Posttraumatic lipoma: analysis of 10 cases and explanation of possible mechanisms

Extension patterns of giant lipomas arising from the brachial plexus: giant lipomas from brachial plexus

PURPOSE

Benign adipose tumors in close proximity to the major nerves are termed troublesome lipomas and are indicated for resection because of neurological impairment. Until now, however, limited cases of giant lipoma arising from the brachial plexus region have been reported. We discussed our experience with cases of giant lipomas arising from the brachial plexus region.

METHODS

We reviewed six cases treated in our hospital. There were four males and two females with the mean age of 55 years. On its greatest dimension, the size of the giant tumor ranged from 14 to 30 cm with an average of 21.6 cm. Based on MRI findings, the tumor extension patterns were divided, (1) lateral type, (2) posterior type and (3) inferior type. The symptoms were characteristic according to extension patterns of the tumor.

RESULTS

Five patients who underwent tumor resection showed improvement in subjective symptoms early after surgery. An asymptomatic case with inferior type underwent only open biopsy. The histopathology in all cases confirmed ordinary lipomas. There was no local recurrence postoperatively.

CONCLUSION

Brachial plexus lipoma has potential to grow unexpectedly large due to repetitive microtrauma. The indication for tumor resection surgery should be considered in each type of tumor extension. The lateral type, which directly causes neurological symptoms, is the most indicative for tumor resection, while the posterior type is more suitable for surgery due to stubborn shoulder stiffness and symptom with thoracic outlet syndrome. In the case with inferior extension type, the patient was asymptomatic and the operative indication should be less.

Development of Multiple Subcutaneous Lipomas After Six Months of Hormone Replacement Therapy: A Case Report

Lipomas are common benign soft tissue tumors composed of mature adipocytes, typically presenting as slow-growing, painless subcutaneous nodules. While the underlying etiology remains unclear, various factors have been proposed as potential contributors. In some individuals, multiple subcutaneous lipomas can develop, and their occurrence has been considered in relation to systemic conditions or familial predisposition. Hormone replacement therapy (HRT), commonly used for menopausal symptom management, influences lipid metabolism and angiogenesis through hormonal signaling pathways; however, its potential role in lipoma formation remains uncertain. Herein, we present a case of a 57-year-old woman who developed multiple subcutaneous lipomas on the thighs and buttocks after initiating HRT. This case highlights a possible association between hormonal changes and lipoma formation, emphasizing the importance of further research into the mechanisms underlying adipose tissue growth.

Myxoid lipoma in the perioral mandibular region: two case reports

Lipomas are one of the most common mesenchymal tumors in the human body, exhibiting a heightened prevalence between the ages of 40 and 60 years. However, primary intraoral lipomas are rare. Myxoid lipoma, which is characterized by abundant mucoid components, is a particularly rare histological subtype of lipoma. This study presents two cases of myxoid lipoma that occurred outside the common age range for occurrence, one in the right submandibular area of a 67-year-old male and the other in the lower lip of a 3-year-old child. Through these case reports, the aim was to introduce myxoid lipoma, a rare subtype affecting facial areas, and provide a brief review to assist in the differential diagnosis, emphasizing the importance of pathological assessment. Even in age groups and anatomical locations not typically associated with lipomas, it is crucial to emphasize the necessity of careful evaluation.

Giant Cervical Occipital Lipoma: A Case Report

Lipomas are common, well-circumscribed neoplasms of mesodermal origin, characterized by being slow, painless growths that are mostly subcutaneous, not invasive, and not recurring after surgery. Lipomas are the most prevalent kind of mesenchymal tumor, yet giant lipomas are rare in the cervical region and the occipital area. We report a 46-year-old female with diabetes insipidus was referred with a giant occipital cervical tumor, which she had noticed for 17 years and which had rarely given her any complaints of compressive symptoms. The clinical assessment indicated a firm, painless, and mobile swelling, which demonstrated features of venous ectasia, and there was no external ulceration. Ultrasonography and MRI of the neck revealed a large, subcutaneous fatty tumor with distinctive echographic features on both modalities, including hyperintense signals on T1 and T2 and no ring enhancement after Gadolinium injection. Due to the mass being smooth, round, and not attached to any structure, the patient underwent surgical enucleation under general anesthesia, resulting in full recovery without complications. Pathology revealed a benign adipose tissue tumor without liposarcoma, and there were no difficulties observed during follow-up for two years.

Lump on the scalp of a child arising over a previous parietal fracture: growing skull fracture or post-traumatic lipoma?

A young girl was referred to our Institution for the appearance of a painless soft swelling in the right parietal region of the scalp. In the same site, the patient had a parietal bone fracture 1 year ago. In the suspicion of a growing skull fracture, the patient underwent radiological investigations. Ultrasound showed a soft, poorly vascularised swelling with parenchymatous content. The skull X-ray showed an apparent healing of the previous fracture. CT scan and MRI confirmed the correct healing of the fracture and described the presence of a lipomatous mass. The mass was surgically removed and histology confirmed the diagnosis of encapsulated lipoma. The postoperative period was uneventful, with no evidence of infections or recurrence in the 6-month follow-up.

Subcutaneous angiolipoma in the scrotum: A case report

BACKGROUND

Angiolipoma has been reported in many cases, and it often occurs in the skin of the trunk and limbs. However, angiolipoma in the scrotum is a rare disease with unknown etiology. This condition is difficult to diagnosis with other lumps in the scrotum.

CASE SUMMARY

A 32-year-old man presented to the urinary department with a history of an enlarged left scrotum with increasing discomfort for about 5 years. Physical examination revealed that there were a palpable mass measuring about 7.0 cm × 6.5 cm in the left scrotum, with smooth surfaces but without tenderness or adhesion to the skin. Ultrasound showed that there was a hyperechoic mass under the skin of the top scrotum, about 72 mm × 64 mm × 21 mm in size, with clear borders, uneven internal echo, and abundant blood flow signals. Serum human chorionic gonadotropin and alpha-fetoprotein were in normal level. Subcutaneous mass resection at the bottom of the left scrotum was performed under local anesthesia with 1% lidocaine. Postoperative pathological examination resulted in a diagnosis of subcutaneous angiolipoma of the scrotum. No evidence of recurrence was found at 6 mo after surgery and there were no complaints of discomfort.

CONCLUSION

Angiolipoma is an extremely rare type of benign tumor extremely rarely found in the scrotum, but needs to be considered when evaluating scrotal masses especially when the mass is solid. According to the characteristics of angiolipoma, surgical resection is the best treatment strategy and it is not prone to recurrence after resection.

Giant Posttraumatic Angiolipoma of the Forearm: A Case Report and Review of the Literature

Angiolipoma is a type of lipoma, a benign soft tissue tumor. It is distinguished by the excessive degree of vascular proliferation and the presence of mature adipocytes. It occurs commonly on the trunk and extremities. Angiolipomas larger than 4 cm are classified as "giant," and due to their size, histological evaluation is necessary to exclude malignancy. We report a case of a male patient who suffered from a giant noninfiltrating intramuscular angiolipoma which formed after venipuncture in the antecubital fossa. Clinical examination showed a palpable painless soft mass. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a giant angiolipoma on the right forearm. Surgical removal of the mass was performed, and the biopsy was negative for malignancy. To the best of our knowledge, this is the first report in the literature of posttraumatic intramuscular angiolipoma. Physicians and orthopedic/general surgeons should be aware of the possibility of soft tissue masses in a posttrauma situation.

Lipomas as an Extremely Rare Cause for Brachial Plexus Compression: A Case Series and Systematic Review

Introduction  Brachial plexus lipomas are extremely rare benign tumors that may cause slow progression of neurological deficits leading to thoracic outlet syndrome. Up to now, surgery remains challenging. The aim of this study is to present our surgical treatment regime and long-term neurological outcome in three cases of giant brachial plexus lipomas and to show results of systematic review.

Patients and Methods  Retrospective analysis of our database “peripheral nerve lesion” to identify patients suffering from brachial plexus lipomas between January 1, 2012, and December 31, 2019. Systematic review was performed for literature published until March 31, 2020, analyzing PubMed, Google Scholar, Scopus, and the Cochrane Collaboration Library independently by two authors.

Results  Over the past years, three patients suffering from giant brachial plexus lipomas attended to our neurosurgical department. All patients underwent preoperative magnetic resonance imaging (MRI), ultrasound examinations, and electrophysiological testing. Tumors were removed microsurgically via anterior/posterior, supraclavicular/infraclavicular, and combined approaches. The patients were accessed postoperatively by MRI and clinical follow-up. Systematic review of the literature revealed 22 cases, which were analyzed in regard to demographics, surgical treatment, and neurological outcome.

Conclusion  Brachial plexus lipomas are an extremely rare cause for brachial plexus compression. Total microsurgical removal with intraoperative electrophysiological monitoring is the treatment of choice with excellent long-term MRI and clinical outcome.

Giant Lipoma in the Fronto-Temporo-Parietal Region in an Adult Man: Case Report and Literature Review

Lipoma belongs to a group of benign mesenchymal tumors. It is in the form of soft masses of adipose tissue encapsulated by a thin layer of fibrous tissue and usually localized subcutaneously. The tumor most often appears in the upper part of the body. Lipomas tend to grow slowly and are small (less than 5cm) lesions. Larger tumors are rare. In this article, we present the case of a patient with a giant head lipoma in the fronto-temporo-parietal region. Both tumor size and location are unique and no such case has been described in the literature so far.

A Retrospective Study of Superficial Type Atypical Lipomatous Tumor

Atypical lipomatous tumor (ALT) has been defined as a well-differentiated liposarcoma exhibiting a higher frequency of a local recurrence after surgical resection. ALT is mainly classified into deep type and superficial type. Compared with deep type ALT, superficial type ALT is rarely observed. One of the most important issues is that little has been known about superficial type ALT and it is not easy to predict the presence of superficial type ALT before surgical resection. To clarify the clinical manifestations of superficial type ALT, we examined 15 cases with superficial type ALT and 118 cases with benign lipoma, and analyzed their differences in clinical characteristics and the findings of MRI test. In clinical characteristics, the tumor size of superficial type ALT was significantly greater than that of benign lipoma, and superficial type ALT showed a significantly higher frequency of the tumor size of more than 4 cm. Superficial type ALT exhibited poor tumor mobility and hardness with elastic soft. In addition, a significantly higher frequency of tumor location of superficial type ALT was observed in extremities. Among tumor sites at the trunk, buttocks, and shoulder were high frequent location in superficial type ALT. In an MRI examination, superficial type ALT exhibited a significantly higher frequency of the septal structures compared with benign lipoma. The combinations of clinical characteristics, including physical examinations, MRI, and histological examinations, are helpful for the diagnosis of superficial type ALT.

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.

Giant gluteal lipoma surgical management

Surgical treatment of lipomas is typically only considered when they are painful or unsightly. We present the case of a massive hip lipoma; with this extreme case, we show that the global prolongation of life expectancy can lead to other indications of removal.

Management and Excision of a 15 cm Paratesticular Angiolipoma

Paratesticular tumors are rare and often benign causes of scrotal masses. Intrascrotal angiolipomas are an uncommon paratesticular tumor that has seldom been reported in the literature. This report describes a 77 year old man who presented with a 15 cm extratesticular mass. The mass was removed due to increasing discomfort and specimen pathology confirmed it as an angiolipoma. This case highlights the feasibility of conservative management for slow growing masses, such as angiolipomas.

Approach and management of a giant lipoma in the left lumbar region

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We present a case of giant lipoma in the left lumbar region.

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Movements were hindered, especially rotation, flexion and extension of the trunk.

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The size of the bulk presents differential diagnostic problems with liposarcoma.

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Surgical excision was performed to confirm diagnosis with histological evaluation.

Introduction

Lipomas are the most common benign tumors of the adipose tissue and can be located in any region of the body. In most cases lipomas are small and asymptomatic, but they can at times reach considerable dimensions and, depending on their anatomic site, hinder movements, get inflamed, cause lymphedema, pain and/or a compression syndrome.

Presentation of case

We here report the case of an otherwise healthy patient who came to our observation with a giant bulk in the left lumbar region which had been showing progressive growth in the previous 5–6 years. Physical examination, ultrasound and MRI were carried out in order to characterize the size, vascularization and limits of the lesion. Due to the pain and restriction of movement that this bulky lesion caused, surgical excision of the lesion was performed.

Discussion

Giant lipomas display an important differential diagnosis problem with malignant neoplasms, especially liposarcomas, with which they share many features; often the final diagnosis rests on histological evaluation. We here discuss the diagnostic problems that arise with a giant lipoma and all the possible approaches concerning treatment of such a big lesion, explaining the reasons of our approach and management of a common tumor in our case presenting unusual dimensions and location.

Conclusion

Our approach revealed to be successful in order to nurse our patient's pain, restore the mobility and address the aesthetic issues that this lesion caused. Postoperative checkups were carried out for one year and no signs of relapse have been reported.

Trauma as pathogenesis of a plantar forefoot fibrolipoma: first case and review of the literature

Lipomas and their variants are benign soft-tissue tumors that occur at any age and most frequently on the upper back and neck, shoulder, and abdomen. The foot is a relatively uncommon site for soft-tissue neoplasia and the etiology is not usually related to trauma. We describe a case of a pedunculated fibrolipoma of the forefoot that originated from a cut wound at the Atlantic Ocean. A brief review of the literature is also given.

Fibrolipomas masquerading as abdominal hernias

A 15-year-old Caucasian girl presented to her general practitioner with a tender, irreducible mass in the paraumbilical region. On examination, two small masses could be felt. She was referred to general surgery. Ultrasound imaging and MRI were unremarkable. However, clinical suspicion suggested multiple areas of abdominal wall herniation. The patient was admitted for elective surgery to exclude herniation. At operation, three subcutaneous masses were found but with no evidence of abdominal wall herniation. Histopathology results from the specimens showed mature adipose tissue mixed with fibrous deposits. There was no evidence of malignancy. A diagnosis of fibrolipoma was given.

Gaint axillary lipoma following excision

Lipomas are benign tumors and are most common mesenchymal soft tissue tumors, composed of mature lipocytes. Frequent site are trunk and extremities. Axilla is an uncommon site of lipoma while giant axillary lipomas are rare. We report a case of recurrence of small axillary lipoma into giant axillary lipoma following excision.

Traumatic pseudolipoma causing facial asymmetry: An uncommon pathology and review of its pathogenesis

We present an uncommon case of traumatic pseudolipoma in a 24-year-old female, causing facial asymmetry. Literature review suggests trauma as a possible etiology for its pathogenesis, which was present in this case. Microscopically, sometimes it is difficult to differentiate between normal adipose tissue and lipoma. Clinician must provide accurate clinical information in order to make a definitive diagnosis of traumatic pseudolipoma. Its pathogenesis has also been highlighted in this article.

Unilateral pseudogynecomastia: an occupational hazard in manual metal-pressing factories?

BACKGROUND

Five cases of unilateral occupation-related pseudogynecomastia are presented. All the patients in these cases worked in the same metal-pressing factory.

METHODS

One patient with grade 4 unilateral gynecomastia in the right breast presented to the authors' outpatient department asking persistently for surgery. He also reported that all his male colleagues working in the same business (a total of 5) had different degrees of unilateral gynecomastia. Their line of work involved holding a long round rod under the axilla and then pressing the distal end of it firmly against a spinning metal plate. The patient underwent a superior pedicle breast reduction, with 1,800 ml of tissue removed from his right breast. Unfortunately, the patient experienced partial nipple loss. However, he was satisfied with the final result, and good symmetry was achieved.

RESULTS

All five patients who worked in the same metal-pressing factory presented with unilateral gynecomastia and were examined in our department. Their average age was 51.4 years. All the patients had normal hormonal and biochemical status, and the results of screening for toxins and heavy metal exposure were negative. All the patients were heavy smokers. At examination, none of the patients had nipple discharge or retraction, skin changes, galactorrhea, or lymphadenopathy. Examination showed one patient with grade 4, three patients had grade 2, and one patient with grade 1 unilateral gynecomastia.

CONCLUSIONS

The authors believe that gynecomastia may be considered an occupational risk in analogous metal-pressing factories because all the workers in this factory presented with some degree of unilateral gynecomastia. However, they emphasize that this may simply be an observational phenomenon without a true cause and effect relationship.

Giant inframuscular lipoma disclosed 14 years after a blunt trauma: a case report

INTRODUCTION

Lipoma is the most frequent benign tumor of the soft tissue. This lesion is often asymptomatic except in cases of enormous masses compressing nervous-vascular structures. Although the diagnosis is mostly clinical, imaging tools are useful to confirm the adipose nature of the lesion and to define its anatomic border. Sometimes, lipomas may be the result of a previous trauma, such as in this patient.

CASE PRESENTATION

A 45-year-old man presented at our institution with a giant hard firm mass in the upper external quadrant of the right buttock disclosed after a weight loss diet. Subsequent magnetic resonance imaging showed a giant adipose mass developed beneath the large gluteal muscle and among the fibers of the medium and small gluteal muscles. When questioned on his medical history, the patient reported a blunt trauma of the lower back 14 years earlier. He underwent surgery and histological examination confirmed a giant lipoma.

CONCLUSION

Lipomas might result from a previous trauma. It is hypothesized that the trigger mechanism is activated by cytokine and growth factors released after the trauma. We herein present an exceptional case of a giant post-traumatic lipoma which caused a painful compression on the right sciatic nerve.

Post-traumatic soft tissue tumors: case report and review of the literature a propos a post-traumatic paraspinal desmoid tumor

Background

Antecedent trauma has been implicated in the causation of soft tissue tumors. Several criteria have been established to define a cause-and-effect relationship. We postulate possible mechanisms in the genesis of soft tissue tumors following antecedent traumatic injury.

Case presentation

We present a 27-year-old woman with a paraspinal desmoid tumor, diagnosed 3-years following a motor vehicle accident. Literature is reviewed.

Conclusion

Soft tissue tumors arising at the site of previous trauma may be desmoids, pseudolipomas or rarely, other soft tissue growths. The cause-and-effect issue of desmoid or other soft tissue tumors goes beyond their diagnosis and treatment. Surgeons should be acquainted with this diagnostic entity as it may also involve questions of longer follow-up and compensation and disability privileges.

Posttraumatic lipoma: fact or fiction?

BACKGROUND

Both trauma and lipomas are a common occurrence in surgical practice. Lipomas are usually benign adipose tumors with as-yet unexplained pathogenesis and etiology. A link between soft tissue trauma and the formation of lipomas has been described, with the latter being named posttraumatic lipomas.

METHODS

Twenty-three cases of posttraumatic lipomas in 19 patients treated at our institution between August 2001 and January 2005 were reviewed with regard to medical history, magnetic resonance imaging findings, intraoperative findings, clinical chemistry, and histology.

RESULTS

The mean age of the patients was 50.0 years (+/-15.5). The average time between soft tissue trauma and lipoma formation was 2.6 years (range, 0.5-6.0 years). Sixteen of the 19 patients reported extensive and slowly resolving hematoma formation after the traumatic event. Nine of 23 lipomas were found on the upper extremities, 3 on the lower extremities, 9 on the trunk, and 2 on the face. All tumors were located epifascially. Twenty-two lipomas were removed by simple excision and, in one case, aspiration lipectomy was performed. Pathology demonstrated capsulated and noncapsulated benign adipose tumors in 23 cases. The average body mass index, amounted to 30 kg/m(2) (+/-7.6 kg/m(2)). Seven patients without known bleeding disorders presented with an elevated partial thromboplastin time.

CONCLUSIONS

The pathogenetic link between soft tissue trauma and the formation of posttraumatic lipomas is still controversially discussed. There are 2 potential explanations to correlate soft tissue trauma and adipose tissue tumor growth. The first is the formation of so-called posttraumatic pseudolipomas by prolapsing adipose tissue through fascia resulting from direct impact. A second possibility points toward lipoma formation as a result of preadipocyte differentiation and proliferation mediated by cytokine release following soft tissue trauma and hematoma formation.

Post-traumatic pseudolipoma of the forehead

A forehead lipoma is a rare finding in a child, and one that penetrates the underlying layers of muscle and bone to attach to dura has not previously been reported. Two such cases, both in children who underwent uneventful deliveries aided by forceps, are presented. Both lesions were present at birth and, based on clinical findings, were originally thought to be dermoid cysts. Dermoid cysts could not be ruled out with computed tomography and magnetic resonance imaging. Histopathology identified fibrofatty tissue consistent with lipoma. Both lesions extended from the subcutaneous tissue through the frontalis muscle and frontal bone to the dura. Given these findings and the history of forceps delivery, the most likely diagnosis is post-traumatic pseudolipoma. This lesion should be considered in the differential diagnosis of congenital lesions of the forehead, particularly if there is a history of forceps delivery or other trauma to the area.

Lipomas after blunt soft tissue trauma: are they real? Analysis of 31 cases

BACKGROUND

Soft tissue trauma and lipomas are common occurrences in surgical practice. Lipomas are defined as benign tumours of adipose tissue with so far unexplained pathogenesis and aetiology. A link between preceding blunt soft tissue trauma at the site of the tumour and the formation of lipomas has been described earlier. These soft tissue tumours have been named 'post-traumatic lipomas'.

OBJECTIVES

In a retrospective review, to analyse all patients with benign adipose tissue tumours treated at our institution between August 2001 and January 2007.

METHODS

All cases were reviewed regarding medical history, magnetic resonance imaging findings, intraoperative findings, clinical chemistry and histology.

RESULTS

In 170 patients presenting with lipomas, 34 lipomas in 31 patients were identified as post-traumatic. The mean +/- SD age of the patients with post-traumatic lipomas was 52 +/- 14.5 years. The mean time elapsed between soft tissue trauma and lipoma formation was 2.0 years (range 0.5-5). Twenty-five of the 31 patients reported an extensive and slowly resolving haematoma after blunt tissue trauma at the site of lipoma formation. The mean +/- SD body mass index was 29.0 +/- 7.6 kg m(-2). Fourteen of 31 patients presented with an elevated partial thromboplastin time. Eleven of 34 lipomas were found on the upper extremities, five on the lower extremities, 13 on the trunk, and two on the face. All tumours were located subcutaneously, superficial to the musculofascial system. Thirty-three lipomas were removed by surgical excision and one by liposuction following an incisional biopsy. Histological examination revealed capsulated and noncapsulated benign adipose tissue in all 34 tumours.

CONCLUSIONS

The existence of a pathogenic link between blunt soft tissue trauma and the formation of post-traumatic lipomas is still controversial. Two potential mechanisms are discussed. Firstly, the formation of so-called post-traumatic 'pseudolipomas' may result from a prolapse of adipose tissue through fascia induced by direct impact. Alternatively, lipoma formation may be explained as a result of preadipocyte differentiation and proliferation mediated by cytokine release following soft tissue damage after blunt trauma and haematoma formation.

Soft tissue neck lumps in rugby union players

Dorsal neck masses are well recognised in front row rugby union players. Previously undescribed in the medical literature, they may present in the primary or secondary care setting when they become symptomatic. Often misdiagnosed as lipomata, they may in fact be fibrous and deeply connected, with the consequences of embarking on surgery subsequently underestimated. This paper describes an epidemiological study using the rugby union media and gives key points for healthcare professionals involved in the management of such masses.