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Endoscopic excision of large capsulated lipomas.

The technique of endoscopic excision of large capsulated lipomas is presented and the versatility of this method is discussed based on our clinical experience. We have applied this new technique in 6 cases. In all cases the lipoma was completely removed in one piece through a single incision, up to 1.5 cm in length. The endoscope made it possible to view the lipoma through a narrow space with a wide range of vision on a TV monitor. We stress that this method is not only appropriate as treatment for benign lipomas but also effective from a cosmetic point of view. The applications of the endoscope should widen in plastic surgery when the advantages of it are recognized and new operative approaches for using it are developed.

Adult↗

Giant lipoma of the breast.

Lipomas of the breast are usually small, benign neoplasms which can be treated by simple excision. Diagnosis of these masses, however, can be difficult because of the normal fatty composition of the breast. A number of radiological manoeuvres have been described for diagnosing deep lipomas in the breast, yet the clinical and radiographic identification of these masses remains challenging. We present a case of giant lipoma of the breast which was not appreciated on initial clinical and radiographic evaluation, and which was later found to comprise most of the mass of the breast. Following resection, the deformed breast was reconstructed using folded dermoglandular flaps from the areas expanded by the lipoma with excellent results. This case is an excellent illustration of the difficulties associated with diagnosis of these tumours and the reconstructive options available following excision.

Adult↗

Hourglass thoracic lipoma of infancy: case report and review of the literature.

The authors present a case of lipoma in infancy. A 12-year-old boy was referred for an asymptomatic fast-growing thoracic tumor of 1-month evolution. A simple chest x-ray showed an intra- and extrathoracic mass of extrapleural localization. Ultrasound scan and computed tomography studies were performed, and the diagnosis of an hourglass lipoma was confirmed by a fine-needle aspiration biopsy. Surgical excision of the tumor was performed and the pathological study reassessed the initial diagnosis of lipoma. The thoracic lipoma is a benign disease and has a good evolution after surgery.

Child↗

Pleomorphic lipoma of the orbit: a case series and review of literature.

OBJECTIVE: Pleomorphic lipomas are rare benign tumors that can resemble a variety of malignant soft tissue tumors on histologic examination. Six cases of patients with orbital pleomorphic lipoma, one of which was proven to be bilateral, are presented. DESIGN: Retrospective, noncomparative, interventional case series with clinicopathologic correlation. METHODS: Clinical and histologic review of 6 patients with pleomorphic lipomas of the orbit and histologic review of fat from 22 exenteration specimens and 20 other orbital procedures. MAIN OUTCOME MEASURES: Evidence of histologic abnormalities in histologic specimens. RESULTS: Pleomorphic spindle cells and multinucleated cells with nuclei arranged in a floret-like pattern were present in 7 specimens from 6 patients presenting with a clinical diagnosis of orbital fat prolapse, but there were no similar cell types present in the adipose tissue of 22 exenteration or 20 other orbital specimens. CONCLUSION: Pleomorphic lipoma may arise in the orbit, presenting as what was hitherto considered to be age-related epibulbar prolapse of orbital fat.

Aged↗

HMGA2 is expressed in an allele-specific manner in human lipomas.

The architectural transcription factor HMGA2 is almost exclusively expressed in undifferentiated mesenchymal cells. Interestingly, it has been mapped to the translocation site in a variety of human mesenchymal tumors that reveal a terminally differentiated phenotype. The expression of chimeric HMGA2 transcripts encoding three DNA-binding domains fused to novel transcriptional regulatory domains was previously described in lipomas. In this study with lipoma ST91-198, we report the expression of truncated HMGA2 transcripts that gained no functional domains. The highly polymorphic region in the 5' untranslated region (UTR) of HMGA2 was used to determine the allele-specific expression of HMGA2 in lipomas. Microsatellite PCR revealed a monoallelic expression pattern, and only the translocated allele was expressed when the DNA-binding domains of the rearranged allele were fused with transcription activation domains. Surprisingly, a diallelic expression pattern of HMGA2 was observed in lipoma ST91-198, and the wild-type allele was also expressed. In conjunction with studies involving rearrangements of HMGA genes in other benign mesenchymal tumors, our results support a model in which the expression of the wild-type HMGA allele is critical for the pathogenesis of mesenchymal tumors and in which rearrangements of HMGA do not lead to a gain of function in the chimeric HMGA protein.

5' Untranslated Regions↗

Cytogenetic investigation of canine lipomas.

Akin to humans, lipomas are common in the dog as well; however, until now there were no reports of cytogenetic investigations on these tumors in the canine. We report our results of cytogenetic investigations on a series of ten canine lipomas. Clonal aberrations were observed in seven cases. In one case a trisomy 27 was evident; in another case a trisomy 13 was present in addition to a marker chromosome. A third lipoma showed a fusion of chromosomes 2 and 13. These cases showed one derivative chromosome each (der(X), der(7), and der(4)), and one case had two derivative chromosomes (der(X) plus der(4)). In the two cases with derivative chromosomes 4, the same region (4q31) was affected. It is tempting to speculate that this region might harbor a gene associated with tumor development. The results are compared to the cytogenetic situation in human lipomas.

Animals↗

Dorsal mesencephalic lipoma with inferior collicular hypoplasia: a case report and review of literature.

Intracranial lipomas are rare lesions the pathogenesis of which is still a matter of debate. We report the case of a patient presenting an asymptomatic lipoma located in the quadrigeminal and supra-cerebellar cisterns. The lipoma was associated with hypoplasia of the right inferior colliculus and of the rostral part of the vermis. Analysis of the relationships between neural tube and meninges prompts us to propose that the primary event of this malformation is a defect of the neural anlage which gives rise to both nervous dysplasia and lack of meningeal induction responsible for lipoma development.

Adult↗

Histopathology of rare chondroosteoblastic metaplasia in benign lipomas.

Lipomas are frequent findings in the routine work of a pathologist. Variants of lipomas are characterized by an additional component, e.g. capillaries in angiolipomas, but ordinarily their classification does not pose any problem. In contrast to the high incidence of lipomas metaplastic formation of cartilage and bone is only rarely seen. This metaplasia is thought to develop on the basis of myxoid and chondroid change within the lipoma. Mechanical stress, trophic disturbances, the conspicuously frequent contact with periosteum and even still unknown factors may represent the causes for the metaplastic transformations. Four own case reports of chondro- and osteolipomas are described and discussed in view of the gross and microscopic findings.

Adipose Tissue↗

Lipoma of the pancreas: MRI findings.

Lipomas of the pancreas are very rare. Focal fatty infiltration of the pancreas is an entity that should be differentiated from a pancreatic lipoma. In this report the MRI findings of an incidentally found pancreatic lipoma are presented and the role of MRI in the differentiation of pancreatic lipoma and focal fatty infiltration of the pancreas is discussed.

Diagnosis, Differential↗

Intraoral lipoma. A rare cause of dysphagia.

Lipomas of the oral cavity are rare and in most cases asymptomatic. A case of lipoma in the floor of the mouth in a 89-year-old man, causing severe dysphagia and difficulty with speech, is presented. After surgical excision of the lipoma, the symptoms disappeared. Histologically, lipomas are composed of mature fat cells. Their aetiology is uncertain. Recurrence after surgical excision is unusual.

Aged↗

Spinal intramedullary lipoma: report of three cases.

STUDY DESIGN: Case report. OBJECTIVE: To report three cases of spinal intramedullary lipoma seen in the last 10 years and present the clinical characteristics and surgical outcome of these cases. METHOD: Two patients were boys aged 12 years and 7 months, respectively. The other was a female patient aged 6 months. Chief complaints were hemiparesis, back swelling and thoracic scoliosis. All patients were diagnosed with magnetic resonance images. The lesion was located in the cervico-thoracic spine (foramen magnum to T1) in one case, thoracic spine (T9-T12) with the back swelling at L2-4 level in the second, and in the third, one mass extended from C6 to T11 and the other mass was located in the L1-2 level, separately. RESULT: All masses were removed subtotally and dysraphism was absent. Postoperatively, neurological status of the first and the second patient were unchanged, but in the third case weakness was transiently aggravated. CONCLUSION: Intramedullary lipoma is a rare spinal lesion and multiple intramedullary lipoma is extremely rare. Treatment principle is surgical decompression before symptom progression. Laminoplastic laminotomy is an appropriate approach for decompression of an intramedullary lipoma.

Child↗

Spindle cell lipoma of the scalp: a case report and review.

Cutaneous surgeons frequently evaluate and manage soft tissue tumors arising on the head and neck of adults. Of these, the most common tumor is the lipoma, and specific mesenchymal variants of lipoma occur classically on the head and neck. We describe a case of a large spindle cell lipoma of the posterior scalp, in order to highlight the classic location and differential diagnosis of the lipoma variants presenting commonly in this anatomic region. In addition, we review the role of preoperative imaging studies of scalp soft tissue tumors and discuss how imaging may assist the dermatologic surgeon in establishing the diagnosis and designing a rational surgical approach.

Diagnosis, Differential↗

The expression of MDM2/CDK4 gene product in the differential diagnosis of well differentiated liposarcoma and large deep-seated lipoma.

Ordinary lipomas are cytogenetically characterized by a variety of balanced rearrangements involving chromosome segment 12q13-15, whereas well differentiated liposarcomas (WDL) show supernumerary ring and giant marker chromosomes, known to contain amplified 12q sequences. The tight correlation between the presence of ring chromosomes and both amplification and overexpression of MDM2 and CDK4 genes suggests the exploration of the possibility that immunocytochemistry (ICC) might assist in the differential diagnosis of lipoma-like well differentiated liposarcomas (LL-WDL) and large deep-seated lipomas (LDSL). For this purpose, 21 cases of the former and 19 cases of the latter tumours were analysed by ICC and, according to the availability of material, by molecular and cytogenetic approaches. All lipomas displayed a null MDM2/CDK4 phenotype, whereas all LL-WDL showed MDM2/CDK4 or CDK4 phenotypes. Southern blot analysis performed on 16 suitable cases, complemented by fluorescence in situ hybridization and classical cytogenetic analysis in 11 cases, was consistent with, and further supported the immunophenotyping data. In conclusion, MDM2/CDK4 product-based immunophenotyping appears to represent a valuable method for the categorization of arguable LDSL.

Adult↗

[Lipoma of the cerebellopontine angle - a case report].

BACKGROUND: Lipomas of the cerebellopontine angle are rare. Until today in the english literature only isolated cases are described. The most frequent symptoms are: hearing loss (62,2 %), vertigo (43,3 %) and tinnitus (42,2 %). With the help of MRI intracranial lipomas can be diagnosed almost certainly. PATIENT: A 26 year old patient presented himself to our outpatient departement with recurrent vertigo and tinnitus since two months. Electronystagmography and caloric testing showed a unilateral weakness of the right vestibular organ. Audiometric examination revealed a Normacusis on the right side. BERA resulted in borderline prolonged interpeaklatency on the right side, wave I-V. MRI showed a ca. 5x8x11 mm Lipoma of the right cerebellopontine angel which surrounded the vestibulocochlear nerve. In contrast to schwannomas which are often described in this area the lesion did not enhance contrast medium. On the native T1 sequence the tumor was hyperintense and fat-supression images confirmed the tumor to be fat in origin. Because of the minor symptoms and the small size of the tumor we recommended a BERA after six months and an MRI every year. CONCLUSION: The therapeutic options of a lipoma of the cerebellopontine angel depend on the clinical symptoms and a radiologic confirmed progression of size. Because of the received data until today an operative therapy is only indicated when symptoms clinically can not be treated or the leason seems to be a well differentiated liposarcoma.

Adult↗

Lipomas of the peripheral lung--a case report and review of the literature.

Bronchial lipomas are uncommon benign neoplasms of the lung and the number of these tumours is only 109 cases in the international literature (108 cases reported in English and one in German) up to date. Moreover, most of the tumours occur in the proximal portions of lobar or segmental bronchi: the references in the literature to peripheral lipoma of the lung make up only 6 cases. Peripheral lipomas of the lung are thought to originate from fatty tissue in the wall of peripheral bronchi. We present a further case of peripheral lipoma and analyze the reported 7 cases.

Adult↗

Glycosylation of lipoprotein lipase in human subcutaneous lipomas.

Glycosylation of lipoprotein lipase (LPL) was studied in human subcutaneous lipomas. Heparin-releasable LPL activities were higher in lipomas than those in adjacent normal adipose tissues, and showed good correlation with cellular LPL protein mass. Molecular weight of LPL subunit was 57 kDa in both tissues. After endoglycosidase H-digestion, two types of LPL subunits were found in normal adipose tissues; partially sensitive (55 kDa) and totally sensitive (52 kDa) form. In lipoma tissues, the fraction of partially sensitive form (55 kDa) was increased comparing with control adipose tissues. These results suggest that partially sensitive subunits constitute the major secretable form of LPL in human subcutaneous lipomas.

Adipose Tissue↗

Lipomatosis and true lipomas of the ileocecal valve.

Two patients with lipomatosis and two patients with true lipoma of the ileocecal valve are described. The symptomatology, radiological appearances, pathological findings and treatment are discussed. True lipomas of the ileocecal valve should be differentiated from the more commonly occurring lipomatosis or lipohyperplasia. The rare true lipomas have a demarcating capsule around the fatty tissue and are confined to only one of the ileocecal lips. The lipomatosis, on the other hand, is characterized by a diffus fatty deposition in the submucosa of the valve with no encapsulation. Lipomatosis as well as true lipomas may appear as rounded, smoothly outlined and sharply demarcated masses on barium enema examination. Occasionally, these filling defects may present problems of differential diagnosis with respect to malignant involvement of the ileocecal region. A correct preoperative diagnosis, however, is important to prevent unnecessary or too radical surgical treatment.

Aged↗

Transgenic mice expressing a truncated form of the high mobility group I-C protein develop adiposity and an abnormally high prevalence of lipomas.

Chromosomal translocations in human lipomas frequently create fusion transcripts encoding high mobility group (HMG) I-C DNA-binding domains and C-terminal sequences from different presumed transcription factors, suggesting a potential role for HMG I-C in the development of lipomas. To evaluate the role of the HMG I-C component, the three DNA-binding domains of HMG I-C have now been expressed in transgenic mice. Despite the ubiquitous expression of the truncated HMG I-C protein, the transgenic mice develop a selective abundance of fat tissue early in life, show marked adipose tissue inflammation, and have an abnormally high incidence of lipomas. These findings demonstrate that the DNA-binding domains of HMG I-C, in the absence of a C-terminal fusion partner, are sufficient to perturb adipogenesis and predispose to lipomas. We provide data supporting the central utility of this animal model as a tool to understand the molecular mechanisms underlying the development of one of the most common kind of human benign tumors.

Adipocytes↗