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Choroid plexus lipomas (CPL) are known to be associated with pericallosal lipomas (lipomas of the corpus callosum--LCC). Twenty-six cases have previously been reported. Approximately half of these lipomas are connected via the choroidal fissure (LCC-CPL); this connection is almost always bilateral. We present an unusual unilaterally connected LCC-CPL in a neonate.
Twenty-four cases of histologically confirmed congenital intraspinal lipoma of the lumbosacral region were studied by means of myelography with metrizamide. The findings were compared with intraoperative observations. Myelography with metrizamide clearly revealed the detailed intrathecal structures and allowed a classification of intraspinal lipomas into four types, in terms of their insertion into the conus medullaris: dorsal type, either with direct or indirect (via an intrathecal stalk) insertion of the extrathecal lipoma into the dorsal aspect of the conus medullaris; caudal type; combined type; and filar lipoma. Based on our surgical experience in untethering and decompression of the lesions, the classification was found to be useful in designing a safe and effective surgical procedure which minimized all possible trauma to the intrathecal neural structures.
We report herein, a rare case of esophageal lipoma and review the Japanese literature on this subject. Lipoma of the alimentary tract is relatively uncommon but that of the esophagus is extremely rare with only 17 cases having been reported in Japan. The majority of these cases occurred in the cervical esophagus with the most serious symptom being regurgitation of the pedunculated tumor which lead to asphyxia and death in one case. Only 2 cases occurred in the thoracic esophagus and these tumors were small in size and resected endoscopically. This is the first reported case of an esophageal lipoma being located in the thoracic esophagus which was resected through a thorocotomy. The clinical features of esophageal lipoma are also described herein.
We report herein the unusual case of a 45-year-old Japanese man whose chest X-rays revealed an abnormal shadow, increasing in size. A chest wall tumor was suspected, based on the findings of computed tomography (CT) of the thorax, the CT number of which was -137, chest roentgenogram, and an echograph. An open biopsy was performed to establish the final diagnosis. The resected tumor was a pedunculated pleural mass, yellowish in color, the pathological diagnosis of which confirmed a lipoma. Intrathoracic lipomas are rare, but pleural lipomas are seen even less frequently. CT, echography, and percutaneous needle biopsy have been found useful for diagnosing intrathoracic lipomas, but these examinations are not always adequate for confirming the final diagnosis. Consequently, tumor resection is essential for obtaining a pathological diagnosis.
Two cases of symptomatic submucosal lipomas of the large intestine are described. One occurred in a patient with familial multiple lipomatosis causing an intussusception and intermittent obstruction. The other caused subacute obstruction and rectal bleeding and was thought to represent a carcinoma. These two cases closely resemble those few patients with symptomatic lipomas of the colon that make up a small subgroup (6 percent) of a series of 91 patients with this diagnosis managed surgically at the Mayo Clinic between the years 1976 to 1985. The majority of patients in this series had lipomas that were entirely incidental findings usually associated with more significant pathology that dictated the operative procedures undertaken. Lipomas themselves may be managed by local excision only although segmental resection may be necessary in isolated cases.
Lipoma in the ventricular septum is very rare. Our review of the English literature revealed that our case is the sixth of removal of lipoma in the ventricular septum. A 60-year-old male was admitted because a mass in the ventricular septum was found incidentally in abdominal CT taken following type B hepatitis. CT scanning of the heart showed 2 cm diameter of tumor in the ventricular septum. The tumor had very low radiodensity, so it was thought to be identical to fat tissue. The tumor was more clearly visualized by MR imaging and the signal intensity was high on the T1-weighted image. The tumor was suspected to be lipoma. The intraoperative histological diagnosis showed the tumor was lipoma. The tumor adhered strictly on the myocardium of the septum, and it was located near the left anterior descending coronary artery. It could not completely resected, in these reasons. Postoperative course was uneventful, and echocardiogram taken 9 months after the operation showed no evidence of enlargement of the residual tumor. It is necessary to follow-up rigidly for the potential of enlargement of the residual tumor.
Lipoma is the most frequently encountered benign soft tissue tumor. However, intra-articular lipomas are rarely seen. Anterior knee pain is a frequent complaint of adults and is of diverse etiology. This 42-year-old female patient had severe anterior knee pain, unresponsive to medical treatment. Magnetic resonance imaging revealed an intra-articular tumor of the knee joint. Arthroscopic intervention and subsequent histological examination resulted in the diagnosis of strangulated lipoma originating from infrapatellar fat pad. We present clinical, radiological and operative features of this rare case of intra-articular lipoma.
OBJECTIVE: The imaging characteristics of lipoma arborescens using plain radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) are described. DESIGN AND PATIENTS: Five patients with a diagnosis of lipoma arborescens are presented. Three had monoarticular involvement of the knee joint. In the remaining two patients both knees and both hips, respectively, were affected. All patients were examined using plain radiographs and MRI. CT was employed in two cases. RESULTS AND CONCLUSIONS: A conclusive diagnosis with exclusion of other synovial pathologies having similar clinical and radiological behavior can be achieved on the basis of the MRI characteristics of lipoma arborescens. The aetiology of lipoma arborescens remains unknown, but its association with previous pathology of the affected joints in all our patients supports the theory of a non-neoplastic reactive process involving the synovial membrane.
Minimally invasive techniques and newer endoscopic surgical techniques are being introduced to aesthetic and reconstructive procedures at an accelerating pace. A new and modified technique of endoscopic excision of large encapsulated lipomas is presented and the versatility of creation of an optical cavity and incorporation of balloon dissection is discussed in two cases. Large encapsulated lipomas were removed endoscopically via transaxillary incisions and no immediate or late complication was observed. Endoscopic removal of lipomas offers several advantages over conventional direct excision and liposuction such as avoiding blind manipulation and fragmentation of lipoma mass, and unsightly scars. One drawback of this technique can be lengthy operation times, which have been near two hours for the presented cases. We conclude that endoscopic removal of tumors from a relatively remote site is beneficial in treating such encapsulated tumors and we speculate that endoscopy will prevent unsightly scarring in important areas while decreasing the operating time as experience is gained.
A case of parosteal lipoma of the femur combined with hyperostosis is presented. The parosteal lipoma is a rare benign tumor containing adipose tissue and is intimately related to the periosteum. We report the MRI features and correlative pathologic findings of a parosteal lipoma. The MRI technique is useful for evaluating the relationship between the periosteum and the lipoma.
OBJECTS: The authors report results of preoperative and postoperative urodynamic studies (UDS) and prognostic factors of urologic outcome in cases of lumbosacral lipomas for which prolonged follow-up data were available. MATERIALS AND METHODS: The present series includes 42 consecutive cases of lumbosacral lipoma in patients aged 2 months to 15 years who underwent untethering operation during the period from 1986 to 1997. All of them underwent preoperative and postoperative UDS. At the last follow-up (mean duration of follow-up 108 months, range 44 to 176 months), 26 cases maintained social continence with or without intermittent catheterization. Young age (< or =12 months) at operation, preoperative absence of urologic symptoms, and absence of neurologic abnormalities were significantly correlated with favorable urologic outcome. CONCLUSION: UDS in cases with lumbosacral lipomas is a valuable tool for detecting neurourologic abnormalities as well as for monitoring the postoperative course and guiding management. History taking and neurologic examination are also proved to be important aspects in the evaluation of children with lumbosacral lipomas, predictive of urologic outcome. Better urologic results are anticipated if surgery is performed when the child is 12 months old or younger.
OBJECTS AND METHODS: In this study, we demonstrate the morphological change in two cases of lumbosacral lipoma during the first few months of life using a three-dimensional Fourier transformation-constructive interference in a steady-state (CISS) sequence that enables high-resolution images to be obtained with excellent contrast between cerebrospinal fluid (CSF), spinal roots, and lipoma. RESULTS: The CISS images clearly demonstrated the dynamic morphological changes such as lipoma growth observed in both cases and increased tethering effect in the case with lipomyelomeningocele. CONCLUSION: We have to keep in mind the potential for these morphological changes of the spinal lipoma during the first few months of life.
Lipoblastoma is a rare adipose tumor occurring exclusively in childhood. There have been no reports of metastases, making the designation "blastoma" confusing, since this term is usually reserved for malignant tumors. Two recent cases treated at our institution confirm its benign nature. In addition, a review of the literature supports the idea that the tumor may more accurately be described as an "infantile lipoma". Infantile lipoma better reflects many of the tumor's characteristics such as, its early occurrence, it's ability to mature into a simple lipoma, it's cellular composition of mainly mature adipocytes, and its benign course. Although lipoblastoma is an uncommonly encountered tumor, making an effort to change its name to infantile lipoma will result in a more a accurate term that will facilitate treatment.
The major cytogenetic subgroup of lipomas is characterized by aberrations of chromosome segment 12q13-15, which recombines with a large number of other chromosomal regions. The gene HMGA2 is the main target in these aberrations. For some recurrent rearrangements, chimeric transcripts, including the 5' part of HMGA2, have been described. The 3' partners identified are LPP, LHFP, CMKOR1, and EBF. In addition, subsets of other benign solid tumors show aberrations of 12q13-15. Among pleomorphic adenomas of the salivary glands, where the preferred recombination partner with 12q13-15 is 9p22-24, an HMGA2/NFIB fusion gene has been reported. In the present study, two cases of lipoma with rearrangements of 9p22-24 and 12q15 were analyzed by reverse transcription polymerase chain reaction to find out if HMGA2/NFIB was also present in lipoma. An in-frame fusion transcript, combining the four first exons of HMGA2 with exon 8 of NFIB, was detected in one case. It was identical to a transcript that was previously described in salivary gland adenoma and contained a stop codon shortly 3' of the fusion point. The finding of the same fusion gene in different tumors is not unique. For example, HMGA2/LPP has been reported in lipoma, pulmonary chondroid hamartoma, and soft tissue chondroma. Since similar 9;12 translocations have been described also in rare cases of hamartoma and uterine leiomyoma, the occurrence of HMGA2/NFIB could be postulated in these tumors as well.
BACKGROUND: Missed lipoma of the spermatic cord is a pitfall unique to the transabdominal preperitoneal (TAPP) laparoscopic hernia repair. This problem occurs when a palpable inguinal mass is noted preoperatively, but no identifiable hernia defect is found at time of laparoscopy and the procedure is terminated. METHODS: Our group encountered six patients without intraperitoneal defects that had large cord lipomas on preperitoneal exploration. Two of these patients had undergone previous intraabdominal laparoscopy for a proposed TAPP repair, which was aborted when no defect was seen. RESULTS: Both patients were referred for continued symptomatic groin masses, which were subsequently treated by lipoma resection in conjunction with inguinal floor repair. CONCLUSIONS: When patients present with a groin mass, exploration of the preperitoneal space and cord structures is indicated during TAPP repair, even in the presence of a normal-appearing abdominal floor. Abandoning a transabdominal approach without exploration of the preperitoneal structures may lead to a failure to identify symptomatic and/or palpable cord lipomas.
Cardiac lipomas are very rare. We herein report a case of a 57-year-old woman who presented with intrapericardial extracavitary giant lipoma, and we also review the relevant literature. The patient had no symptoms except for a tendency to easily feel slightly fatigued. She underwent a resection of the lipoma through a clamshell thoracotomy. The lipoma weighed 1 700 g and had a cylindircal stalk measuring about 5 cm in diameter connected to the myocardium of the right ventricle.
This case report concerns a girl with spindle cell lipoma of the neck. Spindle cell lipoma is a variant of lipomas and was first described by Enzinger and Harvey in 1975. It occurs chiefly in males between 40 and 70 years of age. It is a benign lesion that can be cured by excision, and local recurrence is rare. Spindle cell lipoma is composed of adipocytes and non-fat-storing immature mesenchymal cells. The condition is uncommon in adults and had not been reported to occur in children.
Myxoid lipoma is an unusual histologic type of lipoma. This article reports four cases of myxoid lipoma that arose in the mouth. In frozen sections stained with oil red O, the cytoplasm of tumor cells stained strongly positive. Intercellular mucoid material was PAS-positive and diastase-resistant. It also stained positively with alcian blue. Electron microscopic observations revealed that adipocytes were in different stages of differentiation, with lipid globules of variable size observed in the cytoplasm. Many pinocytotic vesicles appeared at the plasma membrane. Mature adipocytes were surrounded by a basal lamina. Fibroblasts, collagen fibers, and mucoid material were scattered among adipocytes. It appears possible that, in the histogenesis of myxoid lipoma, multipotent mesenchymal cells undergo multidirectional differentiation. Some cells differentiate to produce mucosubstance, while others differentiate to become adipocytes.