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Lipoma

Fatty Tumor

A lipoma is a benign soft-tissue tumor.


Presentation

Lipoma are usually subcutaneous in origin and lie under the skin in regions of the body where there is ample of subcutaneous fat [4]. Most common locations are axillae, arms, neck, shoulder and thighs. They do not grow in size too much and tend to limit the size up to a 1 centimeter diameter only. In few cases, the size may increase till 5 centimeters. Lipomas are usually single but can grow in crops. They are soft and doughy in consistency.

Lipomas are essentially painless and usually asymptomatic when noticed [5]. They will be noticed only when one feels a swelling over the part of the body. The “slippage sign” is very characteristic and helps to diagnose lipoma. When a lipoma is held between the fingers, it will slip out of the fingers and hence, the diagnostic sign is called as “slippage sign” [6]. The skin overlying the lipoma is absolutely normal. If at all there is a sebaceous cyst or an abscess, there is accompanying induration which is felt along with the swelling. Lipomas are per se painless and non-malignant. They are essentially nothing but a cosmetic nuisance.

Lipomas if present in the upper respiratory tract can lead to bronchial obstruction and airway distress. This is an emergency and in such a case, lipoma removal is a must. Intestinal lipomas present as obstruction and hemorrhage; hence, present as an emergency.

There are many types of lipomas [7]:

  1. Adenolipoma: These are lipomas that are associated with major sweat glands of the body also called as eccrine sweat glands.
  2. Angiolipoma: These are lipomas that are painful and have all the characteristics of a typical lipoma. These typically contain one or many blood vessels leading to accompanying pain. They are easily confused with an ordinary lipoma.
  3. Chondroid lipoma: These lipomas are located on the legs of the women and they are deep seated, yellow and firm to feel. They are completely opposite in features as compared to a normal lipoma.
  4. Angiolipoleomyoma: These lipomas have variants of soft tissue circumscribed within and composed of smooth muscles, blood vessels, connective tissue and fat.
  5. Hibernoma: A hibernoma is a lipoma which is composed of brown fat.
  6. Superficial subcutaneous lipoma: These are most common lipomas and are frequently diagnosed by feeling or examining the part.
  7. Neural fibrolipoma: This type of lipoma is actually an overgrowth along the nerve trunk consisting of fibro-fatty tissue. It tends to compress the nerve and produce pain or tingling or numbness along the nerve distribution.
Progressive Dysphagia
  • An 87-year-old man, who had been experiencing progressive dysphagia and slight chest discomfort for 12 months, presented for an esophagram with a diagnosis of achalasia.[ncbi.nlm.nih.gov]
Palpitations
  • She also reported frequent headaches and palpitations. She underwent a transoesophageal echocardiogram which showed a 2.6 1.6 1.6 cm echogenic mass at the superior vena cava (SVC) and RA junction.[ncbi.nlm.nih.gov]
Muscle Weakness
  • Parosteal lipomas occurring in the proximal radius may easily cause paralysis of the posterior interosseous nerve or muscle weakness. Level IV, Therapeutic study.[ncbi.nlm.nih.gov]
Subcutaneous Mass
  • Five patients presented with solitary and one with multiple subcutaneous masses measuring 5 to 9cm (median, 7.5cm). Affected sites were upper arm (3), shoulder (2), neck (1), trunk (1) and chest wall (1).[ncbi.nlm.nih.gov]
  • Differential Diagnosis: Subcutaneous Mass X.[fpnotebook.com]
  • Diagnostic Criteria Circumscribed subcutaneous mass Frequently multiple Rarely 2 cm We consider infiltrating intramuscular tumors to be intramuscular hemangiomas We consider spinal angiolipoma to be a distinct entity Composed of mature fat with numerous[surgpathcriteria.stanford.edu]
Scrotal Mass
  • We describe a case of a primary intrascrotal lipoma diagnosed after surgical excision in a young man presented at our Urological Department complaining a painful left scrotal mass.[ncbi.nlm.nih.gov]

Workup

Lipomas look very similar to other tumors and growths [8]. Diagnosis is best made by clinical examination and commonly no other investigative tests are needed. Sebaceous cysts look very similar to lipomas but there is a characteristic differentiation seen in the external appearance of the sebaceous cyst. Sebaceous cyst has a centrally located punctum and surrounding induration.

Abscesses have overlying induration and redness of the skin and an incision and drainage needs to be done for the removal of the abscess. Also, in contrast to lipomas, abscesses are extremely tender and painful, and tend to be associated with systemic signs like fever.

To increase the accuracy of the diagnosis and to be sure, one has to combine imaging techniques along with fine needle aspiration cytology. Generally, fine needle aspiration cytology is not done because the lipoma can be totally removed along with the capsule by a minor surgery and the trouble of undergoing investigative procedures is saved.

Treatment

There is no specific medical management for a lipoma but only surgical management. Medical management involves the use of alternative medicine of treatment as modern medicine has no medication for the prevention or control of growth for lipoma.

Surgical therapy is used in cases where there is concern as regards to cosmetic appearance of a visible lipoma [9]. A very tiny incision should be taken while removing subcutaneous lipomas as they are mostly removed only for cosmetic reasons. They do not pose any threat to health. Liposuction is an alternative which allows removal of the lipoma through a very small incision and the recovery time of such surgeries is very high. The actual lipoma may be very distant from the site of liposuction and this is an added advantage in this mode of treatment.

Endoscopic removal of the lipoma is done in cases of gastrointestinal growths and it can cause bleeding or perforation if the base of the lipoma is very broad [10]. Removal is suggested in case of intestinal lipomas which may be causing obstruction and hemorrhage.

Prognosis

Lipomas being benign, the outcome and the prognoses are very good. There is hardly any recurrence seen. In about 1 % of the patients recurrence may occur, that too only when there is incomplete excision of the lipoma.

Etiology

The exact cause of lipoma is not understood as yet but studies have confirmed that there is a link between chromosome number 12 and certain cases with solitary lipoma growth [2]. There have been several speculations about the etiology of lipoma but nothing specific has been demonstrated as yet.

Epidemiology

About 1 % of the population is affected with this complaint but very few opt for surgical removal owing to the harmless nature. Those who do opt for operations are for cosmetic purposes only. Medically, there is no treatment for curing lipoma or to prevent a lipoma.

Sex distribution
Age distribution

Pathophysiology

Lipomas are benign mesenchymal tumors which may originate in any part of the body [3]. Histologically, lipomas are tumors derived from cells called as adipocytes. Angiolipomas contain small blood vessels on doing fine needle aspiration cytology.

Prevention

There is no known way of preventing lipomas as the exact causes of lipoma formation are unknown. At best, maintaining correct BMI and low LDL might help.

Summary

A lipoma is a slow-growing, benign, fatty tumor that is mostly situated in the subcutaneous region between the skin and the underlying muscle layer. The mass is easy to identify as it moves readily between the two examining fingers. It is doughy to touch, soft in consistency and usually, not tender. Lipomas can be single or multiple and are the most common soft tissue swelling which can occur at any age, but are mostly detected during middle age [1]. A lipoma is usually benign and harmless. It is mostly left untreated, however if it is painful or increasing in size, it may need to be removed.

Patient Information

A lipoma is an innocent and harmless growth which is subcutaneous in origin. Lipomas are slow growing in nature and can affect people of any age group. They are the most common soft tissue swellings seen in people. A lipoma is basically a fatty lump. It is usually single in number and the size is limited to less than 1 centimeter in most of the cases but occasionally, there may be multiple lipomas in a single person.

They are subcutaneous in origin i.e. lie below the skin and can be lifted easily between two fingers when pinched. The characteristic sign for identifying lipoma is to lift it between two fingers and check if it slips down. This is known as slippage sign and used to differentiate a lipoma from various other growths in the body.

Lipomas grow in places where there is ample of subcutaneous fat in the body. Most commonly lipomas occur in the axilla, buttocks, thighs, neck etc. A lipoma is painless and does not have any other sign and symptom and patients are advised not to worry about them. There is no treatment which will help cure lipomas fully but there are certain surgeries which will help deal with a lipoma.

People who are cosmetically concerned can opt for surgery with a minimal incision. Prognosis of lipoma is excellent and chances of a recurrence are minimal. Lipomas aren’t fatal or life threatening and need not be surgically treated, if the cosmetic appearance is not a bother.

References

Article

  1. Pang D, Zovickian J, Oviedo A et al. Long-term outcome of total and near-total resection of spinal cord lipomas and radical reconstruction of the neural placode, part II: outcome analysis and preoperative profiling. Neurosurgery. 2010 Feb;66(2):253-72; discussion 272.
  2. Pang D, Zovickian J, Oviedo A et al. Long-term outcome of total and near-total resection of spinal cord lipomas and radical reconstruction of the neural placode: part I-surgical technique. Neurosurgery. 2009 Sep;65(3):511-28; discussion 528-9.
  3. Signorini M, Campiglio GL et al. Posttraumatic lipomas: where do they really come from? Plast Reconstr Surg. 1998 Mar;101(3):699-705.
  4. Italiano A, Ebran N, Attias R, et al. NFIB rearrangement in superficial, retroperitoneal, and colonic lipomas with aberrations involving chromosome band 9p22. Genes Chromosomes Cancer. 2008 Nov;47(11):971-7.
  5. Chiang JM, Lin YS et al. Tumor spectrum of adult intussusceptions. J Surg Oncol. 2008 Nov 1;98(6):444-7.
  6. Sakurai H, Kaji M, Yamazaki K, et al. Intrathoracic lipomas: their clinicopathological behaviors are not as straightforward as expected. Ann Thorac Surg. 2008 Jul;86(1):261-5.
  7. Erdem HR, Nacir B, Ozeri Z, Karagöz Aet al. [Episacral lipoma: a treatable cause of low back pain]. Agri. 2013 Apr;25(2):83-6.
  8. Lee HK, Hwang SB, Chung GH, Hong KH, Jang KY et al. Retropharyngeal spindle cell /pleomorphic lipoma. Korean J Radiol. 2013 May;14(3):493-6.
  9. Jain P, Chakrabarty B, Kumar A, Gupta N, et al. Encephalocraniocutaneous Lipomatosis With Neurocutaneous Melanosis. J Child Neurol. 2013 Apr 25;29(6):846-49..
  10. Choi JW, Kim HJ, Kim J, Kim HJ, Cha JH, Kim ST. Spindle cell lipoma of the head and neck: CT and MR imaging findings. Neuroradiology. 2013 Jan;55(1):101-6

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Last updated: 2017-08-09 18:19