Lipoma

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Intradermal Spindle Cell Lipoma on the neck

Lipoma Definition

Lipoma is a growth of a “small ball” typically found underneath the skin composed of fatty lumps or mass of tissues. This is the most common benign soft tissue neoplasm (“new growth”) [1].

Types of Lipoma

  1. Angiolipoleiomyoma

This is a solitary, asymptomatic, benign lump made up of fatty tissue, smooth muscle cells, connective tissue, and blood vessels.

Angiolipoleiomyoma composed of fat, smooth muscle, and vessels

Angiolipoleiomyoma composed of fat, smooth muscle, and vessels.

Source: Pathorama

  1. Angiolipoma

It is also called lipoma cavernosum or telangiectatic lipoma. Unlike the other lipoma types, angiolipoma is painful. It is a vascular subcutaneous nodule.[2] Though benign, individuals with angiolipoma might opt to have it removed because of the pain. You don’t want to experience a lifelong pain, do you?

Angiolipoma has two types: non-infiltrating and infiltrating. Non-infiltrating angiolipoma, which is more common, comprises of tender and painful tumors. Infiltrating angiolipoma has the ability to spread tumors in the surrounding tissues. This condition is rare.[2]

Subcutaneous growth of angiolipoma

Subcutaneous growth of angiolipoma.

Source: medicaforum.com

  1. Chondroid Lipoma

You might be wondering why it is named “chondroid” which typically refers to a “cartilage”. It is so because it somehow looks like a cartilage in a muscle[3]. It is a firm, yellow, benign tumor commonly found in women’s legs. Chondroid lipoma is a rare condition that is commonly misdiagnosed as sarcoma [3] because unlike the other lipoma types which are more superficial, it is situated in the deeper area. This makes the physician mistake it as a sarcoma or cancer of the muscles.

Cut surface of the tumor showing yellow white and tan-brown areas

Cut surface of the tumor showing yellow white and tan-brown areas.

Source: ijpmonline.org

 

  1. Hibernoma

Hibernoma is so-named because it originates from the vestiges of brown fat which are remnants of fetal fatty tissues [4]. For that reason, it is also called fetal lipoma or lipoma of embryonic fat [5]. It is a rare benign tumor which increases in size very slowly, though there were no findings of metastasis on the surrounding tissues.

Axial gadolinium contrast MRI study that shows slight perfusion through the hibernoma

Axial gadolinium contrast MRI study that shows slight perfusion through the hibernoma.

Image Source: Tumor Library

 

  1. Intradermal Spindle Cell Lipoma

This is a type of lipoma which is mostly seen women and appears commonly on the dermis of head, neck, trunk, or the extremieties. It is a slow-growing benign tumor.

Intradermal Spindle Cell Lipoma on the neck

Intradermal Spindle Cell Lipoma on the neck.

Source: lipomacauses.com

 

  1. Neural Fibrolipoma

As the name implies, this type of lipoma involves the nerves. And when we talk about the involvement of nerves, this usually makes us think that there is pain. This is true in the case of neural fibrolipoma. This lump of fibrofatty tissues compresses the nerves surrounding the affected area, most likely the median nerve, hence the individual suffers from pain. This is mostly seen on the hands, wrists, or forearms [6]. Since our extremities are very functional, we cannot ignore this lipoma even though it grows slowly and it’s benign. Surgical removal is a good option.

Fibrolipomatous hamartoma of the median nerve

Fibrolipomatous hamartoma of the median nerve.

Source: radiology.casereports.net

 

Lipoma Causes

Lipomas have an idiopathic cause, meaning the exact cause is unknown or obscure. Although there are studies that point out to heredity. It is likely to be inherited [1]. It is also said that injuries in specific body areas cause the lipoma to spontaneously occur.

Lipoma Signs and Symptoms

Lipoma has many types but these are the general symptoms experienced by individuals with this growth [1]:

  • Small growth of about 1-3 cm or 0.4-1.2 in underlying the skin
  • Movable
  • Soft and rubbery consistency
  • Usually no pain
  • Non-growing or slow-growing
  • Benign

Pain in People with Lipoma

Generally, there is no pain in lipoma. Pain is only felt by the individual if lipoma presses onto the adjacent nerves or numerous blood vessels. Individuals suffering from pain-causing lipomas such as neural fibrolipoma and angiolipoma usually opt to remove the growth surgically. Imagine if you have to live with this lipoma without surgical intervention. The individual may suffer for life, if this growth doesn’t shrink. In cases like these, doctors recommend to have it removed than let the patient suffer.

Cancer-Related Lipoma

When a layman who has no medical background hears of a tumor, the first thing that might come to his mind is cancer. Well lipoma is “fake cancer”. Lipoma does not turn itself into cancer. These fatty lumps will never be cancer cells. If this happens, it’s either the doctor misdiagnosed the patient’s case in the first place, or there came a negative medical miracle.

However, patients who are diagnosed to have lipoma may not be at ease. Well if that growth doesn’t bother, just let it be. Those are just fat cells. If it causes pain, then consult a doctor and remove it surgically. But if you are experiencing signs and symptoms of whatever type of cancer, you better go to your doctor now.

Who are at Risk of Having Lipoma?

Everybody is at risk. And because it has an idiopathic cause, there is nothing we can do to prevent it. In a population of people with lipoma, it occurs that most of them are in the middle age. In solitary growths, there are more females than males. But in multiple growths, the tide changes. Males get the higher number on this one. [1]

Lipoma Removal

  • Steroid Injection

A mixture of steroid (triamcinolone acetonide) and local anesthetic (lidocaine) is injected into the center of the lipoma. This is usually preferred by those patients who do not want to have a scar and for those who are afraid of “body invasion”. This is best done for patients who have a lipoma measuring less than 1 inch in diameter.

This will be performed every month. And even though it is done monthly, there is no guarantee that the lipoma will be totally removed. Steroid injections will shrink the lipoma, yes, but we can never be sure if it will be removed completely. [7]

  • Liposuction

Like administration of steroid injections, liposuction is preferred by those who do not want a scar. This can be done for patients with small or large lipoma. The fatty cells of the lipoma is being “sucked”, thereby shrinking the lipoma. However, its total removal is also unguaranteed. [7]

 

  • Surgical Excision

For total removal and cure of lipoma, surgical excision is the best intervention. If you want your lipoma to be completely out of your life, you must be brave enough to let that part of your body be incised.

 

So here is an overview on how surgical excision is done. This is an outpatient procedure so not much preparation is needed. Local anesthesia will be used so you will be awake the entire procedure. Do not panic because the anesthesia will definitely do its job on numbing you.

 

The markings that you see serve as a guide to the surgeon where to cut to ensure the complete removal of the lipoma. These markings will be avoided while cleansing your skin with povidone iodine or chlorhexidine.

Markings that guide the surgeon on the exact location of the lipoma

Markings that guide the surgeon on the exact location of the lipoma.

Source: aafp.org

There is a procedure called enucleation wherein an a very small incision (3-4 mm) is made. This is typical for those who have small lipomas. A curette will be used to free your lipoma from the surrounding tissues and once it’s free, it can be grasped along with the lipoma. This simple procedure does not need to be sutured. Pressure dressing is enough.

For large lipomas, a larger incision should be made for the lipoma to pass through. The skin beneath the incised area should be held with a hemostat to provide traction, as seen below.

To provide traction, the skin beneath the incised area should be held with a hemostat

To provide traction, the skin beneath the incised area should be held with a hemostat.

Source: aafp.org

Once freed, grasp the tumor with hemostats or clamps then pull it out.

Once freed, grasp the tumor with hemostats or clamps then pull it out.

Source: aafp.org

The scalpel and scissors will then do its job to free the lipoma from the surrounding tissues, blood vessels, and nerves. Once the tumor is free, clamp it with hemostats and pull it out. Palpate the surrounding area to ensure that the tumor is completely out.

References:

  1. http://www.webmd.com/skin-problems-and-treatments/tc/lipoma-topic-overview
  2. http://www.wisegeek.com/what-is-an-angiolipoma.htm
  3. http://www.medscape.com/viewarticle/410446
  4. http://radiopaedia.org/articles/hibernoma
  5. http://www.bonetumor.org/soft-tissue-tumors/hibernoma
  6. http://musculoskeletal-radiology.blogspot.com/2006/08/neural-fibrolipoma.html

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