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  • • Lipomas are slow growing, benign adipose tumors, most often found in the subcutaneous tissues

    • Lipomas also occur in the deeper tissues such as the intramuscular septa, thoracic cavity, abdominal organs, and the GI tract

    • Histologically, lipomas are composed of mature adipocytes arranged in lobules, surrounded by a fibrous capsule

    • Infiltrating lipomas are non-encapsulated benign lesions with extensions into muscle

    • Variants of lipomas include angiolipoma, pleomorphic lipoma, spindle cell lipoma, and adenolipoma

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Epidemiology

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  • • Lipomas are identified in all age groups but most commonly appear first between the ages of 40 and 60

    • Multiple lipomas (lipomatosis) associated with hereditary syndromes:

    • -Gardner syndrome

      -Madelung disease

    • Hereditary multiple lipomatosis

    • -Adiposis dolorosa (Dercum disease)

      -Multiple endocrine neoplasia type 1

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Symptoms and Signs

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  • • Nontender, oval, mobile subcutaneous masses

    • Characteristic soft, doughy texture

    • Overlying skin normal

    • Deeply positioned lipomas typically present as nontender, nonmobile, soft-tissue masses

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Imaging Findings

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  • MRI

    • -Demonstrates the extent of the lesion

      -May be able to differentiate between lipoma and liposarcoma

      -Useful for deep lesions and/or when malignancy is suspected

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  • • Lipoma

    • Fibroma

    • Epidermoid cyst

    • Hemangioma

    • Desmoid tumor

    • Soft-tissue sarcoma (especially liposarcoma)

    • Cutaneous metastases

    • Nodular subcutaneous fat necrosis

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Rule Out

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  • • Soft-tissue sarcoma

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  • • Thorough history and physical exam

    • When malignancy is suspected, a MRI may be indicated, especially for large or deep-seated lesions

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  • • Surgical excision of symptomatic or enlarging lesions

    • Lesions > 4 cm should be approached with an incisional biopsy to confirm benign histology prior to complete excision

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Surgery

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Indications

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  • • Symptomatic lipoma

    • Enlarging soft-tissue mass

    • Cosmetic considerations

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Medications

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  • • Kenalog steroid injection is an alternative to excision (results in fat atrophy)

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Treatment Monitoring

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  • • Physical exam to detect "recurrence"

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Complications

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  • • Surgical infection

    • Ecchymosis

    • Hematoma

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Prognosis

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  • • Uniformly excellent

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References

Shelly MJ. MacMahon PJ. Eustace S Radiology of soft tissue tumors including melanoma. Cancer Treatment & Research. 2008, 143:423-52  [PubMed: 18619227]
Dalal KM. Antonescu CR. Singer S. Diagnosis and management of lipomatous tumors. Journal of Surgical Oncology. 2008, 97(4):298-313.  [PubMed: 18286473]

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