Lipoma

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

II. Definition

  1. Subcutaneous tumors of adipose tissue
  2. Usually benign (except in rare cases of Liposarcoma)

III. 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 45:940-2 [PubMed]
  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

IV. Epidemiology

  1. Most common subcutaneous soft-tissue tumor
  2. Prevalence: 1%
  3. Age of onset usually 40 to 60 years
  4. Gender prediposition
    1. Single Lipomas more common in women
    2. Multiple Lipomas (Lipomatosis) more common in men

V. Pathophysiology

  1. Mesenchymal tumor with thin fibrous capsule surrounding fatty tissue

VI. Symptoms

  1. Usually asymptomatic
  2. Irritation may occur with local Trauma
  3. Painful if local compression of nerves
  4. Large Lipomas may cause local compression with second

VII. 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
    4. Slow growing lesion
  2. Distribution
    1. Lipomas may occur in any subcutaneous location
      1. May also occur in any organ
    2. Common sites
      1. Trunk
      2. Shoulders
      3. Posterior neck
      4. Axilla

VIII. Diagnostics: Bedside Ultrasound

  1. Use high frequency Ultrasound probe (>20 MHz)
  2. Distinguishes solid vs fluid filled lesions

IX. Differential Diagnosis: Subcutaneous Mass

  1. Epidermoid Cyst (Sebaceous Cyst)
  2. Skin Abscess
  3. Liposarcoma (rare, but malignant tumor)
  4. Rheumatic Nodules
  5. Sarcoidosis

X. Labs: 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 (esp. thighs)

XI. Precautions

  1. Consider referral for facial Lipoma management or Lipoma recurrence

XII. Management: Indications for Excision

  1. Cosmesis
  2. Local nerve compression
  3. Suspect Liposarcoma (malignancy)
    1. Imaging (CT, MRI) recommended before excision for suspicious lesions
    2. Red flags for Liposarcoma
      1. Lesion >10 cm
      2. Location in deep thigh
      3. Rapid growth
      4. Local nerve or bone invasion

XIII. 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

XIV. 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):1864-7 [PubMed]

XV. 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

XVI. 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

XVII. 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):675-6 [PubMed]
    2. Gupta (2001) Int J Dermatol 40:420-4 [PubMed]

XVIII. References

  1. Higgins (2015) Am Fam Physician 92(7): 601-7 [PubMed]
  2. Salam (2002) Am Fam Physician 65:901-5 [PubMed]

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Related Studies

Ontology: Lipoma (C0023798)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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