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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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CASE REPORT
Year : 2018  |  Volume : 36  |  Issue : 3  |  Page : 324-326
 

A rare presentation of lobular panniculitis in the oral cavity of a 2-year-old patient


Department of Pedodontics and Preventive Dentistry, AJ Institute of Dental Sciences, Mangalore, Karnataka, India

Date of Web Publication24-Sep-2018

Correspondence Address:
Dr. Pooja Nair
Department of Pedodontics and Preventive Dentistry, A.J Institute of Dental Sciences, Kuntikana, Mangalore - 575 004, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISPPD.JISPPD_16_18

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   Abstract 


Pannicultis is a rare disorder which usually affects the organ and tissue which are abundant in fat cells. It causes fatty degeneration of the fat cells and the diagnosis is usually made histologically. Here we present you a rare case of lobular pannicultis which occurred in a 2 year old patient in its oral cavity.


Keywords: Fat cells, fatty degeneration, panniculitis


How to cite this article:
Shetty SB, Thomas A, Shetty S, Nair P. A rare presentation of lobular panniculitis in the oral cavity of a 2-year-old patient. J Indian Soc Pedod Prev Dent 2018;36:324-6

How to cite this URL:
Shetty SB, Thomas A, Shetty S, Nair P. A rare presentation of lobular panniculitis in the oral cavity of a 2-year-old patient. J Indian Soc Pedod Prev Dent [serial online] 2018 [cited 2019 Dec 15];36:324-6. Available from: http://www.jisppd.com/text.asp?2018/36/3/324/241963





   Introduction Top


Panniculitis is a rare and poorly understood disorder of the adipose tissue with an unknown etiology. It usually occurs in the third to fourth decades of life. It has equal predilection for males and females. Pannicultis is a group of diseases characterized by inflammation of the subcutaneous adipose tissue that is the fatty layer under the skin. It is localized to the subcutaneous fat and hence termed as “panniculitis.”[1] It usually consists of a group of disorders which is usually challenging to the clinician.

Symptoms generally include tender skin nodules and systemic signs such as weight loss and fatigue. Clinically in all forms of panniculitis, lesions may be present as subcutaneous-indurated nodules. Most often on the lower extremities, but the torso, buttocks, arms, and head and neck area can be the primary sites of inflammation.[2]

Diagnosis is based on skin by biopsy, further classified by histological characteristics which are based on the location of the inflammatory cells within fatty lobules or in the septa which separate them, and by either the presence or absence of vacuities.[3]

This is a rare case of lobular panniculitis occurring in the buccal mucosa of a 2-year-old healthy male patient following a trauma.


   Case Report Top


A 2-year-old healthy patient reported to the outpatient department with the chief complaint of swelling over the left cheek region along with cut on the lower lip on the same side. After he accidentally fell over the sickle shaped knife while playing which eventually lead to the laceration of the lower lip and the swelling on the left cheek region which caused the growth overnight [Figure 1]. The patient was crying all the while during examination due to pain. On clinical examination, a growth was seen over the left buccal mucosa with a broad base which was attached to the inner side of the cheek which measured approximately (8 cm × 4 cm) and on palpation, no bleeding was seen. The mass was soft, edematous firm, and rubbery in consistency and it appeared almost as a secondary tongue. [Figure 2] The mother presented with complaint of uneasiness and difficulty in swallowing. The patient was admitted immediately as the swelling had increased overnight and any further increase in size would have obstructed the airway. After all the required investigations, the patient was treated later under general anesthesia; total excision was performed; and the specimen was sent for microbiological and histopathological examination, in which lymphocytes, neutrophils, and multiple multinucleated giant cells and multiple needle-shaped clefts were seen which confirmed the diagnosis as lobular panniculitis of the soft tissue [Figure 3] and [Figure 4].
Figure 1: Clinical picture of patient showing growth in the oral cavity and laceration on the lower lip (left lateral view)

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Figure 2: Clinical picture of patient showing growth in the oral cavity and laceration on the lower lip (right lateral view)

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Figure 3: Histologically showing fatty cell degeneration with needle shaped clefts

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Figure 4: Normal fatty cells along with degenerated cells and multinucleated giant cells

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   Discussion Top


Lobular panniculitis can either be generalized or localized [Figure 5] and [Figure 6]. Localized panniculitis has mainly three main differential diagnoses: trauma, cold panniculitis, or Munchausen's syndrome. An inflammatory disorder that is primarily localized in the subcutaneous fat is termed as panniculitis. This group of disorders may be challenging both for dermatologist and for the pathologist.[4] Clinically, they are present as erythematous or skin-colored subcutaneous nodules or indurated plaques that may be tender. The etiology of panniculitis can vary from physical insults to infections or to malignancies. The precise mechanism by which the panniculitis arises is not known. It is hypothesized that the withdrawal of systemic corticosteroid leads to abnor mal lipid metabolism, resulting in the elevation of saturated to unsaturated fatty acid ratio. As most of the cases resolve spontaneously, no treatment is needed.
Figure 5: Causes of pathology in fat cells

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Figure 6: Classification of pannicultis

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In the presented case, in total, elliptical biopsy was performed to involve the fat tissue followed by a detailed clinical history which is indispensable for histopathological assessment. Stepwise serials were made to identify the pattern of panniculitis, i.e., septal, lobular, and mixed, with or without vasculitis. A careful search for the diagnostic clues should be made, for example, crystals in lipocytes or histiocytes in order to know the causative factor in paniculities. Special stains in “obscure” suppurative or granulomatous panniculitis cases, to see fungal hyphae or spores, are obligatory. Sometimes, polarizing the sections is also important to look for sclerosing lipogranulomas or factitial panniculitis. Advising follow-up for biopsies of representative lesions is imperative to study the stages of evolution of the diseases, especially in cases with vasculitis.[5],[6]

In our presented case, there was no recurrence seen even after a period of 6 months and the patient is kept on a regular follow-up to see any chance of recurrence since the kid was not under the treatment of corticosteroids before the occurrence of growth; hence, it could be concluded by saying that this was a rare case of lobular panniculitis which happened in a 2-year-old patient and can be categorized as a lobulular panniculitis without vasculitis resulting from a trauma which usually has a good prognosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Peters MS, Su WP. Panniculitis. Dermatol Clin 1992;10:37-57.  Back to cited text no. 1
    
2.
Diaz Cascajo C, Borghi S, Weyers W. Panniculitis: Definition of terms and diagnostic strategy. Am J Dermatopathol 2000;22:530-49.  Back to cited text no. 2
    
3.
Ter Poorten MC, Thiers BH. Panniculitis. Dermatol Clin 2002;20:421-33, vi.  Back to cited text no. 3
    
4.
Patterson JW. Differential diagnosis of panniculitis. Adv Dermatol 1991;6:309-29.  Back to cited text no. 4
    
5.
Henry F, Piérard GE. Current classification of panniculitis. Rev Med Liege 1998;53:603-9.  Back to cited text no. 5
    
6.
Segura S, Requena L. Anatomy and histology of normal subcutaneous fat, necrosis of adipocytes, and classification of the panniculitides. Dermatol Clin 2008;26:419-24, v.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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