Deep Lipomas Research Articles

[Translated article] Comparative study of deep lipomas and atypical lipomatous tumours: Malignancy risk factors

Background and objectivesThe diagnostic suspicion of an atypical lipomatous tumour (ALT) is difficult. The aim of this study is to delve into the most controversial diagnostic aspects of the subject. Material and methodObservational, longitudinal and retrospective study of a series of 96 deep adipose tumours (75 lipomas and 21 TLA) from 2006 to 2016: demographic, clinical, imaging and pathological variables were analysed and compared, as well as other variables related to treatment and oncological outcomes of the patients. A descriptive analysis of the collected variables was performed for the statistical study. To evaluate the potential predictor variables of malignancy, a multivariate logistic regression analysis was performed, including those that were statistically significant in the univariate analysis. ResultsOlder age at diagnosis, lower limb location and larger size were significantly more frequent in ALTs. MRI findings showed no statistically significant differences between the two groups. In multivariate analysis, the same clinical variables were confirmed as predictors of malignancy. In the ROC curve, an optimal cut-off point of 134.0mm was used as a predictor of malignancy. ConclusionsAdvanced age, location in the lower limbs and larger size are risk factors for malignancy in the differential diagnosis of deep lipomas and atypical lipomatous tumours. No radiological variable on MRI reached significance as a predictor of malignancy in our series.

Estudio comparativo de lipomas profundos y tumor lipomatoso atípico. Factores pronósticos de malignidad

Background and objectivesThe diagnostic suspicion of an atypical lipomatous tumour (ALT) is difficult. The aim of this study is to delve into the most controversial diagnostic aspects of the subject. Material and methodObservational, longitudinal, and retrospective study of a series of 96 deep adipose tumours (75 lipomas and 21 TLA) from 2006 to 2016: demographic, clinical, imaging and pathological variables were analysed and compared, as well as other variables related to treatment and oncological outcomes of the patients. A descriptive analysis of the collected variables was performed for the statistical study. To evaluate the potential predictor variables of malignancy, a multivariate logistic regression analysis was performed, including those that were statistically significant in the univariate analysis. ResultsOlder age at diagnosis, lower limb location and larger size were significantly more frequent in ALTs. MRI findings showed no statistically significant differences between the two groups. In multivariate analysis, the same clinical variables were confirmed as predictors of malignancy. In the ROC curve, an optimal cut-off point of 134.0 mm was used as a predictor of malignancy. ConclusionsAdvanced age, location in the lower limbs and larger size are risk factors for malignancy in the differential diagnosis of deep lipomas and atypical lipomatous tumours. No radiological variable on MRI reached significance as a predictor of malignancy in our series.

Large intramuscular and parosteal lipoma of the upper limb: A case report and literature review

Although lipomas are the most common benign soft-tissue tumors, the intramuscular type is rare and the parosteal type is even rarer. These types of tumors can present like malignant tumors like liposarcoma. Unlike superficial lipomas, deep lipomas (intramuscular/parosteal) require magnetic resonance imaging to evaluate for and rule out malignant features. We report this patient with giant and mixed types of rarest lipomas (intramuscular and parosteal) that arise from the humeral periosteum and within the brachioradialis muscle with encasement of the radial nerve. We aimed to increase awareness to think outside the box and shed light on this giant, rarest mixed type of intramuscular and parosteal lipomas. Furthermore, it emphasizes the need for careful investigations to rule out malignant tumors like liposarcoma. Finally, many orthopedic oncology centers designate large, deep lipomas as low-grade liposarcoma due to the risk of local recurrence.

A Large Intermuscular Lipoma of the Posterolateral Neck: A Case Report

Lipomas are a common soft-tissue tumor of mesenchymal origin, but intermuscular lipomas are very infrequently found especially in the cervical region. Although lipoma itself rarely causes complications, an accurate diagnosis and appropriate treatment are important. Surgical excision is indicated for deep lipomas that are 5 cm or larger, grow, or are accompanied by symptoms such as pain. It is also important to differentiate malignant tumors through pathological examination. Since the size of the lipoma was large, lipoma was divided into several pieces to successful removal, and the patient in this case showed successful recovery after surgery.

Lipoma

This soft-tissue tumor was removed from the thigh. The photograph shows a cross section of a well-delineated, irregularly lobulated, pale yellow lipoma. What is most accurate regarding lipomas?a.Lipomas are usually identified in children and are rare in adultsb.Lipomas frequently have chromosomal aberrationsc.Multiple lipomas are more common than solitary lipomasd.Most lipomas occur in the setting of a genetic syndrome Answer: b. Lipomas frequently have chromosomal aberrations Lipomas are benign, often asymptomatic tumors that are most often identified in adults. Lipomas are usually subcutaneous or superficial, and deep lipomas are less common. Although benign, most lipomas are associated with chromosomal aberrations. Aberrations involving 12q13-15 are common in conventional lipomas and may involve the HMGA2 gene, but other chromosomal aberrations can also occur.1Bartuma H. Hallor K.H. Panagopoulos I. et al.Assessment of the clinical and molecular impact of different cytogenetic subgroups in a series of 272 lipomas with abnormal karyotype.Genes Chromosomes Cancer. 2007; 46: 594-606Crossref PubMed Scopus (66) Google Scholar, 2Gamez J. Playan A. Andreu A.L. et al.Familial multiple symmetric lipomatosis associated with the A8344G mutation of mitochondrial DNA.Neurology. 1998; 51: 258-260Google Scholar Most lipomas are solitary tumors, but multiple lipomas can occur, including in syndromes such as familial multiple lipomatosis.

Submandibular lipoma in elderly female in mid western Nepal: A Case Report

Background and Objectives: The submandibular lipomas are relatively rare entity. The reported age of the patients were from birth to 84 years old, and average being 55.7 years. These are mainly asymptomatic and mostly cause aesthetic concerns. Deep lipomas, especially in the head and neck, are not commonly reported. To our knowledge there’s not even a single publication regarding the lipoma in the submandibular region in our mid western region as well as in our country.Presentation of case: A 72 years old female presented with complaints of painless progressive neck swelling in the right submandibular region for about 2 years. Clinically, it was thought to be submandibular gland neoplasm/ lymphadenopathy. Ultrasonography (USG) and fine-needle aspiration cytology (FNAC) were done. It was negative for malignancy. She underwent excision of the mass under general anesthesia without postoperative complications. The histopathology confirmed it to be lipoma. Discussion: Lipoma is a common benign mesenchymal tumour that is found almost anywhere in the body. However, a large lipoma is relatively rare in the submandibular region. On clinical doubt, one can rely on USG / MRI (magnetic resonance imaging) and FNAC to rule out diagnostic dilemma. The treatment of choice is simply excision. Conclusion: It’s a rare entity and may be the first report of a lipoma in the submandibular region in an elderly people. One should rule out its possibility while going through the submandibular region diseases.Janaki Medical College Journal of Medical Sciences (2016) Vol. 4 (2): 46-49

The Accuracy of Ultrasonography on the Location of Lipomas in the Forehead.

Preoperative recognition of tumor plane is important to avoid surgical complications in surgeries involving the scalp. Ultrasonography is a useful diagnostic tool to detect the depth of tumor noninvasively. However, some findings are not always in accordance with the actual locations of lipomas, especially in the forehead. To evaluate the accuracy of preoperative ultrasonographic findings for the location of lipomas in the forehead. The study included 14 patients with lipomas in the forehead who all underwent preoperative ultrasonography and surgical excision of the lesions. The authors compared the diagnostic location of tumors by ultrasonography with the actual location in the surgical field. On ultrasonography, 10 of 14 cases were diagnosed as frontalis-associated lipomas. However, 13 cases were confirmed as frontalis-associated lipomas intraoperatively, and only 1 case as superficial lipoma, which did not correspond with the ultrasonographic finding. The ultrasonographic findings were accurate in 9 of 14 cases (64.3%). The accuracy of ultrasonography on the location of lipomas in the forehead is not as high as expected. Therefore, the surgeon must consider the possibility of deep lipoma even if a forehead lipoma is superficial in location on ultrasonography.

Lipoma in Thenar Region

ABSTRACT Lipomas can be found anywhere in the body, with the majority being located in the head and neck region, as well as the back and abdomen. Lipomas are one of the most common benign, mesenchymal neoplasms. They may progress in size overtime and they may or may not be painful. They may be superficial or deep. Deep soft-tissue lipomas of the hand are rare. Among them, thenar intramuscular lipomas are very rare. We are reporting case of thenar intramuscular lipoma. Desai AA, Chandrakar BL, Thakkar R, Peswani R. Lipoma in Thenar Region. The Duke Orthop J 2015;5(1):68-69.

Compression syndrome of the posterior interosseous nerve by a deep lipoma: A case report

Compression syndrome of the posterior interosseous nerve by a deep lipoma: A case report

Compression of the posterior interosseous nerve by a deep lipoma

Joint Bone Spine - In Press.Proof corrected by the author Available online since vendredi 21 fevrier 2014

Clinical Characteristics of the Forehead Lipoma.

BackgroundLipomas can be categorized into deep and superficial lipomas according to anatomical depth. Many cases of forehead lipomas are reported to be deep to the muscle layer. We analyze ultrasound in delineating depth of forehead lipomas.MethodsA retrospective review was performed for all patients who underwent excision of forehead lipomas between January 2008 and March 2013 and for whom preoperative ultrasound study was available. Sensitivity and specificity of ultrasound imaging was evalauted against depth finding at the time of surgical excision.ResultsThe review identified 42 patients who met the inclusion criteria. Preoperative ultrasound reading was 18 as deep lipomas and 24 as superficial. However, intraoperative finding revealed 2 of the 18 deep lipomas to be superficial and 13 of the 24 superficial lipomas to be deep lipomas. Overall, ultrasonography turned out to be 69% (29/42) accurate in correctly delineating superficial versus deep lipomas.ConclusionLipomas of the forehead tend to be located in deeper tissue plane compared to lipomas found elsewhere in the body. Preoperative ultrasonography of lipomas can be helpful, but was not accurate in identifying the depth of forehead lipomas in our patient population. Even if a forehead lipoma is found to be superficial on ultrasound, operative planning should include the possibility of deep lipomas.

An unusual location of osteolipoma: a case report

Lipomas are the most common benign tumors of soft tissue in adults [1]. They may be located in either deep or surface tissues. Deep tissue-located lipomas are classified as intramuscular, intermuscular, parosteal, and interosseous lipomas [1]. It is common to encounter intraosseous lipomas originating from bony tissues, whereas it is very rare to encounter adipocytic cells with osteoid and/or chondroid tissues independent of bony tissues [2]. Osteoid lipomas (benign osteoid lipoma, osteolipoma, degenerative osteolipoma) are lipomas containing mature osteoid tissues [3, 4]. Osteoid lipomas are reported to be less than 1 % in the literature [2]. Osteolipomas, which found independent of bony tissue, are rare kind of tumors [5]. In our study, we intend to report a rare case of osteolipoma with a rare location independent of bony tissue and to emphasize that this lesion should be included in differential diagnosis of lipomatous lesions present in extremities.

Infiltrating lipoma of neck

Lipomas are common benign soft tissue neoplasms of mature adipose tissue. The peak incidence is usually in the fifth or sixth decade of life, while occurrence in children is very uncommo. Multiple presentations may occur in about 5% patients. The tumors may or encapsulated may not be. In a review of more than 1000 benign tumors of adipose tissue, over 80% were ordinary lipomas; nearly all the others were angiolipomas, intramuscular lipomas, or lipoblastomas. Other types accounted for less than 2% of all benign lipomatous neoplasms. The occurrence in the head and neck is relatively rare. Only 25% lipomas arise from the head and neck. Lipomas of the anterior neck are extremely rare. They may extend posteriomedially between the sternocleidomastoid and digastric muscles. Most commonly, they arise at the posterior subcutaneous neck. The deep lipoma is usually larger and deforms the surrounding tissue as compared to superficial lipomas which are generally more circumscribed.

Well-circumscribed deep-seated lipomas of the upper extremity. A report of 13 cases

The purpose of this study is to determine if giant size is of bad prognosis in deep lipomas of the upper extremity. We report a retrospective study of 13 patients with deep-seated lipomas of the upper extremity treated during the period from April 1997 to April 2008. We evaluated the clinical and radiological characteristics, treatment and evolution profile of these patients. There were 10 women and three men, with an average age of 53 years (range 30–79 years). Seven of these lipomas were in the arm, one in the shoulder, and five in the forearm. six lipomas were intramuscular, six intermuscular (three of them being attached to bone and labelled parosteal lipoma) and one epivaginal lipoma of the flexor tendon sheath. All patients presented a progressive slow-growing mass that was associated with radial paralysis in one case and carpal tunnel syndrome in one case. Plain radiographs showed a radiolucent soft tissue image in all cases and an associated osteochondroma in one parosteal lipoma. Computer tomography (CT) or magnetic resonance imaging (MRI) suggested the lipomatous nature and benign characteristics of these deep lipomas that were giant in all cases (mean size: 7 cm). Lipoma marginal excision was performed and histopathological examination demonstrated features consistent with a benign lipoma. There was good function and no clinical recurrence was observed after a mean follow-up of 3 years. Giant deep-seated lipomas of the upper extremity are uncommon and can be intermuscular or intramuscular. A painless soft-tissue mass is the most frequent chief complaint. MRI with fat suppression suggests the diagnosis and studies the extension of deep lipoma. Marginal excision is the treatment of choice and histopathology eliminates diagnosis of well-differentiated liposarcoma. Appropriate evaluation of deep lipoma is to rule out malignancy by systematically performing MRI and biopsy. In contrast to deep-seated lipomas of the lower extremity or the retroperitoneal space , the prognosis of deep-seated lipomas of the upper extremity is good irrelevant of their size. Recurrence and the degeneration are very rare. Level 4.

Well-circumscribed deep-seated lipomas of the upper extremity. A report of 13 cases

The purpose of this study is to determine if giant size is of bad prognosis in deep lipomas of the upper extremity. We report a retrospective study of 13 patients with deep-seated lipomas of the upper extremity treated during the period from April 1997 to April 2008. We evaluated the clinical and radiological characteristics, treatment and evolution profile of these patients. There were 10 women and three men, with an average age of 53 years (range 30-79 years). Seven of these lipomas were in the arm, one in the shoulder, and five in the forearm. Six lipomas were intramuscular, six intermuscular (three of them being attached to bone and labelled parosteal lipoma) and one epivaginal lipoma of the flexor tendon sheath. All patients presented a progressive slow-growing mass that was associated with radial paralysis in one case and carpal tunnel syndrome in one case. Plain radiographs showed a radiolucent soft-tissue image in all cases and an associated osteochondroma in one parosteal lipoma. Computer tomography (CT) or magnetic resonance imaging (MRI) suggested the lipomatous nature and benign characteristics of these deep lipomas that were giant in all cases (mean size: 7 cm). Lipoma marginal excision was performed and histopathological examination demonstrated features consistent with a benign lipoma. There was good function and no clinical recurrence was observed after a mean follow-up of three years. Giant deep-seated lipomas of the upper extremity are uncommon and can be intermuscular or intramuscular. A painless soft-tissue mass is the most frequent chief complaint. MRI with fat suppression suggests the diagnosis and studies the extension of deep lipoma. Marginal excision is the treatment of choice and histopathology eliminates diagnosis of well-differentiated liposarcoma. Appropriate evaluation of deep lipoma is to rule out malignancy by systematically performing MRI and biopsy. In contrast to deep-seated lipomas of the lower extremity or the retroperitoneal space, the prognosis of deep-seated lipomas of the upper extremity is good irrelevant of their size. Recurrence and the degeneration are very rare. Level 4.

Intermuscular lipoma of the submandibular space

Deep lipomas, especially in the head and neck region, are uncommon. This report describes the case of a patient with a large intermuscular lipoma of the submandibular space, which had been present for 10 years and was diagnosed by computed tomography. The clinical, imaging, and histopathological features, as well as the management of the tumor, are described.

Deep muscular lipoma of the transverse colon misdiagnosed as malignant stromal tumor: a report of one case

Deep muscular lipoma of the transverse colon misdiagnosed as malignant stromal tumor: a report of one case

Unilateral Carpal Tunnel Syndrome Caused by an Occult Palmar Lipoma

Carpal tunnel syndrome usually presents bilaterally and space-occupying lesions should be suspected in patients with unilateral symptoms, especially with a long history and when the symptomatic hand shows severe neurophysiologic impairment, while the contralateral hand is neurophysiologically intact. Approximately half of patients with unilateral symptoms have positive electrodiagnostic test results in the asymptomatic, contralateral hand. Space-occupying lesions are known to cause carpal tunnel syndrome and the incidence of space-occupying lesions in unilateral carpal tunnel syndrome is higher than that of bilateral carpal tunnel syndrome. It is easy to detect a mass when it is palpable, but occult lesions may be overlooked easily. Whenever a patient presents with unilateral symptoms and unilateral neurophysiologic impairment, the possibility of a space-occupying lesion compressing the median nerve should be kept in mind in the differential diagnosis. This article presents 2 cases of patients with occult deep palmar lipomas compressing the median nerve and causing unilateral symptoms of carpal tunnel syndrome. We stress the importance of imaging studies in patients with unilateral symptoms that are usually not used in carpal tunnel syndrome. While both patients' symptomatic hands showed severe neurophysiologic impairment, the contralateral hands were totally intact, which is contradictory with a long history. The reported patients were evaluated and magnetic resonance images revealed intra-tunnel lesions. Although lipomas are the most common soft tissue tumor in the body, <5% of the benign tumors of the hand are lipomas. Since the thick palmar fascia is strong, a deep lipoma may not be recognized although nerve compression symptoms may be gross.

REVIEW OF LARGE DEEP LIPOMATOUS TUMOURS

Lipomatous tumours comprise a range of diagnoses. There are controversies regarding the histopathological diagnosis, nomenclature, diagnostic method, surgical management, roles of radiotherapy and the risk of metastasis, local recurrence and dedifferentiation. This study describes our experience with such tumours. Retrospective review of 224 soft tissue tumours from the Senior Author's (J. W. S.) database identified 28 patients with deep lipomatous tumours. Clinical features and outcomes were studied with median follow up of 1.5 years. Eleven deep lipomas, six deep atypical lipomas, four well-differentiated (lipoma-like) liposarcomas, three well-differentiated liposarcomas and four liposarcomas were studied. Preoperative diagnosis was established by image-guided core biopsy in 20 patients, excisional biopsy in 6, incisional biopsy in 1 and fine-needle aspiration in 1. All patients diagnosed with deep lipoma and deep atypical lipoma underwent marginal excision. The median size of the excised tumour was 11 cm. Recurrence occurred in three deep atypical lipomas and one liposarcoma. Dedifferentiation occurred in one deep atypical lipoma, which transformed into a liposarcoma. None had metastasis or died of metastatic malignancy. Large deep lipomatous tumours are uncommon and although they do not tend to metastasize, they not infrequently recur locally. Hence their local treatment to prevent local recurrence is important. Key aspects in achieving a complete, but marginal resection of the deep atypical lipoma and the well-differentiated lipoma-like liposarcoma is accurate preoperative diagnosis with core biopsy and accurate imaging to assess deep unsuspected extensions of the tumour.

MRI findings of an intermuscular lipoma in a 2-year-old

We report the MRI findings of a large deep intermuscular lipoma in a 2-year-old child with a painless palpable shoulder mass, and its differentiation from liposarcoma and other soft-tissue masses. To our knowledge, the imaging features of deep lipomas in children have not been reported.