II. Definitions
- Lipoma
- 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 (accounts for 50% of Soft Tissue Masses)
- 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. Risk Factors
- Obesity
- Familial Multiple Lipomatosis
VI. Pathophysiology
- Mesenchymal tumor with thin fibrous capsule surrounding fatty tissue
- Growth rate increases at times of rapid weight gain
VII. Symptoms
- Usually asymptomatic
- Irritation may occur with local Trauma
- Painful if local compression of nerves
- Large Lipomas may cause local compression with second
VIII. Signs
IX. Diagnostics: Bedside Ultrasound
- Use high frequency linear Ultrasound probe
- Distinguishes solid vs fluid filled lesions
- Lipomas are elongated, well circumscribed solid masses
- Fibrous capsule may be present
- Fatty necrosis with calcifications may be present in up to one third of cases
- Distinguish from Liposarcoma
X. Differential Diagnosis: Subcutaneous Mass
- Epidermoid Cyst (Sebaceous Cyst)
- Skin Abscess
- Liposarcoma (rare, but malignant tumor)
- Rheumatic Nodules
- Sarcoidosis
XI. 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)
XII. Precautions
- Consider referral for facial Lipoma management or Lipoma recurrence
XIII. Management: Indications for Excision
- Cosmesis
- Local nerve compression
- Suspect Liposarcoma (malignancy)
- Imaging (CT, MRI) recommended before excision for suspicious lesions
- Suspicious changes include septations >2 mm, nodular soft tissue change
- Red flags for Liposarcoma
- Lesion >5 cm (esp. >10 cm)
- Location in deep thigh
- Rapid growth
- Local nerve or bone invasion
- Imaging (CT, MRI) recommended before excision for suspicious lesions
XIV. Management: Corticosteroid Injection (incomplete removal)
XV. 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
XVI. Management: Standard Lipoma excision
- Indicated for large Lipoma
- Evaluate suspicious lesions with imaging before excision
-
Informed Consent
- Risk of adhesions, scarring, Muscle injury or permanent nerve injury
- Low risk of recurrence after complete excision
- 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
XVII. 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
XVIII. 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
Images: Related links to external sites (from Bing)
Related Studies
| 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: 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 |
