Fibrolipoma of the nasal septum; report of the first case

Transoral Endoscopic Resection of Oropharyngeal Pedunculated Giant Fibrolipoma Using Harmonic Scalpel: A Case Report

Lipoma is the most common soft tissue benign tumor in the body. It can occur in the head and neck area as well. Fibrolipoma is a variant of lipoma that contains fibrous tissue. Fibrolipomas of the head and neck are relatively rare, and their presentation depends largely on their size and location; some slowly growing tumors might go unnoticed until they reach significant size and become symptomatic. Here, we report a case of 64-year-old male who presented with large pedunculated oropharyngeal fibrolipoma that originated from the posterior oropharyngeal wall and extended downward into the postcricoid area and cervical esophagus. It was excised transorally using rigid endoscope, and ACE Harmonic scalpel was utilized to excise this 16.7 cm long mass. The postoperative pain was minimal, the surgical site showed complete healing, and oral diet was resumed easily in 5 days.

Fibrolipoma of Flexor Digitorum Profundus Tendon of Ring Finger Causing Triggering and Intermittent Carpal Tunnel Syndrome

Introduction

Lipomas are most common soft-tissue tumors but rarely are found to be symptomatic. <1% of lipomas are found in hand. Subfascial lipomas can cause pressure symptoms. Carpal tunnel syndrome (CTS) can be idiopathic or secondary to any space-occupying lesion. Triggering usually occurs due to inflammation/thickening of A1 pulley. Most have reported a lipoma in distal forearm or near median nerve, leading to triggering of index or middle finger and carpal tunnel symptoms. All the cases reported had either an intramuscular lipoma in flexor digitorum superficialis (FDS) tendon slip of index or middle finger, with or without accessory belly of FDS muscle or a neurofibrolipoma of the median nerve. In our case, the lipoma was under palmer fascia, in flexor digitorum profundus (FDP) tendon sheath of fourth finger causing triggering of the ring finger and CTS symptoms in flexion of the ring finger. Hence, this is a first report of this kind in the literature.

Case Report

We hereby report a one of its kind case in which a 40-year-old Asian male patient had triggering of the ring finger with associated intermittent CTS symptoms, on making a fist, secondary to space-occupying lesion in palm, which was diagnosed by ultrasound as lipoma in FDP tendon of the ring finger in palm. This lipoma was surgically removed by AO ulnar palmer approach and carpal tunnel was decompressed. Histopathology report confirmed the lump to be fibrolipoma. The patient had complete relief of symptoms postoperatively. At 2 years follow-up, there was no recurrence.

Fibrolipoma presenting as a posterior nasal septum mass: a report of a unique case and review of the literature

Unilateral sinonasal mass presenting as nasal block is a common presentation but poses a diagnostic challenge. The differential diagnosis includes inflammatory polyps, benign and malignant sinonasal neoplasm. Fibrolipoma presenting in the sinonasal area is an uncommon pathology. As it is uncommon, there is potential for a misdiagnosis, unnecessary investigation and delay in the definitive treatment. We report a patient with a fibrolipoma originating from the posterior nasal septum. The diagnostic and surgical features of this unique case are discussed.

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.

One-Pot Biosynthesis of l-Aspartate from Maleate via an Engineered Strain Containing a Dual-Enzyme System

l-Aspartate has been widely used in medicine and the food and chemical industries. In this study, Serratia marcescens maleate cis-trans isomerase (MaiA) and Escherichia coli aspartase (AspA) were coupled and coexpressed in an engineered E. coli strain in which the byproduct metabolic pathway was inactivated. The engineered E. coli strain containing the dual-enzyme system (pMA) was employed to bioproduce l-aspartate from maleate with a conversion of 98%. We optimized the activity ratio of double enzymes through ribosome binding site (RBS) regulation and molecular modification of MaiA, resulting in an engineered strain: pMA-RBS4-G27A/G171A. The conversion of l-aspartate biotransformed from maleate using the pMA-RBS4-G27A/G171A strain was almost 100%. It required 40 min to complete the whole-cell catalysis, without the intermediate product and byproduct, compared to 120 min before optimization. The induction timing and the amount of inducer in a 5-liter fermentor were optimized for scale-up of the production of l-aspartate. The amount of produced l-aspartate using the cells obtained by fermentation reached 419.8 g/liter (3.15 M), and the conversion was 98.4%. Our study demonstrated an environmentally responsible and efficient method to bioproduce l-aspartate from maleate and provided an available pathway for the industrial production of l-aspartate. This work should greatly improve the economic benefits of l-aspartate, which can now be simply produced from maleate by the engineered strain constructed based on dual-enzyme coupling.IMPORTANCE l-Aspartate is currently produced from fumarate by biological methods, and fumarate is synthesized from maleate by chemical methods in industry. We established a biosynthesis method to produce l-aspartate from maleate that is environmentally responsible, convenient, and efficient. Compared to conventional l-aspartate production, no separation and purification of intermediate products is required, which could greatly improve production efficiency and reduce costs. As environmental issues are attracting increasing attention, conventional chemical methods gradually will be replaced by biological methods. Our results lay an important foundation for the industrialization of l-aspartate biosynthesis from maleate.

A girl with a giant fibrolipoma in her thoracic cavity: a rare case report

Background

Fibrolipoma is an uncommon subtype of lipoma. On the basis of the results of a survey of the PubMed database, only approximately a dozen cases in children have been described in which the histological diagnosis of fibrolipoma has been confirmed. In children, fibrolipomas have been reported in the eyelids, ears, lips, nasopharynx, mouth, and other locations but not in the thoracic cavity. We present the case of a 15-year-old girl with a giant fibrolipoma in the left side of her thoracic cavity.

Case presentation

A 15-year-old Chinese girl presented with chest tightness and exercise-induced shortness of breath of 4 months’ duration. Computed tomography revealed a giant mixed-density space-occupying lesion in the left side of her thoracic cavity, originating possibly from the pleura. Radiological findings were inconclusive and failed to exclude malignant mesenchymal tumor. After excluding malignant tumor with two needle biopsies and identifying the tumor’s feeding blood vessels by computed tomography angiography examination, our treatment plan was, first, embolization of the tumor’s blood vessels by digital subtraction angiography and, second, to remove the tumor by thoracotomy.

Conclusions

Thoracic fibrolipoma in children is rare; its treatment is complete resection of the tumor. Pathological examination of the removed tissue is the gold standard for diagnosis. Early computed tomography and magnetic resonance imaging examinations are helpful to determine the extent and nature of the tumor and to reduce damage of the surrounding organs. Preoperative examination of tumor markers, ultrasound-guided biopsy, and preoperative digital subtraction angiography tumor vascular embolization are important preoperative preparations to ensure surgical resection.

Fibrolipoma on upper eyelid in child

An 18-months-old male infant presented with a rapidly growing tumor on the right upper eyelid. Orbital computed tomography (CT) revealed a large, well-circumscribed mass with low density signal in the right upper eyelid. Magnetic resonance images (MRI) showed a lesion of mixed T1-signal intensity and high signal intensity in T2-weighted images. The tumor was treated by simple anterior orbitotomy with excisional biopsy, and the diagnosis of fibrolipoma was made by histopathologic examination. There was no evidence of tumor at the four-year follow-up. Fibrolipoma is one of the rare variant of the lipoma and only four cases have been reported in the orbit including the present case. Except for this case all other cases were reported in adults.

Infant Fibrolipoma Mimicking Hemangioma in Neck Region

Fibrolipoma is an extremely rare variant of lipoma. And it usually presents clinically as a slowly growing mass with a firm or soft consistency and usually occurs in middle-aged person. The authors report an unusual case of infant fibrolipma with fast-growing speed, which was misdiagnosis and mistreatment as hemangioma in local hospital. The diagnosis of hemangioma was ruled out by fine-needle aspiration cytology in authors' hospital. Operation was performed in authors' hospital and the prognosis of fibrolipma was good.