lipomas are the most common soft tissue mesenchymal neoplasms , with 1520% of cases involving the head and neck region and only 14% affecting the oral cavity.1 the first description of an oral lesion was provided in 1848 by roux in a review of alveolar masses , where he referred to it as a yellow epulis.2 the pathogenesis of lipoma is uncertain , but they appear to be more common in obese people . if the caloric intake is reduced , lipomas do not decrease in size , although normal body fat may be lost . lipomas are slowly enlarging , with a soft , smooth - surface mass of the submucosal tissues . the lesion may be pedunculated or sessile and occasional cases show surface bosselation.3 multiple lipomas of head and neck have been observed in neurofibromatosis , gardner syndrome , encephalocraniocutaneous lipomatosis , multiple familial lipomatosis and proteus syndrome . generalised lipomatosis have been reported to contribute to unilateral facial enlargement in hemifacial hypertrophy.4 although its etiology is unknown , possible causes may include trauma , infection , chronic irritation and hormone alterations.5 in few cases of lipoma , rearrangement of 12q , 13q , 6p chromosomes have been observed.2 case 1 was a 54 years old male patient , who complained of painless soft tissue mass in the labial mucosa in the last 10 years . it was solitary , lobulated soft mass , 2x3 cm in size , with smooth margins and was not fixed to underlying deeper structures ( figure 1 ) . other investigations included full blood count , serum and urea electrolytes , and urine analysis , all were in normal limits . case 2 was a 52 years male patient , who complained of slowly growing mass in the buccal mucosa since one and half years ago , which was non - pulsatile and non - tender in nature , 2.5x3.5 cm in size with smoother margins ( figure 2 ) . during extraoral physical examination , the patient was cooperative and appeared to be in good nutritional health with normal vital signs . case 3 was a 55 years old male complained of painless doughy swelling , growing very slowly in the buccal mucosa for the last four years , which was about 2.51.5 cm in size , yellowish in colour , compressible , fluctuant , well localized and pedunculated ( figure 3 ) . fine needle aspiration cytology was performed in this case and aspirated fluid showed fat cells ( figure 4 ) . photomicrograph showing mature adipocytes having nucleus placed to periphery with intervening connective tissue stroma ( 10 ) . in these cases , clinical diagnosis varied from focal reactive overgrowths , neural tumors , granular cell tumors to lipomas . surgical excision was done for all the cases under local anaesthesia along with peritumor anaesthesia . histopathology . grossly , these tumors were soft , well circumscribed , and non - infiltrating . microscopically , these tissues revealed sheets of mature adipocytes containing clear cytoplasm and eccentric nucleus , with no evidence of cellular atypia or metaplasia ( figure 5 ) . the tumor cells were arranged in lobules with intervening fibrovascular connective tissue septa . based on the histopathological features , case 1 was a 54 years old male patient , who complained of painless soft tissue mass in the labial mucosa in the last 10 years . it was solitary , lobulated soft mass , 2x3 cm in size , with smooth margins and was not fixed to underlying deeper structures ( figure 1 ) . other investigations included full blood count , serum and urea electrolytes , and urine analysis , all were in normal limits . case 2 was a 52 years male patient , who complained of slowly growing mass in the buccal mucosa since one and half years ago , which was non - pulsatile and non - tender in nature , 2.5x3.5 cm in size with smoother margins ( figure 2 ) . during extraoral physical examination , the patient was cooperative and appeared to be in good nutritional health with normal vital signs . case 3 was a 55 years old male complained of painless doughy swelling , growing very slowly in the buccal mucosa for the last four years , which was about 2.51.5 cm in size , yellowish in colour , compressible , fluctuant , well localized and pedunculated ( figure 3 ) . fine needle aspiration cytology was performed in this case and aspirated fluid showed fat cells ( figure 4 ) . photomicrograph showing mature adipocytes having nucleus placed to periphery with intervening connective tissue stroma ( 10 ) . in these cases , clinical diagnosis varied from focal reactive overgrowths , neural tumors , granular cell tumors to lipomas . surgical excision was done for all the cases under local anaesthesia along with peritumor anaesthesia . histopathology . grossly , these tumors were soft , well circumscribed , and non - infiltrating . microscopically , these tissues revealed sheets of mature adipocytes containing clear cytoplasm and eccentric nucleus , with no evidence of cellular atypia or metaplasia ( figure 5 ) . the tumor cells were arranged in lobules with intervening fibrovascular connective tissue septa . based on the histopathological features , lipomas are adipose mesenchymal neoplasms that rarely occur within oral cavity ( 1% to 4% ) . lipids unavailable for metabolism6 coupled with the autonomous growth of a lipoma have rendered it to be a true benign neoplasm.7 generally , their prevalence does not differ with gender , although a predilection for men has been reported,5 and they occur most often in patients older than 40 years.8 similar trend was seen in our reported cases . the cheek is the commonest site of occurrence in the intraoral cavity followed by tongue , floor of the mouth , buccal sulcus and vestibule , palate , lip and gingiva.9 this pattern corresponds closely to the quantity of fat deposit in the oral cavity . oral lipomas are slow growing masses , and patients commonly present with a well - circumscribed nodule that has been developing for several years.1 the average duration of tumor in our study prior to resection was 7.7 years . this may be biased due to greater duration of one lesion being present since 10 years ago . clinically , oral lipomas generally present as mobile , painless submucosal nodules , with yellowish tinge , as observed in our cases . in some cases , oral soft tissue lipomas can present as a fluctuant nodule . because of these clinical features , other lesions , such as oral dermoid and epidermoid cysts and oral lymphoepithelial cysts must be considered in the differential diagnosis of oral lipomas.10 although , oral lymphoepithelial cysts present as movable , painless submucosal nodules with a yellow or yellow - white colouration , they differ from oral lipomas in that the nodules are usually small at the time of diagnosis and usually occur in the first to third decade of life . also , most oral lymphoepithelial cysts are found on the floor of the mouth , soft palate and mucosa of the pharyngeal tonsil,11 which are uncommon sites for oral lipomas . oral dermoid and epidermoid cysts also present as submucosal nodules and , typically , occur on the midline of the floor of the mouth.12 however , oral dermoid and epidermoid cysts can occur in other locations of oral mucosa . because an oral lipoma can occasionally present as a deep nodule with normal surface colour , salivary gland tumors and benign mesenchymal neoplasms should also be included in the differential diagnosis.13 lipomas have a less dense and more uniform appearance than the surrounding fibrovascular tissue when transilluminated . magnetic resonance imaging scans are very useful in the clinical diagnosis while ct scan and ultrasonography are less reliable . definitive diagnosis depends on correlation between the histological and clinical features.14 the histopathology remains the gold standard in the diagnosis of lipoma . lipomas are not very different in microscopic appearance from the surrounding fat . like fat , they are composed of mature fat cells , but the cells vary slightly in size and shape and are somewhat larger , measuring up to 200 mm in diameter . deep - seated lipomas have a more irregular configuration , largely depending on the site of origin . all are well vascularised , but under normal conditions , the vascular network is compressed by the distended lipocytes and is not clearly discernible . lipomas are occasionally altered by the admixture of other mesenchymal elements that comprise an intrinsic part of the tumor . the most common element is fibrous connective tissue , which is often hyalinized and may or may not be associated with the capsule or the fibrous septa . lipomas with these features are often classified as fibrolipomas.15 quite often , however , lesional fat cells are seen to  infiltrate  into surrounding tissues , perhaps producing long thin extensions of fatty tissue radiating from the central tumor mass . when located within striated muscle , this infiltrating variant is called intramuscular lipoma ( infiltrating lipoma ) , but extensive involvement of a wide area of fibrovascular or stromal tissues is best termed as lipomatosis . occasional lesions exhibit excess numbers of small vascular channels ( angiolipoma ) , a myxoid background stroma ( myxoid lipoma , myxolipoma ) , or areas with uniform spindle shaped cells interspersed among normal adipocytes ( spindle cell lipoma ) . when spindle cells appear somewhat dysplastic or mixed with pleomorphic giant cells with or without hyperchromatic enlarged nuclei , the term  pleomorphic lipoma when the spindle cells are of smooth muscle origin , the term myolipoma may be used , it is angiomyolipoma when the smooth muscle appears to be derived from the walls of arterioles . rarely , chondroid or osseous metaplasia may be seen in a lipoma which is described as chondroid lipoma , osteolipoma or ossifying lipoma . on occasions , lipomas of the buccal mucosa can not be distinguished from a herniated buccal fat pad , except by the lack of a history of sudden onset after trauma . otherwise , lipomas of the oral and pharyngeal region are not difficult to differentiate from other lesions , although spindle cell and pleomorphic types of lipoma must be distinguished from liposarcoma.14 most of these microscopic variations do not affect the prognosis , which is usually good.16 the treatment of oral lipomas , including all the histological variants is simple surgical excision . no recurrence has been observed.1 although the growth of oral lipomas is usually limited , they can reach great dimensions , interfering with speech and mastication19 and reinforcing the need for excision.17 in the current series , all tumors were excised surgically , and no recurrence has been observed till now . solitary lipomas have enthused little interest in the past and have largely been ignored in the literature . the reason is that the most lipomas grow insidiously and cause few problems other than those of a localised mass . approximately 15 - 20% of lipoma occurs in the head and neck region . among the reported intraoral lipomas , surgical excision is the ideal treatment with excellent outcome , however complete resection should be emphasized as this is the key factor to avoid recurrence .
lipoma , a benign tumor of adipose tissue is one of the most common benign neoplasms of the body . however , its occurrence in oral cavity is very rare . 
 it accounts for 1 to 4% of benign neoplasms of mouth affecting predominantly the buccal mucosa , floor of mouth and tongue . 
 we report three cases of intraoral lipoma , two in buccal mucosa and one in labial mucosa . 
 an excisional biopsy was performed and histopathological examination revealed proliferation of mature adipocytes arranged in lobules and separated by fibrous septa . 
 after 3 years follow up , the patients showed no signs of recurrence .