Resection Of Lipoma Research Articles

Treatment of subcutaneous lipomas in the horse.

To describe the treatment of subcutaneous lipomas in the horse. 3 horses. The horses were aged 1 to 2 years old, with lipoma of the abdomen, prepuce, and tarsus. All cases had surgical removal of the masses under general anesthesia. Recurrence of an invasive abdominal lipoma occurred in case 1 at the exit site of a passive drain. The recurrence was treated unsuccessfully with injectable cisplatin, and a second revision surgery with the use of an active drain resulted in resolution. In case 2, complete resection of an encapsulated lipoma of the lateral prepuce was successful with no recurrence. In case 3, incomplete resection of a tarsal lipoma resulted in a sound horse, with no further growth. Histopathologic analysis revealed that all masses were composed of well-differentiated adipocytes with no evidence of malignancy. Subcutaneous lipomas are relatively rare and affect horses primarily ≤ 2 years of age. They are benign, although their presence can be deleterious due to invasion of local structures or the impact on normal locomotion. The margins of invasive tumors are difficult to identify due to their integration with normal tissue. Incomplete removal may allow for mass recurrence. Active suctions drains are beneficial if dead space is a concern.

Endoscopic resection of a large symptomatic duodenal lipoma

Endoscopic resection of a large symptomatic duodenal lipoma

Duodenal lipoma: An incidental finding or something more

This is a case report of successful endoscopic resection of duodenal lipoma. A 68-year-old male with intermittent vomiting for 1 month. Upper endoscopy revealed a 3 cm pedunculated tumor in horizontal part of duodenum.

Duodenal lipoma: An incidental finding or something more

This is a case report of successful endoscopic resection of duodenal lipoma. A 68-year-old male with intermittent vomiting for 1 month. Upper endoscopy revealed a 3 cm pedunculated tumor in horizontal part of duodenum.

Giant cervical lipoma adjacent to carotid artery: a case report and literature review

Cervical lipomas accompanied by neurovascular compression are extremely rare and require surgical treatment in case of appropriate symptoms. The preferable method is gross total resection, as otherwise they tend to recur. Invasive growth is not typical for lipomas. However, large tumors can involve adjacent nerves and vessels and significantly complicate resection. We present a 57-year-old patient who underwent resection of giant soft tissue cervical lipoma invading neurovascular bundle and compressing the oropharynx and esophagus with dysphagia and positional asphyxia. The patient was followed-up for previous 5 years. Resection was necessary due to tumor enlargement with appropriate symptoms. Searching for literature data was performed in the Pubmed, Medline, EMBASE, Cochrane Library and eLibrary databases. Gross total resection of 7-cm tumor was accompanied by mobilization of hypoglossal and vagus nerves, common, external and internal carotid arteries and jugular vein with repositioning of the oropharynx and esophagus. There was mild Horner's syndrome in early postoperative period. The patient was discharged in 4 days after surgery with regression of complaints. We found only 5 reports describing giant cervical lipomas invading neurovascular bundle. Giant cervical lipomas are extremely rare, and total resection with preservation of critical structures is possible in a specialized hospital.

Abstract 18453: Giant Right Atrial Lipoma Inducing Atrial Flutter and Tachycardia-Mediated Cardiomyopathy: The Value of Multimodality Cardiac Imaging

Case Presentation: A 60-year-old male who presented with progressive dyspnea on exertion and atrial flutter with rapid ventricular response. His TTE showed a large (5.1 x 3.9 cm) right atrial (RA) mass occupying 80% of a severely dilated RA attached to the lateral wall (Fig A) and severe global LV hypokinesis with an ejection fraction of 20 - 25%. A TEE was then performed to further characterize this mass and showed a large (6.3 x 5.5 x 3.7 cm), heterogeneously echoreflectant, bi-lobed, and partially mobile RA mass attached to the lateral wall (Fig B,C) just below the superior vena cava and extending near the tricuspid valve annulus with sparing of the leaflets and only mild tricuspid regurgitation. At last, a chest CT scan showed a large (5.5 x 4.5 x 3.3 cm) mass which was tissue characterized as RA lipoma (Fig D). Therefore, patient underwent an uncomplicated surgical resection of the mass with partial removal of RA free wall (Fig D,E) repaired with a pericardial patch. Pathology confirmed a RA lipoma. Patient’s atrial flutter was then ablated, and patient was discharged home in stable condition. Discussion: This case illustrates an unreported cavitary giant RA lipoma inducing atrial flutter and tachycardia-mediated cardiomyopathy and emphasizes the importance of multimodality cardiac imaging in its diagnosis and management. Cardiac lipomas are rare benign tumors usually of small size and therefore mostly incidentally detected. They can rarely lead to embolization, conduction abnormalities, and flow obstruction requiring surgical resection. In this patient, pre-operative echocardiography and CT imaging were critical in the assessment of the tumor size, tissue characterization, location, motion, relation or extension to other cardiac structures, and obstruction or dysfunction of heart valves. Pre-and-intraoperative echocardiography were also essential in planning and performing the successful surgical resection of the RA lipoma.

Endoscopic En-Bloc Resection of Intra-Muscular Lipoma of the Flexor Digitorum Profundus: A Uniportal Technique

Deep-seated lipomas can be intramuscular, intermuscular, and rarely, parosteal lipomas. Intramuscular lipoma can be divided into infiltrative, well-circumscribed, and mixed types. Marginal excision is the treatment of choice for well-circumscribed intramuscular lipoma, and histopathology eliminates diagnosis of well-differentiated liposarcoma. The purpose of this technical note is to describe the details of endoscopic en-bloc resection of intramuscular lipoma of the flexor digitorum profundus. This minimally invasive approach allows en-bloc resection of the lipoma for histopathological study, with minimal risk to the surrounding neurovascular structures.

Diagnosis and management of bilateral lipoma of the middle ear.

Middle ear lipomas are rare, accounting for less than 1% of all middle ear tumours. To our knowledge there have been only 16 reported patients with middle ear lipoma. Only one of these had bilateral congenital middle ear lipomas. The aim of this review is to comprehensive overview the diagnosis and management of congenital lipomas of the middle ear. A literature review was performed searching multiple data bases, using the key words "middle ear", AND "lipoma", AND "congenital". A total of 116 articles were identified. One hundred were excluded on various criteria, leaving 16 articles for detailed review. Additionally, we report the second case of bilateral congenital middle ear lipoma. Based on this case report and literature review, the incidence of middle ear lipomas is greater in paediatric patients than in adult patients. Middle ear lipomas are distributed evenly between males and females. Three patients had recognised genetic syndromes, while five had prior ventilation tube placement. Clinically patients present with conductive hearing loss and middle ear effusions. In some cases, presence of a white or yellow mass behind the anterior aspect of the tympanic membrane is recognised. The most common location of the masses is in the anterosuperior quadrant of the middle ear, the site of predilection for small congenital cholesteatomas. An MRI scan is most useful in distinguishing between lipoma and cholesteatoma. All cases reported surgical excision of the middle ear lipoma. There was no evidence of recurrence noted up to 4 years follow up. Though rare, congenital lipomas of the middle ear should be a differential diagnosis of a middle ear masses. Early identification can allow surgical lipoma resection with minimal disruption to the ossicular chain. Though there is currently no consensus regarding management, surgical removal and appropriate reconstruction of the ossicular chain if needed, is appropriate.

Endoscopic En-Bloc Resection of Lipoma of the Tibialis Anterior Tendon

Lipoma is benign soft-tissue tumor that consists entirely of mature fat and can occur in a superficial or deep location. Lipoma of the foot and ankle can even develop within a tendon sheath or joint. Classically, lipoma is resected via open approach, which may result in a lengthy disfiguring surgical scar. Endoscopic en-bloc tumor resection is a minimally invasive approach and can provide a whole block specimen for histologic examination. The purpose of this Technical Note is to describe the details of endoscopic en-bloc resection of lipoma of the tibialis anterior tendon.

Delayed iatrogenic diaphragmatic hernia after thoracoscopic resection of diaphragm lipoma

BackgroundIatrogenic diaphragmatic hernias have been reported as a rare complication of thoracic and abdominal surgery. We herein report a case of delayed iatrogenic left diaphragmatic hernia after diaphragm pedunculated lipoma resection with minimally invasive surgery.Case presentationA 72-year-old Japanese man was found to have an abnormal shadow by medical checkup X-ray and was admitted to our hospital. Chest computed tomography (CT) showed a 5 × 2-cm solid tumor at the left diaphragm. He was diagnosed with a left diaphragm tumor. We performed three-port video-assisted thoracic surgery. This tumor was pedunculated at the left central tendon of the diaphragm. We therefore dissected this tumor using an electric scalpel. Although there was about 5 × 4 mm in diameter slight heat damage to the diaphragm, it was not reinforced because it was very minor injury. He was diagnosed with a left diaphragmatic hernia without any symptoms by routine CT examination which scheduled 1 year after surgery. One day after hospitalization, on the morning of the operation, he suddenly complained of left back pain with acute exacerbation of the left diaphragmatic hernia. We therefore immediately performed emergency surgery and rescued this patient. No adverse events or complications were seen, and he was discharged on postoperative day 11. Three months after this surgery, this patient is doing very well.ConclusionsCaution should be exercised when using energy devices on the diaphragmatic surface, especially the left side, to avoid causing delayed diaphragmatic hernia. In cases of surgery involving the left-side diaphragm, it seems that careful follow-up after surgery is necessary.

ID: 218045 Fast Acting Sub-Perception Therapy Spinal Cord Stimulation for Chronic CRPS Type II After Lipoma Resection

Spinal cord stimulators (SCS) are indicated for chronic intractable pain of the back or limbs including unilateral or bilateral pain associated with failed back surgery syndrome, Complex Regional Pain Syndrome (CRPS) Types I and II, and neuropathic pain1. The mechanism of action is unclear though current theory involves stimulation of Aβ-fibers2 via the Gate Control theory, and modulation of neurotransmitters such as GABA2,3. Recent research suggests activation of Aβ-fibers at adjacent segments also play a significant role via surround inhibition4,5. Here we present a patient with intractable right leg pain following a lipoma resection with significant improvement after fast-acting sub-perception therapy (FAST) spinal cord stimulator placement.

RETROPERITONEAL LIPOMAS PRESENTING AS INGUINAL HERNIA – A DIAGNOSTIC DILEMMA

Introduction - Retroperitoneal lipomas rarely present as inguinal hernia. The part of the tumour that herniates represents only the tip of the iceberg as the main part of herniated mass is not detected clinically. - A Case discussion 60-year-old male presented with complaints of pain over irreducible swelling in left inguinoscrotal region for 3 days which was present for 2 years. Lump was palpable of size ~20x10x7 cm with mild tenderness with ultrasonography suggestive of left inguinal hernia with 2.8 cm defect with bowel and omentum as content with sluggish peristalsis. Patient was posted for hernia repair through inguinal incision with intraoperative ndings where sac could not be visualised with irreducible contents. Hence exploratory laparotomy was done and mass was found to originate from retroperitoneum of size ~ 30 x15x10 cm encasing left testes. Enbloc resection of the retroperitoneal lipoma with left orchidectomy done and sent for histopathology which was suggestive of Retroperitoneal Multilobular Lipoma. - The presented case points out that abdomi Conclusion nal lipomas can be misdiagnosed as irreducible inguinal hernia. Not all groin masses are simple hernias, and hernia cases have the potential to reect distant disease processes.

Successful Treatment of Refractory Neuropathic Pain Following Axillary Dissection and Lipoma Resection Using Cervical and Thoracic Dorsal Root Ganglion Stimulation

BACKGROUND: Neuropathy is a pain condition that is caused by an insult to the somatosensory system. Providing adequate management of neuropathic pain (NP) conditions can be challenging as the dis-ease may become progressively nonresponsive to conventional therapies. If conventional treatment options prove ineffective, cervical dorsal root ganglion (DRG) stimulation is a relatively effective, off-label-use therapy for NP, which requires expert cervical placement to be completed safely and effectively. The Neuromodulation Appropriateness Consensus Committee guidelines highlight safety features and general indications for DRG stimulation, which includes current on-label usage up to T10. Although this committee’s expert opinions stated that DRG is safe up to the C5 level, there is limited published efficacy and safety data at levels higher than T10. CASE REPORT: A 36-year-old woman with a significant medical history of anxiety developed intractable right upper extremity NP following an axillary dissection for a lipoma excision. De-spite conservative management, she presented with debilitating NP and severe right upper ex-tremity functional restrictions following the procedure. The patient underwent a C8-T1 DRG stimulation trial, which decreased her pain levels over 50%, and significantly increased her functional abilities. Right-sided C8-T1 permanent DRG leads were placed, which resulted in improved sleep, increased ability to use her right upper extremity, a 95% to 97% reduction in pain, and elimination of regularly scheduled analgesic medications. CONCLUSIONS: Cervical and high thoracic DRG was safe and successful in the treatment of right upper extremity NP in the upper dermatomal levels secondary to axillary dissection and lipoma resection. KEY WORDS: Cervical and high thoracic DRG, neuropathic pain, axillary dissection, lipoma re-section, neuromodulation, case report

Endoscopic resection of a large symptomatic duodenal lipoma

Endoscopic resection of a large symptomatic duodenal lipoma

Management of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensus

AimsThere is considerable controversy regarding optimal management of patients with paraesophageal hiatus hernia (pHH). This survey aims at identifying recommended strategies for work-up, surgical therapy, and postoperative follow-up using Delphi methodology.MethodsWe conducted a 2-round, 33-question, web-based Delphi survey on perioperative management (preoperative work-up, surgical procedure and follow-up) of non-revisional, elective pHH among European surgeons with expertise in upper-GI. Responses were graded on a 5-point Likert scale and analyzed using descriptive statistics. Items from the questionnaire were defined as “recommended” or “discouraged” if positive or negative concordance among participants was > 75%. Items with lower concordance levels were labelled “acceptable” (neither recommended nor discouraged).ResultsSeventy-two surgeons with a median (IQR) experience of 23 (14–30) years from 17 European countries participated (response rate 60%). The annual median (IQR) individual and institutional caseload was 25 (15–36) and 40 (28–60) pHH-surgeries, respectively. After Delphi round 2, “recommended” strategies were defined for preoperative work-up (endoscopy), indication for surgery (typical symptoms and/or chronic anemia), surgical dissection (hernia sac dissection and resection, preservation of the vagal nerves, crural fascia and pleura, resection of retrocardial lipoma) and reconstruction (posterior crurorrhaphy with single stitches, lower esophageal sphincter augmentation (Nissen or Toupet), and postoperative follow-up (contrast radiography). In addition, we identified “discouraged” strategies for preoperative work-up (endosonography), and surgical reconstruction (crurorrhaphy with running sutures, tension-free hiatus repair with mesh only). In contrast, many items from the questionnaire including most details of mesh augmentation (indication, material, shape, placement, and fixation technique) were “acceptable”.ConclusionsThis multinational European Delphi survey represents the first expert-led process to identify recommended strategies for the management of pHH. Our work may be useful in clinical practice to guide the diagnostic process, increase procedural consistency and standardization, and to foster collaborative research.

A Scoring System That Predicts Difficult Lipoma Resection: Logistic Regression and Tenfold Cross-Validation Analysis.

IntroductionMost lipomas are readily dissected and removed. However, some cases can pose surgical difficulties. This retrospective study sought to identify clinical and radiological risk factors that predict difficult lipoma resection and can be used in a clinically useful scoring system that predicts difficulty preoperatively.MethodsThe study cohort consisted of all consecutive patients who underwent resection of pathology-confirmed lipoma during 2016–2018 at a tertiary care referral center in Tokyo, Japan. Surgical difficulty was defined as difficulty separating some/all of the tumor from the surrounding tissue by hand and inability to extract the tumor in one piece. Descriptive, univariate, and multivariate logistic regression analyses were conducted to identify predictive factors. The predictive accuracy of the scoring system that included these factors was assessed by tenfold cross-validation analysis. Receiver-operating curve (ROC) analysis was conducted to identify the optimal cutoff score for predicting surgical difficulty.ResultsOf the 86 cases, 36% involved surgical difficulty. Multivariate analysis showed that subfascial intramuscular location (odds ratio 42.7, 95% confidence interval 3.0–608.0), broad touching of underlying structures (46.5, 3.7–586.0), in-flowing blood vessels (9.3, 1.1–78.5), and unclear boundaries (109.0, 1.1–1110.0) significantly predicted surgical difficulty. These factors were used to construct a 0–4 point scoring system (with one point per variable). On cross-validation, the accuracy of the scoring system was 82.4% (Cohen’s kappa of 0.57). ROC analysis showed that scores ≥ 2 predicted surgical difficulty with sensitivity and specificity of 55% and 98%, respectively.ConclusionsOur scoring system accurately predicted lipoma resection difficulty and may help operators prepare, thereby facilitating surgery.

Endoscopically Assisted Resection of Intramuscular Lipoma of the Soleus

Intramuscular lipoma is a rare soft-tissue tumor with an overall incidence of less than 1% of all lipomas. It primarily occurs in the trunk and proximal parts of the upper and lower extremities. Intramuscular lipoma of the soleus muscle has not been reported before in the English literature and the best treatment option is not known. The purpose of this Technical Note is to describe the details of endoscopically assisted resection of intramuscular lipoma of the soleus. This is indicated for well demarcated intramuscular lipoma of the soleus and is contraindicated in infiltrating intramuscular lipoma. Besides the advantage of minimally invasive surgery, this endoscopic technique allows en bloc resection of the intramuscular lipoma.

P138 CARDIAC LIPOMA IN PATIENT WITH SYSTEMIC LIPOMATOSIS

Abstract Introduction Primary adipose cardiac tumors are divided into two different entities: lipomatous hypertrophy of the interatrial septum (LHIS) and lipomas. Lipomas are usually benign masses of unknown pathogenesis. Currently few cases are reported in literature, with no differences in gender distribution. Clinical Case A 63–year–old patient presented to our emergency room complaining chest pain and dyspnea on exercise. Her medical history shows severe obesity, hypertention, past surgical removal of several systemic lipomas (uterus lipoma, right ovary lipoma, right thigh and leg lipoma, right forearm and wrist lipoma). A coronary angiography was performed showing the lack of angiographically significant lesions. On suspicion of microvascular angina, she began therapy with Ranolazine and Beta–blockers. Echocardiographic examination showed a lipomatous interatrial septum in the postero–superior tract with a maximum of 22.5mm thickness (image 1). At 12 months, chest CT and MRI scan showed a hyperintense mass on interatrial septum measuring 32x34mm. The formation, mainly protruding in the right atrium, does not obstruct the outlet of the hollow veins, nor the outlet of the pulmonary veins. No hemodynamic compromise and compression were detected. Last follow–up visit our patient presented dyspnea and chest pain, the echocardiogram showed a slight increase of the mass size (see image), with unchanged thicknesses and biventricular pump function. Conclusions In literature there is no evidence of malignant transformation of cardiac lipomas, however well–differentiated cell tumors can coexist with liposarcomas. There are no guidelines for the treatment of cardiac lipomas, radical resection is practiced in the majority of symptomatic patients and should be considered in all patients with cardiac lipoma. Asymptomatic lipomas can excessively grow up and infiltrate into the myocardium, resulting in negative outcomes to a possible subsequent resection. According to the worsening of the clinical course, the patient under consideration was referred for lipoma resection surgery.

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.

Transmitral resection of left ventricular lipoma by right mini-thoracotomy using a rolled up flexible ruler.

Left ventricular lipoma is a rare intracardiac tumour that is usually resected through sternotomy to effectively explore the left ventricular cavity. We introduce a simple technique to expose the left ventricular cavity and resect the intraventricular lipoma using a rolled up flexible ruler through right mini-thoracotomy. Imaging studies and gross and microscopic photography of intraventricular lipoma are presented in this report.