Abstract
Background: This case report describes a well documented proximal femoral metadiaphysis intraosseous lipoma which later developed metastasis from a new esophageal cancer. Metastatic disease to benign conditions is a rare finding. To the best of our knowledge, this is the first reported case of metastatic disease to an intraosseous lipoma. Case Description: The metastatic deposit was initially detected by plain-film radiography, performed to evaluate new onset right hip pain, as possible new cortical breakthrough with irregularity in the site of previously known proximal right femur intraosseous lipoma. Concurrent follow-up PET/CT study showed a new hypermetabolic focus within the known intraosseous lipoma indicating a new metastasis that was confirmed with an MRI as a new enhancing mass within the preexisting intraosseous lipoma. Subsequently, an MRI-guided biopsy and eventually surgical excision was performed providing the histological samples for radiologic-pathologic correlation. Purpose and Clinical Relevance: Clinicians need to be aware that unusual, complex patterns within benign lesions may be a reflection of unexpected conditions, such as insufficiency injury, malignant transformation and secondary metastatic disease, as exemplified by our case report.
Highlights
Intraosseous lipomas are rare benign tumors of the bone that are most commonly found within the calcaneus and the proximal femur [1,2]
In the long bones the intramedullary lipomas (IMLs) are centered within the metaphysis and may occasionally extend into the diaphysis as is seen in our case report
MRI is highly sensitive for detection of IMLs, which have signal intensity similar to that of subcutaneous adipose tissue on T1 and T2 weighted images and demonstrate fat “drop-out” on fat suppressed or STIR sequences [7,8,9]
Summary
Intraosseous lipomas are rare benign tumors of the bone that are most commonly found within the calcaneus and the proximal femur [1,2]. The intraosseous lipomas are composed of mature adipose tissue along with varying amounts of fibrous and vascular tissues. They can involute resulting in foci of fat necrosis, cystic degeneration and dystrophic calcifications. To the best of our knowledge, this is the first reported case of metastatic disease to a pre-existing intraosseous lipoma
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