Large Lipoma Research Articles

Giant Lipoma of the Hand.

A 70-year-old man was referred by his GP to the hand surgery clinic with an enlarging swelling in the thenar eminence of his left hand. He first noticed this swelling 18 months previously. There was no preceding trauma. He noticed that the size of the swelling was increasing gradually and felt a constant cramp-like pain in his hand with intermittent parasthesia on the ulnar side of the thumb. Examination revealed a soft, nonfluctuant, nontender swelling in the bulk of the thenar eminence with indistinct margins. There was no objective neurological deficit. Plain X-rays showed a radiolucency in the first web space (Figs. 1 and 2). MRI scan showed a mass which gave a signal similar to fat and was well encapsulated, passing behind the flexor tendons in the palm. The high-signal T1 and T2 images were interpreted as typical of lipoma (Figs. 3 and 4). In view of the increase in size of the swelling and the discomfort, marginal excision was done. The mass extended deep into the carpal tunnel and was intimately attached to the lumbrical of the long flexor tendon to the index finger. The common digital nerve to the first web space was stretched over the lump and was dissected free. The lipoma extended underneath the flexor tendons and seemed to have a pedicle arising from the synovium around the deep flexor tendons. The lipoma was 8 cm 5 cm in size. The patient made an uneventful recovery and his symptoms of pain and parasthesia settled within 2 weeks. Histological examination demonstrated a large benign lipoma.

Missed lipoma of the spermatic cord. A pitfall of transabdominal preperitoneal laparoscopic hernia repair.

Missed lipoma of the spermatic cord is a pitfall unique to the transabdominal preperitoneal (TAPP) laparoscopic hernia repair. This problem occurs when a palpable inguinal mass is noted preoperatively, but no identifiable hernia defect is found at time of laparoscopy and the procedure is terminated. Our group encountered six patients without intraperitoneal defects that had large cord lipomas on preperitoneal exploration. Two of these patients had undergone previous intraabdominal laparoscopy for a proposed TAPP repair, which was aborted when no defect was seen. Both patients were referred for continued symptomatic groin masses, which were subsequently treated by lipoma resection in conjunction with inguinal floor repair. When patients present with a groin mass, exploration of the preperitoneal space and cord structures is indicated during TAPP repair, even in the presence of a normal-appearing abdominal floor. Abandoning a transabdominal approach without exploration of the preperitoneal structures may lead to a failure to identify symptomatic and/or palpable cord lipomas.

Another indication for liposuction: small facial lipomas.

The treatment of facial lipomas at times requires the use of incisions that are less than satisfactory in either size or location. In an effort to minimize scarring, the authors have been removing these lesions with liposuction. The purpose of this study was to review the authors' experience in treating small facial lipomas using liposuction. Over the last 10 years, the authors treated five patients with forehead lipomas by removal with liposuction through hair-bearing scalp incisions. All patients were evaluated after the procedure for bleeding, paresthesias, recurrence, scarring, and overall satisfaction with the procedure. All of these patients had lipomas that measured 4 cm or less at the time of surgery. No patient experienced hematoma, nerve injury, or recurrence. All patients were completely satisfied with their result and scar. The literature describes an advantage to using liposuction for the treatment of medium (4 to 10 cm) and large (>10 cm) lipomas. Because small lipomas (<4 cm) can be extracted through small incisions, the literature reports no advantage to removal with liposuction. However, favorable aesthetic results can be obtained by removing small facial lipomas with liposuction through strategically placed incisions.

Large lipoma of the vulva

Vulvar lipoma is a rare entity. A 52-year-old woman presented with a large mass arising in the right major labium. CT scan revealed that the mass contained adipose tissue. During operation a lipomatous tumor was found which at histologic examination proved to be a lipoma.

Unroofing technique for the endoscopic resection of a large duodenal lipoma

Unroofing technique for the endoscopic resection of a large duodenal lipoma

Large Epicardial Lipoma Associated with Rupture of the Interventricular Septum after an Acute Myocardial Infarct

We report a case of a large epicardial lipoma associated with an unusual rupture of an infarcted interventricular septum. The proximity of the attachment of the lipoma to the rupture site, together with the unusual shape and location of the rupture, suggest that the lipoma perpetrated the rupture.

Intramedullary Holocord Lipoma in an Athlete: Case Report

This case report involves an intramedullary lipoma of the dorsum of the spinal cord, which essentially runs the full length of the cord. This occurred in an individual who had an active life, including involvement in athletics. The authors point out that the case presentation myelopathy as well as nonradicular pain should alert one to the possibility of this type of tumor. Although this is a very brief case report, it does address many of the problems of isolated intradural intramedullary lipomas. I have observed a number of large intradural intramedullary lipomas, but as the authors point out, this is a rare situation in which the lipoma is holocord. I think the management of this case was appropriate. David G. McLone Chicago, Illinois

Microsurgical treatment of intramedullary spinal cord tumors.

Eighty patients with intramedullary spinal cord tumors were treated by microsurgical methods between 1988 and 1996. Twenty-nine patients were diagnosed with astrocytoma, 36 with ependymoma, five with metastasis, four with lipoma, three with dermoid or epidermoid tumor, two with neurofibroma, and one with neuroma. Vascular and infectious lesions (such as abscesses and hemangioblastomas) were excluded. After laminectomy, total removal of the lesion was achieved in 68 of 80 patients and subtotal removal in 12. Postoperative radiation therapy was performed in 13 of 80 patients. The follow-up period ranged from 12 to 92 months (mean 42.2 months). All patients underwent preoperative and postoperative magnetic resonance imaging at intervals ranging from 3 months to 5 years postoperatively. Four patients showed clinical and radiological evidence of local tumor recurrence during the follow-up period. Four patients died 5 months to 15 months postoperatively from the re-expansion of their primary metastatic disease. The operative results at long term (after the 6th postoperative month) were better than the results at short term (before the 6th postoperative month) and revealed clinical improvement in 63, no change in 10, and deterioration in seven patients. We recommend early radical surgery, whenever possible, to be performed when the patient's neurological status is still good. Subtotal removal and irradiation are better for malignant or metastatic tumors. Partial decompressive removal is best for large intramedullary lipomas. Plastic laminotomy with preservation of the intervertebral joints is especially recommended in young or middle-aged patients.

Multiple Cardiac Lipomas and Sudden Death: A Case Report and Literature Review

We report a unique case of multiple subepicardial lipomas found in a 15-year-old girl who died suddenly. This case is, to the best of our knowledge, unique in several aspects. First, the large lipomas arose extensively from the surface of the heart, infiltrating the walls of all four chambers, and the left ventricle was most severely involved. Second, the lipomas were associated with lipomatous hypertrophy of the interatrial groove. Third, multiple lipomas involved the organs of two systems, namely, the heart and the stomach. We speculate that it was fatty infiltration of the left ventricle that led to ventricular fibrillation and sudden death.

A pain in the groin

334 Vol 350 • August 2, 1997 Computed tomograph scan showing a large anterior abdominal wall “lipoma” (arrows) A 64-year-old woman with Dercum’s disease (adiposis dolorosa) attended the gynaecological clinic in February, 1996, with a 4-week history of lower left-sided abdominal and pelvic pain. An ultrasound scan showed uterine fibroids and she underwent hysterectomy and bilateral salpingo-oophorectomy. This did not relieve her symptoms and in July, 1996, she consulted her general practitioner with worsening pain. There was an obvious sausage-shaped lump in the left iliac fossa. She was reassured that this was another lipoma. 4 months later she was still in pain and had frequent bowel motions. A colonoscopy was normal and she was again reassured, as she was not keen to have the lipoma removed. She came back 3 months later with increasing discomfort, and at this time an ultrasound scan, requested to assess the size and position of the lump, failed to identify it. A computed tomograph scan was reported as showing a large abdominal wall lipoma (figure). She was offered surgical excision again, but declined. Despite further reassurance her symptoms got worse.

Pelvic lipoma causing venous obstruction syndrome

Reports of extrinsic obstruction of a major venous channel in the lower limb caused by compression from mass lesions 1-3 are uncommon; ~6 Pochelle et al. in 1991 reported the third case of venous obstruction associated with pelvic lipomatosis. 4 We report a case of right external iliac vein compression, not by pelvic lipomatosis but by a large discrete pelvic lipoma, this being the first known report of its kind.

Distinct mdm2/p53 expression patterns in liposarcoma subgroups: implications for different pathogenetic mechanisms.

Recent findings have indicated that TP53 inactivation in sarcomas may result from mutation and/or deletion of the TP53 gene or, alternatively, from binding to the MDM2 gene products. To investigate further a possible role of the two genes in sarcomas, 24 large and deep-seated lipomas and 74 liposarcomas of various subtypes were analysed for mdm2 and p53 overexpression by immunocytochemistry. Nineteen cases of the same series were also molecularly analysed for both MDM2 gene amplification and TP53 mutations, and a further ten cases for non-random chromosomal abnormalities. In the retroperitoneal well-differentiated-dedifferentiated (WD-DD) group, 15/16 WD and 8/8 DD liposarcomas displayed the mdm2+/p53+ phenotype, consistent with MDM2 gene amplification in the absence of TP53 mutations. In the non-retroperitoneal WD-DD group, 5/11 WD liposarcomas also retained the mdm2+/p53+ phenotype whereas all DD liposarcomas showed an immunophenotype and, when assessed, a genotype consistent with mutant TP53. Null mdm2 immunophenotype, coupled with evidence of a specific chromosome translocation t(12;16), was constantly observed in both the usual and the cellular subtypes of myxoid liposarcoma, three cases of which also showed TP53 alterations at the genetic or protein level. Neither mdm2 nor p53 overexpression was observed in the lipomas. The results show the existence of three main pathogenetically distinct groups of liposarcoma. The first retroperitoneal WD-DD group, which represents a novel class of tumours within a single histological category of sarcoma, where MDM2-mediated inactivation of p53 could be related to the pathogenetic mechanism. The second is the non-retroperitoneal WD-DD group, where the TP53 mutations appear to correlate with the dedifferentiation process. The third is the myxoid group, which is characterized by its own unique cytogenetic profile and never shows any involvement of TP53 or MDM2 genes. As for diagnostic significance, the absence of mdm2 and p53 reactivity in lipomas seems to represent a useful marker for differential diagnosis from lipoma-like WD liposarcomas.

Endoscopic excision of large capsulated lipomas

The technique of endoscopic excision of large capsulated lipomas is presented and the versatility of this method is discussed based on our clinical experience. We have applied this new technique in 6 cases. In all cases the lipoma was completely removed in one piece through a single incision, up to 1.5 cm in length. The endoscope made it possible to view the lipoma through a narrow space with a wide range of vision on a TV monitor. We stress that this method is not only appropriate as treatment for benign lipomas but also effective from a cosmetic point of view. The applications of the endoscope should widen in plastic surgery when the advantages of it are recognized and new operative approaches for using it are developed.

Liposuction-assisted excision of cervicofacial lipomas

A technique is described for use of liposuction-assisted removal of even large lipomas through small skin incisions. (OTOLARYNGOL HEAD NECK SURG 1995;113:401-3.)

Liposuction-assisted excision of cervicofacial lipomas.

A technique is described for use of liposuction-assisted removal of even large lipomas through small Skin incisions.

Videothoracoscopic excision of mediastinal masses: Indications and technique

Mediastinal masses are generally excised through wide thoracotomies or median sternotomies. These lesions are often benign, usually asymptomatic, discovered incidentally, and relatively easy to resect. For these reasons, a minimally invasive approach is appropriate. Videothoracoscopy allows an optimal exploration of the pleural cavity and a panoramic view of the mass. Dissection is usually easy to perform, and the mass can be extracted from the thorax through a trocar incision or through a limited “utility thoracotomy.” To avoid possible tumor seeding, the mass is inserted in a plastic bag before extraction. From September 1991 to January 30, 1994, 20 mediastinal masses (6 thymomas, 2 thymic cysts, 1 hyperplastic thymus, 1 fibrous tumor of the mediastinum, 2 pleuropericardial cysts, 2 thoracic teratomas, 2 large thoracic lipomas, 3 neurogenic tumors, and 1 bronchogenic cyst) were removed through such a minimally invasive approach. Eighteen patients had an uneventful postoperative course. Two patients hemorrhaged in the immediate postoperative period, and repeat thoracoscopy was done. In 1 patient, electrocoagulation of a bleeding intercostal artery controlled the hemorrhage. In the other, the source of bleeding could not be found, and removal of the clots and irrigation of the cavity stopped the hemorrhage. Further data and long-term follow-up are necessary, but videothoracoscopy offers a new, less invasive approach for the management of noninvasive mediastinal masses.

Multiple symmetric lipomatosis

Multiple symmetric lipomatosis (MSL) is a rare disorder of middle life characterized by large nonencapsulated lipomas distributed around the neck, shoulders, and other axial regions. Neurologic involvement, particularly peripheral neuropathy, is frequent. The pathogenesis of the syndrome is still unknown, but ragged-red fibers are occasionally present in muscle of affected patients, suggesting a mitochondrial abnormality. We studied 11 unrelated patients with MSL by means of neurophysiology, muscle morphology, muscle biochemistry, Southern blot, and PCR analysis of mitochondrial DNA. All patients were men aged 41 to 63 years. Clinical or electrophysiologic signs of a sensorimotor polyneuropathy were present in nine patients, eight of whom had a history of alcoholism. In muscle biopsy specimens, the most prominent feature was pathologic subsarcolemmal aggregates of mitochondria. Biochemical analysis of respiratory chain enzymes revealed a moderate but significant decrease of cytochrome c oxidase activity as compared with age-matched controls. In one patient, Southern blot analysis showed multiple deletions of mitochondrial DNA. We conclude that mitochondrial dysfunction is common in MSL and may be based on identifiable defects in the mitochondrial genome.

Computed tomography of an intracranial lipoma confined in the suprasellar cistern

A case of large intracranial lipoma involving the suprasellar cistern is presented in a 50-yr-old man with a history of occipital headaches. Evaluations by routine computed tomography (CT) combined with metrizamide CT citernography were extremely useful in the diagnosis of this rare condition. Intracranial lipomas are reviewed in the literature and the role of CT evaluations is discussed.

Massive cavernous lymphangiomatosis associated with a large lipoma and hemangiomas : a new syndrome?

A 3-year-old girl with massive cavernous lymphangiomatosis, a huge lipoma, and several types of hemangiomata is presented. A deep lipoma on the back was removed. The left margin of the lipoma intertwined with several cysts of cavernous lymphangiomas, resulting in continuous fluid accumulation postoperatively. At the first operation, a partial excision of cavernous lymphangiomas of the forearm was also performed. The forearm healed uneventfully, except for a moderate degree of hypertrophic scarring. As a result of a literature review, it can be stated that the case presented does not conform to any well-defined entity and would appear to represent a new syndrome to be categorized under congenital hamartomatous disorders. Everyone is interested in the fate of massive lymphangiomatoses such as this, and in the effects on several tissues or organs, such as breasts, muscles and bones.

Supernumerary ring marker chromosome as a secondary rearrangement in a parapharyngeal lipoma with t(10;12)(q25;q15) as the primary karyotypic abnormality

Cytogenetic analysis of a large parapharyngeal lipoma, a rare tumor at this site, showed the karyotype 46, XY,t(10;12)( q25; q15) 47, XY,t(10;12)( q25; q15) ,+r. The primary abnormality must have been t(10;12), whereas the +r developed secondarily as an additional aberration. Although a similar translocation between chromosomes 10 and 12 has not been described previously, that the tumor had a rearrangement of the 12q13–15 region, the most frequently involved genomic region in lipogenic tumors, indicates that the tumorigenetic mechanisms are identical in parapharyngeal lipomas and lipomas of other locations. Supernumerary ring markers are not usually detected in lipomas with 12q rearrangements but are common in atypical lipomas and well-differentiated liposarcomas. The parapharyngeal lipoma we describe recurred after initial resection, and we hypothesize that the more aggressive tumor phenotype thus demonstrated may be causally related to the clonal evolution it had undergone.