Successful Resection of Gastric Subepithelial Lipoma Using the Bite-on-Bite Approach: Reviving Old Techniques in a Peripheral Hospital

Subepithelial lesions (SELs) are common findings in the gastrointestinal (GI) tract. They are often benign and asymptomatic but can cause symptoms in some cases. The approach to endoscopic management of these lesions depends on various factors, including associated symptoms, location, available equipment, and operator expertise. In this case report, we present a 50-year-old male with long-standing dyspepsia who was found to have a submucosal lesion in the stomach. The lesion was successfully treated using the bite-on-bite method with cold biopsy forceps. This report aims to discuss gastric subepithelial lesions and current management options, and highlight an old technique for endoscopists in the era of advanced endoscopy.

Nasopalpebral Lipoma sine Coloboma Syndrome-First Case Report

The nasopalpebral lipoma-coloboma syndrome was described for the first time in 1982. It is an autosomal dominant syndrome with complete penetrance and is characterized by features like congenital symmetric upper eyelid and nasopalpebral lipomas, bilateral symmetric upper and lower eyelid colobomas, broad forehead, widow's peak, abnormal eyebrow pattern, telecanthus, broad nasal bridge, maxillary hypoplasia, and ophthalmological abnormalities. We report a case of a milder variant of the nasopalpebral lipoma-coloboma syndrome that we have termed "nasopalpebral lipoma sine coloboma syndrome." Such a milder variant is not reported hitherto in the literature. We also describe the surgical correction of the deformity in a case that presented in adulthood, with a satisfactory and pleasing aesthetic outcome.

Vascular anomaly, lipoma, and polymicrogyria associated with schizencephaly: developmental and diagnostic insights. Illustrative case

BACKGROUND

Schizencephaly is an uncommon central nervous system malformation. Intracranial lipomas are also rare, accounting for approximately 0.1% of brain "tumors." They are believed to be derived from a persistent meninx primitiva, a neural crest-derived mesenchyme that develops into the dura and leptomeninges.

OBSERVATIONS

The authors present a case of heterotopic adipose tissue and a nonshunting arterial vascular malformation arising within a schizencephalic cleft in a 22-year-old male. Imaging showed right frontal gray matter abnormality and an associated suspected arteriovenous malformation with evidence of hemorrhage. Brain magnetic resonance imaging revealed right frontal polymicrogyria lining an open-lip schizencephaly, periventricular heterotopic gray matter, fat within the schizencephalic cleft, and gradient echo hypointensity concerning for prior hemorrhage. Histological assessment demonstrated mature adipose tissue with large-bore, thick-walled, irregular arteries. Mural calcifications and subendothelial cushions suggesting nonlaminar blood flow were observed. There were no arterialized veins or direct transitions from the arteries to veins. Hemosiderin deposition was scant, and hemorrhage was not present. The final diagnosis was consistent with ectopic mature adipose tissue and arteries with meningocerebral cicatrix.

LESSONS

This example of a complex maldevelopment of derivatives of the meninx primitiva in association with cortical maldevelopment highlights the unique challenges from both a radiological and histological perspective during diagnostic workup.

Deep Frontal Lipoma With Frontal Bone Invasion: Report of a Rare Case

Lipomas are benign masses of fatty tissue, and in the forehead, they may develop in the subcutaneous or deep fat tissue. While subcutaneous lipomas are common, deep forehead lipomas are unusual and rarely invade the underlying bone. Only a few cases have been reported in the literature, and even fewer cases are reported in children. We present a case of a slowly growing frontal mass corresponding to a deep lipoma responsible for frontal bone invasion, resulting in a bony defect reaching the dural space. Through this case, we aim to emphasize forehead lipomas' clinical and surgical characteristics.

Lipoma Arborescens Where MRI Is a Boon

Lipoma arborescens is a slow-progressing intra-articular benign lesion that typically affects the knee joint's suprapatellar recess. It occurs due to lipomatous proliferation of the synovium, giving a characteristic frond-like appearance. It is a rare cause of intermittent knee pain and joint effusion. We draw attention to this rare condition to increase the knowledge of its clinical symptoms and imaging characteristics, allowing for an early diagnosis and appropriate management. Magnetic resonance imaging (MRI) is considered the initial and the single imaging modality to evaluate this condition in the current era.

A Once-Thought Lipoma Turned Malignant Chondroid Syringoma

Chondroid syringoma is a relatively rare benign skin appendageal tumor with an incidence of <0.098%. Malignant chondroid syringoma (MCS) arises from cutaneous sweat glands and occurs on the extremities or trunk more commonly in women with only 51 reported cases. Due to the rarity of the disease and lack of published cases of MCS, the diagnostic criteria and treatment protocols are not clear. Based on available recommendations and histological criteria, MCS was diagnosed in a previously classified elbow lipoma following increased size and pain, and skin color changes in a 65-year-old woman.

Subdeltoid Lipoma Associated With Subscapularis Tear Successfully Treated With Arthroscopic Resection and Cuff Repair: A Case Report

A 61-year-old male patient presented with left shoulder pain and an associated lump. Magnetic resonance imaging revealed a subscapularis tear, and subdeltoid lipoma obliterated its insertion. He was successfully treated with arthroscopic subscapularis repair and resection of mass simultaneously.To the authors' knowledge, this will be the first documented case of lipoma occurring under the deltoid muscle associated with the subscapularis tear. The reported arthroscopic approach for resection of the subdeltoid lipoma provides a complete removal, minimal muscle dissection, limited surgical scar, and satisfying functional outcomes. Therefore, it may be considered an option for benign tumor resection in this area.

Tumor-to-bone distance and radiomic features on MRI distinguish intramuscular lipomas from well-differentiated liposarcomas

Background

To develop a machine learning model based on tumor-to-bone distance and radiomic features derived from preoperative MRI images to distinguish intramuscular (IM) lipomas and atypical lipomatous tumors/well-differentiated liposarcomas (ALTs/WDLSs) and compared with radiologists.

Methods

The study included patients with IM lipomas and ALTs/WDLSs diagnosed between 2010 and 2022, and with MRI scans (sequence/field strength: T1-weighted (T1W) imaging at 1.5 or 3.0 Tesla MRI). Manual segmentation of tumors based on the three-dimensional T1W images was performed by two observers to appraise the intra- and interobserver variability. After radiomic features and tumor-to-bone distance were extracted, it was used to train a machine learning model to distinguish IM lipomas and ALTs/WDLSs. Both feature selection and classification steps were performed using Least Absolute Shrinkage and Selection Operator logistic regression. The performance of the classification model was assessed using a tenfold cross-validation strategy and subsequently evaluated using the receiver operating characteristic curve (ROC) analysis. The classification agreement of two experienced musculoskeletal (MSK) radiologists was assessed using the kappa statistics. The diagnosis accuracy of each radiologist was evaluated using the final pathological results as the gold standard. Additionally, we compared the performance of the model and two radiologists in terms of the area under the receiver operator characteristic curves (AUCs) using the Delong’s test.

Results

There were 68 tumors (38 IM lipomas and 30 ALTs/WDLSs). The AUC of the machine learning model was 0.88 [95% CI 0.72–1] (sensitivity, 91.6%; specificity, 85.7%; and accuracy, 89.0%). For Radiologist 1, the AUC was 0.94 [95% CI 0.87–1] (sensitivity, 97.4%; specificity, 90.9%; and accuracy, 95.0%), and as to Radiologist 2, the AUC was 0.91 [95% CI 0.83–0.99] (sensitivity, 100%; specificity, 81.8%; and accuracy, 93.3%). The classification agreement of the radiologists was 0.89 of kappa value (95% CI 0.76–1). Although the AUC of the model was lower than of two experienced MSK radiologists, there was no statistically significant difference between the model and two radiologists (all P > 0.05).

Conclusions

The novel machine learning model based on tumor-to-bone distance and radiomic features is a noninvasive procedure that has the potential for distinguishing IM lipomas from ALTs/WDLSs. The predictive features that suggested malignancy were size, shape, depth, texture, histogram, and tumor-to-bone distance.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13018-023-03718-4.

Uncommon presentation of a giant psoas muscle lipoma: a case report and brief literature review

Giant retroperitoneal lipomas, particularly within the psoas muscle, are a rare condition. We herein present one such case of a 45-year-old Italian man and a literature review. There are only two case reports published in the literature, thus posing challenges for the appropriate diagnosis and treatment. Our patient was admitted to the emergency department with colicky abdominal pain. Computerized tomography (CT) with contrast enhancement revealed kidney stones and a 19.5×13.6×18 cm mass of adipose tissue with septa located in the right retroperitoneum, in close continuity with the right psoas major muscle. Magnetic resonance imaging showed a voluminous neoformation with predominantly adipose content and a compressive effect on adjacent vascular structures. The CT-guided biopsy indicated spindle cell mesenchymal neoplasm, not otherwise specified. Surgical resection of the retroperitoneal mass with the capsule was performed, and a histopathology examination confirmed the diagnosis of spindle cell lipoma. Despite the fact that CT and MRI are the main diagnostic tools, this case report emphasizes the need for a CT-guided core needle biopsy prior to surgery for appropriate diagnosis.

PTEN regulates proliferation and osteogenesis of dental pulp cells and adipogenesis of human adipose-derived stem cells

OBJECTIVE

To investigate the role of phosphatase and tensin homolog (PTEN) in dental pulp cells (hDPs) and adipose-derived mesenchymal stem cells (hADSCs).

MATERIALS AND METHODS

Genetic variant was identified with exome sequencing. The hDPs isolated from a patient with Cowden syndrome were investigated for their proliferation, osteogenesis, adipogenesis, and gene expression compared with controls. The normal hDPs and hADSCs were treated with the PTEN inhibitor, VO-OHpic trihydrate (VOT), to investigate the effect of PTEN inhibition.

RESULTS

A heterozygous nonsense PTEN variant, c.289C>T (p.Gln97*), was identified in the Cowden patient's blood and intraoral lipomas. The mutated hDPs showed significantly decreased proliferation, but significantly upregulated RUNX2 and OSX expression and mineralization, indicating enhanced osteogenic ability in mutated cells. The normal hDPs treated with VOT showed the decreases in proliferation, colony formation, osteogenic marker genes, alkaline phosphatase activity, and mineral deposition, suggesting that PTEN inhibition diminishes proliferation and osteogenic potential of hDPs. Regarding adipogenesis, the VOT-treated hADSCs showed a reduced number of cells containing lipid droplets, suggesting that PTEN inhibition might compromise adipogenic ability of hADSCs.

CONCLUSIONS

PTEN regulates proliferation, enhances osteogenesis of hDPs, and induces adipogenesis of hADSCs. The gain-of-function PTEN variant, p.Gln97*, enhances osteogenic ability of PTEN in hDPs.

Recurrent 8q11-13 Aberrations Leading to PLAG1 Rearrangements, Including Novel Chimeras HNRNPA2B1::PLAG1 and SDCBP::PLAG1, in Lipomatous Tumors

BACKGROUND/AIM

Structural abnormalities of chromosome bands 8q11-13, resulting in rearrangement of the pleomorphic adenoma gene 1 (PLAG1), are known to characterize lipoblastoma, a benign fat cell tumor, found mainly in children. Here, we describe 8q11-13 rearrangements and their molecular consequences on PLAG1 in 7 lipomatous tumors in adults.

MATERIALS AND METHODS

The patients were 5 males and 2 females between 23 and 62 years old. The tumors, namely five lipomas, one fibrolipoma and one spindle cell lipoma, were examined using G-banding with karyotyping, fluorescence in situ hybridization (FISH; three tumors), RNA sequencing, reverse transcription (RT) PCR, and Sanger sequencing analyses (two tumors).

RESULTS

All 7 tumors had karyotypic aberrations which included rearrangements of chromosome bands 8q11-13 (the criterion for selection into this study). FISH analyses with a PLAG1 break apart probe showed abnormal hybridization signals in both interphase nuclei and on metaphase spreads indicating PLAG1 rearrangement. RNA sequencing detected fusion between exon 1 of heterogeneous nuclear ribonucleoprotein A2/B1 (HNRNPA2B1) and exon 2 or 3 of PLAG1 in a lipoma and fusion between exon 2 of syndecan binding protein (SDCBP) and exon 2 or 3 of PLAG1 in a spindle cell lipoma. The HNRNPA2B1::PLAG1 and SDCBP::PLAG1 fusion transcripts were confirmed using RT-PCR/Sanger sequencing analyses.

CONCLUSION

As 8q11-13 aberrations/PLAG1-rearrangements/PLAG1-chimeras may evidently be a defining pathogenetic feature of lipogenic neoplasms of several histological types and not just lipoblastomas, we suggest that the term "8q11-13/PLAG1-rearranged lipomatous tumors" be generally adopted for this tumor subset.

Thyroglossal Duct Lipoma: A Case Report and a Systematic Review of the Literature for Its Management

Thyroglossal duct (TGD) remnants in the form of cysts or fistulas usually present as midline neck masses and they are removed along with the central body of the hyoid bone (Sistrunk's procedure). For other pathologies associated with the TGD tract, the latter operation might be not necessary. In the present report, a case of a TGD lipoma is presented and a systematic review of the pertinent literature was performed. We present the case of a 57-year-old woman with a pathologically confirmed TGD lipoma who underwent transcervical excision without resecting the hyoid bone. Recurrence was not observed after six months of follow-up. The literature search revealed only one other case of TGD lipoma and controversies are addressed. TGD lipoma is an exceedingly rare entity whose management might avoid hyoid bone excision.

MDM4 amplification in atypical lipomatous tumors/well-differentiated liposarcoma: Private event or alternative oncogenic mechanism?

Adipocytic tumors are the most common mesenchymal tumors in soft tissues. Among them, a diagnostic challenge relies in the distinction between lipoma and atypical lipomatous tumor (ALT)/well differentiated liposarcoma (WDLPS), as both entities are often undistinguishable not only from a radiological point of view, but also at the microscopic level and particularly when dealing with small tumor specimen. Thus, detection of recurrent MDM2 amplifications may be the only criteria to discriminate malignant tumors from lipomas. In this study, we report the case of a patient diagnosed with a well differentiated, adipocytic tumor located in the inferior limb and lacking MDM2 amplification, whose diagnosis was reclassified for ALT/WDLPS after identification of an alternative MDM4 amplification by comparative genomic hybridization profiling, whole exome sequencing and fluorescence in situ hybridization (FISH). Screening of a cohort of 37 large, deep-seated, well-differentiated adipocytic tumors previously classified as lipomas using RT-qPCR and FISH failed to detect other cases of MDM4-amplified ALT/WDLPS. This report shows that MDM4 amplification is an exceptional molecular event alternative to MDM2 amplification in ALT/WDLPS. This alteration should be considered and looked for in suspicious adipocytic tumors to optimize their surgical management.

MERRF Mutation A8344G in a Four-Generation Family without Central Nervous System Involvement: Clinical and Molecular Characterization

A 53-year-old man approached our Neuromuscular Unit following an incidental finding of hyperckemia. Similar to his mother who had died at the age of 77 years, he was diabetic and had a few lipomas. The patient's two sisters, aged 60 and 50 years, did not have any neurological symptoms. Proband's skeletal muscle biopsy showed several COX-negative fibers, many of which were "ragged red". Genetic analysis revealed the presence of the A8344G mtDNA mutation, which is most commonly associated with a maternally inherited multisystem mitochondrial disorder known as MERRF (myoclonus epilepsy with ragged-red fibers). The two sisters also carry the mutation. Family members on the maternal side were reported healthy. Although atypical phenotypes have been reported in association with the A8344G mutation, central nervous system (CSN) manifestations other than myoclonic epilepsy are always reported in the family tree. If present, our four-generation family manifestations are late-onset and do not affect CNS. This could be explained by the fact that the mutational load remains low and therefore prevents tissues/organs from reaching the pathologic threshold. The fact that this occurs throughout generations and that CNS, which has the highest energetic demand, is clinically spared, suggests that regulatory genes and/or pathways affect mitochondrial segregation and replication, and protect organs from progressive dysfunction.

A Giant Mixed Infiltrative Angiolipoma of the Back with Venous Malformation- A Case Report and Related Gene Mutation Detection

We report a case of a middle-aged male patient with a diffuse large mixed infiltrating angiolipoma on the back with venous malformation that grew from the age of 3 years. We discussed the design of the surgical flap for this large lipoma, observed its blood supply using SPY, and screened for possible causative genes, FCGR2A, BMP5, MUC2, and KRTAP4-9. To date, no invasive lipomas of this size and duration have been reported.

Spectrum of salivary gland diseases: A 24-year single-institution retrospective study

Introduction

Salivary glands are exocrine glands and are classified as major and minor salivary glands. Salivary gland pathologies are classified as neoplastic and non-neoplastic. The neoplasms of salivary glands can be benign or malignant.

Aim

The aim of the study was to describe the frequency of various salivary gland diseases reported in our institution from 1997 to 2021.

Methodology

This was a 24-year retrospective study of salivary gland lesions processed and reported by the Department of Oral Pathology and Microbiology. Data regarding age, gender, site, and diagnosis were obtained and studied.

Results

Amongst the total 5928 biopsied cases reported, 6% were salivary gland pathologies. Two hundred sixty-six were non-neoplastic lesions and 81 were neoplastic. The most common non-neoplastic lesion was mucous extravasation cyst. The most common neoplastic lesion was pleomorphic adenoma.

Conclusion

The frequency of occurrence of salivary gland lesions in the last 24 years of this institution is almost similar to that stated in other published studies.

Verrucous epidermal nevus as a manifestation of a type 2 mosaic PTEN mutation in Cowden syndrome

Linear Cowden nevus, also known as linear PTEN nevus, is a type of epidermal nevus, first described in 2007, which is seen in patients with PTEN hamartoma tumor syndrome. It is considered to be a type 2 form of segmental mosaicism, and we suggest that it has certain clinical features that distinguish it from epidermal nevi seen in similar conditions, such as Proteus syndrome. We present a case of linear Cowden nevus in a 4-year-old boy and review the literature.

A Unique Cause of Upper Airway Obstruction in a Child: Laryngeal Lipoma

There are lots of diseases causing pediatric upper airway obstruction and stridor. They can be both congenital or acquired. While congenital causes are laryngomalacia, vocal cord palsy, congenital subglottic stenosis, acquired ones range from infections to foreign bodies or neoplasms. Laryngeal neoplasms develop almost epithelial in origin. Non-epithelial tumors consist 1% of laryngeal neoplasms. Although lipoma is the most common soft tissue tumor, laryngeal involvement is very rare and seen in the ages between 40-60 years. A 13-month-old child who had laryngeal lipoma and upper airway obstruction was aimed to present in this paper.

Lipoma management with a minimally invasive 1,444 nm Nd:YAG laser technique

BACKGROUND

Lipoma is the most common benign mesenchymal tumor that is composed of mature fat cells. Subdermal laser lipoma treatment may be recommended as an alternative to surgery for its removal.

PURPOSE

The purpose of the study was to investigate the efficacy of the 1,444 nm Nd:YAG laser subcutaneous intralesional application as a treatment option for lipoma.

MATERIALS AND METHODS

On 60 patients (37 women and 23 men) with lipomas localized above the muscle and lipomatosis in various regions, a subcutaneous, micro-pulsed 1,444 nm Nd:YAG laser procedure was executed. Before treatment, an ultrasound was performed and the lipomas were measured. The same lighting setup and photographic tools were used to take pictures of each patient.

RESULTS

The lipoma reduced or completely disappeared in all cases at the last follow-up, and no infections, burns, skin lesions, episodes of severe bleeding, or other serious adverse effects were reported. The most common transient side effects were ecchymosis and edema. Partial lesion reduction refers to rare cases of lipomatosis in which the lipomas were so small that suction and accurate positioning of the capsular membrane contours were impossible.

CONCLUSION

Lipoma treatment with a 1,444 nm Nd:YAG laser is a safe and effective minimally invasive procedure without risk of scarring. For cellular disruption, laser treatment is an effective and safe option.

Rare fibrolipoma of attached gingiva: A case report and review of the literature

Lipoma is a rare benign tumor. Fibrolipoma, a variant of lipoma, is relatively uncommon in mouth tissues. Among all benign lesions of oral cavity, the approximate incidence rate of lipoma is 1%-4%, with a prevalence rate of about 0.0002%. Fibrolipoma is an extremely rare subtype of lipoma, especially in the attached gingiva. This subtype accounts for 1.6% of all facial lipomas, with a prevalence rate of 1/5000 adults in the oral and oropharyngeal region. It is diagnosed by histopathologic and immunohistochemistry evaluation and treated by total excision. Due to the adhesion to the surrounding tissues and pseudo-infiltrating characteristics of this lesion, it can get mistaken with malignant lesions; therefore, a histological examination is mandatory. In this paper, a case of a patient with attached gingiva fibrolipoma treated by surgical excision is reported. This case report is about a 26-year-old female patient in Shiraz School of Dentistry with a fibrolipoma of attached gingiva. Because of fibrolipoma's growth tendency, adhesion to the surrounding tissues, and specific histological characteristics, its differential diagnosis with malignant infiltrating tumors is important. Surgical excision is the gold standard for treatment. Accurate differential diagnosis, careful histological examination, and periodic follow-up are essential.

Lipoma with osteocartilaginous metaplasia in infrapatellar fat pad: A case report and review of literature

RATIONALE

Lipomas are tumors composed of mature adipocytes, originating from the mesoderm, and are the most common soft tissue tumor. According to the World Health Organization classification of human soft tissue and bone tumors, there are 14 types of benign tumors, including mature adipose tissue. Osteolipoma is known as the rarest subtype of lipoma.

PATIENT CONCERNS

A 63-year-old female presented to our hospital for the evaluation and treatment of a palpable mass with pain in the right knee.

DIAGNOSIS

The diagnosis was confirmed as lipoma with osteocartilaginous metaplasia.

INTERVENTIONS

Surgical removal of the tumor was performed.

OUTCOMES

The main symptoms improved immediately after the surgery and recovered without any complications or recurrence until 2 years after surgery.

LESSONS

Lipoma with osteochondral degeneration is a rare variant of lipoma and it is important to differentiate it from other malignant tumors. Pathological confirmation should be performed after marginal resection of the mass.

Photoacoustic Tomography Appearance of Fat Necrosis: A First-in-Human Demonstration of Biochemical Signatures along with Histological Correlation

A 50-year-old woman with no past medical history presented with a left anterior chest wall mass that was clinically soft, mobile, and non-tender. A targeted ultrasound (US) showed findings suggestive of a lipoma. However, focal “mass-like” nodules seen within the inferior portion suggested malignant transformation of a lipomatous lesion called for cross sectional imaging, such as MRI or invasive biopsy or excision for histological confirmation. A T1-weighted image demonstrated a large lipoma that has a central fat-containing region surrounded by an irregular hypointense rim in the inferior portion, confirming the benignity of the lipoma. An ultrasound-guided photoacoustic imaging (PA) of the excised specimen to derive the biochemical distribution demonstrated the “mass-like” hypoechoic regions on US as fat-containing, suggestive of benignity of lesion, rather than fat-replacing suggestive of malignancy. The case showed the potential of PA as an adjunct to US in improving the diagnostic confidence in lesion characterization.

Experience with Liposuction for the Treatment of Subcutaneous Lipoma: A Case Series from a Tertiary Health Institution in Nigeria

Background

Lipomas are the commonest benign tumours in the body. Treatment is often by excision biopsy. Liposuction has traditionally been used for body sculpturing, but recently, it was introduced for the operative management of lipomas. The aim of this study was to present our experience with liposuction lipectomy-assisted lipoma aspiration in terms of its efficacy, complications, risk of recurrence, and patient satisfaction.

Materials and Methods

A retrospective review of 16 patients with solitary or multiple lipomas managed with liposuction over a 5-year period was done. All the patients had a prior fine needle aspiration cytology, which was reported as benign. Informed consent was obtained, and the procedures were performed as a day case under tumescent anaesthesia. Lipo-aspiration was done with manual liposuction device. The patients were discharged on oral analgesics and antibiotics.

Results

Sixteen patients (10 females and six males) with 21 lesions were managed. The median age was 43 years (23-66 years). All the patients had satisfactory outcomes. The procedure was converted to open-excisional surgery in one patient, and the histology was reported as fibro lipoma. Friction burn at the cannula site occurred in one patient, which subsequently healed with scars. No recurrence was reported in any of the patients.

Conclusion

In well-selected patients, liposuction-assisted lipectomy may have an advantage over the classical open technique. All patients should have a minimum investigation of fine needle aspiration cytology because of the risk of atypical lipomas or liposarcoma, which might have similar features as subcutaneous lipoma.

Application of self-made rubber drainage strip in the operation of giant lipoma

Lipoma is a common benign soft-tissue tumor. Giant lipoma [1] is generally defined as more than 10 cm in length or more than 1000 g in weight. We report a 33-year-old patient with a giant lipoma in the left scapular region. We placed a self-made rubber drainage strip during the operation to control exudate, which is effective in improving incision effusion.