Lipoma Research Articles

Preclinical Evidence of Curcuma longa and Its Noncurcuminoid Constituents against Hepatobiliary Diseases: A Review.

Hepatobiliary disease currently serves as an important public health issue due to the fact that it is one of the major causes of death among economically active individuals and can easily progress to chronic diseases. Despite the development of vaccines and numerous drugs, a definite treatment remains lacking owing to different stages of the disease itself, its intricate pathogenesis, an effect uncertainty for long-term use, resistance, and side effects. Curcuma longa (C. longa), which belongs to the family Zingiberaceae and the genus Curcuma, has long been used not only as spice for curry or dye but also as a constituent of herbal formula for the treatment of different diseases due to its bioactive activities. Recently, many studies on the experimental results of C. longa have been published relative to hepatobiliary diseases such as fatty liver, hepatitis, cirrhosis, and tumors. Therefore, in this review, we aimed to summarize the pharmacological effects and underlying molecular mechanisms of C. longa and its four compounds, β-elemene, germacrone, ar-turmerone, and bisacurone, against hepatobiliary diseases. C. longa exhibited antioxidant, hepatoprotective, antisteatotic, anti-inflammatory, antifibrotic, antitumor, and cholagogic effects by regulating apoptosis, CYP2E1, Nrf, lipid metabolism-related factors, TGF-β, NF-κB, CYP7A1, and so on. In particular, β-elemene could be an attractive compound owing to its remarkable hepatoprotective, anti-inflammatory, antifibrotic, and antitumor activities. Altogether, the present review provides a preclinical basis for the efficacy of C. longa as an effective therapeutic agent for the prevention and treatment of hepatobiliary diseases, despite the need for further studies to establish the extraction conditions and separation of active constituents with high bioavailability, and warrants further evaluation in clinical trials.

SPINDLE CELL LIPOMA OF THE ORAL CAVITY: CASE REPORT OF AN UNCOMMON AND DISTINCT VARIANT OF LIPOMA

Spindle cell lipoma (SCL), an uncommon histologic variant of lipoma, is a benign tumor that often occurs in the posterior neck or shoulder with rare occurrence in the oral cavity. It comprises about 1.6% of intraoral lipomatous tumors. The aim of the case report is to present the histopathologic features of a SCL. A 60-year-old woman with noncontributory medical history was examined for an asymptomatic nodule in the left buccal mucosa. The intraoral examination showed a 7-mm sessile and well-circumscribed nodule with firm consistency and smooth surface covered by slightly whitish mucosa. Excisional biopsy was carried out based on a clinical diagnosis of inflammatory fibrous hyperplasia. The histopathology demonstrated mature adipose tissue, spindle cells (CD34+), and many mast cells in a connective tissue stroma. The diagnosis of SCL was hence established. The patient is being followed up.

The largest reported intrathoracic lipoma: a case report and current perspectives review

BackgroundThe huge size intrathoracic lipomas are very rare. Few cases have been reported worldwide. To our knowledge, this presented case is one of the few cases reported. Here we report a single case as very huge intrathoracic lipoma compressing the right lung and displacing the diaphragm and liver downward. It has been managed by right posterolateral thoracotomy and complete excision, with excellent outcome.Case presentationA 32-year-old male presented with a symptomatic right intrathoracic mass, which was confirmed to be a lipomatous tumor using computed tomography. A penduculated tumor originating from the mediastinal pleura was resected through the conventional right posterior thoracotomy. Pathological examination indicated a diagnosis of fibrolipoma.ConclusionThe tumor was symptomatic and relatively huge when detected during a medical checkup. This enabled the successful tumor resection via conventional thoracotomy approach. Although intrathoracic lipomas are histologically benign, careful observation and follow-up are crucial due to the possibility of recurrence.

A case of tumor of the tongue that was considered a morphologically atypical lipomatous tumor

A case of tumor of the tongue that was considered a morphologically atypical lipomatous tumor

The malignancy among gastric submucosal tumor

The origin and characteristics of most submucosal tumors (SMTs) cannot easily be confirmed by gastrointestinal endoscopy or other radiological examinations. Excluding GISTs, for those other gastric SMTs, most of which are deemed benign, the necessity and timing of intervention has been ignored. Thus, the malignancy of gastric SMTs still remains unknown. In order to summarize the malignancy of these gastric SMTs, we reviewed literatures and analyzed cases of gastric SMTs including heterotopic pancreas, leiomyoma, schwannoma, glomus tumor, hemangioendothelioma, granular cell tumor (GCT), lipoma, hemangiopericytoma, lymphangioma and neurofibroma. In these literatures, there are cases of malignancy among heterotopic pancreas, leiomyoma, schwannoma, glomus tumor, hemangioendothelioma and GCT. As a result, it suggests that although most of gastric SMTs are considered benign, there are still possibilities of malignancy, which requires our attention, even active intervention and long-term follow-up.

Diagnostic Utility and Limitations of Immunohistochemistry of p16, CDK4, and MDM2 and Automated Dual-color In Situ Hybridization of MDM2 for the Diagnosis of Challenging Cases of Dedifferentiated Liposarcoma.

The diagnosis of dedifferentiated liposarcoma (DDLPS) is challenging when an atypical lipomatous tumor component is absent or obscure. To analyze the utility and limitations of ancillary techniques, we studied 11 cases of DDLPS in challenging conditions and 17 cases of nonlipogenic high-grade sarcomas with immunohistochemistry (IHC) for p16, CDK4, and MDM2 and automated dual-color in situ hybridization (DISH) for MDM2 amplification. All DDLPS specimens lacked clear lipogenic components and were immunoreactive for p16, CDK4, and MDM2. DISH analyses also revealed high-level amplification of MDM2 in all DDLPS. In contrast, among nonlipogenic sarcomas, p16, CDK4, and MDM2 were expressed in 8, 9, and 3 cases, respectively. MDM2 amplification was detected in 3 of 8 studied. The MDM2-amplified tumors were the same as the MDM2-immunoreactive tumors. After careful reevaluation of these 3 sarcomas, 2 were reclassified as DDLPS because small areas of lipogenic components were detected in the original specimens. The respective sensitivities and specificities of these markers were as follows: p16 IHC (100% and 60%), CDK4 IHC (100% and 53.3%), MDM2 IHC (100% and 93.3%), and MDM2 DISH (100% and 83.3%). The results of MDM2 IHC completely coincided with those of MDM2 DISH. The present study confirmed the substantial utility of MDM2 IHC and MDM2 DISH in the diagnosis of DDLPS, especially when lipogenic components were indistinct compared with IHC for p16 and CDK4. Furthermore, automated DISH was more practical than fluorescent in situ hybridization.

Primary Atypical Lipomatous Tumor of the Orbit.

This is a Letter to the Editor and does not have an abstract.

Investigation of stemness and multipotency of equine adipose-derived mesenchymal stem cells (ASCs) from different fat sources in comparison with lipoma

BackgroundAdipose tissue-derived mesenchymal stem cells (ASCs) offer a promising cell source for therapeutic applications in musculoskeletal disorders. The appropriate selection of ASCs from various fat depots for cell-based therapy is challenging. The present study aims to compare stemness and multipotency of ASCs derived from retroperitoneal (RP), subcutaneous (SC), and lipoma (LP) fat to assess their usefulness for clinical application.MethodsEquine ASCs from the three fat tissue sources were isolated and characterized. The cell viability, proliferation, and self-renewal were evaluated using MTT, sulforhodamine B, and colony forming unit (CFU) assays. Stem cell relative marker CD44, CD90, and CD105 and tumor marker CA9 and osteopontin (OPN) expression were quantified using RT-qPCR. Multipotency of ASCs for adipogenic, osteogenic, and chondrogenic differentiation was examined by quantifying Oil Red O and Alizarin Red S staining, alkaline phosphatase activity (ALP), and expression of differentiation relative markers. All data were statistically analyzed using ANOVA.ResultsRP fat-derived ASCs showed a higher cell proliferation rate compared to SC and LP derived cells. In contrast, ASCs from lipoma displayed a lower proliferation rate and impaired CFU capacities. The expression of CD44, CD90, and CD105 was upregulated in RP and SC derived cells but not in LP cells. RP fat-derived cells displayed a higher adipogenic potential compared to SC and LP cells. Although ASCs from all fat sources showed enhanced ALP activity following osteogenic differentiation, SC fat-derived cells revealed upregulated ALP and bone morphogenetic protein-2 expression together with a higher calcium deposition. We found an enhanced chondrogenic potency of RP and SC fat-derived cells as shown by Alcian blue staining and upregulation of aggrecan (Aggre), cartilage oligomeric matrix protein precursor (COMP), and collagen 2a1 (Col2a1) expression compared to LP. The expression of OPN and CA9 was exclusively upregulated in the ASCs of LP.ConclusionsThe results provide evidence of variation in ASC performance not only between normal fat depots but also compared to LP cells which suggest a different molecular regulation controlling the cell fate. These data provided are useful when considering a source for cell replacement therapy in equine veterinary medicine.

Three Novel Aberrations Involving PLAG1 Leading to Lipoblastoma in Three Different Patients: High Amplification, Partial Deletion, and a Unique Complex Rearrangement

Lipoblastoma is a rare benign neoplasm with overlapping histology with other lipomatous tumors. Genetic aberrations including translocations of 8q and splitting of the PLAG1 probe leading to “promoter swapping” and gains of chromosome 8 or PLAG1 foci have been described in lipoblastoma. Here, we report 3 lipoblastomas revealing novel genetic aberrations involving PLAG1: a high level of PLAG1 amplification up to 50 copies in a 4-year-old girl with recurrence of a right flank mass, a partial deletion of PLAG1 with the flanking junction breakpoints involving the 3′PLAG1 and 5′HAS2 genes in a 17-month-old boy with a retroperitoneal mass, and an insertion of 2q31 into 8q11.2 and translocation of 8q to 2q with the latter translocated onto 12q leading to separation of the PLAG1 FISH probe in a 5-year-old girl with a left back mass. Our novel cytogenetic findings further expand the mechanisms of PLAG1 transcriptional upregulation in lipoblastoma pathogenesis.

Atypical lipomatous tumour/well-differentiated liposarcoma and de-differentiated liposarcoma in patients aged≤40years: a study of 116 patients.

Limited data exist on atypical lipomatous tumour (ALT)/well-differentiated liposarcoma (WDL) and de-differentiated liposarcoma (DDLPS) in children and young adults. Cases of ALT/WDL/DDLPS arising in patients aged≤40years were collected from multiple institutional and consultation archives. A total of 116 cases of ALT/WDL (75) and DDLPS (41) were identified, representing fewer than 5% of these tumours seen at our institutions during this time-period. The patients (59 male/57 female) ranged in age from 8 to 40years. Sites included deep central (abdomen/retroperitoneum/pelvis/groin) (n=60), extremity (n=42), trunk (n=5), head/neck (n=8) and mediastinum (n=1). De-differentiated patterns included: high-grade pleomorphic sarcoma, myxofibrosarcoma-like, heterologous rhabdomyoblastic differentiation, low-grade spindle cell sarcoma and homologous lipoblastic differentiation. Forty-one patients experienced a local recurrence and 11 patients with DDLPS developed metastasis. ALT arising in the extremities had lower recurrence rates than deep central WDL (5-year recurrence-free survival 88.9% versus 59.0%; P=0.002), while patients with deep central DDLPS experienced significantly more adverse events compared to WDL at this site (5-year event-free survival 11.9% versus 59.0%) (P<0.0001). Seven (of eight) head/neck tumours had follow-up available; five recurred, and one patient (DDLPS) with recurrence also experienced a metastasis. The single mediastinal tumour (DDLPS) recurred and metastasised. ALT/WDL and DDLPS occurring in patients aged≤40years is rare, but exhibits similar morphological features to its counterparts in older adults, including potential for heterologous and homologous de-differentiation in the latter. Although case numbers are limited, tumours arising in the head and neck exhibit high rates of adverse events, suggesting that classification as WDL rather than ALT is more appropriate.

Identification of somatic alterations in lipoma using whole exome sequencing

Lipomas are benign fatty tumors with a high prevalence rate, mostly found in adults but have a good prognosis. Until now, reason for lipoma occurrence not been identified. We performed whole exome sequencing to define the mutational spectrum in ten lipoma patients along with their matching control samples. We presented genomic insight into the development of lipomas, the most common benign tumor of soft tissue. Our analysis identified 412 somatic variants including missense mutations, splice site variants, frameshift indels, and stop gain/lost. Copy number variation analysis highlighted minor aberrations in patients. Kinase genes and transcriptions factors were among the validated mutated genes critical for cell proliferation and survival. Pathway analysis revealed enrichment of calcium, Wnt and phospholipase D signaling in patients. In conclusion, whole exome sequencing in lipomas identified mutations in genes with a possible role in development and progression of lipomas.

1613 A Case of Extreme Fatty Expulsion Per Rectum

INTRODUCTION: The purpose of colonoscopies (CLN) is primarily for the prevention &amp; management of disease in the lower gastrointestinal (GI) tract. Colonoscopies can often find fleshy masses found to be benign polyps, colorectal cancer, and even lipomas. These masses are rarely passed through the GI tract. The mechanism of spontaneous expulsion is thought to be primarily from auto-amputation. This auto-amputation occurs when a polyp or mass on a pedunculated stalk twists upon itself. It continues to twist until becoming free from the mucosal layers inside the GI tract. This allows the mass to be free to pass into rectal vault &amp; present as a bowel movement. Though this mechanism is known, spontaneous expulsion of such fleshy masses is thought to be quite rare. CASE DESCRIPTION/METHODS: A 48-year-old male with a past medical history of a partial small bowel obstruction &amp; atrial fibrillation (AF) on rivaroxaban presented to ED with complaints of intermittent abdominal pain &amp; an abnormal bloody bowel movement. Prior CLN in 2014 was negative except for benign polyps. Patient described his stool as an "abnormal mass.” On gross evaluation the stool was noted to be a large yellow/tan fatty mass measuring 4 × 3.4 × 5.3 cm. Histological examination showed benign adipose tissue separated by thin fibro-vascular septae. Evaluation with CLN showed an 18mm pedunculated polypoid lesion on a thick 15mm stalk in the descending colon. The head of the lesion was found to be erythematous with granulation tissue on its surface consistent with recent removal of a large polypoid lesion. Cold forceps were used to biopsy the lesion &amp; revealed benign submucosal lipomatous neoplasm. DISCUSSION: Lipomas are non-malignant neoplasms composed of adipose tissue. They can often be found throughout the body and rarely present in the GI tract. If present in the GI tract they are often found to be submucosal &amp; in the colon. Majority are asymptomatic but can produce symptoms if &gt; 2 cm. This patient’s lipoma was noted to be &gt; 4 cm. This patient presented with intermittent lower abdominal pain, changes in bowel habits, passage of fresh blood per rectum, recurrent AF episodes, along with passing a lipomatous mass. After expulsion of this mass the patient noted decreased episodes of AF. This case &amp; its findings demonstrate that spontaneous expulsion of a lipoma can occur via similar mechanisms of auto-amputation for polyps as previous cases have shown. It also reminds us the relationship between abdominal pathologies &amp; the propensity for AF.

Low Recurrence Rate and Risk of Distant Metastases following Marginal Surgery of Intramuscular Lipoma and Atypical Lipomatous Tumors of the Extremities and Trunk Wall

Objective:The purpose of the present study was to determine the local recurrence rate, risk of dedifferentiation, and distant metastasis after surgical excision of intramuscular lipomas (IML) and atypical lipomatous tumors (ALT). Subjects and Methods: We retrospectively assessed all IML and ALT surgically removed from the extremities or trunk wall in our clinic between 1997 and 2006. Data from 141 patients with IML and 35 patients with ALT were extracted from the National Pathology Registry and patient files. Results: IML and ALT recurred in 10 and 6 tumors, respectively. No metastases were observed in either group. The 5- and 10-year local recurrence-free survival rates were 97.1% (94.3–99.9) and 94.8% (CI: 91.1–98.6) for IML and 84.6% (CI: 72.1–97.1) and 81.1% (CI: 67.6–94.8) for ALT, respectively. ALT were found to dedifferentiate in 2/35 cases. Conclusion: Both IML and ALT showed a low recurrence rate when removed surgically from the extremities or trunk wall with intended marginal resection. No distant metastases were observed in any of the groups. It, therefore, seems safe to treat these tumors with marginal resection.

Diagnostic performance of MRI and histology in assessment of deep lipomatous tumours.

Deep lipomatous tumours can be benign lipomas or intermediate/locally recurring atypical lipomatous tumours (ALTs). Differentiating between these two entities clinically and radiologically is difficult. The aims of this study were to report a series of deep lipomatous tumours, comparing the clinical, radiological and pathological features of ALTs and lipomas; and to predict the likelihood of a lipomatous tumour being ALT based on anatomical site and MRI characteristics. This was a retrospective review of patients with deep lipomatous tumours presenting over 6 years to a tertiary sarcoma centre, with preoperative MRI, and preoperative or postoperative histology including MDM2 gene analysis. Sensitivity, specificity, predictive values and accuracy in diagnosing ALT were calculated for MRI and histopathological features. Some 248 patients were included; 81 (32·7 per cent) had a final diagnosis of ALT. ALTs were larger than lipomas (median 19 versus 10 cm; P < 0·001); there was no ALT smaller than 5 cm. A tumour presenting in the lower limb was more likely to be an ALT than a lesion at any other site (48·4 versus 13·5 per cent; P < 0·001). In patients with lipomatous tumours at sites other than the lower limbs, MRI had a negative predictive value of 95 per cent for excluding ALT. Despite concern, most deep lipomatous tumours (nearly 70 per cent) are benign lipomas. Certain features imply that tumours are almost never ALT: smaller than 5 cm or located outside the lower limb with no suspicious characteristics on MRI. Tumours with these features might safely and confidently be managed outside tertiary sarcoma centres.

What's new in adipocytic neoplasia?

Adipocytic tumors are frequently encountered in routine practice, and while the vast majority represent commonly encountered tumor types (e.g., benign lipoma), the heterogeneity and rarity of other adipocytic neoplasms can pose diagnostic challenges. Atypical and malignant adipocytic tumors account for approximately 20% of all sarcomas. The 2013 World Health Organization (WHO) classification of soft tissue and bone tumors recognizes four major liposarcoma subtypes, characterized by distinct clinical behavior, distinctive morphologies, as well as unique genetic findings: atypical lipomatous tumor/well-differentiated liposarcoma, dedifferentiated liposarcoma, myxoid liposarcoma, and pleomorphic liposarcoma. Since the publication of the 2013 WHO classification of soft tissue and bone tumors, the most notable change in the category of adipocytic tumors has been made in the clinicopathologic and molecular characterization of the heterogeneous but distinct group of "atypical low-grade adipocytic neoplasms with spindle cell features," for which the term atypical spindle cell/pleomorphic lipomatous tumor has been proposed. Another substantive change in the group of adipocytic tumors is the introduction of pleomorphic myxoid liposarcoma (myxoid pleomorphic liposarcoma) as an apparently novel subtype of aggressive liposarcoma, especially occurring in children and young adults with a predilection for the mediastinum. This review will further focus upon the diagnostic criteria of these novel emerging entities in the group of adipocytic tumors.

Parosteal lipoma of proximal radius: A rare case report and its clinical approach

Lipoma is the most common benign soft tissue tumor; however, they are rarely seen in bony tissue. Osseous lipomas are classified as intraosseous (originating within the bone) or juxtacortical (on its surface). Surface lipomas may be further subdivided into parosteal lipoma and subparosteal lipoma, depending on its anatomical relationship to periosteum. Parosteal lipoma is a rare benign fatty neoplasm, accounting for less than 0.3% of all lipomas. They are almost always solitary occurring in the extremities sometimes with periosteal changes. Owing to its rarity, we report a case of parosteal lipoma of proximal radius in a 32-year-old female without periosteal changes and without nerve involvement. It was evaluated clinically and radiologically and a core needle biopsy was done which was suggestive of benign lipomatous lesion. Then en masse excisional biopsy was done and the diagnosis of parosteal lipoma was established after histopathological examination. Pertaining to its anatomical location, surgical dissection is very important to preserve superficial radial nerve, posterior interosseous nerve, and supinator muscle. At final follow-up, patient is doing well with full range of motion, preserved nerve function and elbow function.

Prophylactic operation for asymptomatic spinal lipomas in children

Objective To explore the clinical outcome and value of prophylactic operation of asymptomatic spinal lipomas in children. Methods We retrospectively analyzed the clinical data of 168 patients with asymptomatic spinal lipomas who underwent prophylactic operation from April 2001 to June 2015 at Department of Neurosurgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University. Those patients (with an average age of 7 months) aged from 1.5 months to 15 years old were free of preoperative symptoms such as pain, gatism and/or bilateral lower limb dysfunction. Surgical protocols included removal of the lipomas in subcutaneous and extramedullary tissues, complete excision of extraspinal lipomas, subtotal resection of intraspinal fat, detaching of the medullary cones from dura sac and release of the tethered cord. Results In 168 patients, complete resection was achieved for the dorsal spinal lipoma(132 patients) and subtotal resection was undertaken for the lateral type and the wrapped lipoma(36 patients). Five cases developed cerebrospinal fluid leakage that caused subcutaneous effusion after surgery, which resolved following multiple punctures and pressure dressing. Six patients had slight gatism. Among them, 5 recovered in 1 month and 1 had no relief of symptoms. In this series, 159 out of 168 cases were successfully followed up for 3-19 years (with an average of 76 months). Long-term postoperative symptoms were observed in 13 patients, with an incidence of 8.2%. Twelve patients of them had spinal cord retethering and 1 had lipoma enlargement. Conclusion Prophylactic surgery could lead to favorable outcomes in children with asymptomatic spinal lipomas and help prevent neurologic dysfunction in the future. Key words: Spinal cord; Lipoma; Neurosurgical procedures; Prognosis

Mystery Lipomas and the Deceptive Ultrasound

Mystery Lipomas and the Deceptive Ultrasound

Sialolipoma of Parotid Gland: a Lesser Known Entity

Around 51 cases of sialolipoma of the salivary gland have been reported worldwide as per the literature reviewed. Majority of cases (n = 25) arise from the parotid gland (51.4%) clinically behaving like pleomorphic adenoma with very less incidence of facial nerve entrapment (14%). Sialolipoma is a rare neoplasm of the salivary glands, described as a distinct entity by Nagao et al. in 2001. Lipomatous neoplasms of the parotid gland are rare tumours accounting 0.6 to 4.4% of all parotid neoplasms with most series reporting an incidence of 1%. It is extremely rare in females, being 10 times more common in males, and the most common age of presentation is the fifth to sixth decade. Numerous histological variants of salivary gland lipoma have been described. Sialolipoma is a rare variant having proliferation of mature adipocytes with secondary entrapment of the normal salivary gland element. We report a rare case of sialolipoma in the left parotid of a 49-year-old woman presented to General Surgery Department who was treated with superficial parotidectomy.

A rare case of adipocytic tumor in subscapular region: hibernoma

Hibernoma is a rare lipomatous tumor of brown fat origin that emerges from remnants of fetal brown adipose tissue. They are encapsulated, yellow-tan colored, painless and benign soft tissue tumors, usually seen in adults and occur with large cells that have acidophilic, granular and vacuolar cytoplasm and centraly nuclei. Our case is a 33-year-old female who had swelling in the subscapular region. Imaging studies depicted a lesion compatible with lipoma. Macroscopic evaluation of the excision specimen revealed brown, tan-yellow colored and hemorrhagic cut surface compatible with fat tissue. In microscopic examination, a tumor composed of cells with vacuolar, granular and eosinophilic cytoplasm, centrally or peripherally localized small, round nuclei, were observed. These cells were stained with immunhistochemical S-100 and were evaluated to be comparable with lipocytes. With these findings, the patient was diagnosed as having hibernoma. We present this case for its rarity, and for the fact that it can be treated with simple excision, and should be kept in mind especially in the differential diagnosis of lesions with high vascularity