lipomas are the most common soft tissue mesenchymal neoplasms ; it involves 15 - 20% in the head and neck region and 1 - 4% in the oral cavity .
lipomas commonly present as slowly enlarging asymptomatic lesions , with a soft , and smooth - surface when it is superficial with a yellow coloration .
they most commonly occur in the areas of fat accumulation , especially the cheek , followed by the tongue , floor of the mouth , buccal sulcus and vestibule , lip , palate , and gingiva .
its exact etiology is unknown , possible causes may include trauma , infection , chronic irritation and hormone alterations and 12q , 13q , 6p chromosomes alterations .
its occurrence in the oral cavity is less , but if affected gingiva followed by lip , tongue , and palate are chiefly involved .
a 13-year - old boy reported to the department of oral medicine and radiology , with a chief complaint of swelling in his right lower buccal vestibule since 2 years , the swelling was initially smaller in size , when noticed by the parents , which gradually progressed to the present size and not associated with any pain or any functional impairment .
on intraoral examination , a solitary , sessile , dome - shaped normal mucosal colored swelling was present in the right lower buccal vestibule , measuring approximately 3 cm  2 cm in diameter , extending anterio - posteriorly from mesial aspect of 44 to the distal aspect of 46 , mediolaterally from the attached gingiva of 44 , 45 , 46 to till 0.5 cm away from lower buccal vestibule and superio - inferiorly 1 cm above the occlusal level of 44 , 45 , 46 to till the lower buccal vestibule with well - defined borders [ figure 1 ] .
on palpation , swelling was measuring about 3.5 cm  2.5 cm in diameter with smooth surface , normothermic , nontender , soft in consistency with few palpable masses , mobile , compressible , nonreducible , fluctuant with no palpable pulsations .
intraoral hard tissue examination showed retained deciduous 55 and yellowish white flecks on all the teeth .
panoramic radiograph was noncontributory [ figure 2 ] . based on clinical signs and symptoms , a provisional diagnosis of lipoma was established with a differential diagnosis of hemangioma and mucocele .
swelling in the right buccal vestibule panoramic radiograph revealed no loss of bone in relation to the lesion hemogram of the patient was within normal limits .
further investigations such as ultrasonography ( usg ) with doppler and magnetic resonance imaging ( mri ) were done , which were noncontributory .
usg revealed 2.6 cm  0.9 cm mass in the right buccal mucosa , which is predominantly hypo - echogenic with no evidence of internal vascularity [ figure 3 ] .
mri study of head and neck showed hypointense area on the right side of the mandible measuring about 26 mm  9 mm  10 mm [ figure 4 ] .
the lesion was excised [ figure 5 ] under local anesthesia with all necessary emergency equipment and excised specimen was sent for histopathological examination [ figure 6 ] which revealed overlying epithelium and connective tissue with numerous blood vessels of varying sizes and shapes intermingled with proliferating blood capillaries embedded in fibrous connective tissue .
the blood vessels are lined by plump endothelial cells and are engorged by rbc 's dense collagen fibers lined by spindle - shaped fibroblasts and fibrocytes are seen , which confirmed the diagnosis of sclerotic capillary hemangioma .
the patient was under follow - up since 6-months with a good prognosis [ figure 7 ] .
ultrasonography showing hypoechogenic areas magnetic resonance imaging showing hypointense area on the right side of mandible intraoperative photograph histopathological photomicrograph , 10 and 40 postoperative photograph ( after 6-months )
hemangiomas are considered to be benign tumors of infancy that are characterized by a rapid growth phase with endothelial cell proliferation followed by gradual involution .
hemangiomas follow a predictable course with three distinct developmental phases : proliferation , quiescence , and final unique phase of involution .
historical reports suggest that involution of 50% , 70% , and 90% of the hemangioma occurs by 5 , 7 , and 9 years of age with some variability .
they are classified on the basis of their histological appearance as capillary , mixed cavernous , or a sclerosing variety that tends to undergo fibrosis .
capillary hemangiomas may be sessile or pedunculated , soft , painless , and may be smooth or irregularly bulbous in outline .
its color varies from reddish blue to deep blue depending on the depth of vascular proliferation within the oral submucosa .
they blanch upon application of pressure ; conversely , when intraluminal clots form they become palpable and the lesion will usually not blanch as in the present case .
the exact etiology of vascular lesions is not known but according to few authors , angiogenesis plays a vital role in the pathogenesis of vascular lesions .
cytokines like basic fibroblast growth factor and vascular endothelial growth factor induce the process of angiogenesis and the factors which conquer angiogenesis ( gamma interferon , tumor necrosis factor beta , transforming factor - beta ) .
60% of the hemangiomas occurs in the head and neck region and its occurrence in the oral cavity is less , but if affected gingiva followed by lip , tongue , and palate are chiefly involved .
hemangiomas occur in the skin of 4 - 10% of caucasian newborn and much more common in females than males at a ratio 3:1 .
they show lower incidence in dark - skinned infants , but in our case , the patient was male . according to krishna kripal et al . , nadeem jeddy et al . , alparslan dilsiz et al . ,
clinically , the hemangiomas were soft , sessile or pedunculated , smooth or lobulated , painless , purple or deep dark blue in color with size varying from small to a larger lesion .
the findings in our case were similar to the finding noted by above authors except for the color , which was of normal mucosal color . clinically and histopathologically
, hemangiomas can mimic many other soft tissue tumors like the vascular malformations , pyogenic granuloma , epulis , varicosities , oral squamous cell carcinoma , kaposi sarcomas .
the differential diagnosis has a vital role to play in these lesions as it can dedicate the treatment option and the outcome of the disease .
hemangioma classification is based on histological appearance , therefore , histopathological assessment remains the most accurate and satisfactory means of diagnosis .
hemangiomas are histologically classified as capillary , cavernous , mixed and sclerosing type our case is of sclerotic capillary hemangioma . depending upon anatomic location and clinical manifestation , the treatment of hemangiomas varies .
surgical excision is the treatment of choice and for those lesions which are not amenable to surgery , other treatment modalities such as sclerotherapy , cryosurgery , laser therapy , electrocoagulation , and radiation may be utilized .
sclerotic capillary hemangioma being a very rare lesion , it should be included in the differential diagnosis of benign mucosal lesions with normal mucosal color , which do not blanch on pressure . when a clinician is in a dilemma , not cognizant with the possibility of this lesion in its unusual site , can be solved by histopathological assessment which remains the most accurate and satisfactory .
 lipomas and hemangiomas are well - known benign lesions of the body . however , their occurrence in the oral cavity is rare . 
 lipoma accounts for 1 - 4% of benign neoplasms of mouth affecting predominantly the buccal mucosa , floor of mouth and tongue . 
 hemangiomas occur mostly on the lips , buccal mucosa , tongue , and palate . 
 lipomas when superficially placed show yellowish surface discoloration and hemangiomas usually have reddish blue to deep blue color . here , we report an unusual case of benign tumor occurring in the buccal vestibule . 