the common occurrence of these tumors is prevalent among males in their second or third decades of life with site predilection toward trunk and extremities , especially in the forearm .
however , the incidence of al is extremely rare in the intraoral region , with only 21 reported cases in english literature .
a 90-year - old woman with no significant medical history was referred to our department for evaluation of painless mass arising from oral cavity .
the tumor was noticed by the patient 20 years ago as a small nodule on the right buccal mucosa and since then it gradually increased in its size . the growth reached a size , which could not accommodate in mouth , and due to constant irritation from the tumor , the patient coughed the growth for 5 years . since then
on extraoral examination , a solitary , smooth , nontender and nonpulsatile pedunculated growth of size 14 cm  10 cm with variable consistency was evident with intraoral origin [ figure 1 ] .
clinical image shows preoperative tumor on intraoral examination , single , smooth , firm and nontender stalk - like pedicle of diameter 2 cm was seen originating from the right buccal mucosa .
based on the history and clinical examination , we provisionally diagnosed it as a benign growth . surgical excision of the tumor was done under general anesthesia [ figures 2 and 3 ] .
clinical image shows excised tumor mass clinical image shows postoperative frontal view histopathology confirmed it as noninfiltrating al [ figures 46 ] .
one - year follow - up of the patient revealed no evidence of recurrence . ethical approval from the institutional review board
was obtained for the publication , and patient release form was signed by the patient .
clinical image shows histopathology section ( 4 magnifications ) clinical image shows histopathology section ( 10 magnifications ) clinical image shows histopathology section ( 40 magnifications )
lipomas are the most frequently found soft - tissue benign tumors , but their occurrence in head and neck region is rare .
al , in the oral cavity , was first documented by davis et al . as a growth on the hard palate .
history of trauma , lipomatous differentiation by hormones during puberty , vascular proliferation of a congenital lipoma and fatty degeneration of a central hemangioma have been implicated as possible etiological factors .
the mean diameter at the largest portions of all the 21 documented als occurring in oral region was 3 cm , and the mean onset age of the patients was about 29 years old . although diagnostic modalities such as magnetic resonance imaging , computed tomography , ultrasonography and aspiration biopsy have been used to differentiate between hemangioma , lipomas and al , the diagnosis of these tumors is confirmed only by histopathology .
the standard treatment of choice is surgical excision for the noninfiltrating als and complete surgical excision with a clear surgical margin for poorly encapsulated infiltrating als to avoid recurrence .
the case we have presented showed the typical clinical and histological findings of a noninfiltrating al .
its most striking and unique features were its occurrence in a 90-year - old female with a 20-year long history and pedunculated mass of 14 cm  10 cm .
with regard to the size and its typical pedunculated appearance , our present case can be considered to be the first of its kind in literature .
 we present an extremely rare case of noninfiltrating angiolipoma ( al ) of the buccal mucosa in a 90-year - old patient reaching a size of 14 cm  10 cm . 
 al is rare in the soft tissues of oral cavity , and till date , only 22 cases have been reported , including our case . 
 if size be taken into consideration , our case can be considered to be the first in literature to reach this massive size . 
 surgical excision of the tumor mass was performed . 
 the histopathological findings confirmed the diagnosis of noninfiltrating al . 
 follow - up for 1 year revealed no signs of recurrence . 
INTRODUCTION
CASE REPORT
DISCUSSION
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