Intraosseous lipoma in the periapical region of a maxillary third molar

Images of oral lesions can look so exceptionally similar that a diagnosis hypothesis could be difficult. Lesions mimicking apical periodontitis must be considered when making a differential diagnosis. Intraosseous lipoma is a rare benign tumor of low incidence among all bone tumors, and therefore few cases have been reported in the literature.

A case of intraosseous lipoma associated with the distobuccal root of tooth #1 in a 39-year-old woman is described. The dental general practitioner did not perceive anything of note in terms of the radiographic aspect, so consequently the periapical lesion went unnoticed. However, after tooth extraction, a different feature was noticed in the surgical specimen. The lesion associated to the roots of tooth #1 was surrounded by soft tissue forming a fibrous capsule (10 mm in diameter). A histopathologic examination showed an area of bone of lamellar aspect surrounding a central area of fat tissue diagnosed as intraosseous lipoma. This type of lesion is asymptomatic, and its etiology is unclear.

Intraosseous lipoma should be considered in the differential diagnosis of other jaw lesions. A histologic examination is mandatory for the diagnosis, because this lesion is characterized by bone of lamellar aspect surrounding a central area of fat tissue. The treatment chosen in this case was surgical excision, and the outcome was favorable.