[Trigeminal nerve lipoma presenting with trigeminal neuralgia: case report and literature review]

Cerebellopontine angle lipomas are benign mass lesions and rarely result trigeminal neuralgia. A 61-year-old male with right-sided trigeminal neuralgia in V2 and V3 divisions without sensory disturbances is reported in the article. MRI revealed mass lesion 11´11´4 mm on the lateral pontine surface spreading to the right trigeminal nerve root entry zone. No signs of neurovascular compression were found. Microsurgical exploration of the cerebellopontine angle showed a fatty mass adherent to the brainstem with incorporation of inferior part of trigeminal nerve root. Fatty tissue resection was followed by partial sensory trigeminal rhizotomy. Histological examination identified lipoma. Postoperative MRI showed small residual tissue with minimal ischemic area near trigeminal nerve root entry zone. Mild hypoesthesia within V2 and V3 trigeminal branches occurred after surgery. Trigeminal neuralgia completely resolved, and medications were discontinued. This clinical case and literature review clearly demonstrated successful elimination of trigeminal neuralgia in patients with cerebellopontine angle lipoma after resection of mass lesion and partial trigeminal rhizotomy.

Lipoblastoma phenotype contains a somatic PIK3CA mutation

Lipoblastoma typically occurs in childhood and is associated with rearrangements of the PLAG1 gene. We present a patient with an isolated mass thought to be a lipoblastoma clinically, radiographically, and histologically. The lesion was diagnosed as a PIK3CA-adipose lesion after the tissue was negative for PLAG1 rearrangement and contained a somatic PIK3CA mutation (H1047R). Although PIK3CA variants are associated with PROS (PIK3CA-related overgrowth spectrum), this report illustrates a non-syndromic, lipoblastoma phenotype caused by a PIK3CA mutation.

Surgical treatment of congenital left ventricular diverticulum

Background

Congenital left ventricular diverticulum (LVD) is a rare cardiac malformation. Its prevalence rate is less than 0.1% of the congenital heart diseases requiring surgery. Some scholars suggest that all LVD should be actively removed to prevent possible risks, including diverticulum rupture, arterial embolism, and malignant arrhythmia. However, others believe that asymptomatic LVD can be followed up without immediate surgery. We reviewed and reported the diagnosis, clinical features, and surgical treatment of four cases of congenital LVD to provide clinical experience and a reference for the treatment of such patients.

Methods

Four patients (aged 3–32 years old) were diagnosed with congenital LVD and received surgical treatment at the Department of Cardiovascular Surgery of PLA General Hospital, Beijing, China from September 2009 to July 2019. All four patients had complete long-term postoperative follow-up data, including echocardiogram, enhanced cardiac computed tomography (CT), and electrocardiogram to monitor changes in left ventricular structure, heart function, and heart rhythm.

Results

In the first case, the fibrodiverticulum under the aortic valve squeezed the right ventricular outflow tract and the right main coronary artery; the morphology of the right ventricle and coronary artery returned to normal after surgery. The second patient was complicated with a huge lipoma in the apex of the left ventricle and underwent lipoma resection during LVD resection surgery. The third and fourth cases had muscular diverticula in the left ventricular apexes and received LVD removal surgery. All four patients recovered well after surgery and their left ventricular morphology and cardiac function were normal without adverse complications, such as atrial fibrillation, ventricular arrhythmia, and cerebrovascular accident.

Conclusions

Although the morphology and character of congenital LVD were different in each case, the use of effective diagnostic and follow-up tools, including echocardiogram, enhanced CT, and magnetic resonance imaging (MRI), allowed for successful surgical treatment of the left ventricular diverticula and symptoms or other malformations. We propose that congenital LVD should be actively treated with surgery, especially considering effectiveness and low risk associated with this therapeutic option.

An unusual approach for a cervical mass: sternotomy for the treatment of a giant cervico-thoracic lipoma

BACKGROUND AND AIM

Lipoma is a benign mesenchymal tumor. It is a very common tumor and in 13% of cases occurs in head and neck. Giant lipomas are extraordinary and cervical involvement with mediastinal extension is an exceedingly rare presentation. Only a few cases of thoracic extension are reported in literature.

METHODS

We describe the case of a 62-years-old man with a giant cervico-mediastinic lipoma which required a combined approach through cervicotomy and sternotomy to ensure surgical radicality. Differential diagnoses could be thymolipoma, liposarcoma or familiar lipomatosis.

RESULTS

The mass was removed en-bloc with thymus and locoregional lymph nodes. The patient recovered uneventfully.

CONCLUSIONS

The aim of this report is to discuss potential pitfalls of differential diagnosis and implementation of the therapeutic treatment. Focus on the relevance of performing fluorescence in situ hybridization (FISH) for MDM2 amplification is reported, a necessary technique for the differential diagnosis. (www.actabiomedica.it).

Bladder lipoma: Moroccan case report

Lipomas are encapsulated benign tumors typically found in the integument, central nervous system or gastrointestinal tract and represent the most common benign mesenchymal neoplasm in adults. Bladder lipoma is a rare tumor that has been reported in a handful of cases in medical literature. A literature review from PubMed, MEDLINE, EMBASE and Cochrane databases of bladder lipoma yielded less than 20 cases. We report a case of a 69 year-old Moroccan male patient with hematuria as a chief symptom. The diagnosis of bladder lipoma was suspected by flexible fibroscopy and assessed by transurethral resection. Macroscopic and histological examination revealed a lipomatous tumour with no sign of malignancy. There was no recurrence after one year of follow-up. Although bladder lipomas are rare entities, they must be considered in the differential diagnosis of bladder tumor. However, we should always keep in mind that any bladder tumor is malignant until proven otherwise.

Complex Regional Pain Syndrome Caused by an Axillary Lipoma

Complex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy syndrome, is a rare chronic neuro-inflammatory pain condition, which can follow a soft-tissue, bone (type I), or nerve injury (type II) that can be severe and often lasts longer than the original tissue damage. Lipomas impinging on the brachial plexus are rare. To date, there have been no documented cases of CRPS caused by a benign tumor. Here, we report a rare case of CRPS caused by surgical removal of a left axillary lipoma impinging on the brachial plexus. The patient presented with neuropathic pain and hyperalgesia of the left arm, in a non-dermatomal pattern, and pain out of proportion to touch and painful stimulus. Persistent CRPS continued to occur post-operatively for one year without significant change in her pain characteristics. CRPS following elective or emergent surgery to the extremities can pose significant complications to recovery and post-operative care. This condition can be induced through surgery or trauma, which can complicate recovery, impair motor functionality, and cause debilitating pain. Treatment modalities and pathogenesis for CRPS remain obscure and limited, which leads to wide misdiagnosis. Our case highlights the importance of considering CRPS when evaluating differential diagnoses for pre- and post-operative conditions affecting the upper and lower extremities.

Lipoma of the nasal septum: A case report

Even routine diagnoses, such as septal deviation, which most people do not think need imaging, require careful examination because rare diagnoses such as lipoma may occur in the nose. Careful examination and imaging lead to the best treatment.

Fibrolipomatous Hamartoma of the Median Nerve: An Outcome of Surgical Management in Six Consecutive Cases

Background

Lipoma is a nonneurogenic benign tumor. Neurolipoma and fibrolipomatous hamartoma are variants of this universal tumor. All these variants are grouped under lipomatosis of the nerve. Majority of these tumors are asymptomatic, which can be observed. Symptomatic patients require surgery, which is not standardized. As there are insufficient number of cases, no randomized controlled studies have been performed in the treatment of fibrolipomatous hamartoma. The aim of our study was to determine the pattern of presentation of fibrolipomatous hamartoma, surgical management offered, and the outcome in the form of recovery and complications.

Materials and Methods

This retrospective descriptive study includes six patients diagnosed with fibrolipomatous hamartoma over a period of 12 years. Patient details were collected from the medical records. Patients diagnosed of fibrolipomatous hamartoma in the hand were included. Patients with other soft-tissue tumors were excluded from the study. Out of six patients, four required excision of nerve followed by reconstruction using sural nerve graft and two underwent microsurgical dissection of neural element. Patients were instructed to take care of the operated hand during the recovery phase. Institutional physiotherapy protocol was started during the 3^rd postoperative week. Follow-up period was between 1 and 3 years.

Results

All the six patients were free from symptoms postoperatively. Minimal complications were noted in two patients, which were managed conservatively.

Conclusion

Surgical excision of fibrolipomatous hamartoma of median nerve below elbow, with nerve dissection or with nerve reconstruction using sural nerve graft, followed by proper postoperative care and physiotherapy has proven beneficial for the patients in our study.

A single institutional experience treating adipocytic tumors: incidence, disease-related outcomes, and the clinical significance of MDM2 analysis

Adipocytic tumors exist either as a benign or malignant form. The benign variant, lipoma, is composed of normal fat tissue. Lipomas typically develop from superficial fat cells beneath the skin or mucous membranes. Liposarcoma, the malignant counterpart, often develops in deeper tissues and is the most commonly diagnosed Soft Tissue Sarcoma (STS), comprising at least 20% of adult STS. However, malignant tumors of fatty origin exist as a spectrum of diagnoses, each carrying a unique risk of recurrence, metastasis, and longterm survival. The World Health Organization classifies liposarcomas into five categories: i) Atypical Lipomatous Tumors/Well Differentiated (ALT/WD); Ii) Dedifferentiated (ALT/DD); Iii) Myxoid; Iv) Round cell; and v) Pleomorphic. Lipomatous tumors often exhibit different immunohistochemical patterns. Benign lipomas are distinguished by the absence of Murine Double-Minute 2 (MDM2) amplification. Similarly, ALT/WD, classically defined as a low-grade and locally aggressive tumor, demonstrates consistent patterns of MDM2 amplification. Some studies suggest 10% of ALT/WD progress to the highgrade DD form, with others report a dedifferentiation rate of as high as 20% for primary ALT/WD based on location. The ALT/DD subtype is aggressive and has a high capacity to metastasize. While the mechanism of pathogenesis of ALT/DD metastasis is unknown, previous studies suggest that increased MDM2 amplification may play a role. This study sought to evaluate a single institutional experience treating the entire spectrum of lipomatous tumors and describe utilization patterns of MDM2 testing. The group hypothesized: i) Atypical Lipomatous Tumors (ALT), which include ALT/DD and ALT/WD, would exhibit a higher rate of local recurrence than lipomas with no significantly increased incidence of metastases; and ii) at least 50% of our MDM2 testing of ALT would prove positive for the MDM2 overamplification. This study retrospectively reviewed 105 cases (66 lipomas, 27 ALTs, 12 liposarcomas) of patients who underwent lipomatous tumor excision at our institution from 2013 to 2017. Twenty-five tumors (6 lipomas, 18 ALT, 1 liposarcoma) were tested for MDM2 amplification. Three of the tested tumors recurred (2 ALT, 1 liposarcoma), and each exhibited MDM2 overamplification. Five tumors (5 liposarcoma) developed late metastases. These data suggest that although ALT is associated with a higher rate of local recurrence, metastases are quite rare. Additionally, the data demonstrate a high rate of positive MDM2 testing (76%) based on clinical and imaging characteristics of the tumors.

Primary echinococcal cyst in Trapezius muscle: An unusual intermuscular hydatidosis and review of literature

The primary hydatid disease in musculoskeletal position is not common, but maybe present in endemic areas. The human being is always an accidental host. We reported a 30 years adult male patient with trapezius muscle primary hydatidosis. He admitted with a complaint of large swelling right upper back for 2 years. The clinical diagnosis was a lipoma, but ultrasound suggested cystic changes in soft tissue tumor or lipoma and FNAC was inconclusive. Finally, the MRI report revealed hydatid cyst disease and diagnosis become clear with intraoperative findings as well as histopathology reports. We are reporting this case to show the very rare location of primary echinococcal cyst in trapezius muscle and challenging approach to diagnose this case with basic investigation.

Large Intermuscular Lipoma Presenting as a Groin Hernia

Lipomas are the commonest benign mesenchymal tumours, commonly seen as a subcutaneous lump. However, intermuscular lipomas are uncommon and can remain asymptomatic until they attain larger sizes. We discuss a rare case of a large symptomatic intermuscular lipoma in a 34-year-old woman who presented with acute on chronic groin pain. Clinical examination findings were consistent with an incarcerated inguinal hernia and imaging confirmed a large intermuscular lipoma of the anterior abdominal wall, the tip of which herniated into the inguinal canal. She underwent open primary repair of the hernia along with excision of the lipoma. An intermuscular lipoma presenting as an incarcerated inguinal hernia at the first instance is an uncommon finding. Due to lack of obvious clinical findings, uncomplicated intermuscular lipomas can be challenging to diagnose until they become symptomatic, and a high degree of suspicion in patients reporting atypical abdominal and groin pain, or abdominal wall fullness is required.

Resection of a Giant Hypopharyngeal Liposarcoma Invading the Esophagus by Lateral Pharyngotomy: A Case Report

Hypopharyngeal liposarcomas are extremely rare. Due to the lack of experience, pathologists and surgeons find it difficult to make a clear diagnosis and provide accurate, timely treatment. A 43-year-old man with a complaint of foreign body sensation in the throat for 6 months and swallowing difficulty for 2 months was admitted to our department. Contrast-enhanced computed tomography of the chest and larynx revealed a lesion with smooth surface in the esophagus, connected by a pedicle to the hypopharyngeal lesion. The same result was found by gastroscopy. Lateral pharyngotomy was performed for tumor removal, and after 3 weeks, the patient showed good movement of bilateral vocal cords, without dysphagia, choking cough, or hoarseness. This is the first case report of hypopharyngeal liposarcoma invading the esophagus. A thorough preoperative evaluation may be required for the proper diagnosis, prevention, and treatment.

Speech and mastication difficulties following treatment by a "street dentist": A case of oral lipoma

In this report, we present the case of a 68-year-old male patient with a complaint of mastication and speech limitations one year after the prescription of a fixed bridge and the construction of "connected" crowns by a "street dentist." A thorough oral examination revealed a multilobulated swelling in the right buccal mucosa that extended to the buccal sulcus. The lesion, which was first noticed as a small, asymptomatic swelling by the patient one year prior, seemed to have undergone enlargement since the prostheses were prescribed. The lesion was completely removed via surgical excision under general anesthesia. Histopathological examination of the excisional mass revealed mature adipocytes and features consistent with conventional or classic lipoma. This case highlights the importance of receiving dental treatment from a qualified professional, whose responsibilities include performing a thorough examination of the oral cavity during treatment planning and delivery, review appointments, and regular dental visits. Such investigation is important to allow for early disease detection and control, especially for patients with complex treatment needs as well as those who may present with asymptomatic and slow-growing lesions such as lipomas.

Discovering Pathologies in the Anatomy Lab: The Case of Brachial Plexopathy Mimicking Neurological Thoracic Outlet Syndrome

CONTEXT

Well-established human anatomy labs with access to expert faculty are exceedingly valuable tools to medical student education. In this manuscript, we detail an infero-lateral subclavicular lipoma which was discovered as a result of the utilization of both those labs and expert faculty. This lipoma may have caused brachial plexopathy or may serve as an unusual cause of neurologic thoracic outlet syndrome (NTOS) due to the location of the mass.

EDUCATIONAL CASE PRESENTATION

During prosection of a donor in the human anatomy lab, a mass was discovered by a medical student. This medical student utilized the human anatomy lab faculty members and resources to identify the mass as a lipoma. The lipoma compressed the lateral cord of the brachial plexus and the suprascapular nerve, but no diagnosis of NTOS or brachial plexopathy was made during the life of the donor, nor was any surgical intervention indicated. Removal of the lipoma immediately relieved stress upon the nerves. Histochemical analysis confirmed the diagnosis of a lipoma and demonstrated almost only mature adipocytes.

CONCLUSION

The authors concluded that the lipoma of this patient was not identifiable with computerized tomography imaging modalities, despite ultrasound demonstrating a hyperechoic outline of the mass in the cadaver of the patient. It is very likely that this lipoma had not been diagnosed previously due to the atypical location of the tumor. Equally, typical surgical methods associated with brachial plexopathy or NTOS treatment would be difficult or more complicated, due to the lateral and inferior location of the lipoma. Physicians treating thoracic outlet syndrome-type symptoms without resolution should consider potential non-malignant obstruction located outside the thoracic outlet, toward the extremity. Deep palpatory methods and physical therapy should be considered until diagnosis is certain, as ultrasound would be difficult and typical transaxillary surgical methods would be nonhelpful. Medical students and early-career residents and physicians should be aware of the resources provided to them via campus human anatomy laboratories which they may utilize to further their understanding and knowledge of specific pathologies.

Chondrolipoma of the finger in a child: A case study

Chondrolipoma is, based on the limited case reports available, an extremely rare histological variant of lipoma with the proliferation of mature adipocytes containing an area of true hyaline cartilage. Chondrolipoma is characterized by adult onset and is often identified in the breast, pharynx and tongue. The current study presents a case of chondrolipoma of the finger in an 11 year-old girl. Physical examination indicated a well-defined elastic soft mass, measuring 2.5x2 cm, on the dorsal aspect of the proximal phalanx of the left middle finger. Magnetic resonance imaging (MRI) revealed a well-circumscribed lesion with heterogeneous signal intensity. On T1- and T2-weighted images, the lesion indicated a predominantly marked hyperintense signal containing linear hypointense regions, and on fat-suppressed short-tau inversion recovery sequences, the lesion indicated a predominant hypointensity, with linear regions displaying hyperintensity. Marginal excision of the tumor was performed. Histologically, the major component of the tumor was mature adipose tissue containing a limited area of mature hyaline cartilage matrix, without lipoblasts or malignancy. The postoperative course of the patient was excellent, with no local recurrence three years after surgery. To the best of our knowledge, the current study outlines the first pediatric case of chondrolipoma arising in the finger.

Adipose Tissue as Pain Generator in the Lower Back and Lower Extremity: Application in Musculoskeletal Medicine

Description Adipose tissue (AT) has diverse and important functions in body insulation, mechanical protection, energy metabolism and the endocrine system. Despite its relative abundance in the human body, the clinical significance of AT in musculoskeletal (MSK) medicine, particularly its role in painful MSK conditions, is under-recognized. Pain associated with AT can be divided into intrinsic (AT as a primary pain generator), extrinsic (AT as a secondary pain generator) or mixed origin. Understanding AT as an MSK pain generator, both by mechanism and its specific role in pain generation by body region, enhances the clinical decision-making process and guides therapeutic strategies in patients with AT-related MSK disorders. This article reviews the existing literature of AT in the context of pain generation in the lower back and lower extremity to increase clinician awareness and stimulate further investigation into AT in MSK medicine.

Pediatric tumors of the buccal fat pad: lipoma and hemangioma

Background: The buccal fat pad (BFP) has prompted numerous publications in anatomy, reconstructive and aesthetic surgery over the years; however, description of surgical treatment of pathologic conditions affecting this space is rare, especially in children. An extensive search of the English literature retrieved only five lipomas and one hemangioma in this age group.Methods: The authors report on two of these exceptional pediatric tumors of the BFP: one lipoma and one hemangioma referred to the outpatient clinic for diagnosis and treatment.Results: Both children had a similar clinical presentation and a characteristic MR image. The two lesions were excised through an intraoral approach, which proved to be a fast, safe and effective technique.Conclusions: Being extremely rare, tumors of the BFP in children have an indicative clinical presentation and radiologic image. A detailed intraoral approach is described and proposed as effective and safe surgical treatment.

Intra-articular Knee Lipomatous Tumor: Two Similar but Different Cases

Although lipomatous tumors are common, intra-articular occurrence is exceedingly rare and sparsely described in the literature. Regarding these rare entities, most are benign, progressively growing tumors and often occur in the knee, yet it is crucial to distinguish the less infrequent lipoma arborescens (LA) from the rarer synovial lipoma, as they differ in presentation and pathogenesis. Magnetic resonance imaging is the exam of choice in their assessment and in differential diagnosis, playing a central role nowadays. Excision and synovectomy, either arthroscopic or by arthrotomy, provide good outcomes with low recurrence rates. By reporting two surgically treated distinct cases of intra-articular lipomatous tumors of the knee, the authors intend to review the literature and discuss their etiology, clinical and imaging aspects as well as treatment approach.

Frequent activating PIK3CA mutations in sporadic angiolipoma

BACKGROUND

Angiolipoma (AL) is considered as a lipoma variant that is characterized by the combination of mature adipocytes and capillary blood vessels diffusely distributed within the tumor. With the exception of recurrent PRKD2 mutations of uncertain pathogenetic significance, the genetic abnormalities of ALs are unknown, in the absence of any of the specific chromosomal aberrations described in other lipoma variants.

METHODS

Formalin-fixed and paraffin-embedded blocks of 13 conventional ALs and 5 cellular ALs from 17 individuals were retrieved and analyzed for mutations in exons 9 and 20 of PIK3CA by polymerase chain reaction and Sanger sequencing.

RESULTS

Activating PIK3CA mutations were identified in 14 tumors (78%). All PIK3CA-mutated samples carried the same exon 9 mutation, c.1634A>C (p.E545A). No mutation was detected in exon 20 of PIK3CA. No significant difference between PIK3CA-mutated and wild-type samples appeared to exist based on age, gender, and location of the tumor. All 5 cellular ALs carried the p.E545A PIK3CA mutation.

CONCLUSION

The high frequency of the p.E545A PIK3CA mutation in both conventional and cellular ALs suggests that activation of the PI3K/AKT pathway plays a key role in AL pathogenesis and reinforces the concept that cellular AL should be regarded as a variant of AL.

Cutaneous lipomas and macrocephaly as early signs of PTEN hamartoma tumor syndrome

BACKGROUND

The diagnosis of PTEN hamartoma tumor syndrome (PHTS) is difficult in children because they usually do not meet diagnostic criteria. The objective of our study was to characterize lipoma as an early presentation of PHTS.

METHODS

We performed a retrospective review of children with PHTS diagnosed in French academic hospitals from 2000 to 2019. We included patients presenting at least one lipoma and PTEN-related disorder confirmed genetically.

RESULTS

Thirteen children were included (mean age 5.5 years [range 2.5-16]). All children had solitary (n = 5) or multiple (n = 8) lipomas, all located on the trunk. Clinical examination revealed macrocephaly in all patients. Genital lentiginosis was found in all patients in whom genitalia were examined (n = 6).

CONCLUSIONS

In addition to the classical presentation of PHTS with neurological disorders and macrocephaly, some patients, especially the youngest ones, have an initial dermatologic presentation with multiple lipomas. Search for penile freckling and macrocephaly in these patients allows for the diagnosis of PHTS. Lipomatosis should be a major diagnostic criterion in children.

Ileocolic intussusception caused by ileal lipoma: A case report

RATIONALE

Adult intussusception is rarely observed, accounting for about 5% of all cases of intussusception. Most ileal lipomas are asymptomatic and do not need any special treatment. Herein, we describe a case with ileocolic intussusception caused by ileal lipoma.

PATIENT CONCERNS

A 27-year-old woman complaints of intermittent abdominal pain for 10 days.

DIAGNOSIS

Abdominal computed tomography demonstrated ileocolic intussusception. Colonoscopy revealed a spherical polypoid lesion with surface capillary rising from the lateral wall of the ileum. A diagnosis of ileocolic intussusception was made.

INTERVENTIONS

The patient underwent primary resection of the intussuscepted intestine after which an end-to-end anastomosis was performed.

OUTCOMES

Histopathology report confirmed a 4.5 cm × 3.5 cm lipoma in the terminal ileum. The patient was discharged on a postoperative day 9 without complications.

LESSONS

We describe the difficulties in diagnosis and treatment of this rare cause of intussusception and review the literature on adult intussusceptions. The ileal lipoma is a very rare cause of ileocolic intussusception. Abdominal CT and colonoscopy are important for the diagnosis of intussusception and abdominal lipomas. Surgical resection remains the treatment of choice.

Spermatic Cord Lipoma-A Review of the Literature

Introduction: A spermatic cord lipoma is found in 20–70% of all inguinal hernia repairs. The clinical picture of an inguinal hernia with bulging and pain but without an actual indirect hernia sac may become manifest in up to 8% of these cases. Missed spermatic cord lipoma can result in recurrence or pseudo-recurrence. This review presents the relevant literature on this topic.

Materials and Methods: A systematic search of the available literature was performed in February 2020 using Medline, PubMed, Google Scholar, Scopus, Embase, Springer Link, and the Cochrane Library, as well as a search of relevant journals and reference lists. Forty-two publications were identified as relevant for this topic.

Results: Spermatic cord lipoma seems to originate from preperitoneal fatty tissue within the internal spermatic fascia in topographical proximity to the arteries, veins, lymphatics, nerves, and deferent duct within the spermatic cord. Reliable diagnosis cannot be made clinically, but rather with ultrasound, CT, or MRI. In the absence of a real hernia sac, a spermatic cord lipoma is classified as a lateral inguinal hernia with a defect size <1.5 cm according to the European Hernia Society (EHS LI). Missed or inadequately treated spermatic cord lipoma results in recurrence or pseudo-recurrence. Since spermatic cord lipoma obtains its vascular supply from the preperitoneal space, it can be reduced or resected.

Conclusion: Spermatic cord lipoma is a common finding in inguinal hernia repairs and must be properly diagnosed and treated with care respecting the anatomy of the spermatic cord.

Diagnostic and therapeutic treatment methods for intrathoracic extrapulmonary lipomas

Background

Lipomas are rarely seen tumors of adipose tissue that are benign in character. Although mostly located to the subcutaneous region, specifically in the upper back, neck, and shoulder, they may also occur in thoracic cavity.

Aim

They aim of the study was to analyse clinical features and outcome of treatment of intrathoracic pleural lipomas.

Materials and Method

We retrospectively evaluated the clinicopathological records of seven patients with intrathoracic lipomas who had undergone surgery between 2005 and 2017. We made analyses in terms of age, gender, admission complaints, lesion locations and dimensions, diagnostic techniques, operative procedures, histopathological features, and prognosis.

Results

Four women and three men with a mean age 62.7 (range, 48-75 years) were included. They had chest pain (n = 2), effort dyspnea (n = 1) as the admission symptom, whereas four patients were asymptomatic, whose lesions were detected on chest radiography on an incidental basis. The radiological features of the tumors were well-demarcated, homogenous lesions with fat density. Tumors of all cases were excised, which were located on the right side in two patients and left in five. We used video-assisted thoracoscopy in two patients, single-port video-assisted thoracoscopy in three patients, thoracotomy in two patients. All lesions were of parietal pleural origin and were located intrathoracically. They had a range of size between 4 and 10 cm, with an average of 6.7 cm. All cases were operated with complete resection. At a mean follow-up duration of 4.7 years no recurrence was noted.

Conclusion

Intrathoracic lipomas are rare, benignly behaving tumors. As it may prove difficult to differentiate them from malignant lesions and they may grow in an invasive growth pattern, surgery should be pursued in all patients for both diagnosis and treatment.

Clinical management of lipomas in dogs under primary care in the UK

Lipomas are relatively common and biologically benign masses of mesenchymal origin consisting of adipocytes. This study reports benchmark data on the clinical management and outcomes of lipomas in dogs under UK primary veterinary care. The study used a cross-sectional analysis of cohort clinical data from dogs that were under veterinary care at practices participating within VetCompass from January 1, 2013 to December 31, 2013. Descriptive and analytic statistics characterised the clinical management and outcomes following presumptive lipoma diagnosis. The study included 2765 lipoma cases from 384 284 dogs under UK veterinary care during 2013. Diagnostics included fine needle aspirate in 1119 (40.5 per cent) cases, biopsy in 215 (7.8 per cent) cases and diagnostic imaging in 11 (0.4 per cent) cases. Overall, 525 (19.0 per cent) cases were managed surgically. Of the surgical cases, 307 (58.5 per cent) solely had mass removal whilst 218 (41.5 per cent) included another procedure during the same surgical episode. A surgical drain was placed during surgery in 90 (17.1 per cent) cases. Wound breakdown was reported in 14 (2.7 per cent) surgical procedures. Wound infection followed surgery in 11 (2.1 per cent) dogs. The findings provide veterinarians with an evidence base that benchmarks how lipoma cases are currently managed in the UK, but these results do not necessarily reflect optimal management or best practice.