Large Lipoma Research Articles

Minimally invasive management of large duodenal lipoma: endoscopic submucosal dissection.

ObjectiveThis study was performed to compare the clinical outcomes of large duodenal lipomas (DLs) of ≥2 cm between endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFTR).MethodsThis retrospective study included patients who underwent endoscopic resection of large DLs from June 2017 to March 2021 at our hospital. Clinicopathologic features, clinical outcomes, and follow-up endoscopy findings were retrospectively reviewed.ResultsTwenty-three patients (12 men) with a mean age of 57.4 years were included. The median tumor size was 28.4 ± 13.3 mm. ESD was performed in 19 patients, and EFTR was performed in 4. Complete resection was achieved in 21 patients. The operative time and postoperative hospital stay were significantly shorter in the ESD than EFTR group. Four patients in the EFTR group developed a fever; no other adverse events occurred. No patients required surgical intervention. During the average follow-up of 21.1 months, no residual tumor, recurrence, or metastasis was observed.ConclusionBoth ESD and EFTR provide minimally invasive, localized treatment of selected DLs. ESD might have some advantages in resecting large DLs in terms of procedure time and hospitalization.

A case report of hibernoma in the thigh comprising the femoral neuromuscular bundle.

IntroductionHibernomas are rare, slow-growing, painless, benign tumors of soft tissue that develop from residual brown fat cell showing predilection for areas where brown fat is more common in fetuses and infants. Due to the rarity of the tumor its often overlooked or mistaken for other pathologies such as liposarcoma.Case presentationUsing the CARE 2020 criteria we describe a 26-year-old man who presented with painful swelling of the thigh. A magnetic resonance imaging examination without contrast showed a mass in the medial thigh just lateral to the femoral artery. A biopsy specimen was obtained from his thigh for histopathological analysis, and the findings suggested a hibernoma. A wide resection was performed, and it showed that the femoral nerve was lateral to the mass, with the course of the nerve altered due to mass effect. The mass was sent for a histopathological examination, and the findings were consistent with a hibernoma. Two weeks post-operative, the patient reported a considerable decrease in pain intensity, and six months post-operative, he reported complete pain relief.DiscussionHibernomas are unusual tumors that are benign and usually painless, but the large size the tumor can reach and proximity to vital structures can explain the growing trends symptomatic nature of some hibernomas. A proper and step wise approach using clinical, radiological and histopathology is important to Diagnose and plan surgical management. Proper understanding of the proximity of adjacent structures and the high vascularity of the tumor.ConclusionBecause of the rarity and under reporting of hibernomas they are often misdiagnosed as large lipomas or malignant soft tissue tumors, underscoring the importance of histopathology in ensuring accurate diagnosis and anticipating intraoperative. Careful dissection and ligation of the vasculature with the understanding of adjacent anatomy are key to safe tumor excision.

International survey on the management of lumbosacral cutaneous stigmata in infants with suspected occult spinal dysraphism.

Occult spinal dysraphism (OSD) is a common pediatric neurosurgical diagnosis rife with controversy surrounding both the screening of asymptomatic infants and the threshold to offer a prophylactic detethering operation. The authors sought to clarify international practice patterns with a survey of pediatric neurosurgeons. A survey asked pediatric neurosurgeons whether they would perform imaging in patients with a variety of cutaneous stigmata associated with OSD and whether they would offer prophylactic detethering surgery for asymptomatic patients with a variety of imaging findings on the OSD spectrum. Completed surveys were received from 141 pediatric neurosurgeons. Broad consensus was demonstrated on the need for obtaining images in sample patients with more severe stigmata ranging from large lipoma with a skin appendage to focal dysplastic skin in the lumbar midline. Ninety percent of respondents would perform MRI for these patients. In contrast, for patients with a low-sacral dimple, flat hemangioma, and symmetric (Y-shaped) splaying of the intergluteal cleft, opinion on the need for imaging varied considerably (between 57% and 89% recommended imaging). Respondents differed on the type of imaging that they would perform, with 31% to 38% recommending ultrasound screening. The responses reflected less consensus on when to offer surgery to patients with simple spinal tethering (low-lying conus medullaris and fatty filum terminale). Both a lower level of the conus and increased thickness of the filum terminale affected decision-making. The results of this survey showed significant consensus on the recommendation for screening imaging in patients with more dramatic cutaneous stigmata, although these stigmata are the rarest. A significant variance in opinions was reflected in the recommendation for imaging of the most common cutaneous stigmata. Consensus was also lacking on which lesions deserve prophylactic detethering surgery. Significant equipoise exists for future study of screening imaging and of surgical decision-making in patients with asymptomatic OSD and associated cutaneous stigmata.

EP.FRI.874 Laparoscopic Assisted Submucosal Excision of an Intussuscepted Colonic Lipoma through a Colotomy; A New Technique

Abstract Lipomas are the most common non-epithelial tumours of the colon. Nevertheless, symptomatic colonic lipomas are a rare entity in adults. Intussusception is the commonest complication of submucosal lipomas and often presents with absent, non-specific or intermittent symptoms, hence the diagnosis is challenging. In non-emergency situations, most patients undergo computed tomography scan as well as endoscopic evaluation of the colon prior to any surgical intervention. While successful endoscopic excision of lipomas has been reported, segmental resection of the colon is most commonly practiced. To the best of our knowledge, this is the first report of laparoscopic assisted submucosal excision of an intussuscepting colonic lipoma through a colotomy. We present the case of a young female patient with few weeks history of intermittent abdominal pain associated with nausea. She had previously undergone various investigations including colonoscopy and was awaiting an elective left hemicolectomy. She presented to our Emergency department with subacute large bowel obstruction. A CT scan confirmed the diagnosis of colo-colic intussusception due to a large descending colon lipoma. The patient underwent a laparoscopic assisted procedure - following laparoscopic colonic mobilisation, submucosal excision of the large lipoma was performed through a colotomy placed through the taenia on the opposite wall. The mucosal defect and colotomy were closed following the excision. The patient recovery was uneventful and histopathology of the specimen confirmed the diagnosis.

592 A Large Lipoma: An Unusual Presentation of the Tongue

Abstract Background Lipomas are commonly identified tumours of the body however they are rarely found in the oral cavity. Rarer still is it to report a case of a lipoma in the tongue as they are more commonly located in the buccal mucosa. Objectives To diagnose and explore the pathogenesis of a soft-tissue swelling of unknown origin Method A thorough patient history and clinical examination was undertaken followed by magnetic resonance imaging (MRI) which revealed an alarming report at first glance. An incisional biopsy of the lesion was then carried out to aid in diagnosing the lesion. Results The swelling caused the patient no pain however the mere size of the lesion affected the patient’s tongue movement and function which therefore affected the patient’s quality of life. The imaging and the biopsy of the lesion led to a diagnosis of a large lipoma on the lateral border of the tongue. Conclusions To the authors’ best knowledge, we present a rare case of a patient whom we diagnosed with a large lipoma on the lateral border of the tongue. This case report discusses the stages of patient management from initial presenting complaint, up to the maintenance of the patient following the diagnosis of this lesion.

830 A Case of Colo-Colonic Intussusception Secondary to A Large Lipoma in An Adult

Abstract Colonic lipomas are benign tumours, most commonly in the right colon or caecum, usually detected incidentally at colonoscopy and are often asymptomatic not requiring treatment. Lipomas leading to intussusception have previously been described in case reports, but it remains a rare occurrence, no specific incidence data has been documented. We present the case of a patient with a 7cm colonic lipoma that developed an intussusception. This patient suffered non-specific pulling pain along the right and upper abdomen for many years. A distal ascending colonic lipoma was identified, on repeated imaging and colonoscopy and biopsied. It was concluded that the abdominal pain was due to gallstones, diverticulitis and adhesions from previous pelvic surgery. In early December 2020, the patient was reviewed and listed for elective cholecystectomy. Later the same month, the patient was admitted with severe abdominal pain, watery and bloody diarrhoea. CT scan showed the colonic lipoma had acted as the lead point for an intussusception, with the lipoma and surrounding colon having intussuscepted into the transverse colon. Patient had an open right hemicolectomy and anastomosis for colo-colic intussusception secondary to the lipoma. Subsequently, the patient developed anastomotic breakdown requiring relook laparotomy with resection of ileo-colic anastomosis and end ileostomy formation. Adults presenting with intussusception is rare and associated with nonspecific signs and symptoms. Variability in clinical presentation highlights the need for a low index of suspicion in people with known colonic masses. In addition, early surgical intervention should be considered in masses >4cm as previously suggested in the literature.

Esthetic Management of a Huge Labiomental Lipoma: A Case Report

Lipomas are benign soft tissue neoplasm. Despite they are the most common tumours of mesenchymal nature in human body, they are unusual in oral and maxillofacial regions The oral cavity occurrence rate ranges from 1% to 4%. The etiology remains unclear and different theories have been proposed to explain the pathogenesis of this tumour. Clinically, lipomas Exhibit painless, well-circumscribed nodular swelling with yellow color or covered by normal mucosa. The case report is about a large and deep-seated lipoma occuring in labiomental region in a 60-year-old-male patient causing esthetic impediment and speech problem. The lesion was removed through intra-oral approach for esthetic reason. No recurrence was reported after 3 months follow-up.

V03-08 TRUE DIPHALLIA: EVALUATION AND SURGICAL CORRECTION OF A RARE CASE OF COMPLETE DUPLICATED PENIS

You have accessJournal of UrologyPediatrics (V03)1 Sep 2021V03-08 TRUE DIPHALLIA: EVALUATION AND SURGICAL CORRECTION OF A RARE CASE OF COMPLETE DUPLICATED PENIS Amr A. Elbakry, Chad Crigger, and Osama Al-Omar Amr A. ElbakryAmr A. Elbakry More articles by this author , Chad CriggerChad Crigger More articles by this author , and Osama Al-OmarOsama Al-Omar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001991.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We are presenting a rare case of true diphallia. In this video, we will present our evaluation and demonstrate the surgical technique for management of a patient with complete duplicated penis. METHODS: Our patient is an 11-month-old male who presented initially as 28-day-old that was referred for evaluation of abnormal male genitalia. Physical examination showed duplicated penis with penoscrotal transposition and large scrotal lipoma. VCUG was done and showed Y-shaped duplicated urethra, with normal right urethra and atretic narrow left urethra. Diagnosis was confirmed with US and MRI, that showed complete duplication of the penis with separate two corpora cavernous and a corpus spongiosum and urethra in each penis. We decided to proceed with surgical correction with amputation of the left penis as right penis has the normal urethra evidenced by the VCUG. We started our procedure with performing a cystourethroscopy that confirmed normal right urethra that in continuation with prostatic urethra and bladder neck. Next, bilateral sub-coronal circumferential incisions were made, and complete deglovig of both penises was completed. The lipoma of the scrotum was dissected excised. The left penis was amputated, and the stump was oversewn. Next, we turned our attention to correction of pent-scrotal transposition. The two hemiscrotums were mobilized at the level of the peso-scrotal junction, paying attention to maintain penile skin attached at peno-pubic junction to maintain blood supply. The scrotal flaps were brought ventrally and approximated in the midline in 3 layers. penile skin was trimmed and redistributed for penile coverage. penile skin was approximated ventrally in the midline and was sutured to the foreskin of the left penis. A catheter was left place and dressing was applied. RESULTS: Our procedure was successful with total operative time of 4 hours, minimal blood loss and the patient was discharged home on the same day. Urethral catheter was removed at POD7. There was no reported Complications, no fistula, no wound dehiscence or discharge. Pathology confirmed the diagnosis of accessory penis with normal left and right corpora cavernosum and atretic urethra. CONCLUSIONS: We showed a case of a complete duplicated penis which is a rare congenital anomaly of the genitalia. We demonstrated a surgical technique for correction and reconstruction of the male genitalia in this rare case. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e224-e224 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amr A. Elbakry More articles by this author Chad Crigger More articles by this author Osama Al-Omar More articles by this author Expand All Advertisement Loading ...

Surgical Correction of True Diphallia in a Newborn Male

Diphallia is an exceedingly rare anomaly characterized by partial or complete duplication of the phallus. Approximately 100 cases have been reported worldwide since its initial documentation, and incidence is estimated at 1 in 5 to 6 million live births. Therapeutic management is dependent on the extent of the anomaly, ranging from phallic excision to complex reconstructive procedures in cases of broader systemic involvement. We present the case of congenital true diphallia with associated penoscrotal transposition, bifid scrotum, partial urethral duplication, ventral chordee, large scrotal lipoma and sacral dimple. We further present a review of available literature pertaining to diphallia.

Endoscopically Assisted En Bloc Resection of Anterior Knee Lipoma

Open resection of a large lipoma requires a large incision that may result in disfigurement from the scar. Endoscopic resection of the lipoma can have better cosmetic results. However, piecemeal removal of the lipoma has the disadvantage of fragmentation of the tumor before it can be determined whether it is benign or malignant. In this Technical Note, the technical details of endoscopically assisted en bloc resection of an anterior knee lipoma are described. This can provide a whole-block specimen for histologic examination.

1003 A Case of Tunnel-Vision in Upper Renal Tract Imaging: The Invisible Gorilla

Abstract We present an interesting case of a 70-year-old female who presented with haematuria on the suspected cancer pathway. Renal ultrasound showed a vascular renal mass on her right kidney measuring 8x7cm with an unremarkable left kidney. She underwent a laparoscopic radical nephrectomy following confirmation of an 8cm renal mass in the right kidney on the contrasted staging CT scan with a repeat review at the multidisciplinary meeting. Post-operatively a subsequent review of the pre-operative CT and ultrasound scan, showed an incidental large left(contralateral) upper quadrant retroperitoneal fatty mass sized 15x10cm, displacing the stomach and spleen. Further investigation in the form of an MRI Abdomen excluded features of a liposarcoma, resulting in the diagnosis of a large retroperitoneal lipoma. This case highlights the significance of selective attention in imaging interpretation. We believe this to be a prime example of the level of meticulousness required as fat-rich tissues have low attenuation on CT-scans, which can be easily missed out. A cautious multi-clinician interpretation of scans should be performed to avoid missing potentially sinister pathology which would impact patient care dramatically. This case has led to more thorough review of future pre-operative imaging by the operating surgical team.

Left Hemicolectomy for Intussusception of the Transverse Colon Caused by a Giant Benign Lipoma

Colocolonic intussusception, caused by submucosal lipomas, is extremely rare. These benign soft tissue tumours comprise mature adipocytes of mesenchymal origin. While the majority of patients with lipomas remain asymptomatic, large or giant size lipomas (>4 cm) have been shown to cause debilitating abdominal pain, alternating bowel pattern, and anaemia secondary to gastrointestinal blood loss. This necessitates intervention in the form of surgical resection or endoscopic removal. However, once lipomas increase beyond 2 cm in size there is a significant risk of complications with an endoscopic approach, and open surgery or laparoscopic resection with bowel re-anastomosis is warranted. In this case put forth, the patient underwent a successful transverse colectomy and primary anastomosis.

Successful endoscopic management of adult ileocecal intussusception secondary to a large ileal lipoma.

A 90-year-old man presented to our hospital with abdominal pain, nausea, and loss of appetite that started the day before arrival. Initial CT revealed a target sign with a low-density mass at the center located in the terminal ileum (Fig. 1). Although a severely distended small bowel and ascites were present, physical and serum laboratory findings were not suggestive of peritonitis. From the CT findings, the patient was diagnosed with adult intussusception secondary to a lipoma. Because vital signs were stable and abdominal pain was under control without administration of anesthetics, we attempted endoscopic reduction under fluoroscopic guidance (Video 1, available online at www.VideoGIE.org).

Rare Mesenchimal Tumors of The Large Bowel: Colonic Lipomas

Objective: Colonic lipomas are the second most common benign tumor after polyps. Although large lipomas cause bleeding, perforation and invagination, they are generally asymptomatic. Symptomatic lipomas are treated with surgical and endoscopic methods. By presenting our case series on colonic lipomas in the light of the literature, we aimed to show that most of the lipomas, albeit large, do not require intervention. Methods: Colonoscopy procedures performed between 01.06.2013 and 01.03.2019 due to colorectal cancer (CRC) screening and follow-up, rectal bleeding, changes in bowel habit and anemia were included in the study. Data including age, gender, indication and colonoscopy findings of patients with lipomas larger than two cm in their large intestines were recorded. Results: Colonoscopy was performed on 4072 patients. Colonic lipoma larger than 2 cm was detected in 17 patients. Ten patients (58.8%) were female and seven patients (41.2%) were male. The mean age was 60.8 ± 8.8 years. Colonoscopy was performed in seven patients (41.2%) for CRC scanning, two patients (11.8%) for CRC follow-up, three patients (17.6%) for change in bowel habit, three patients (17.6%) for rectal bleeding, and two patients (11.8%) for anemia. The mean lesion size was 3.7 ± 1.5 cm. Lesions were seen in 14 lipomas (56%) in the right colon, six lipomas (24%) in the transverse colon, and five lipomas (20%) in the left colon. Conclusion: Colon lipomas are often not recognized or misdiagnosed due to factors such as insufficient colon cleansing or insufficient right colon intubations due to the patient’s inability to tolerate, insufficient attention and experience of the endoscopist. With the increase of awareness about colonic lipomas, we believe that only a few of the lesions diagnosed will require an invasive procedure.

Parapharyngeal Lipomas: A Literature Review and Surgical Management

Parapharyngeal space is a potential deep neck space extending between skull base and the hyoid bone. It is considered to be a rare site for neoplasms and it is even unusual to see Lipomas presenting in this space. Due to the proximity to skull base and presence of important structures in this space, surgical intervention can be complicated. An extensive literature review was carried out to comprehend the presenting features and management of this rare entity. Thirty-six reports/series were included presenting 37 patients between 15-83 years of age with a peak in 5th decade having lipoma in the parapharyngeal space/skull base region. The dimensions of these benign entities ranged between 3 cm to 16 cm. We present & discuss our experience with a large lipoma traversing parotid, submandibular and parapharyngeal spaces and its surgical management. We hope that this review and surgical principles presented will be helpful to the trainees and surgeons dealing with these entities.

Modified endoscopic unroofing enucleation using nylon ring traction for a large gastric lipoma.

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Endoscopic unroofing and mucosal resection for a large colonic lipoma with intussusception: an effective hybrid technique.

Lipomas account for 4% of benign subepithelial tumors of the GI tract and are found mainly in the colon (65%-75%).1 Colonic lipomas are often found incidentally during colonoscopy and are often asymptomatic and <20 mm in size and therefore do not require routine colonoscopy or treatment.2 However, in rare cases, colonic lipoma may grow to the point of being symptomatic.

A large intermuscular shoulder lipoma causing pain and weakness in an 87-year-old patient: a case report

A large intermuscular shoulder lipoma causing pain and weakness in an 87-year-old patient: a case report

Case Report: A Giant Lipoma from the Buccal Fat Pad Resembling Two Different Masses

We report a surgically challenging case of a large lipoma located from the temple, across the zygomatic region to the buccal area, resembling two different masses.An 82-year-old man presented with two persistently growing soft masses at his left temple and cheek. A computed tomographic scan revealed a single large radiolucent mass extending from the submuscular layer of the left temple crossing beneath the zygomatic arch to the buccal region, rather than two individual masses. Excision was performed through upper gingivobuccal and temporal incisions. The mass was dissected through both incisions, cut in half, and extracted from both sides.No complications were observed. The biopsy result was consistent with a lipoma. Four months later, the scars were inconspicuous, and the patient was satisfied.Considering the size, shape, and location, this is a rare and intriguing case. The bi-directional approach allowed for successful total excision without any complications, leaving inconspicuous scars. Key Words: Lipoma, Neoplasms, Cheek

Treatment of intramuscular lipoma of tongue with enveloped mucosal flap design: a case report and review of the literature

BackgroundLipomas are benign soft tissue neoplasms of mature adipose tissue commonly occurring in the trunk or extremities. But, intraoral lipomas are rare entities which may be only noticed during routine dental examinations. Especially intramuscular lipomas on the tongue have been reported very rarely. In this study, we report a case of intramuscular lipoma on tongue, with a review of the literature from 1978 to 2019, providing data on age, gender, location, presenting symptoms, size, surgical methods, and recurrence.Case presentationA case of intramuscular lipoma occurring in tongue region in a 65-year-old male is reported. Surgical excision is the mainstay of treatment for the lesion. In order to decrease the deformity and discomfort after the excision, we tried to modify surgical technique using enveloped mucosal flap. This technique provided more comfortable healing procedure on the operative site without recurrence.ConclusionThis is a rare case of large intramuscular lipoma on tongue. Surgical excision with enveloped mucosal flap design was performed to diminish postoperative raw surface and discomfort and a 24-month follow-up showed excellent healing without any recurrence. A case of intramuscular lipoma on tongue and relevant literature reviews are presented in this study.