LIPOMA

Lipoma is a benign growth made up of fatty cells. It is normally non-cancerous in nature and commonly occurs under the skin. It may be felt as diffuse, soft swelling, over the shoulders, trunks and arms. Lipomas rarely cause problems and can be easily removed surgically. However lipomas of the breast are fairly common and can be mistaken for malignant growths especially if they feel firmer than normal. Although lipomas can occur in all age groups, they usually first appear between 40 and 60 years of age. Multiple lipomas (lipomatosis) are predominant in men while single lipoma is more common in women.

Signs and symptoms

Lipomas usually present themselves as soft, round, mobile swellings under the skin. They are non-painful in nature with doughy characteristic and can be diagnosed by their clinical appearance.

Types of lipomas

· Infiltrating lipomas are a non-capsular and infiltrate the muscle.
· Angiolipomas are a variant form of painful lipomas with multiple blood vessels.
· Pleomorphic lipomas are multinucleated giant cells with normal adipocytes.
· Spindle cell lipomas are spindle cells intermixed with normal adipocytes.
· Adenolipomas are eccrine sweat glands intermixed with normal adipocytes.
· Liposarcomas are rare malignant lesions similar to lipomas

Associated Syndromes.

1. Hereditary multiple lipomatosis (Autosomal dominant)
a. Trunk and extremities are most commonly affected.
2. Madelung's Disease -(Benign symmetric lipomatosis)
a. Affects head, neck, shoulders and proximal arms.
b. Affects men who consume alcohol.
c. May present with constricting "horse collar" cervical appearance.
3. Gardner's Syndrome (Autosomal dominant)
a. Intestinal polyps.
b. Cysts formation.
c. Osteomas.
4. Dercum's Disease (Adiposis dolosa)
a. Irregular painful lipomas on trunk and extremities.
b. Most common in middle aged women.

Treatment

Non-surgical treatment is by injection of Corticosteroid (incomplete removal). This is indicated for lipomas less than 1 inch in diameter. The steroid injections result in local fat atrophy, thus shrinking the lipoma but not eliminating it completely. A mixture of lidocaine (Xylocaine) and triamcinolone acetonide (Kenalog) is injected in the centre of the lipoma. This procedure is repeated over several months at monthly intervals depending on the response. Complications are rare.

Liposuction can also be used to remove small or large lipomas. This technique is used particularly in areas where large scars should be avoided but complete elimination of the lipoma is difficult to achieve with liposuction. Local anaesthetic and lidocaine are normally used for this procedure.

Surgical excision of lipomas can be done under local or general anaesthetic depending on the patient's wish or state of health. Before the surgery, an outline of the lipoma is often drawn on the skin surface with a marking pen to prevent obscurity of the margin after injection of local anaesthetic. The incision is normally much smaller than the size of the lipoma. Most of times it is easy to enucleate the lipoma with a curette or blunt dissection through the incision. It is sometimes possible to use the finger to scoop out the lipoma or even squeeze it out. Once the lipoma is excised the dead space is closed with an absorbable suture and the skin with interrupted nylon sutures.
Pressure dressing is used to prevent haemtoma.

Possible complications.

Surgical infection
Haematoma
Injury to nearby nerves or vessels
Permanent deformity due to excision of large lesion
Scarring with cosmetic deformity
Fat embolus