Sublingual Lipoma — ORE Part 1 MCQ

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ModerateOral PathologySublingual LipomaORE Part 1

A patient presents with a slowly enlarging, painless swelling in the right sublingual region. It is firm and well-circumscribed. CT shows a well-defined mass in the sublingual space separate from the sublingual gland. The mass shows lobulated fat density. What is the most likely diagnosis?

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Correct answer: D — Lipoma

Explanation lettering: D = shown as A · C = shown as B · E = shown as C · A = shown as D · B = shown as E

The diagnosis is lipoma (A). The combination of slow growth, painless presentation, firm well-circumscribed mass with fat density on CT imaging is pathognomonic for a benign lipoma. Lipomas are encapsulated mesenchymal tumours composed of mature adipose tissue, characteristically showing fat density (−50 to −100 HU) on CT and frequently displaying a lobulated appearance. The mass being separate from the sublingual gland excludes gland-origin pathology. Dermoid cysts (B) present as non-enhancing cystic lesions with stratified squamous epithelium, not as fat-density masses. Ranulas (C) are retention cysts arising from salivary gland obstruction; they appear as unilocular fluid-density cystic lesions, not fat-density masses. Sublingual gland tumours (D) are ruled out by the stem stating the mass is separate from the sublingual gland and would show soft tissue density rather than fat density. Lymphangiomas (E) are multilocular cystic lesions containing lymph fluid, not mature fat.

Reference: Imaging of benign soft tissue tumors: focus on lipoma. Benign fatty tumors: classification, clinical course, imaging appearance, and treatment. American Journal of Roentgenology 2006; https://pubmed.ncbi.nlm.nih.gov/16927086/