Large Lipoma Research Articles

Lipoma of the deep lobe of parotid gland - a case report and review of literature.

Lipoma of deep lobe of parotid gland is a rare clinical entity. Less than 10 cases have been reported in the literature in our knowledge. Because of their rarity, they are not often considered in the differential diagnosis of parotid tumors. A case of 45-year-old man with an unusually large deep lobe lipoma of parotid gland is presented in this article which was surgically managed by total conservative parotidectmy. The clinical picture, radiological and histopathological features of this entity is being discussed here. Review of literature of this clinical situation has been presented in the present article.

Primary Retroperitoneal Lipoma: A Soft Tissue Pathology Heresy?

Adipose tissue tumors of the retroperitoneum showing no identifiable cytologic atypia are usually classified as lipomalike well-differentiated liposarcoma. Whether a subset of these tumors represents true examples of retroperitoneal lipoma remains a controversial subject, because the diagnostic liposarcoma cells may be of difficult identification, even after extensive sampling. Herein, we describe a large retroperitoneal lipoma with classic histopathologic, cytogenetic, molecular cytogenetic, and molecular genetic features. Extensive morphologic inspection showed no evidence of cytologic atypia. Cytogenetic analysis performed on fresh tissue material revealed the classic lipoma chromosome t(3;12)(q27;q14-15). Fluorescence in situ hybridization on multiple sections excluded the presence of MDM2 and CDK4 amplification, but showed HMGA2 balanced rearrangement in most cells. Reverse-transcriptase polymerase chain reaction followed by sequencing analysis confirmed the presence of the HMGA2-LPP fusion gene, a characteristic and the most common fusion product found in lipoma. The patient has been followed for 2.5 years without evidence of recurrence or metastasis. These results indicate that retroperitoneal lipomata do exist, but their diagnosis must rely on stringent histologic, cytogenetic, and molecular genetic analysis.

A massive cervicomedullary intramedullary spinal cord lipoma

We present a large cervicomedullary intramedullary lipoma in a 17-year-old boy, who presented with spastic quadriparesis and exaggerated reflexes. MRI revealed an intramedullary lipoma extending from the craniovertebral junction to the sixth cervical vertebra. There was no spinal dysraphism. Subtotal excision with primary dural closure was performed, which produced an improvement in the patient’s condition. The technique we used is discussed.

Safe endoscopic treatment of large colonic lipomas using endoscopic looping technique

Colonic lipomas are benign, submucosal tumours that are usually asymptomatic. Typically, they are incidentally diagnosed during colonoscopy. Due to a low prevalence, the natural history of lipomas remains largely unknown. While large (>2 cm) lesions can cause symptoms and complications, their endoscopic treatment is not routinely recommended because of prior reports of a high rate of perforation. We used a standardized technique of polypectomy, using endoscopic looping to resect large colonic lipomas in 8 patients and followed their clinical outcomes. The mean lipoma size was 3.8+/-1.2 cm (range 2.5-6 cm). No patient developed bleeding or perforation. On follow-up (mean=13.5 months, range 2-29), there was one small residual lesion. Colonic lipomas larger than 2 cm can be safely and efficaciously removed using endoloop assisted polypectomy technique.

Endoloop ligation of large pedunculated submucosal tumors (with videos)

Endoscopic treatment of a pedunculated submucosal tumor (SMT) has not been well established. In particular, endoscopic cautery snare resection of a large pedunculated SMT is discouraged because of the increased risk of bowel perforation. To report the clinical outcome of endoloop ligation for the treatment of various pedunculated SMTs with a clip-marking technique. Prospective evaluation of 10 patients who, between June 2005 and May 2006, received endoloop ligation with a clip-marking technique. At a tertiary-care, academic medical center. Ten patients with various pedunculated SMTs with either symptomatic lesions or large-sized lesions (>4 cm). Clinical procedural success, reported adverse events. Nine cases were successfully treated, with tumor removal within 4 weeks. In contrast, only 1 patient needed a second session of loop ligation. Only 6 specimens were retrieved. There were no procedure-related complications, such as bleeding or perforation. Retrieval by the patient of a specimen from stool was possible in only 60% of cases; a limited number of 10 patients; by oncology standards, not the correct treatment for nonlipomatous lesions, which limits its application to surgical risk candidates. Endoloop ligation of large pedunculated SMTs seemed to be technically feasible and appeared to be safe in this case series. Further controlled clinical trials have to be conducted before application of this technique to a large submucosal lipoma or other SMTs in surgical high-risk candidates can be generally recommended.

Diagnostic problems in fine needle aspiration cytology of fat necrosis within a subcutaneous lipoma

Fat necrosis in subcutaneous lipomas is very unusual and has been reported only occasionally. Literature regarding fine needle aspiration cytology of such a lesion is lacking although fat necrosis is well described in the breast. We came across a case of a large subcutaneous lipoma in the anterior abdominal wall with a well encapsulated area of fat necrosis. The aspiration smears showed an unusual picture which was misinterpreted as the fragments of the hydatid cyst wall. They were actually enlarged, nonnucleate, single adipocytes showing laminations, along with calcification and paucity of inflammation. Histopathology confirmed the diagnosis of fat necrosis within the lipoma. Such lesions can be mistaken on radiology for malignancy.

Large Vulvar Lipoma in an Adolescent: A Case Report

Lipomas are the most common benign tumors of soft tissues. However, conventional lipomas have been reported only rarely as presenting in the vulva. We present a case of vulvar lipoma in a 17-yr-old woman, possibly caused by chronic intermittent irritation.

Intraneural Lipoma of the Posterior Interosseous Nerve

Lipomas arising in the peripheral nerves are rare tumors, with most arising in the forearm and wrist, and most have occurred within the median nerve. This report describes a case with large lipoma arising in the posterior interosseous nerve.

Usefulness of virtual colonoscopy in the diagnosis of symptomatic large colonic lipomas

Lipomas of the colon are uncommon tumour of the gastrointestinal tract, but cause diagnostic difficulty when they are symptomatic. We reported two cases of symptomatic, large colonic lipoma. Colonoscopy was incomplete because of the narrowing lumen caused by lipomas. By the help of computed tomography colonography/virtual colonoscopy, colonic lipomas were diagnosed correctly, but also proximal colon was examined.

Suspected Asymptomatic Large Colon Lipoma: Biopsy?

Lipomas are the second most common benign tumors of the colon, after adenomatous polyps. Management of incidentally detected asymptomatic large colon lipomas has not been well studied. To our knowledge, this is the first case report of asymptomatic colon lipoma that was complicated by both hemorrhage and bowel obstruction after endoscopic biopsy. Case report: A 59-year-old female with history of hypertension and hyperlipidemia, underwent routine colonoscopy that showed 3.5 cm lipomatous appearing polyp in the sigmoid colon. Patient was referred to gastroenterology clinic for evaluation of the sigmoid mass. At this point, review of systems was negative. Patient had no previous surgeries and family history was unremarkable. Patient was taking Atorvastatin and hydrochlorothiazide. One year after her initial procedure, a repeat colonoscopy revealed a 3.5 cm, soft, mobile, pedunculated mass in the sigmoid colon with positive pillow sign (indents when depressed using biopsy forceps) and was biopsied with cold forceps. Histopathology revealed smooth muscle prominence and fibrovascular tissue. One week after the procedure patient presented with bright red blood per rectum and mild crampy abdominal pain. The patient was hemodynamically stable at her baseline hemoglobin level. Physical exam revealed left lower quadrant tenderness on deep palpation with no peritoneal signs. The patient underwent immediate flexible sigmoidoscopy that showed completely obstructing purplish mass in the sigmoid colon with an overlying clot. Virtual colonoscopy was performed which showed a pendunculated soft tissue density consistent with lipoma and 2.9 cm mass in the lumen of sigmoid colon consistent with hematoma. Patient was managed conservatively; bleeding resolved spontaneously and was discharged to home. During six months of follow-up patient remained asymptomatic. Conclusion: Colon lipomas, can be diagnosed by colonoscopy by their characteristic features i.e, mobile, soft mass with positive pillow sign and CT scan appearance of smooth borders and uniform fat equivalent density. In our review, out of 22 colon lipoma biopsies reported in literature only 4 are conclusive with a diagnostic yield of 18%. In addition to a low diagnostic yield, biopsy may result in complications such as bleeding or obstruction. We report a novel case in which both bleeding and colonic obstruction resulted from biopsy of a large sigmoid lipoma. For this reason EUS evaluation is likely preferable to biopsy of these lesions.

Poster 104: A Case of Lipoma Extending to the Parapharyngeal Space

Lipoma is a common tumor that is found almost anywhere on the body. However, a large lipoma of the submandibular region is rare. We will report a case of a lipoma of the submandibular region which extended into the parapharyngeal space.

Large Descending Colon Lipoma Causing Intussusception and Mimicking Malignancy

Presentation & History: A 69-year-old previously healthy male presented with a 1-month history of hematochezia and 10 lb wt loss. The patient denied any changes in bowel movement frequency; he continued to average 1–2 bowel movements per day. The patient denied abdominal pain, nausea or vomiting. Previous medical history included an appendectomy and hernia repair, ankle fracture. The patient took no medications, and denied any behavioral risk factors. Family history revealed a daughter with ulcerative colitis, and no colorectal cancer. Physical Exam & Laboratory Evaluation: Physical exam was unremarkable. The complete blood count and the basic metabolic panel were normal. CT revealed a mass in the descending colon with partial intussusception involving the sigmoid colon, suggestive of carcinoma. There was no adenopathy or evidence of metastases. Treatment & Hospital Course: Colonoscopy revealed a 7 cm, pedunculated, ulcerated, fungating mass with partial intussusception just distal to the splenic flexure at 70 centimeters from the anal verge. Biopsies only revealed inflammation.[figure1]A repeat colonoscopy was performed and the lesion was removed with a large snare and electrocautery. Pathology revealed a lipoma with no evidence of malignancy. The patient has done well thereafter.FigureDiscussion: This case is unusual for several reasons: First, colonic lipomas are comparatively rare, with a reported incidence less than 5%. Second, colonic lipomas are positively correlated with distance from the anus. Our patient's lipoma was found in the descending colon. Third, colonic lipomas are most frequently small and asymptomatic. Lipomas larger than 2 cm are more often symptomatic, potentially causing obstruction, bleeding, or– very rarely – intussusception. Our patient had both a symptomatic and intussuscepted lipoma. Fourth, grossly, lipomas are generally covered by smooth mucosa. Our examination revealed an ulcerated fungating mass that appeared grossly malignant. Large lipomas associated with intussusception are not easily differentiated from malignancies. Our experience shows that lipomas with unexpected gross appearance can also be easily mistaken for malignancy.

Sonographic findings of a large vulvar lipoma

Lipomas of the vulva are rare benign tumors that consist of mature fat cells often interspersed with strands of fibrous connective tissue. They arise from the vulvar fatty pads and present as soft, multilobulated subcutaneous neoplasms. Histological examination reveals a thin capsule surrounding a lobular proliferation of lipocytes. Liposarcomas of the vulva have been described rarely. We present the sonographic findings of a large lipoma of the vulva, and demonstrate the contribution of topical application of a high-frequency transvaginal transducer in depicting lobular structural features, characteristic of this soft tissue tumor.

Surgical approach to a large dumbbell-shaped pelvic lipoma extending through the obturator foramen

Lipomas are the most commonly occurring mesenchymal tumors. We report a technique used to manage a patient with a large dumbbell-shaped pelvic lipoma passing through the obturator foramen. Using the combined expertise of an orthopedic and pelvic surgeon, successful and safe removal of this benign dumbbell-shaped pelvic lipoma was achieved.

A Novel Technique for the Treatment of a Symptomatic Giant Colonic Lipoma

Submucosal lipomas are usually harmless neoplasms arising from submucosal adipocytes. They are found most commonly in the colon, but may develop in any part of the gastrointestinal tract. Most colonic lipomas are asymptomatic and need no treatment, whereas larger ones (>2 cm) may present with abdominal pain, changes in bowel habits, rectal bleeding, and intussusception or prolapse. The literature on the endoscopic resection of colonic lipomas is limited owing to the increased risk of colonic perforation. In this paper, we describe a novel technique for the treatment of colonic obstruction resulting from a giant lipoma by placing two large clips at the narrow base of the lipoma and performing multiple cuttings on the mucosa covering the fatty tissue by using a needle-knife to facilitate the fat's discharge into the colon's lumen. Our case showed that the endoclipping of semi- or pedunculated large colonic lipomas not amenable for endoloop ligation and associated with cuttings of the mucosa covering the fat is a promising new technique, which avoids the risk of perforation or bleeding of the snare cautery, especially in high-risk patients.

A Case of a Large Intrapericardial Lipoma Occupying Pericardial Space

Although cardiac lipomas are quite rare, they represent the second most common primary benign cardiac tumors. In this case report we present a 71-year-old man with a large intrapericardial lipoma originating from pericardium. In this case, intrapericardial lipoma was diagnosed by echocardiographic methods (transthoracic and transesophageal echocardiography) and imaging techniques such as computed tomography, magnetic resonance imaging. The patient had an uneventful postoperative recovery. She is currently asymptomatic and has no evidence of recurrence at 12 months follow-up.

Acute stridor caused by a previously asymptomatic large oropharyngeal spindle cell lipoma

Lipomas of the larynx, oropharynx and hypopharynx are rare, accounting for approximately 1% of benign laryngeal neoplasms. Spindle cell lipoma is a rarer histological variant characterised by mature adipocytes mixed with collagen-forming spindle cells. We present an unusual case of a 62-year-old lady who acutely presented to the emergency department with a large spindle cell lipoma arising from the vallecula. This lipoma was causing intermittent stridor unless traction was applied to it. Despite the size of the lesion, she had been completely asymptomatic prior to this single episode. To our knowledge, only one previous case of a spindle cell lipoma has been reported as specifically arising from the vallecula. This case also appears to be the largest reported from the oropharynx (17 cm length, 4 cm width). The tumour was completely removed endoscopically and the patient made an excellent recovery, returning home 3 days post-operatively. The histology, management and follow up of these lipomas are discussed.

A safe and efficient strategy for endoscopic resection of large, gastrointestinal lipoma

Gastrointestinal (GI) lipomas are benign, slowly growing, submucosal tumors, which may cause gastrointestinal bleeding, anemia, intussusception, and bowel obstruction. The aim of this study is to explore the safe and effective strategy for endoscopic removal of large GI lipomas. During last 10 years, fifteen large and symptomatic GI lipomas were resected under endoscopy in our hospital. In them, two large lipomas with small stalk (< 2 m in diameter) were resected by polypectomy; ten large lipomas with base size greater than 2 cm in diameter were removed using a "subtotal resection." Three other large lipomas with small stalk (< 2 m in diameter) were resected by multistep resection. Endoscopic ultrasonography (EUS) and miniprobe endoscopic ultrasound were performed in six cases from January 2000 to July 2004 to confirm that those lesions were lipomas that were superficial to the muscularis propria. All 15 lesions were successfully removed and were histopathologically confirmed to be lipomas. No severe complications, such as perforation or hemorrhage, developed after endoscopic removal. No recurrence was observed after 1-8 years follow-up endoscopic examination. Various, large GI lipomas can be removed safely by electrosurgical snare resection under endoscopy following the guidance of the present therapeutic strategy.

Handcrafted two-channel colonoscope for removing large lipomas

We read with interest the article by Koo & Kaffes [1] on a novel endoscopic technique for removing large colonic lipomas in which an endoloop was used to reduce the potential risk of bleeding. The device allowed successful endoscopic removal of four lipomas in three symptomatic patients, resulting in resolution of their symptoms without major complications. They used a two-channel endoscope, and placed an endoloop around the tumor base with the assistance of a grasping forceps. The technique had already been reported for the endoscopic removal of large pedunculated polyps [2] and large lipomas [3]. The main drawback of this technique, however, is that two-channel endoscopes are not available in every hospital [4].

Treatment of lipomas assisted with tumescent liposuction

Lipoma is a common soft-tissue tumour of mature fat cells. Although surgical excision is effective, treatments that are less invasive and not associated with disfigurement of scar would be ideal for the treatment of lipomas. Recently, tumescent liposuction has been used for the treatment of lipomas. To evaluate the efficacy of tumescent liposuction in lipoma treatment, we reviewed our experience of lipoma treatment by tumescent liposuction. A total of 21 patients presenting with 31 lipomas were treated with tumescent liposuction. After liposuction, remaining stromas were removed by a haemostat through the small incision. Tumour size and post-operative complications were recorded before and after treatment. A total of 31 lipomas of 21 patients were treated by tumescent liposuction. The size of lipomas ranged between 1.2 and 11 cm (mean size, 4.1 cm). In 23 cases, there were no complications. However, remnant lipomas, bruise, haematoma and immediate dimpling were found as complications. Tumescent liposuctions with extracting remnant fat tissue and fibrous tissue through the opening for liposuction can be an effective treatment technique in lipoma treatment in the efficacy and cosmetic outcomes and this method can be a substitute for excision in treating large lipomas.