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Lipomas

  1. 1. LIPOMAS Dr. Ajayi Babajide O. Dept. of Family Medicine. EKO Hospitals, Ikeja.
  2. 2. OUTLINE  INTRODUCTION  EPIDEMIOLOGY  AETIOLOGY  CLASSIFICATION  CLINICAL FEATURES  DIFFERENTIALS  COMPLICATIONS  TREATMENT MODALITIES
  3. 3. INTRODUCTION  A lipoma is a benign soft tissue tumor composed of adipose tissue (body fat) enclosed in a capsule of connective tissue.  It is the most common benign form of soft tissue tumor.  It may be arranged in lobules separated by fibrous septa.  It may also become pedunculated.
  4. 4. EPIDEMIOLOGY  Lipomas are commonly found in adults from 40 to 60 years of age but can also be found in younger adults and children.
  5. 5. Causes of Lipomas  The tendency to develop a lipoma is not necessarily hereditary although hereditary conditions, such as familial multiple lipomatosis, may include lipoma development.  Gardeners syndrome  Dercums’ syndrome  Cases have been reported where minor injuries are alleged to have triggered the growth of a lipoma, called “post- traumatic lipomas”. However, the link between trauma and the development of lipomas is controversial.
  6. 6. Classification There are many methods of classification Based on histologic types Based on location  Superficial subcutaneous lipomas, the most common type of lipoma, They lie just below the surface of the skin. Most occur on the trunk, thigh, and forearm, although they may be found anywhere in the body where fat is located.  Adenolipomas are lipomas associated with eccrine sweat glands.  Angiolipoleiomyomas are acquired, solitary, asymptomatic acral nodules, characterized histologically by well-circumscribed subcutaneous tumors composed of smooth muscle cells, blood vessels, connective tissue, and fat.  Angiolipomas painful subcutaneous nodules having all other features of a typical lipoma.
  7. 7.  Cerebellar pontine angle and internal auditory canal lipomas.  Chondroid lipomas are deep-seated, firm, yellow tumors that characteristically occur on the legs of women.[4]:625  Corpus callosum lipoma is a rare congenital brain condition that may or may not present with symptoms. This occurs in the corpus callosum, also known as the colossal commissure, which is a wide, flat bundle of neural fibers beneath the cortex in the human brain.  Hibernomas are lipoma of brown fat.
  8. 8.  Intradermal spindle cell lipomas are distinct in that they most commonly affect women and have a wide distribution, occurring with relatively equal frequency on the head and neck, trunk, and upper and lower extremities.  Neural fibrolipomas are overgrowths of fibro-fatty tissue along a nerve trunk, which often leads to nerve compression.  Pleomorphic lipomas, like spindle-cell lipomas, occur for the most part on the backs and necks of elderly men and are characterized by floret giant cells with overlapping nuclei.  Spindle-cell lipomas are asymptomatic, slow-growing subcutaneous tumors that have a predilection for the posterior back, neck, and shoulders of older men.
  9. 9. HISTORY  History-taking is guided by the anatomical location of the lesion. Questions should explore factors such as:  When the lump was first noticed  What brought the lump to the attention of the patient  The symptoms that are related to the lump  Changes that have occurred to the lump since it first appeared  Whether the lump ever disappears and what causes it to reappear  Whether the patient ever had any other lumps and what they were like  Whether there has been any loss of body weight  Whether the lump has been treated before and has recurred.
  10. 10. CLINICAL FEATURES  Most lipomas are small (under one centimeter diameter) but can enlarge to sizes greater than six centimeters.  Localized,  Lobular  Fluctuant.  Mobile.  Exhibit “Slip sign”. (They move easily when pressure is placed on them)  Skin free.  Soft  On examination they do not exhibit differential warmth.  Lipomas are usually painless soft and non tender.
  11. 11. Reaching a Diagnosis  This is usually done clinically. Any doubt about the diagnosis calls for immediate refferall to a dermatologist.  Ancillary investigations include:-  Pre-operative radiography  Both ultrasound and magnetic resonance imaging have been used with some success to differentiate lipomas and liposarcomas but are not entirely reliable.  CT scan are occasionally required.  Alternatively, fine-needle aspiration may be used to evaluate suspicious lesions
  12. 12. Differential DiagnosisThese include but are not limited to:-  Fibrosarcomas  Abcesses (Localized)  Cold abcesses  Neurofibromas  Hernias  Pappiloma  Sebaceous cysts (contain sebum. Affect the s.glands)  Epidermoid cysts (contain keratin and fat)  Nodular fasciitis  Erythema nodosum  Nodular subcutaneous fat necrosis  Haematoma
  13. 13. Sebaceous cysts
  14. 14. Draining Sebum
  15. 15. Epidemoid Cyst
  16. 16. COMPLICATIONS  Myxomatous degeneration  Saponification  Calcification  Infection  Ulceration  Intussusception & intestinal obstruction  Some sources claim that malignant transformation can occur while others say this has yet to be convincingly documented.
  17. 17. Treatment of Lipomas
  18. 18. Indications for Treatment  Usually, treatment of a lipoma is not necessary, unless the tumor becomes painful or restricts movement. They are usually removed for cosmetic reasons,  However reasons to remove lipomas include when they grow very large, or for histopathology to check that they are not a more dangerous type of tumor such as a lipo-sarcoma. This last point can be important as the actual characteristics of a “lump" is not known until after it is removed and medically examined.
  19. 19.  Liposarcoma  This malignancy is rare but can be found in a lesion with the clinical appearance of a lipoma. Liposarcoma presents in a fashion similar to that of a lipoma and appears to be more common in the retro peritoneum, on the shoulders and lower extremities.  Hence some recommend an immediate and complete excision of a lipoma with subsequent histologic studies to exclude a possible Liposarcoma,
  20. 20. Suspicious Signs that warrant immediate removal  If the lump suddenly starts to grow very large  Greater than 5 cm in diameter  Located in the extremities, retroperitoneally, in the groin, in the scrotum or in the abdominal wall  Deep (beneath or fixed to superficial fascia)  Exhibiting malignant behaviour (invasion into nerve or bone)
  21. 21. Surgical excision of Lipomas  They can be left alone. They may need to be removed for cosmetic reasons, because of compression of surrounding structures or if the diagnosis is uncertain  Lipomas are normally removed by simple excision. The removal can often be done under local anaesthetic, and takes fewer than 30 minutes. This cures the great majority of cases, with about 1– 2% of lipomas recurring after excision.  . Because lipomas generally do not infiltrate into surrounding tissue, they can usually be shelled out easily during excision.  Minimal scarring can be achieved with a technique called segmental extraction - a small stab incision followed by blind dissection of the lipoma and extraction in a segmental fashion
  22. 22.  Liposuction is another option if the lipoma is soft and has a small connective tissue component. Liposuction typically results in less scarring; however, with large lipomas it may fail to remove the entire tumor, which can lead to re-growth.
  23. 23.  New methods under development are supposed to remove the lipomas without scarring. One is removal by injecting compounds that trigger lipolysis, such as steroids or phosphatidylcholine.

Editor's Notes

  • HERMIAS PAPILLOMAS ABCESSESS
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