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Bengaluru.
On Aug 2018




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Aug 2018




Dr. Rajendra Kumar Ghritlaharey

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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
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Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Dentistry
Year : 2012 | Month : May | Volume : 6 | Issue : 3 | Page : 524 - 526

Fibrolipoma : Report of Two Intraoral Cases

Sheela Kumar Gujjari, Mishal Shah, Usha Hegde, Vidya G. Doddawad

1. MDS, Professor, Department of periodontology 2. PG Student, Department of periodontology 3. MDS, Professor and Head, Department of oral pathology 4. MDS, Reader, Department of oral pathology JSS Dental College and Hospital A constituent of JSS University SS Nagar, Mysore 570015

Correspondence Address :
Dr Mishal Shah, PG Student
Department of Periodontology
JSS dental college and hospital
A Constituent of JSS university
SS Nagar, Mysore 570015
Phone: 9739061501
E-mail: drmishalshah@yahoo.com

Abstract

Fibrolipoma, a benign tumour, is classified as a variant of conventional lipoma. It usually presents as a soft, smooth – surfaced nodular masses that can be sessile or pedunculated. Most of them are less than 3 cm in size, but it can become much larger. The buccal mucosa and buccal vestibule are the most common intra-oral sites. Here, we present two cases of fibrolipoma, one on buccal mucosa and the other on the lateral border of tongue.

Keywords

Buccal Mucosa, Fibrolipoma, Lateral Border of Tongue, Pedunculated

Introduction
Fibrolipoma is an uncommon histological variant of the classic lipoma, in which neoplastic fat cells are embedded within dense collagen (1). Most patients are 40-years of age or older. Lipoma is a benign mesenchymal soft tissue neoplasm of mature adipose tissue (2),(3). They are relatively rare in the oral cavity, accounting for 1%–4.4% of all benign tumors (4),(5). Their aetiology and pathogenesis remain unclear, although mechanical, endocrine and inflammatory influences have been reported (6). Histologically, lipomas are classified as simple lipoma or variants such as fibrolipoma, spindle cell lipoma, intramuscular or infiltrating lipoma, angiolipoma, salivary gland lipoma (sialolipoma), pleomorphic lipoma, myxoid and atypical lipomas (1). Fibrolipoma of the oral cavity has been infrequently reported. It can occur in various anatomic sites including the buccal mucosa, lips, tongue, palate, buccal vestibule, floor of the mouth, and retromolar area (5). Fibrolipomas have also been reported in the extra-oral sites such as esophagus, pharynx, colon, trachea, larynx and other locations (7),(8). They are well-circumscribed, slow-growing, long standing, painless soft tissue tumours that may be superficially or more deeply located and covered by normal mucosa (2),(3),(5),(6),(9). They are usually slow growing and rarely recur after surgical treatment. Hence, the prognosis of these benign tumours is considered good (10),(11). Here, we present two cases of fibrolipoma, one on buccal mucosa and the other on the lateral border of tongue.

Case Report

Case 1
A 71-year-old male patient reported to the Department of Periodontology with the chief complaint of swelling in the right cheek since 6 years. The swelling was asymptomatic and the patient had not undergone any treatment for the same. Patient first noticed the swelling 6 years back which was small in size and slowly increased to the present size. Patient gave a medical history of being hypertensive and diabetic since 21-years and was on medication for the same. Both hyperCase Report Dentistry Section tension and diabetes was found to be under control. There was no other relevant medical history. The patient was a known smoker and an occasional alcoholic. On intra-oral examination, the oral hygiene status was found to be fair with a plaque and gingival index of < 2. There was a soft swelling measuring 10 mm in diameter noted on the right buccal mucosa. The lesion was well-circumscribed, pedunculated and had normal mucosal color. On palpation, it was non-tender, soft in consistency and had a smooth surface. There was no bleeding on provocation in the same area (Table/Fig 1).
Case 2
A 47-year-old male patient reported with the chief complaint of swelling in the right lateral border of tongue since 3 years. The swelling was asymptomatic and patient had not undergone any treatment for the same. Patient first noticed with swelling 3 years back which was small in size and slowly increased to the present size. There was no other relevant medical history. On intra-oral examination, the oral hygiene status was found to be fair with a plaque and gingival index of < 2. There was a soft swelling measuring 5 mm in diameter noted on the right lateral border of tongue. The lesion was well-circumscribed, pedunculated and yellow in color. On palpation, it was non-tender, soft in consistency and had smooth surface. There was no bleeding on provocation in the same area. In both the cases, a clinical diagnosis of lipoma/benign salivary gland tumour/fibroma was given. Routine haematological investigations were uneventful. The patients were called for phase I therapy and on the following visit, the swelling was excised surgically and sent for histopathological examination. Post-op instructions were given and patients were kept on antibiotic and analgesic coverage. Histologically, both the cases revealed connective tissue stroma consisting of dense collagen bundles, fibroblasts and mature adipocytes without any cellular atypia. Few chronic inflammatory cells and blood vessels could also be seen in the stroma. Stratified squamous epithelium was found covering the surface of the lesion (Table/Fig 2),(Table/Fig 3),(Table/Fig 5). Based on these findings, a diagnosis of fibrolipoma was given in both the case. Patients were recalled after a week and the healing was found to be satisfactory (Table/Fig 4). Follow up of the patient for the past 6 months in case 1 and 6 years in case 2 has not shown any recurrence.

Discussion

Benign lipomas are the most common mesenchymal tumours of soft tissue, but are relatively uncommon in the oral and maxillofacial region (2). The first description of this oral lesion was provided in 1848 by Roux in a review of alveolar masses; he referred to it as a “yellow epulis”. While most lesions are developmental anomalies, those which occur in t1he maxillofacial region usually arise late in life and are presumed to be neoplasms of adipocytes, occasionally associated with trauma. Few lipomas show rearrangement of 12q, 13q, 6p chromosomes (1),(12). Fibrolipoma, a benign tumour, is classified as a variant of conventional lipoma by the WHO (1). Oral lipomas are usually soft, smooth – surfaced nodular masses that can be sessile or pedunculated. Most of the lesions are less than 3 cm in size, but occasional lesions can become much larger. The buccal mucosa and buccal vestibule are the most common intra-oral sites and account for 50% of all cases. Less common sites include the tongue, floor of the mouth and lips. In our cases, the tumors were in buccal mucosa and on lateral border of tongue. Most patients are 40-years of age or older (1). In our case, the lesion was found in 71-year and 47-year old male patients. It has been suggested that fibrolipoma arise from the maturation of the lipoblastomatosis, which is an infiltrative type of benign neoplasm with lobules of immature fat cells separated by connective tissue septa and areas of loose myxoid matrix. Further, maturation of both adipose and fibrous tissue results in mature strands of collagen separating fat cells into lobules (9). Histologically, classic lipomas are composed of mature adipose tissue with true lipoblasts showing no cellular atypia. Adipose tissues can be admixed with other mature benign mesenchymal tissues, thus necessitating sub-classification (12). Several variants of lipoma have been described, such as fibrolipoma, spindle cell lipoma, intramuscular or infiltrating lipoma, angiolipoma, salivary gland lipoma (sialolipoma), pleomorphic lipoma, myxoid and atypical lipomas (1). In our cases, the diagnosis of fibrolipoma was given based on the presence of mature adipocytes interspersed with dense collagen fiber bundles. Fibrolipoma should be differentiated from spindle cell lipomas which are composed of mature lipocytes and uniform spindle cells in a mucinous and fibrous background. On occasions, fibrolipoma can be confused with herniated buccal pad of fat but the characteristic well –circumscribed nature and lack of history of trauma will help in differentiating it (1). The treatment of lipomas including fibrolipoma is usually surgical excision and the recurrence is rare. The asymptomatic course will allow the lesion to grow in most cases and only a cosmetic or functional problem will prompt the patient to seek dental assistance, as in our present cases (10),(11). Though reported complications of fibrolipoma are usually irrelevant, this tumour can be life threatening because of obstruction of upper airway by virtue of its size, as sudden asphyxial death has been reported in a case of oesophageal fibrolipoma (13). Liposarcoma can occur in long standing cases.

Conclusion

In literature, only few cases of fibrolipoma have been documented and the occurrence of fibrolipoma is very rare in the oral cavity. Hence, we have made an attempt to explain the clinical features and histopathology of this lesion. Many lesions show similar clinical findings but the histopathological examination help us to arrive at confirmative diagnosis. The diagnosis is very much essential for accurate and successful treatment, so that it can prevent further complications or malignant transformation, though rare.

References

1.
Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial Pathology; 2nd edition: Elsevier publication; 2004.
2.
Furlong MA, Fanburg–Smith JC, Childers EL. Lipoma of the oral and maxillofacial region: site and sub – classification of 125 cases. Oral Surg Oral Med Oral Path Oral Radiol Endod 2004;98:441-50.
3.
De Visscher JG. Lipomas and fibrolipomas of the oral cavity. J Maxillofac Surg 1982;10:177-81.
4.
Lombardi T, Odell EW. Spindle cell lipoma of the oral cavity: report of a case. J Oral Pathol Med 1994;23 :237-39.
5.
Fregnani ER, Pires 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.
6.
Aust MC, Spies M, Kall S, et al. Lipomas after blunt soft tissue trauma: Are they real? Analysis of 31 cases. Br J Dermatol 2007;157:92–99.
7.
Perez B, Campos ME, Rivero J, Lopez-Aguado D. Giant esophageal fibrolipoma. Otolaryngol Head Neck Surg 1999;120:445-46.
8.
Nicoli F, Balli C, Pezza V. A case of giant fibrolipoma of the esophagus. Diagnosis using computerized tomography and double-contrast esophagography. [Article in Italian]. Radiol Med 1990;80:99-102.
9.
Greer RO, Richardson JF. The nature of lipomas and their significance in the oral cavity: A review and case report of cases. Oral Surg Oral Med Oral Pathol 1973;36:551–57.
10.
Gupta S, Pathak S. Fibrolipoma of buccal mucosa – a case report. J Ind Dent Assoc 2011;5:737-38.
11.
Rehani S, Bishen KA. Intraoral fibrolipoma – a case report with review of literature. Ind J Dent Advanc 2010;2:215-16.
12.
Gnepp Dr. Diagnostic surgical pathology of the head and neck. Philadelphia; WB Saunders; 2000.
13.
Taft ML, Schwartz IS, Boghan LR. Sudden asphyxia death due to a prolapsed oesophageal fibrolipoma. Am J Forensic Path 1991;12: 85-88.

DOI and Others

DOI: JCDR/2012/3504:1946

Financial OR OTHER COMPETING INTERESTS:
None.


Date of Submission: Oct 26, 2011
Date of Peer Review: Jan 08, 2012
Date of Acceptance: Jan 12, 2012
Date of Publishing: May 01, 2012

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