retromolar area: A case report with review. Med J DY Patil Univ 2012;5:79-82.  Back to cited text no. 18
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19.
Rajendran R. Oral leukoplakia (leukokeratosis): Compilation of facts and figures. J Oral Maxillofac Pathol 2004;8:58-68.  Back to cited text no. 19
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20.
Montazer Lotf-Elahi MS, Farzinnia G, Jaafari-Ashkavandi Z. Clinicopathological study of 1000 biopsied gingival lesions among dental outpatients: A 22-year retrospective study. BMC Oral Health 2022;22:154.  Back to cited text no. 20
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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