II. Definition
- Subcutaneous tumors of adipose tissue
- Usually benign (except in rare cases of Liposarcoma)
III. Associated Syndromes
- Hereditary multiple Lipomatosis (Autosomal Dominant)
- Trunk and extremities most commonly affected
- Gardner's Syndrome (Autosomal Dominant)
- Intestinal polyps
- Cyst formation
- Osteomas
- Parks (2001) J Am Acad Dermatol 45:940-2 [PubMed]
- Benign symmetric Lipomatosis (Madelung's Disease)
- Dercum's Disease (Adiposis dolorosa)
- Irregular painful Lipomas on trunk and extremities
- Most common in middle aged women
IV. Epidemiology
- Most common subcutaneous soft-tissue tumor
- Prevalence: 1%
- Age of onset usually 40 to 60 years
- Gender prediposition
- Single Lipomas more common in women
- Multiple Lipomas (Lipomatosis) more common in men
V. Pathophysiology
- Mesenchymal tumor with thin fibrous capsule surrounding fatty tissue
VI. Symptoms
- Usually asymptomatic
- Irritation may occur with local Trauma
- Painful if local compression of nerves
- Large Lipomas may cause local compression with second
VII. Signs
VIII. Diagnostics: Bedside Ultrasound
- Use high frequency Ultrasound probe (>20 MHz)
- Distinguishes solid vs fluid filled lesions
IX. Differential Diagnosis: Subcutaneous Mass
- Epidermoid Cyst (Sebaceous Cyst)
- Skin Abscess
- Liposarcoma (rare, but malignant tumor)
- Rheumatic Nodules
- Sarcoidosis
X. Labs: Histologic Lipoma Types
- Infiltrating Lipoma (Lipoma infiltrates muscle)
- Angiolipoma (painful Lipomas with numerous vessels)
- Pleomorphic lipoma (multinucleated giant cells)
- Spindle cell lipoma (intermixed spindle cells)
- Adenolipoma (intermixed eccrine Sweat Glands)
- Liposarcoma (rare malignant lesion similar to Lipoma)
- Located in Retroperitoneum, Shoulders, and legs (esp. thighs)
XI. Precautions
- Consider referral for facial Lipoma management or Lipoma recurrence
XII. Management: Indications for Excision
- Cosmesis
- Local nerve compression
- Suspect Liposarcoma (malignancy)
- Imaging (CT, MRI) recommended before excision for suspicious lesions
- Red flags for Liposarcoma
- Lesion >10 cm
- Location in deep thigh
- Rapid growth
- Local nerve or bone invasion
XIII. Management: Corticosteroid Injection (incomplete removal)
XIV. Management: Liposuction (incomplete removal)
- Indicated for Lipomas in areas not amenable to excision
- Areas where excision may cause significant scar
- Not limited by size of Lipoma
- Large Lipomas (>10 cm ideal for this technique)
- Protocol
- Local anesthetic with Lidocaine
- Liposuction via cannula or 16 gauge needle
- References
XV. Management: Standard Lipoma excision
- Indicated for large Lipoma
- Protocol
- Outline entire subcutaneous lesion boundaries
- Do not make incision this size
- Helps to position excision boundaries
- Outline excision boundaries (small central oval)
- Much smaller than size of lesion
- Length: 50% of Lipoma length
- Width: narrow oval, about 20% of Lipoma width
- Position centrally over Lipoma
- Oval shape should follow Relaxed Skin Tension Lines
- Much smaller than size of lesion
- Incise oval (inner outlined oval)
- Dissect away adjacent tissues
- Iris scissors
- Small hemostat
- Carefully with #15 scalpel (direct visualization)
- Remove tumor as a whole
- Close dead space with deep 4-0 Vicryl Sutures
- Close skin with simple interrupted Nylon Sutures
- Outline entire subcutaneous lesion boundaries
XVI. Management: Enucleation Technique (Curette)
- Indicated for small Lipoma
- Protocol
- Incision 3-4 mm in diameter made over Lipoma center
- Curette technique
- Free attached tissues
- Enucleate Lipoma through incision
- Cover with pressure bandage to prevent hematoma
XVII. Management: Narrow Hole Extrusion Technique (Skin Punch)
- Indicated for Lipomas on face and extremities
- Protocol
- Grasp Lipoma tightly
- Apply 4 mm skin punch to center of Lipoma
- Insert punch to hub into Lipoma
- Express Lipoma via incision
- Apply firm lateroinferior pressure
- Pinch lesion deeply with pressure upward
- Explore wound after Lipoma expulsion
- Suture as for complete Lipoma excision above
- Variation: Pot-Lid Technique
- Punched-out piece of skin stored in saline
- Lipoma expulsed as above
- Two absorbable buried SC Sutures close deep space
- Puched-out piece of skin replaced
- Bandage in normal fashion
- References
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| Definition (NCI_CDISC) | A benign neoplasm composed of adipose tissue. |
| Definition (NCI) | A benign, usually painless, well-circumscribed lipomatous tumor composed of adipose tissue. |
| Definition (NCI_NCI-GLOSS) | A benign (not cancer) tumor made of fat cells. |
| 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. |
| Concepts | Neoplastic Process (T191) |
| MSH | D008067 |
| ICD9 | 214.9, 214 |
| ICD10 | M8850/0 , D17.9 |
| SnomedCT | 93163002, 46720004, 189776008, 154612003, 189018005 |
| English | Fatty Tumor, Fatty Tumors, Tumor, Fatty, Tumors, Fatty, LIPOMA, Lipoma NOS, Lipoma, unspecified site, Lipomata, Lipomatas, Lipomas, [M]Lipoma NOS, Lipoma of unspecified body site, Lipoma, no ICD-O subtype, Lipoma [Disease/Finding], fatty tumors, lipomata, lipoma nos, fatty tumor, lipomas, [M]Lipoma NOS (morphologic abnormality), Lipoma NOS (disorder), Lipoma, no ICD-O subtype (morphologic abnormality), Lipoma, no International Classification of Diseases for Oncology subtype (morphologic abnormality), Lipoma, no International Classification of Diseases for Oncology subtype, LIPOMA, BENIGN, lipoma, Lipoma (clinical), Lipoma (disorder), Lipoma, NOS, Lipoma |
| French | LIPOME, Lipome, site non précisé, Lipome SAI, Lipome, Adipome, Tumeur graisseuse |
| Portuguese | LIPOMA, Lipoma de localização NE, Lipoma NE, Lipoma, Tumor Gorduroso |
| Spanish | LIPOMA, morfología: lipoma, no clasificado como subtipo en CIE - O, Lipoma NEOM, Lipoma, localización no especificada, lipoma, SAI (trastorno), [M]lipoma, SAI, lipoma, SAI, [M]lipoma, SAI (anomalía morfológica), lipoma (clínico), lipoma (trastorno), lipoma, morfología: lipoma, no clasificado como subtipo en CIE - O (anomalía morfológica), Lipoma, Tumor de Grasa |
| German | LIPOM, Lipom, unspezifische Stelle, Lipom NNB, Fettgeschwulst, Lipom |
| Dutch | lipoom NAO, lipoom, niet-gespecificeerde plaats, lipoom, Lipoom, Vettumor |
| Italian | Lipoma NAS, Lipoma, sede non specificata, Tumore del tessuto adiposo, Tumore benigno del tessuto adiposo, Lipoma |
| Japanese | 脂肪腫ＮＯＳ, 脂肪腫、部位不明, ｼﾎﾞｳｼｭﾌﾞｲﾌﾒｲ, ｼﾎﾞｳｼｭ, ｼﾎﾞｳｼｭNOS, 脂肪腫-多型性, 皮脂嚢腫, 脂肪腫, 皮脂のう腫, 多型性脂肪腫, 冬眠腺腫 |
| Swedish | Lipom |
| Czech | lipom, Lipom, Lipom blíže neurčené lokalizace, Lipom NOS |
| Finnish | Lipooma |
| Russian | LIPOMA, ЛИПОМА |
| Croatian | LIPOM |
| Polish | Tłuszczak |
| Hungarian | Lipoma, Lipoma k.m.n., Lipoma, nem meghatározott elhelyezkedésű |
| Norwegian | Fettkul, Lipom |
Ontology: Lipomatosis (C0023801)
| Definition (MSH) | A disorder characterized by the accumulation of encapsulated or unencapsulated tumor-like fatty tissue resembling LIPOMA. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D008068 |
| ICD10 | E88.2 |
| SnomedCT | 37095002, 402693001 |
| English | Lipomatoses, Lipomatosis, Lipomatosis [Disease/Finding], lipomatoses, Lipomatosis NOS, lipomatosis (diagnosis), lipomatosis, Lipomatosis (disorder), Lipomatosis (morphologic abnormality), Lipomatosis, NOS |
| Dutch | lipomatose NAO, lipomatose, Lipomatose |
| French | Lipomatose SAI, Lipomatose |
| German | Lipomatose NNB, Lipomatose |
| Italian | Lipomatosi NAS, Lipomatosi |
| Portuguese | Lipomatose NE, Lipomatose |
| Spanish | Lipomatosis NEOM, lipomatosis (anomalía morfológica), lipomatosis (trastorno), lipomatosis, Lipomatosis |
| Japanese | 脂肪腫症ＮＯＳ, 脂肪腫症, ｼﾎﾞｳｼｭｼｮｳNOS, ｼﾎﾞｳｼｭｼｮｳ |
| Swedish | Lipomatos |
| Czech | lipomatóza, Lipomatóza, Lipomatóza NOS |
| Finnish | Lipomatoosi |
| Russian | LIPOMATOZ, ЛИПОМАТОЗ |
| Croatian | LIPOMATOZA |
| Polish | Tłuszczakowatość |
| Hungarian | Lipomatosis, Lipomatosis k.m.n. |
| Norwegian | Lipomatose |
Ontology: liposarcoma (C0023827)
| 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. |
| Definition (NCI_CDISC) | A malignant neoplasm composed of adipose tissue. |
| 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. |
| Concepts | Neoplastic Process (T191) |
| MSH | D008080 |
| ICD10 | M8850/3 |
| SnomedCT | 49430005, 189777004, 254829001 |
| English | Liposarcoma, Liposarcomas, Liposarcoma NOS, [M]Liposarcoma NOS, liposarcoma (diagnosis), Liposarcoma, no ICD-O subtype, Liposarcoma [Disease/Finding], liposarcomas, Liposarcomas malignant, [M]Liposarcoma NOS (morphologic abnormality), Liposarcoma, no International Classification of Diseases for Oncology subtype (morphologic abnormality), Liposarcoma, no International Classification of Diseases for Oncology subtype, Liposarcoma, no ICD-O subtype (morphologic abnormality), LIPOSARCOMA, MALIGNANT, Fibroliposarcoma, Liposarcoma morphology, Liposarcoma (disorder), Liposarcoma, NOS, Liposarcoma (morphologic abnormality), liposarcoma |
| Italian | Liposarcomi maligni, Liposarcoma NAS, Liposarcoma |
| Dutch | liposarcoom NAO, liposarcomata maligne, liposarcoom, Liposarcoom, Sarcoom, lipo- |
| French | Liposarcome SAI, Liposarcomes malins, Liposarcome |
| German | Liposarkom NNB, Liposarkome boesartig, Liposarkom |
| Portuguese | Lipossarcoma NE, Liposarcomas malignos, Liposarcoma, Lipossarcoma |
| Spanish | Liposarcoma NEOM, liposarcoma, no clasificado como subtipo en CIE-O (anomalía morfológica), liposarcoma, no clasificado como subtipo en CIE-O, [M]liposarcoma, SAI (anomalía morfológica), [M]liposarcoma, SAI, fibroliposarcoma, liposarcoma (anomalía morfológica), liposarcoma (trastorno), liposarcoma, SAI, liposarcoma, morfología de liposarcoma, Liposarcomas malignos, Liposarcoma |
| Japanese | 脂肪肉腫, 悪性脂肪肉腫, 脂肪肉腫ＮＯＳ, ｱｸｾｲｼﾎﾞｳﾆｸｼｭ, ｼﾎﾞｳﾆｸｼｭ, ｼﾎﾞｳﾆｸｼｭNOS |
| Swedish | Liposarkom |
| Czech | liposarkom, Liposarkom, Liposarkomy maligní, Liposarkom NOS |
| Finnish | Liposarkooma |
| Russian | LIPOSARKOMA, ЛИПОСАРКОМА |
| Croatian | LIPOSARKOM |
| Polish | Tłuszczak mięsakowy, Tłuszczakomięsak |
| Hungarian | Liposarcoma k.m.n., Liposarcoma, Liposarcomak, rosszindulatú |
| Norwegian | Liposarkom |
Ontology: Angiolipoma (C0206632)
| Definition (NCI_CDISC) | A lipoma characterized by prominent vascularization. |
| 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. |
| Definition (MSH) | A benign neoplasm composed of a mixture of adipose tissue and blood vessels. (Dorland, 27th ed) |
| Concepts | Neoplastic Process (T191) |
| MSH | D018206 |
| ICD10 | M8861/0 |
| SnomedCT | 189780003, 404057003, 73219006 |
| English | Angiolipoma, Angiolipoma NOS, [M]Angiolipoma NOS, angiolipoma of fatty tissue, angiolipoma of fatty tissue (diagnosis), adipose tissue angiolipoma, Angiolipoma [Disease/Finding], angiolipoma, angiolipomas, Angiolipomas, [M]Angiolipoma NOS (morphologic abnormality), ANGIOLIPOMA, ANGIOLIPOMA, BENIGN, Angiolipoma (disorder), Angiolipoma (morphologic abnormality), Angiolipoma, NOS |
| Japanese | 血管脂肪腫, ｹｯｶﾝｼﾎﾞｳｼｭ |
| Swedish | Angiolipom |
| Czech | angiolipom, Angiolipom |
| Finnish | Angiolipooma |
| Russian | ANGIOLIPOMA, АНГИОЛИПОМА |
| Polish | Naczyniakotłuszczak |
| Hungarian | Angiolipoma |
| Norwegian | Angiolipom |
| Spanish | [M]angiolipoma, SAI (anomalía morfológica), [M]angiolipoma, SAI, angiolipoma (anomalía morfológica), angiolipoma (trastorno), angiolipoma, Angiolipoma |
| Dutch | angiolipoom, Angiolipoom |
| French | Angiolipome |
| German | Angiolipom |
| Italian | Angiolipoma |
| Portuguese | Angiolipoma |
Ontology: Lipoadenoma (C0334325)
| Definition (NCI) | An adenoma in which the neoplastic epithelial cells are admixed with adipose tissue cells. |
| Definition (NCI_CDISC) | Benign mixed neoplasm comprised of epithelial/glandular and lipomatous structures. |
| Concepts | Neoplastic Process (T191) |
| ICD10 | M8324/0 |
| SnomedCT | 22024005 |
| Italian | Adenolipoma |
| Japanese | 腺脂肪腫, ｾﾝｼﾎﾞｳｼｭ |
| Czech | Adenolipom |
| English | lipoadenoma, adenolipoma, ADENOLIPOMA, BENIGN, Adenolipoma, Lipoadenoma, Lipoadenoma (morphologic abnormality) |
| Hungarian | Adenolipoma |
| Spanish | adenolipoma, lipoadenoma (anomalía morfológica), lipoadenoma, Adenolipoma |
| Portuguese | Adenolipoma |
| Dutch | adenolipoom |
| French | Adénolipome |
| German | Adenolipom |
