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LipomaAka: Angiolipoma, Lipomatosis, Infiltrating Lipoma, Pleomorphic lipoma, Spindle cell lipoma, Adenolipoma, Liposarcoma

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  1. Definition
    1. Subcutaneous tumors of adipose tissue
    2. Usually benign (except in rare cases of Liposarcoma)
  2. Associated Syndromes
    1. Hereditary multiple lipomatosis (Autosomal dominant)
      1. Trunk and extremities most commonly affected
    2. Gardner's Syndrome (Autosomal dominant)
      1. Intestinal polyps
      2. Cyst formation
      3. Osteomas
      4. Parks (2001) J Am Acad Dermatol 45:940
    3. Benign symmetric lipomatosis (Madelung's Disease)
      1. Involves head, neck, shoulders, proximal arms
      2. Affects men who use Alcohol
      3. Neck may have constricting horse collar appearance
    4. Dercum's Disease (Adiposis dolorosa)
      1. Irregular painful lipomas on trunk and extremities
      2. Most common in middle aged women
  3. Epidemiology
    1. Most common subcutaneous soft-tissue tumor
    2. Age of onset usually 40 to 60 years
    3. Gender prediposition
      1. Single lipomas more common in women
      2. Multiple lipomas (Lipomatosis) more common in men
  4. Symptoms
    1. Usually asymptomatic
    2. Painful if local compression of nerves
  5. Signs
    1. Characteristics
      1. Soft, round, mobile, rubbery subcutaneous tumor
      2. Most lesions <5 cm (rarely may approach 20 cm)
      3. Overlying skin is normal
    2. Distribution
      1. Lipomas may occur in any subcutaneous location
      2. Common sites
        1. Trunk
        2. Shoulders
        3. Posterior neck
        4. Axilla
  6. Differential Diagnosis
    1. Epidermoid Cyst
    2. Liposarcoma (rare, but malignant tumor)
    3. Rheumatic Nodules
    4. Sarcoidosis
  7. Histologic Lipoma Types
    1. Infiltrating lipoma (lipoma infiltrates muscle)
    2. Angiolipoma (painful lipomas with numerous vessels)
    3. Pleomorphic lipoma (multinucleated giant cells)
    4. Spindle cell lipoma (intermixed spindle cells)
    5. Adenolipoma (intermixed eccrine Sweat Glands)
    6. Liposarcoma (rare malignant lesion similar to lipoma)
      1. Located in retroperitoneum, shoulders, and legs
  8. Indications for excision
    1. Cosmesis
    2. Local nerve compression
    3. Suspect liposarcoma (malignancy)
      1. Imaging recommended before excision
      2. Red flags for Liposarcoma
        1. Lesion >5 cm
        2. Location in deep thigh
        3. Rapid growth with local nerve or bone invasion
  9. Management: Corticosteroid Injection (incomplete removal)
    1. Indicated for lipomas <1 inch diameter
    2. Protocol
      1. Draw 1:1 mix
        1. Lidocaine 1%
        2. Kenalog 10 mg/ml
      2. Inject 1-3 ml into center of lipoma
      3. May repeat monthly over several months as needed
  10. Management: Liposuction (incomplete removal)
    1. Indicated for lipomas in areas not amenable to excision
      1. Areas where excision may cause significant scar
      2. Not limited by size of lipoma
        1. Large lipomas (>10 cm ideal for this technique)
    2. Protocol
      1. Local anesthetic with Lidocaine
      2. Liposuction via cannula or 16 gauge needle
    3. References
      1. Wilhelmi (1999) Plast Reconstr Surg 103(7):1864
  11. Management: Standard lipoma excision
    1. Indicated for large lipoma
    2. Protocol
      1. Outline entire subcutaneous lesion boundaries
        1. Do not make incision this size
        2. Helps to position excision boundaries
      2. Outline excision boundaries (small central oval)
        1. Much smaller than size of lesion
          1. Length: 50% of lipoma length
          2. Width: narrow oval, about 20% of lipoma width
        2. Position centrally over lipoma
        3. Oval shape should follow Relaxed Skin Tension Lines
      3. Incise oval (inner outlined oval)
      4. Dissect away adjacent tissues
        1. Iris scissors
        2. Small hemostat
        3. Carefully with #15 scalpel (direct visualization)
      5. Remove tumor as a whole
      6. Close dead space with deep 4-0 Vicryl Sutures
      7. Close skin with simple interrupted Nylon Sutures
  12. Management: Enucleation Technique (Curette)
    1. Indicated for small lipoma
    2. Protocol
      1. Incision 3-4 mm in diameter made over lipoma center
      2. Curette technique
        1. Free attached tissues
        2. Enucleate lipoma through incision
      3. Cover with pressure bandage to prevent hematoma
  13. Management: Narrow Hole Extrusion Technique (Skin Punch)
    1. Indicated for lipomas on face and extremities
    2. Protocol
      1. Grasp lipoma tightly
      2. Apply 4 mm skin punch to center of lipoma
      3. Insert punch to hub into lipoma
      4. Express lipoma via incision
        1. Apply firm lateroinferior pressure
        2. Pinch lesion deeply with pressure upward
      5. Explore wound after lipoma expulsion
      6. Suture as for complete lipoma excision above
    3. Variation: Pot-Lid Technique
      1. Punched-out piece of skin stored in saline
      2. Lipoma expulsed as above
      3. Two absorbable buried SC Sutures close deep space
      4. Puched-out piece of skin replaced
      5. Bandage in normal fashion
    4. References
      1. Christenson (2000) J Am Acad Dermatol 42(4):675
      2. Gupta (2001) Int J Dermatol 40:420
  14. References
    1. Salam (2002) Am Fam Physician 65:901

Lipoma (C0023798)

Definition (MSH)A benign tumor composed of fat cells (ADIPOCYTES). It can be surrounded by a thin layer of connective tissue (encapsulated), or diffuse without the capsule.
Definition (AIR)Skin Biopsy, Diagnostic of PSS: skin biopsy revealing increased compact collagen in the reticular dermis, thinning of the epidermis, loss of rete pegs, atrophy of dermal appendages, and hyalinization and fibrosis of arterioles.
Definition (NCI)A benign, usually painless, well-circumscribed lipomatous tumor composed of adipose tissue.
ConceptsNeoplastic Process (T191)
ICD9214, 214.9
MSHD008067
BasqueAZALEKO LIPOMA
DanishLipom
DutchLipoom
EnglishFatty Tumor, Fatty Tumors, LIPO, Lipoma, Lipoma of unspecified body site, Lipomas, Lipomata, Lipomatas
FrenchLipome
GermanLipom
Hebrewlipoma baor
Hungarianlipoma
ItalianLipoma
NorwegianLIPOM
PortugueseLipoma
Spanishlipoma
SwedishLIPOM
Parent ConceptsSkin Findings: Nodules (C0150867), Nodules, swelling skin, lymph nodes (C0150931), Lipoma (C0023798), Benign Neoplasm (C0086692), Diagnosis/Diseases Component (C0497531), Skin (C1123023), Lipomatous neoplasm (C0206631), Benign lipomatous tumor (C0346118), Lipoma morphology (C0431102), Duplicate concept (C1274013)
SourcesAIR, COSTAR, CSP, CST, ICD9CM, ICPC, ICPCBAQ, ICPCDAN, ICPCDUT, ICPCFIN, ICPCFRE, ICPCGER, ICPCHEB, ICPCHUN, ICPCITA, ICPCNOR, ICPCPOR, ICPCSPA, ICPCSWE, MSH, MTH, NCI, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Lipomatosis (C0023801)

Definition (MSH)A disorder characterized by the accumulation of encapsulated or unencapsulated tumor-like fatty tissue resembling LIPOMA.
Definition (NCI)A neoplastic process characterized by poorly circumscribed overgrowth of adipose tissue.
ConceptsDisease or Syndrome (T047)
MSHD008068
EnglishLaunois-Bensaude Syndrome, Lipomatoses, Lipomatosis, Madelung Disease, Madelung's Disease
Spanishlipomatosis
Parent Conceptsskin disorder (C0037274), Lipid Metabolism Disorders (C0154251), Benign lipomatous tumor (C0346118), Connective Tissue Diseases (C0009782), Dysplasia (C0334044), Disease (C0012634)
SourcesMSH, MTH, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


liposarcoma (C0023827)

Definition (MSH)A malignant tumor derived from primitive or embryonal lipoblastic cells. It may be composed of well-differentiated fat cells or may be dedifferentiated: myxoid (LIPOSARCOMA, MYXOID), round-celled, or pleomorphic, usually in association with a rich network of capillaries. Recurrences are common and dedifferentiated liposarcomas metastasize to the lungs or serosal surfaces. (From Dorland, 27th ed; Stedman, 25th ed)
Definition (CSP)malignant tumor derived from primitive or embryonal lipoblastic cells; may be composed of well-differentiated fat cells or may be dedifferentiated: myxoid, round-celled, or pleomorphic, usually in association with a rich network of capillaries; recurrences are common and dedifferentiated liposarcomas metastasize to the lungs or serosal surfaces.
Definition (NCI)A rare cancer of the fat cells.
Definition (NCI)A usually painless malignant tumor that arises from adipose tissue. Microscopically, it may contain a spectrum of neoplastic adipocytes ranging from lipoblasts to pleomorphic malignant adipocytes. Representative morphologic variants include: well differentiated, dedifferentiated, pleomorphic, and myxoid/round cell liposarcoma. The metastatic potential is higher in less differentiated tumors.
ConceptsNeoplastic Process (T191)
MSHD008080
EnglishFibroliposarcoma, liposarcoma, Liposarcoma morphology, Liposarcomas
Spanishfibroliposarcoma, liposarcoma, morfologia de liposarcoma
Parent ConceptsNeoplasms, Connective Tissue (C0027656), sarcoma (C1261473), Lipomatous neoplasm (C0206631), Malignant Lipomatous Neoplasm (C0346117), liposarcoma (C0023827), Malignant lipomatous tumor morphology (C0474827), Sarcoma - category (C1299262), Primary malignant neoplasm (C1306459), Primary malignant neoplasm of skin (C1314758)
SourcesCSP, DXP, MSH, MTH, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Angiolipoma (C0206632)

Definition (MSH)A benign neoplasm composed of a mixture of adipose tissue and blood vessels. (Dorland, 27th ed)
Definition (NCI)A lipoma with prominent vascularity. The vascular tissue is more abundant at the periphery of the tumor and contains fibrin thrombi. It occurs more frequently in younger individuals as a painful subcutaneous nodule, often on the arms.
ConceptsNeoplastic Process (T191)
MSHD018206
EnglishAngiolipoma, Angiolipomas
Spanishangiolipoma
Parent ConceptsLipomatous neoplasm (C0206631), Lipoma (C0023798), Angiolipoma (C0206632), Benign neoplasm of soft tissue (C0334450), Lipoma morphology (C0431102)
SourcesMSH, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Lipoadenoma (C0334325)

Definition (NCI)An adenoma in which the neoplastic epithelial cells are admixed with adipose tissue cells.
ConceptsNeoplastic Process (T191)
EnglishAdenolipoma, Lipoadenoma
Spanishadenolipoma, lipoadenoma
Parent Conceptsadenoma (C0001430), Benign adenomatous neoplasm - category (C1302714)
SourcesNCI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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