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Tobener WH, Kubinec M. Ultrasound imaging of lipoma arborescens at the suprapatellar recess. PM R 2024; 16:295-296. [PMID: 37528545 DOI: 10.1002/pmrj.13050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Affiliation(s)
- William Henry Tobener
- Department of Neurosurgery, Division of Physical Medicine and Rehabilitation, University of Louisville, Louisville, Kentucky, USA
| | - Mariko Kubinec
- Robley Rex Department of Veterans Affairs Medical Center, Department of Physical Medicine and Rehabilitation, University of Louisville, Louisville, Kentucky, USA
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Therapie des Lipoma arborescens via Kniearthroskopie. ZEITSCHRIFT FÜR ORTHOPÄDIE UND UNFALLCHIRURGIE 2022. [DOI: 10.1055/a-1483-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Elafram R, Ben Romdhane M, Khessairi N, Hamdi A. Case Report: Synchronous bilateral lipoma arborescens of the bicipitoradial bursa. F1000Res 2022; 11:787. [PMID: 38433998 PMCID: PMC10907874 DOI: 10.12688/f1000research.122432.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 03/05/2024] Open
Abstract
Background: Lipoma arborescens (LA) is an infrequent benign tumor made of mature sub-synovial fatty cell proliferation that may arise into the synovial joint, the bursae or the tendon sheaths. This condition affects mainly the knee joint, but the bicipitoradial bursa is an exceptional location. We report herein a case of a synchronous bilateral (LA) of the bicipitoradial bursa. Case presentation: A 52-year-old patient, with no medical history, presented with a swelling of both front arms that had been progressing for nine years. Physical examination showed a mass in the antecubital fossae of 3cm on the left side and 0.5cm on the right side. Both masses were tender, well-defined, fixed, without inflammatory signs and painful on elbow flexion. A magnetic resonance imaging (MRI) scan was performed, revealing the presence of a septate soft-tissue mass of the distal portion of the brachial muscle of 70x46x27mm. This mass had a heterogeneous fat signal in its depth and a homogeneous fat composition on the outside. The diagnosis of liposarcoma was suspected. The patient underwent surgery to remove both masses. Gross examination showed a characteristic frond-like or digitiform pattern. Microscopical examination demonstrated papillary proliferation of the synovial villi. The final diagnosis was of LA. The patient had no complications and there was no recurrence of LA. Conclusions: LA is a rare condition, and the bicipitoradial bursa is an exceptional location. Histological confirmation is mandatory to correct the diagnosis.
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Affiliation(s)
- Rafik Elafram
- Homeland Security Forces Hospital, Tunis Elmanar University, La Marsa, 2074, Tunisia
| | - Majdi Ben Romdhane
- Homeland Security Forces Hospital, Tunis Elmanar University, La Marsa, 2074, Tunisia
| | - Nayssem Khessairi
- Homeland Security Forces Hospital, Tunis Elmanar University, La Marsa, 2074, Tunisia
| | - Ahmed Hamdi
- Homeland Security Forces Hospital, Tunis Elmanar University, La Marsa, 2074, Tunisia
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Auran RL, Martin JR, Duran MD, de Comas AM, Jacofsky DJ. Evaluation and Management of Intra-Articular Tumors of the Knee. J Knee Surg 2022; 35:597-606. [PMID: 35189664 DOI: 10.1055/s-0042-1743223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Intra-articular tumors of the knee are most commonly benign. Overall, this is a relatively rare clinical presentation. The differential diagnosis includes pigmented villonodular synovitis, synovial chondromatosis, lipoma arborescens, synovial hemangioma, and very rarely primary sarcoma (synovial sarcoma being the most common). The clinical presentation for these conditions is usually non-specific, but radiographic and advanced imaging findings are able to differentiate some of these tumors. It is essential to obtain and send tissue specimens to pathology for histologic analysis to rule out a primary malignancy as a missed diagnosis can have grave implications on patient outcomes. This review summarized key aspects of diagnosis and treatment for these conditions.
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Affiliation(s)
- Richard L Auran
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona
| | - John R Martin
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona
| | - Michael D Duran
- The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
| | - Amalia M de Comas
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona.,The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
| | - David J Jacofsky
- The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
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Lobenhoffer P. Offene und arthroskopische Synovialektomie. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00523-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kalifis G, Maffulli N, Migliorini F, Marín Fermín T, Hovsepian JM, Stefanou N, Hantes M. Surgical management of upper limb lipoma arborescens: a systematic review. J Orthop Surg Res 2022; 17:138. [PMID: 35246183 PMCID: PMC8896089 DOI: 10.1186/s13018-022-02997-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background Lipoma arborescens (LA) is a rare benign synovial tumour characterized by the proliferation of mature adipocytes within the synovial cells. Given its rarity, current evidence is mainly based on case reports and case series, and no guidelines are available. The present study investigated the current surgical management and related outcomes of LA in the upper limb. Methods This systematic review was conducted following the PRISMA guidelines. PubMed, Scopus, and Virtual Health Library were accessed in September 2021. Clinical studies evaluating patients with LA undergoing surgical treatment were considered eligible for this systematic review. Only studies which reported data on LA located in the upper limb with histopathological confirmation were considered. Articles that reported data from nonsurgical management were not considered. Results A total of 21 studies reporting 22 lesions in 21 patients were assessed. The mean age of the patients was 48.48 years (range 22–77). Most studies evaluated the restoration of range of motion and symptom resolution for the functional outcome assessment. Open or arthroscopic excision and synovectomy were the most common surgical procedures for LA. The concomitant lesions were treated in a single-stage procedure. All patients had satisfactory outcomes after open or arthroscopic excision and synovectomy without recurrence at a mean follow-up of 21.14 months (range 2–60). One patient developed postoperative cellulitis (4.55%). Conclusion Open and arthroscopic excision combined with synovectomy should be considered the standard treatment option of upper limb LA. Concomitant pathologies can be addressed in a one-stage procedure. Although LA was recognized as a clinical entity decades ago, there is a lack of evidence based guidelines and long term outcome data are unavailable.
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Affiliation(s)
- Georgios Kalifis
- Department of Trauma and Orthopaedics, Hull Royal Infirmary, Anlaby Road, Hull, UK.,Department of Trauma and Orthopaedic Surgery, University Hospital of Larissa, Larissa, Greece
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, England.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, London, England
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.
| | | | | | - Nikolaos Stefanou
- Department of Trauma and Orthopaedic Surgery, University Hospital of Larissa, Larissa, Greece
| | - Michael Hantes
- Department of Trauma and Orthopaedic Surgery, University Hospital of Larissa, Larissa, Greece
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Frkovic M, Kujundzic M, Cavka M, Jelusic M. Successful use of adalimumab as a conservative treatment for bilateral knee lipoma arborescens in patient with psoriatic juvenile idiopathic arthritis - case report and review of literature. Front Pediatr 2022; 10:1014536. [PMID: 36561488 PMCID: PMC9763560 DOI: 10.3389/fped.2022.1014536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Lipoma arborescens (LA) is a chronic, slowly progressive intra-articular mass associated with the proliferation of synovial villi. It can affect one or several joints and has been commonly described in adults with degenerative joint disease. Most patients have been diagnosed with MRI and/or biopsy findings and are usually treated with partial or total synovectomy. Case reports of LA in children, particularly with juvenile idiopathic arthritis (JIA) are scarce. We present a 16-year-old girl with a prolonged course of psoriatic JIA (initial bilateral knee affection and subsequent involvement of wrists and elbows combined with psoriatic scalp lesions) and LA of both knees. Psoriatic JIA has been diagnosed at the age of 13, with immediate start of methotrexate (MTX) therapy. Several weeks later, magnetic resonance imaging (MRI) of the right knee, performed with the aim of the most swollen joint additional evaluation, revealed synovial changes consistent with LA; arthroscopic biopsy confirmed the diagnosis. After two years of MTX treatment, despite the successful maintenance of minimal JIA activity except for repetitive bilateral knee swelling, control MRI revealed bilateral knee lesions identical to those described two years earlier in the right knee. Following the step-up approach in JIA treatment, the TNF inhibitor adalimumab was added in therapy. Finally, six months later, clinical reduction of both knees swelling was noticed with almost complete LA regression in the right, and partial regression in the left knee, confirmed by final MRI control. A conservative approach, including TNF inhibitors, instead of usually performing synovectomy, seems like a reasonable option in cases of LA with underlying JIA.
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Affiliation(s)
- Marijan Frkovic
- Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Magdalena Kujundzic
- Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mislav Cavka
- Department of Diagnostic and Interventional Radiology, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marija Jelusic
- Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
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Pai SN, Ayyadurai P, Jeganathan PV, Perumal S, Arumugam S. Lipoma Arborescens: can we afford to miss it? ANZ J Surg 2021; 92:218-222. [PMID: 34783131 DOI: 10.1111/ans.17357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/19/2021] [Accepted: 10/24/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Lipoma Arborescens is an extremely rare, benign lesion effecting the synovial tissue of joints. It is characterized by villous lipomatous proliferation of the synovial tissue. The aim of our study was to evaluate its diagnostic features and analyse the functional outcome of arthroscopic management. METHODS We studied 13 patients who were diagnosed to have lipoma arborescens at our institution during the period from October 2005 to October 2019. All patients underwent arthroscopic synovectomy. Histopathological examination confirmed the diagnosis. Pre-operative and post-operative functional assessment was done using Tegner Lysholm score. RESULTS Mean age was 46.6 years. All patients presented with progressive swelling of knee joint, while 6 patients also complained of pain. Average duration of symptoms was 34 months. All the patients were diagnosed based on MRI findings. Tegner Lysholm scoring at last follow up visit, had 11 patients with excellent outcome, 1 patient with good outcome, and 1 patient with fair outcome. None of the patients had recurrence, nor underwent any subsequent procedure of the operated joint. CONCLUSIONS Lipoma arborescens is a rare condition which should be a differential in patients with mono-articular swelling of the knee joint, and can be confirmed with MRI. It should not be misdiagnosed or missed at early stages as prolonged duration of symptoms and delay in treatment is likely to lead to development of secondary arthritis of the joint. Arthroscopic synovectomy showed good functional outcome and no recurrence.
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Affiliation(s)
- Satvik N Pai
- Department of Orthopaedic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Prakash Ayyadurai
- Department of Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Parthiban V Jeganathan
- Department of Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Suresh Perumal
- Department of Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Sivaraman Arumugam
- Department of Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Lipoma Arborescens in a 10-Year-Old Boy. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e20.00108. [PMID: 33355429 DOI: 10.5435/jaaosglobal-d-20-00108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/18/2020] [Indexed: 11/18/2022]
Abstract
Lipoma arborescens is an intra-articular benign tumor characterized by villous synovial hypertrophy that can cause chronic joint pain and effusions. This disease is rare in adults and exceptionally rare in children. We present the case of an otherwise healthy 10-year-old boy who presented with a painful chronic left knee effusion. The workup included radiographs, MRI, and laboratory analysis, and he was diagnosed with lipoma arborescens. He underwent arthroscopic synovectomy and had a full recovery with the ability to return to all desired activities.
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Abstract
INTRODUCTION Lipoma Arborescens is a rare pathology that mainly affects the knee. Occurrences in the elbow are even more uncommon and mainly involve the bicipitoradial bursa. CASE'S DESCRIPTION We describe the case of a 54-year-old patient known for rheumatoid arthritis, who consulted for chronic elbow pain associated with swelling and limited extension. DIAGNOSIS The diagnosis of a lipoma arborescens of the elbow involving the whole joint was made using magnetic resonance imaging and confirmed during arthroscopy. INTERVENTIONS After a failed nonoperative treatment consisting in intra-articular cortisone injections and physiotherapy, the patient underwent arthroscopic synovectomy and arthrolysis. OUTCOME At 1-year follow-up, he reported no pain, satisfactory range of motion, and major improvements in clinical scores. CONCLUSION This is the first illustrated case report about lipoma arborescens involving the whole elbow joint. Even though it is a rare disease, awareness of its presentation, imaging patterns, and treatment options is therefore important for clinicians, radiologists, and surgeons. In this case, arthroscopic treatment resulted in satisfactory and long-lasting pain relief and functional results. It may be considered as a safe and effective option in case of failed nonoperative measures.
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Affiliation(s)
| | - Gregory Cunningham
- Department of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Switzerland, Rue Gabrielle-Perret-Gentil 4
- Shoulder Center, Hirslanden Clinique la Colline, Geneva, Switzerland
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