PMC7433934_01
Detail of the lesion causing deformity of the right lower cheek, overlying the mandible
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F1
Movable, nonadherent, nonpainful, well-circumscribed mass on the right mandibular border without local signs of infection, and with rapid growth causing noticeable facial deformity [Figure 1].
Preoperative orthopantomography
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F2
An imaging study was performed using orthopantomography, which was normal [Figure 2], and MRI (Systems Achieva Release 3.2 Level 3, 1.5 T, Philips Medical Systems, the Netherlands), which revealed a well-delimited homogeneous lesion (3.9 cm x 1.6 cm maximum diameter) adjacent to the right mandibular cortex displacing the anterior edge of the masseter without infiltration; the lesion appeared hyperintense on T1- and T2-weighted sequences, which became hypointense in fat-suppressed T1 and T2 sequences, showing the same signal intensity as fat in all pulse sequences [Figures 3a, b and 4a, b].
Preoperative magnetic resonance imaging, axial images, T1-weighted sequences. (a) Image of a hyperintense lesion adjacent to the mandibular cortex. (b) Fat-suppressed sequence showing a hypointense lesion
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F3
An imaging study was performed using orthopantomography, which was normal [Figure 2], and MRI (Systems Achieva Release 3.2 Level 3, 1.5 T, Philips Medical Systems, the Netherlands), which revealed a well-delimited homogeneous lesion (3.9 cm x 1.6 cm maximum diameter) adjacent to the right mandibular cortex displacing the anterior edge of the masseter without infiltration; the lesion appeared hyperintense on T1- and T2-weighted sequences, which became hypointense in fat-suppressed T1 and T2 sequences, showing the same signal intensity as fat in all pulse sequences [Figures 3a, b and 4a, b].
Preoperative magnetic resonance imaging, coronal images, T2-weighted sequences. (a) Image of a hyperintense lesion displacing the masseter. (b) Fat-suppressed image showing a hypointense lesion
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F4
An imaging study was performed using orthopantomography, which was normal [Figure 2], and MRI (Systems Achieva Release 3.2 Level 3, 1.5 T, Philips Medical Systems, the Netherlands), which revealed a well-delimited homogeneous lesion (3.9 cm x 1.6 cm maximum diameter) adjacent to the right mandibular cortex displacing the anterior edge of the masseter without infiltration; the lesion appeared hyperintense on T1- and T2-weighted sequences, which became hypointense in fat-suppressed T1 and T2 sequences, showing the same signal intensity as fat in all pulse sequences [Figures 3a, b and 4a, b].
(a) Surgical view of the intraoral approach. (b) Macroscopic appearance of the tumor after complete excision
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F5
After complete excision, an encapsulated, lobulated lesion of bright, yellowish appearance was observed macroscopically with regular, lobulated, and smooth borders [Figure 5a and b].
Histological examination of lipoblastoma (hematoxylin and eosin). (a) Mature and immature adipose tissues, myxoid stroma, and vessels (original magnification, x4). (b) Lipoblasts with slightly prominent peripheral nuclei and microvacuoles (original magnification, x40)
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F6
Histology confirmed the diagnosis of lipoblastoma, revealing a lesion with a predominance of mature and immature adipose tissue, areas of slight fibroblastic proliferation without atypia, myxoid stroma, and the presence of vessels [Figure 6a and b].
One-year follow-up
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F7
At 1-year follow-up, the patient showed a good facial symmetry and no recurrence [Figures 7 and 8a, b].
One-year magnetic resonance imaging follow-up study without tumor recurrence. (a) Axial T1-weighted image. (b) Coronal T2-weighted image
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F8
At 1-year follow-up, the patient showed a good facial symmetry and no recurrence [Figures 7 and 8a, b].