Lipoma In Children Research Articles

Mesenteric Lipoma in a Child- A Case Report

Mesenteric lipomas are very rare intraperitoneal tumors in children. When symptoms like severe abdominal pain, constipation, repeated vomiting develop, they are brought into medical attention. Despite ambiguous clinical findings, a sonographic suspicion may be further strengthened by CT scan or MRI. However, diagnostic laparotomy with resection of the mass followed by histopathological evaluation may confirm the diagnosis. We report one such rare case of a mesenteric lipoma in an 8 years old girl which may well be among the first 25 cases of mesenteric lipoma in children reported worldwide. J Dhaka Med Coll. 2022; 31(2) : 258-263

Spinal cord lipomas in children: surgical resection and outcome

Spinal cord lipomas in children: surgical resection and outcome

Radical resection of lumbosacral lipomas in children: the Great Ormond Street Hospital experience.

In 2009, Pang described a radical resection technique for congenital lumbosacral lipomas, with lower long-term symptomatic re-tethering rates compared with partial resections and conservative management, and low surgical morbidity. We adopted this technique in 2011, and aim to describe our first results. In this monocentric retrospective audit, we included dorsal, transitional, chaotic, and caudal-type lumbosacral lipomas. Exclusion criteria were previously operated lipomas, pure filar lipomas, and concomitant major congenital anatomical urogenital/gastrointestinal abnormalities. Neuro-uro-orthopaedic status at presentation and at three months, one year and last postoperative follow-up, intraoperative electrophysiology, and extent of resection were collected. From January 2011 to September 2019, 91 patients were operated (median age 2y2m; 63 transitional; 14 caudal; 8 dorsal; 6 chaotic). Preoperatively, 67% were symptomatic. Preoperative and one-year postoperative rates of impaired ambulation (44% to 43%), hypoesthesia (8% to 5%), urodynamic/uroradiological abnormalities (49% to 37%), and foot/ankle deformities (8% to 5%) were comparable, whilst pain improved (25% to 5%) but catheterisation rates increased (21% to 36%). 23/92 (25%) suffered wound-related complications. 2/91 (2%) developed symptomatic re-tethering requiring second surgery. Mean cord/sac ratio was 0.47. 43% had > 20 mm3 residual fat, which improved with increasing surgical experience. Radical lipoma resection, guided by intraoperative neuromonitoring, with reconstruction of the neural placode and expansion duraplasty is technically feasible and results in low rates of late deterioration and re-tethering. Lipoma-type and pre-operative status are important outcome predictors. Operative risks are not insignificant. Future studies need to determine appropriate selection criteria for surgery.

Big and deep seated lipomatous tumours in children : results of surgical treatment

The objective of the study is aimed to evaluate results of our pediatric patients with big and deep-seated lipomatous tumors Results of 32 children who underwent resection for 5 cm or larger and deep-seated lipomas were evaluated. The mean age of the patients was 9.1 years (range, 0-16 ; 11 female/21 male), and median follow-up period was 3.21 years (range, 1-10 years). The median size of the excised tumour was 11 cm (range, 6-28 cm) in maximal dimension. Big lipomas in children can be treated with marginal resection procedures without biopsy with lower complication and local recurrence ratio compared to adult patients with similar tumours in similar size and location.

The Mesenteric Lipoma in Children

Research in Pediatrics & Neonatology The Mesenteric Lipoma in Children Hanine D1,2*, Rouijel B1,2, El Baoudi A1,2, Aboulam Z1,2 and Kisra M1,2 1Pediatric Surgery Department “A”, Children’s Hospital of RABAT, Morocco 2Faculty of Medicine and Pharmacy, Mohammed V University Rabat, Morocco *Corresponding author:Hanine D, Pediatric Surgery Department “A”, Children’s Hospital of RABAT, Faculty of Medicine and Pharmacy, Mohammed V University Rabat, Morocco Submission: April 01, 2021 Published: April 29, 2021 DOI: 10.31031/rpn.2021.05.000616 ISSN: 2577-9200 Volume5 Issue4

Big and deep seated lipomatous tumours in children : results of surgical treatment

The objective of the study is aimed to evaluate results of our pediatric patients with big and deep-seated lipomatous tumors Results of 32 children who underwent resection for 5 cm or larger and deep-seated lipomas were evaluated. The mean age of the patients was 9.1 years (range, 0-16 ; 11 female/21 male), and median follow-up period was 3.21 years (range, 1-10 years). The median size of the excised tumour was 11 cm (range, 6-28 cm) in maximal dimension. Big lipomas in children can be treated with marginal resection procedures without biopsy with lower complication and local recurrence ratio compared to adult patients with similar tumours in similar size and location.

Massive pericardial lipoma causing haemodynamic compromise in a neonate

Cardiac tumours are rare in neonates. Most are benign and have a favourable outcome. However they can cause significant morbidity and mortality secondary to cardiac compromise. We present the first reported case of pericardial lipoma in a neonate. A baby detected to have a cardiac tumour by foetal echocardiography was delivered at term. Even though initially stable, he developed cardiac arrest at 10 minutes of life, needing resuscitation, ventilation and inotropic support. A massive pericardial tumour measuring 4.5cm by 3.5cm with a pericardial effusion was diagnosed by 2D echocardiography and confirmed by non-contrast CT scan. It was excised on day one of life, however the baby succumbed during surgery due to severe left ventricular dysfunction while weaning off from cardio-pulmonary bypass. Lipomas constitute less than 5% of cardiac tumours in children. Knowledge on pericardial lipomas in children is limited to only a few case reports. Although histologically benign, pericardial tumours can cause cardiac compromise by outflow/inflow obstruction and cardiac tamponade. Management depends on degree of haemodynamic compromise. This case report presents the first reported pericardial lipoma in a neonate and highlights the fact that even histologically benign lipomas can cause significant morbidity and mortality depending on tumour size and location.

Urodynamic changes of spinal lipoma in children before and after surgery

To study the urodynamic changes of various types of spinal lipoma in children before and after surgery. Twenty patients with spinal lipoma treated in our hospital were retrospectively analyzed. According to Pang's classification, they were divided into Dorsal, Transitional, Chaotic and Terminal types. Urodynamic changes before and after surgery were compared. Dorsal type: 1 case, the age of surgery was 14 months, low-risk bladder before and after operation; Transitional type: 4 cases, the mean age of surgery was 32.3 months, of which 3 cases were low-risk bladder and 1 case was high-risk bladder before operation, all without change in urodynamics after operation; Chaotic type: 10 cases, the mean age of surgery was 13.2 months, 8 cases were low-risk bladder, 1 was high-risk bladder and 1 was middle-risk bladder before operation. After operation, 4 of 8 low-risk bladders deteriorated to medium-risk bladder. The high-risk bladder improved to low-risk bladder, and the middle-risk bladder remained unchanged. Terminal type: 5 cases, the mean age of surgery was 54.2 months, 2 cases were high-risk bladder and 3 cases were low-risk bladder before operation, 1 case was improved to low-risk bladder, and the other 4 cases remained unchanged. Dorsal and Transitional types occur in the primary neurulation, and there is no significant change in urodynamics before and after surgery. Chaotic type occurs between the primary and secondary neurulation. Lipomas are usually large and mixed with conus medullaris and nerve roots. Even with early surgical treatment, there is still a high probability of deterioration of lower urinary tract function. Terminal type occurs in the secondary neurulation. It is often found late and clinical symptoms often occur before the operation. Urodynamic results could be improved after the operation.

Preventive Surgery for Asymptomatic Spinal Lipomas in Children.

To explore the clinical effect and significance of preventive surgery for asymptomatic spinal lipomas in children. We retrospectively analysed the clinical data of 168 patients with asymptomatic spinal lipoma from April 2001 to June 2019, Shanghai Department of Neurosurgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine. The patients were aged from 1.5 months to 15 years (the average age was 7 months), and there were no neurological symptoms, such as pain, incontinence, and/or bilateral lower limb dysfunction, before surgery. The surgical procedure included completely removing the lipomas in subcutaneous and extramedullary tissues of the spinal cord, subtotal resection of intraspinal fat, and separating the spinal cord, including the medullary conus from the dura sac, to release the tethered cord. For the 168 children with spinal lipomas included in the study, complete resection was undertaken for the dorsal spinal lipomas, and subtotal resection was performed for the transitional lipomas. Subcutaneous effusion caused by cerebrospinal fluid leakage occurred in 5 cases after surgery and was cured after multiple punctures and aspiration. Six patients developed mild incontinence immediately after the operation, 5 of whom completely returned to normal within 1 month, and 1 had no relief of symptoms. A total of 159 of the 168 patients were followed up for 3 to 19 years (the median follow-up time was 76 months). Longterm postoperative symptoms were observed in 13 patients (7.7%), including 12 cases of spinal cord retethering and 1 case of lipoma enlargement. Preventive surgery can reduce the future incidence of neurological dysfunction in children with asymptomatic spinal lipomas.

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

Efficacy of electromyography and nerve conduction velocity monitoring in surgical management of terminal lipoma in children

AbstractBackground: the prognosis of Terminal lipomas is better than that of other sites and pathology especially their management nowadays became clearer with better surgical outcome due to advancement of surgical tools and neurophysiology study. Objective: to assess the outcome of excision of terminal lipomyelomeningocele and reconstruction of the neural tube. Methods: From 2002 to 2016, 32 cases of terminal lipomyelomeningocele in Mansoura university hospital, insurance hospital and El Ahrar specialized center, the age of the cases ranged between 10 days and 4,3 years underwent surgical management of total or near-total lipoma excision and neural tube reformation with minimum follow up of 6 months. Results: according to system which applied to show the success of the operations, Of the 32 patients, 9 cases represent (28.1%) showed total excision of the lipoma; 17 patients represent (53.1%) had 25 mm3 of lipoma or less and 6 patients represent (18.75%) had 26 mm3 of fat or more. The neurological and urological complications was about 25%, while other complications like cerebrospinal fluid leak, wound disruption and infection was 9.4%. The surgical morbidity was comparable with the published papers. Conclusion: the excision of terminal lipomyelomeningocele and recreation of the neural tube by monitoring throughout EMG & NCV with low surgical morbidity and better results than leaving them without management or surgical interference without neurophysiological monitoring.

The value of urodynamic study to assess the children with spinal lipoma

Objective To study the value of urodynamic study for the assessment in children with spinal lipoma.Methods A retrospective study of 16 cases of spinal lipoma in children in our center from 2010 to 2011 was performed. Whole cases were treated with surgery primarily in our center. All were assessed with clinical symptoms,imaging data,urodynamics studies and combined with the intraoperative situation before and 6 months after the surgery to assess their recovery.Results According to the tethered degree,children were divided into two groups:fully releasable type (A group,10 patients) and not fully releasable type ( B group,6 patients).No significant voiding dysfunction was found in 3 cases,and all 16patients had varying degrees of urodynamic abnormal. All16 patients were able to maintain their basic neurological function at 6 months after the surgery.Among them the improvement rate of clinical symptom was 43.8％ (A group,6 patients; B group,1patient),deterioration was 25.0％ (A group,1patients; Bgroup,3 patients).The improvement rate of urodynamic study was 62.5％ ( A group,7 patients,B group,3 patients),deterioration rate of 25.0％ (A group,1patient; B group,3 patients).Conclusions Spinal lipoma in children is often accompanied with varying degrees of bladder dysfunction.Urodyuamic study can indicate subclinical bladder dysfunction and help to decide whether the surgical intervention is necessary.There is a great value to assess bladder function before and after surgery in children with spinal lipoma by urodynamic study. Key words: Children; Spinal lipoma; Urodynamic

Vulvar lipomas in children: an analysis of 7 cases

Purpose Vulvar lipomas are a type of rare benign soft tissue tumor. This study describes 7 cases of vulvar lipomas in children, and it evaluates the clinical characteristics of this disease. Method We performed a retrospective review of pediatric patients at our institution who were diagnosed with vulvar lipomas between January 1998 and December 2007. Results Seven girls who were between the ages of 7 and 11 years were included in the study. In 6 cases, the lipomas were located on the right side of the vulva. In 4 of those 6 cases, the lipomas were found on the right anterolateral side. Five cases had gross swelling of the vulva with a poorly demarcated mass, but 2 cases had a well-demarcated or pedunculated mass. The initial tentative diagnoses made before imaging studies were right inguinal hernia in 4 cases and Bartholin's cyst in 2 cases. Preoperative imaging studies of ultrasound, computed tomography, and magnetic resonance imaging showed lipomatous characteristics of these tumors. All cases underwent surgical excision. Subsequent histopathologic examination demonstrated lipomas in each case. Conclusions Vulvar lipomas in children tend to occur on the right side, especially the right anterolateral side. It is necessary to differentiate this tumor from an inguinal hernia. Radiologic studies such as ultrasonography, computed tomography, and magnetic resonance imaging are useful for making the proper diagnosis. Surgical excision is the treatment of choice.

Subpleural Lipoma in Children

Subpleural Lipoma in Children

Cutaneous lipoma in children: 5 cases with Bannayan-Riley-Ruvalcaba syndrome

Cutaneous lipoma is rare in children, but it can be part of a syndrome such as the Bannayan-Riley-Ruvalcaba syndrome (BRRS). The BRRS is a dominant autosomal disorder characterized by cutaneous lipomas, macrocephaly, intestinal polyps, and developmental delay associated with PTEN gene mutations. This syndrome is thought to represent a pediatric form of the Cowden syndrome, characterized among other features by an increased risk of cancer. We report 5 cases of BRRS, all diagnosed in children with lipoma and macrocephaly. Children presenting with lipomas need a complete physical examination to look for other signs of BRRS, because they may need further follow-up for tumor screening in adulthood.

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.

Giant omental lipoma in children

Lipoma is a rare benign neoplasm of mature fat cells. Asymptomatic abdominal mass, progressive abdominal distension, and intraperitoneal radiolucent fat density mass on computed tomography are the main clinical symptoms and signs. An unusual case is presented in this report. A complete excision was performed on an 11-month-old boy with a giant omental lipoma, and no recurrence was found in the 12-month follow-up.

Congenital lumbosacral lipomas: pitfalls in analysing the results of prophylactic surgery.

Our objectives were to examine the assumption that the natural history of congenital lumbosacral lipomas in children presenting early and those presenting late is the same, and to determine whether there are factors that might predict the post-operative outcome of surgery among the presenting features of children with lumbosacral lipomas. The authors present a clinical series of 50 consecutive cases of congenital lumbosacral lipoma that had been treated surgically. All patients underwent both pre- and post-operative urological assessment and pre-operative imaging with MRI. The case notes, urology assessments and MRI films were studied to provide data on the clinical presentation, follow-up history and urological outcome of the children, as well as on the anatomical features of their lipomas. Analysis of the data revealed a predominance in girls and a bimodal distribution of age at presentation with peaks at 0-2 and 7-8 years. Skin stigmata were more frequent in children below 6 years of age than in older children (P=0.035). The MRI scans demonstrated that the conus lay within the sacral canal more often in girls than boys (P=0.025). Severe bladder dysfunction was significantly more frequent in those presenting at =3 years of age (P=0.017) and there were more normal outcomes in patients operated upon before the age of 3 than in those operated upon at or after this age ( P<0.0001). Eight patients who had been operated upon had severe urological problems at the time of their last assessment (median age of 8 years and 2 months). They were predominantly girls with major pre-operative urological dysfunction. Formal pre-operative urological assessment proved to be the strongest determinant of final urological outcome. Other predictors of poor urological outcome were large lipoma size and sacral position for the lipoma. This series demonstrates how early and late presenting children may represent different patient groups, follow different natural histories and may therefore not be reliable for comparison purposes. Future studies of prophylactic untethering need to follow cohorts beyond the age of deterioration found in untreated cases (8 years) and must report the salient MRI features that we suggest are predictive of poor outcome.

Spinal Lipomas in Children

Spinal cord lipomas are a common cause of cord tethering that can lead to progressive neurological defects. The role of prophylactic surgery for spinal lipomas has recently been questioned. Between 1985 and 1999, 59 children underwent a total of 69 surgical procedures at the Birmingham Children’s Hospital in Birmingham, UK. The spinal lipomas were classified into: 18 terminal, 17 transitional, 6 dorsal and 18 filum lipomas – including 12 who had a typical thickened filum terminale. At the first operation, 19 patients (32%) were asymptomatic, and 40 patients (68%) presented with symptoms. Surgical indications in the asymptomatic group included the presence of a dermal sinus tract or syrinx. Prophylactic surgery was undertaken in selected cases. The mean total follow-up for the group since the first surgical procedure was 61.8 months (range: 7.0–203.0 months). In the asymptomatic group, 26% of the patients had late neurological deterioration. Of the 14 patients with asymptomatic conus lipomas, 3 (21%) developed sphincter dysfunction and motor problems at long-term follow-up. In the symptomatic group, 68% improved, 20% remained unchanged, and 12% had late neurological deterioration. None of the 18 patients with symptomatic filum lipoma deteriorated postoperatively. However, 39% had bladder dysfunction, 54% had neuro-orthopaedic deformity, and only 15% returned to overall normal function at latest follow-up. Of the 27 patients with symptomatic conus lipomas, 67% improved, 15% remained stable, and 18% had late neurological deterioration. However, 74% had bladder dysfunction, 67% had neuro-orthopaedic deformity, and 45% had motor problems at long-term follow-up. Spinal lipomas can cause progressive neurological deficits irrespective of spinal untethering surgery. This study demonstrates that filum and conus lipomas have similar clinical presentation, but differ in their outcome following surgery. Filum lipomas are ‘benign’, for which surgery is safe and effective. Conus lipomas are more difficult to manage. When asymptomatic, our results suggest that prophylactic surgery does provide some protection from future neurological deterioration. When symptomatic, conus lipoma surgery is effective in stopping further deterioration. Improvement in neurological function can occur, but few patients return to normal overall function, and pre-existing sphincter dysfunction is not significantly altered by surgery.

MRI study of lumbosacral lipoma in children.

The authors report 16 cases of lumbosacral lipoma in children studied by MRI. The exact position of the cord and its relationship to the lipoma were well demonstrated in all cases but one. There was as high incidence (25%) of syringomyelia in the terminal conus. Arnold Chiari malformation was never associated, which differentiates lumbosacral lipomas from myelomeningoceles. However, the nerve roots and their relationship to the lipoma were rarely visualized. Despite these drawbacks, MRI is the examination of choice if lumbosacral lipoma is suspected in children.