ClinicalKey* FIRST CONSULT Lipoma Revised: November 19,2013, Copyright Elsevier BV. All ights reserved. Key points + Lipomas are common benign soft tissue masses consisting of adipocytes encapsulated by a layer of connective fibrous tissue. They are soft, mobile masses generally less than 10 cm in size, painless, and ‘most often located in the subcutaneous region of the neck, arms, legs, and trunk + Diagnosis is usually made by clinical examination; histologic confirmation is definitive and required when there is concern for malignancy + Imaging studies or fine needle aspiration (FNA) biopsy is usually reserved for lesions of large size (>5 cm), irregular shape, and suspicion for myofascial involvement + Surgical resection is indicated for pain, nerve impingement, cosmetic concerns, or rapid growth + Lipomas are rarely life-threatening and the recurrence rate following resection for simple subcutaneous lipomas is usually low (< 5%) + Well-differentiated liposarcoma is a rare cancer of connective tissue and is the most common type of liposarcoma that can be confounded with lipoma. It should be considered for large, slowly growing tumors located in the retroperitoneum or deep to the myofascia in the limbs Background Description + Lipomas are benign soft tissue masses composed of adipocytes encapsulated by a thin layer of connective fibrous tissue * Lipomas account for almost 50% of all soft tissue tumors + They can arise virtually in all ti and myofascial layers sues but are most commonly located in the subcutaneous tissue + Simple lipomas are soft to the touch, movable under palpation and, most often, painless + Lipomas are classified clinically by location and number (single or multiple) © Superficial lipomas are defined as those located in the subcutaneous tissue© Deep lipomas invade the myofascial layers and associate with muscle and deeper soft tissue Benign fatty tumors can also be classified into five subgroups: + Lipoma © A tumor composed of adipocytes, further classified as superficial or deep, single or multiple © Single lipomas are far more common than multiple lipomas + Variants of lipoma, comprising a subgroup of fatty lesions with characteristic histological aspeets: © Angiolipoma: = Tender, soft, subcutaneous nodules that present in adolescence = Any associated pain is vaguely defined and may be spontaneous or caused by pressure = Tumors frequently are multilobulated and are somewhat firmer than ordinary lipomas © Myolipoma: = Rare lesions composed of smooth muscle and fat, mostly located in the retroperitoneum and abdomen = Generally found in women = Peak incidence in the fifth and sixth decades of life © Chondroid lipoma: = Deep-seated lesions, yellowish in color = Usually found on the legs, mostly seen in women © Lipoblastoma: = Rare, benign, encapsulated tumor arising from embryonic white fat = Primarily occurs in infancy and early childhood = Most often located in the extremities and trunk; rarely develops in the head, neck and other sites © Spindle cell lipomas: = More frequently develop in men = Usually located on the back, neck, and shoulders + Lipomatous tumors are a subtype of fatty lesions associated with other tissues that inelude: © Intramuscular and intermuscular lipomas = Rare variants of lipoma that infiltrate muscle tissue with a high tendeney to invade and destroy surrounding muscle = Most common in adults; men are more frequently affected© Lipomatosis of nerves: = Fibroadipocyte infiltration of a nerve = Most commonly located in an upper extremity; 80% occur in the median nerve distribution © Lipomas of tendon sheath and joint = Rare tumors that appear on imaging as discrete lipomatous masses = Lipoma arborescens, a diffuse lipoma of the joint, most commonly in the knee; itis rare but more common than the discrete form + Infiltrating lipomas are a subtype of proliferative fatty lesions that compress adjacent structures and include: © Diffuse lipomatosis: is microscopically indistinguishable from lipoma or intramuscular = Usually present by 2 years of age, it typically affeets an extremity or trunk; nerve is not affected = Osseous overgrowth and deformity may be observed © Symmetric lipomatosis, also known as Madelung syndrome = Characterized by multiple fat deposits in the head, neck, and shoulders = Typically seen in middle-aged men and often associated with a history of alcoholism or liver disease © Adiposis dolorosa, also known as Dercum disease = Arare condition characterized by the presence of multiple painful lipomas in the trunk, arms, or legs = Most commonly observed in postmenopausal, obese women, with a female to male ratio greater than 3o:1 = Also associated with generalized obesity, asthenia, weakness, fatigability, and mental disturbances * Hibernoma © A benign tumor of brown adipocytes that contains multiple lipid droplets and mitochondria compared to classic white adipocytes © Women between the ages of 20 and 50 are commonly affected © Has a similar appearance to lipoma on computed tomography or magnetic resonance imaging, but can often be recognized by prominent vessels within the lesion Epidemiology