Slowly enlarging, painful mass in the left cheek.
Slowly enlarging,painful mass in the left cheek.CT scan was performed in the axial plane using 3mm-thick slices.Findings included a well defined mass measuring 2,5x2 cm lateral to the left zygomatic bone,which presented internal homogeneously fatty density and linear calcification of its apparent capsule.The mass was adherent with a broad base to the underlying bone which presented a small but definite periosteal reaction.Patient underwent surgical resection of the tumor and pathologic report was "connective fatty tissue in continuum with tiny bony spicules, bounded by a pseudocapsule consisting of amorphus calcified collagen.
Parosteal lipomas are rare benign tumors (0.3% of all lipomas) that appear to emerge from multidirectional mesenchymal modulation within the periosteum. Pathologically and cytogenetically are indistinct from usual lipomas . Comparative cytogenic tests have revealed common chromosomic alterations to both superficial and parosteal lipomas and more specifically a t(3;12)(q28;q14), giving support to a common histopathogenesis. The peculiarity of the parosteal lipoma lies in its clinical evolution which depends on its site of origin. It is in fact most often described in relation to the long bones of the limbs where it may lead to compression of neurovascular bundles or, as in this case, cause pain. The differential diagnosis should include the usual lipoma, which does not affect bone, a periosteal chondroma which contains no fat and presents characteristic calcification and a liposarcoma which presents mixed densities of fat and soft tissue and does not evoke periosteal reaction.
Parosteal lipoma of the zygoma.
Based on the provided head/face CT images (left cheek area), a well-defined soft tissue mass is observed in the left cheek region. The lesion primarily appears with fat density, with portions of slightly higher soft tissue density visible. It is closely attached to the adjacent cortical bone, and there may be mild bone remodeling or periosteal reaction. No obvious calcification or significant erosive bone destruction is noted.
The lesion has a relatively regular shape and a relatively localized range. However, given its close relationship with the periosteum/bone surface, it may suggest that the lesion originated from subperiosteal adipocytes or other mesenchymal tissues.
Considering the patient is a 32-year-old female who has a gradually enlarging mass in the left cheek area accompanied by pain, along with imaging findings (fat-density lesion closely attached to or slightly embedded in the periosteum surface, possibly causing periosteal or bony reaction), the most likely diagnosis is Parosteal Lipoma.
If there remains any doubt, further soft tissue MRI and pathological biopsy may be considered to confirm the diagnosis and exclude the possibility of other malignant lesions.
Treatment Strategy:
1. Surgical Resection: For parosteal lipomas causing pain, significant enlargement, or cosmetic and functional impact, complete surgical excision may be considered to prevent continued tumor growth and to relieve symptoms.
2. Conservative Observation: If the tumor is small with mild symptoms, and there is no significant pain or functional impairment, regular follow-up and imaging review can be done. Intervene if notable changes are observed.
Rehabilitation and Exercise Prescription:
1. Early Postoperative Stage: Focus on protective rehabilitation. Begin with basic functional exercises of the affected area, such as mouth-opening exercises (if facial muscles are involved) and gentle facial massage to prevent soft tissue adhesions.
2. 4–6 Weeks Postoperative: Gradually increase coordination training of the cheek muscles and exercises to improve the range of motion of the temporomandibular joint. Ensure movements are gentle to avoid pulling on the surgical site.
3. 6–12 Weeks Postoperative: If there are no complications or specific contraindications, strengthen local muscle power and endurance training, such as facial muscle resistance exercises (under professional guidance), combined with general aerobic activities (walking, jogging, etc.) to maintain overall fitness.
4. FITT-VP Principle:
• Frequency: 3–5 times a week, adjusted based on individual recovery.
• Intensity: Initially low intensity, within the tolerable pain range, gradually increasing.
• Time: 15–30 minutes per session to start, gradually extending the duration.
• Type: A combination of joint range-of-motion exercises, local muscle strengthening, and general aerobic training.
• Progression: Gradually increase exercise volume and complexity as symptoms improve and muscle strength increases.
Individualization Emphasized: If the patient has other systemic diseases or special facial skeletal conditions, consultation with specialist physicians and rehabilitation therapists is necessary to develop an individualized rehabilitation plan, with regular follow-up evaluations.
This analysis report is for reference only and cannot replace offline clinical diagnosis and treatment. Patients should make final decisions based on their specific conditions and advice from professional in-person medical consultations.
Parosteal lipoma of the zygoma.
