PMC3633293_01
(a) Extent of the swelling extraorally; (b) Intraoral swelling covering the right buccal mucosa; (c) Gross specimen; (d) Adipocytes infiltrating neurovascular bundle (H and E, x200)
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F1
On extraoral examination, a swelling was seen on the right cheek, extending from preauricular region to the lower border of the mandible, measuring approximately 8 x 10 cm in size [Figure 1a]. Intraorally, it covered the entire right buccal mucosa [Figure 1b]. Excised tissue was submitted to the Department of Oral Pathology as multiple soft tissue bits, with the largest bits measuring around 5 x 3 and 5 x 2 cm in size, brown and yellow in color, irregular in outline, and firm in consistency [Figure 1c]. Numerous thick-walled arteries and nerve bundles were observed surrounded by adipose tissue [Figure 1d].
PMC3633293_02
(a) Extraoral extent; (b) Contrast-enhanced computed tomography showing fatty infiltration of the buccinator, masseter, and parotid gland; (c) Gross specimen; (d) Adipocytes infiltrating the muscle (H and E, x200)
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F2
On extraoral examination, a swelling was present unilaterally over the right maxilla/zygoma, extending upward till orbit, posteriorly till the ear lobe, and inferiorly to the lower border of the mandible [Figure 2a]. There was an increase in the right side buccal fat with extraoral fat stranding which caused poor differentiation of lateral margins of underlying muscles [Figure 2b]. An incisional biopsy was done, which on microscopic examination showed fat cells infiltrating in the muscle and admixed with blood vessels in a loosely collagenous stroma [Figure 2d]. The patient underwent surgical excision and the excised tissue submitted to the department was in the form of multiple soft tissue bits, yellowish in color, the largest measuring 3 x 2.5 x 2 cm [Figure 2c].
PMC3633293_03
(a) Large swelling on the left side of the face; (b) Intraoral expansion of maxillary alveolar process; (c) Adipocytes infiltrating the marrow spaces (H and E, x200)
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F3
On extraoral examination, a swelling was seen on the left side of the face, extending from preauricular region to the lower border of the mandible, measuring approximately 8 x 10 cm in size [Figure 3a]. Intraorally, there was enlargement of the left maxillary and mandibular alveolar processes, causing displacement of teeth [Figure 3b]. Decalcified sections from maxillary alveolus showed adipose tissue within the marrow spaces [Figure 3c].
PMC3633293_04
(a) Diffuse swelling over left cheek; (b) Magnetic resonance imaging showing fatty infiltration
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F4
On clinical examination, there was a diffuse swelling over left cheek region, extending from infraorbital rim to lower border of mandible and anteroposteriorly from the angle of mouth to 2 cm in front of tragus [Figure 4a]. No fatty infiltration of muscles was seen [Figure 4b].