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At least 127 records · Page 7Linked to original sources
PubMed2005

Usefulness of constructive interference in steady-state magnetic resonance imaging in the presurgical examination for lumbosacral lipoma.

OBJECT: The aim of this study was to evaluate three-dimensional Fourier transformation constructive interference in steady-state (CISS) imaging as a preoperative investigation of anatomical structures around the lumbosacral lipoma for surgical untethering of the spinal cord and debulking of the lipoma. METHODS: The CISS imaging was used to visualize neural structures around the lumbosacral lipoma in 13 cases and was compared with conventional magnetic resonance imaging. In all cases, CISS images demonstrated the fine structure of the spinal cord and nerve roots, with good contrast between subarachnoid spaces and lipomas. The CISS findings were closely correlated with microscopic observation and electrophysiological investigation during surgery. In three of eight patients whose CISS images demonstrated abundant nerve roots embedded in the lipoma, untethering of the conus medullaris was not satisfactorily achieved. These three cases had obliteration of the subarachnoid space by the lipomas at the bilateral sides of the cord. In two cases with the vertebral misalignments scoliosis and lordosis, curvilinear reconstruction of CISS images along the spinal cord clearly demonstrated a neuroanatomy around the complicated lipomas. CONCLUSIONS: Using CISS imaging is useful for establishing precise neuroanatomical information around lumbosacral lipomas and for predicting the level of surgical difficulty.

Child↗
PubMed2002

Lipoma excision.

Lipomas are adipose tumors that are often located in the subcutaneous tissues of the head, neck, shoulders, and back. Lipomas have been identified in all age groups but usually first appear between 40 and 60 years of age. These slow-growing, nearly always benign, tumors usually present as nonpainful, round, mobile masses with a characteristic soft, doughy feel. Rarely, lipomas can be associated with syndromes such as hereditary multiple lipomatosis, adiposis dolorosa, Gardner's syndrome, and Madelung's disease. There are also variants such as angiolipomas, neomorphic lipomas, spindle cell lipomas, and adenolipomas. Most lipomas are best left alone, but rapidly growing or painful lipomas can be treated with a variety of procedures ranging from steroid injections to excision of the tumor. Lipomas must be distinguished from liposarcoma, which can have a similar appearance.

Adult↗
PubMedDate not supplied

[Neurosurgical treatment of children with spina bifida associated with congenital spinal lipoma in the lumbosacral region].

This paper presents twelve neurosurgically treated children with spina bifida associated with congenital spinal lumbosacral lipoma over a 3-year period. The introduction deals with various types of lipoma, their development, clinical presentation, local findings in children with spinal lipoma, as well as with the significance of neurosurgical treatment. The age span of children with occult spina bifida and spinal lumbosacral lipoma was from 3 months to 2 years, and there were seven girls and five boys. In all the twelve children, a smaller or bigger fatty mass in the lumbosacral area was noticed immediately after birth, gradually increasing in size. Neurologic examination revealed weakness of lower extremities, with somewhat atonic sphincters, in only two of the children. Spinal dysraphism was demonstrated by plain roentgenograms in all the twelve children, while CT-scans, CT-myelography and recently MR-scans, confirmed the diagnosis of spinal lipoma. In all the twelve children the spinal lipoma and the adherences between the lipoma and the low-lying conus or an enlarged filum terminale were removed by the neurosurgical excision. Follow-up of children 6 and more months following the surgery showed improvement of their condition. Spina bifida associated with congenital spinal lumbosacral lipoma is a condition that although benign in histology, can have devastating effects if not surgically corrected early. Children who are asymptomatic at the time of repair will tend to remain asymptomatic. Those who are not repaired early will develop and show subsequent deterioration as time progresses.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗
PubMed1991

Submucous large-bowel lipomas--presentation and management. An 18-year study.

Gastrointestinal lipomas are rare, but commonest in the colon and rectum, characteristically submucosal and seldom subserosal. An 18-year analysis revealed 17 cases of large-bowel lipoma, 13 presenting with colicky pain, abdominal discomfort, blood-stained feces or rectal bleeding and altered bowel habits and four asymptomatic. The 17 patients had totally 21 lipomas, all submucosal. No patients with multiple lipoma had evidence of lipoma at other sites. The ileocecal valve and cecum were most commonly affected, followed by the rectum, sigmoid colon and descending colon. Tumor size (largest diameter) was 0.5-10 cm, averaging 3.1 cm (3.5 cm in symptomatic, and 1.8 cm in asymptomatic patients). The primary diagnosis (with barium enema, colonoscopy and CT) was lipoma in only five cases, but CT gave the correct diagnosis in all three cases in which it was used. Two lipomas were found in surgical specimens from colorectal malignancy, while nine were misinterpreted as polyps and one as angiodysplasia. In symptomatic patients unnecessary colotomy or colonic resection may be avoidable by colonscopic removal of lipoma.

Adult↗
PubMedDate not supplied

Intrarachidian lipomas. Observations on 4 cases and pathogenetic considerations.

The Authors report 4 cases of spinal lipomas: 2 intradural, 2 completely intrarachidian extradural. The intradural lipomas observed were 2 cases in the lumbo-sacral area, both operated on by the partial removal of the lesion with very good clinical results; histologically they were found to be 2 fibrolipomas. The 2 cases of extradural lipomas, completely intrarachidian, were situated in the thoracic and lumbar areas. Both were operated on with very good results and it was possible to remove all the lesion. They were found to be an angiolipoma and a mature lipoma. On the basis of the literature, the Authors maintain that, for these cases of intradural lipoma, the disembryogenetic hypothesis (such as embryological ectopia) should be accepted as etiopathogenesis. They point out the nature and origin of extradural lipomas, arising in a site where adipose tissue is abundant, have never aroused interest on their origin, but they too can be considered malformative lesions of the hamartomatous type and not neoplastic lesions. These data are confirmed by the remarkable frequency in these cases of the mixed variety of lipoangiomato or angiomiolipomatosis. The Authors thus underline the importance of the relationship between the presence of a subcutaneous lipoma in cases of completely intrarachidian extradural lipomas to support the hypothesis of malformative origin.

Adult↗
PubMedDate not supplied

[Lipomas of the digestive tract. Review of the literature apropos of 5 cases].

In addition to presentation of five personal observations of lipomas of the digestive tract (1 esophageal, 3 gastric, 1 jejunal), the authors review over 1 400 cases published in the literature. No cases of degeneration were found. Esophageal lipomas are extremely rare (1.5 p. cent of digestive tract lipomas) and are often confused, prior to anatomical proof, with leiomyomas, which are much more frequent. Lipomas represent 3 to 5 p. cent of all benign tumors of the stomach; the most frequent site is the antrum and the average diameter is 5 cm. From a clinical standpoint, such tumors are asymptomatic unless they are of large size or peri-orificial. The radiologic diagnosis is usually a benign tumor, lipomas being diagnosed only rarely. Lipomas of the small intestine represent 13 to 15 p. cent of all benign tumors there; the preferential site is the ileum (49.6 p. cent), followed by the duodenum (23.4 p. cent). Clinical latency was associated with 43 p. cent of the cases reviewed. Barium examinations generally led to the diagnosis of a benign tumor but provided no etiological information. Lipomas constitute the most frequent benign tumor of the colon and rectum after adenomas. When compared with all other locations, the colon accounts for 51.1 p. cent of cases. No preferential site was observed within the colon itself, and multiple forms were seen in 14 p. cent of cases. Clinical latency was associated with 30.3 p. cent of the colo-rectal cases reviewed, and radiological exams were generally unable to diagnose lipomas.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[On parosteal lipomas of the limbs].

Among the benign neoplasias of mesenchymal origin, parosteal lipomas represent a relatively rare occurrence. They are deep seated (subfascial) lipomas which during the course of their slow growth become adherent to the periosteum. The parosteal lipoma is not dissimilar to the so-called common or superficial lipoma both in terms of its macroscopic appearance, since this neoplasia has no capsule which separates it from surrounding tissue and likewise enables an easy enucleation owing to the presence of a cleavage plane, and in terms of its microscopic appearance since it is made up of mature adipose cells. Moreover, comparative cytogenic tests have revealed chromosomic alterations common to both the superficial and parosteal lipoma. The peculiarity of the parosteal lipoma lies in its clinical evolution which depends on the original site; it is in fact most often described in relation to bone segments of the limbs where it may lead to the compression of the vasculonervous axes. In particular, parosteal lipoma of the forearm, especially if localised in the upper third, represents a separate clinical entity given that, during the course of its growth, it may cause the compression of the posterior interosseous nerve and the surface (sensitive) branch of the radial nerve. This occurrence, which is observed in approximately half of all cases, must be taken into consideration and should lead to the decision to operate in order to prevent compressive sequelae involving nervous axes. After reviewing the literature on the subject, the authors report their experience of four recent cases and evaluate the anatomical, clinical, diagnostic and therapeutic aspects of parosteal lipoma.

Adult↗
PubMed2003

Intraosseous lipoma: report of 35 new cases and a review of the literature.

OBJECTIVE: To identify the common imaging features of intraosseous lipomas on radiographs, magnetic resonance imaging (MRI) and computed tomography (CT), and review their histological features. DESIGN AND PATIENTS: Thirty-five previously unreported cases of intraosseous lipoma were reviewed and a meta-analysis was performed of another 110 cases identified from the English language literature. RESULTS: The mean age at presentation is 43 years. Sex distribution is nearly equal. Lipomas occur most frequently in the lower limb (71% overall), particularly in the os calcis (32%). Other common sites include the metaphyses of long bones, where lesions are typically eccentric. Lipomas are usually well defined, but marginal sclerosis is commoner in lesions of the os calcis (61%) than at other sites (38%). Calcification is also more frequent in the os calcis (62%), and almost invariably centrally located. Calcification at other sites is less common (30%), and is more variable in appearance. Bone expansion is less common (30%), and usually minimal. Fat necrosis and cyst formation identified on MRI is common (67%), and more frequent in the os calcis. CONCLUSIONS: Although there is correlation between the histological and radiological features of intraosseous lipomas in general, some discrepancies occur in the radiological appearances of lipomas in different sites. The evidence that these lesions are true benign tumours of fat is controversial. Several aetiological factors have been implicated in their development. The constant location of os calcis lesions at the critical angle suggests an aetiology that may be related to biomechanical lines of stress. In other instances it is possible that involution of pre-existing lesions may lead to the development of lipomas.

Adolescent↗
PubMed2002

The value of fat-suppressed T2 or STIR sequences in distinguishing lipoma from well-differentiated liposarcoma.

The objective of this study was to evaluate the diagnostic value of fat-suppressed T2-weighted (FS-T2) images or short tau inversion recovery (STIR) imaging in distinguishing lipoma from lipoma-like subtype of well-differentiated liposarcoma. Spin-echo T1-weighted and STIR or fat-suppression T2-weighted sequences were performed in 60 lipomas and 32 lipoma-like well-differentiated liposarcomas, histologically proven, looking for thick septa or nodules in T1-weighted images and linear, nodular, or amorphous hyperintensities on FS-T2/STIR sequences. Fourteen lipomas (23.3%) showed thick septa and/or nodules on T1, whereas on FS-T2 or STIR sequences only seven (11.7%) displayed hyperintense nodules and/or septa. All well-differentiated liposarcomas contained these signs on FS-T2 or STIR sequences. The presence of hyperintense septa or nodules in a predominantly lipomatous tumor on FS-T2/STIR sequences helps to differentiate malignant tumors from lipomas. Employing the presence of hyperintense nodules and/or septa as criteria of malignancy specificity was 76.6% and sensitivity 100%. Overdiagnoses of well-differentiated liposarcoma can occur due to the presence of non-lipomatous areas within lipomas.

Adipose Tissue↗
PubMed2006

Perineal lipomas associated with anorectal malformations.

Newborns with anorectal malformations may have associated perineal lipomas. These lesions are rare but may make the repair of the anorectal malformation more complex. Knowledge about the functional consequences of these lesions is scanty. The purpose of this study was to review the experience of anorectal malformations with perineal lipomas in two Scandinavian paediatric surgical centres. Six patients with perineal lipomas and anorectal malformation treated in the two centres from 1991 to 2005 were retrospectively reviewed. Bowel function was evaluated in patients more than 4 years old. Three girls and three boys (age 4 months to 14 years) with anorectal malformations and perineal lipoma were included in the study. The boys all had high anorectal malformations with rectourethral or rectovesical fistulas. Two girls had a rectovestibular fistula and one girl had a cloaca. All patients had perineal lipomas, in one associated with an anterior meningocele. The lipomas were excised at time of anorectal reconstruction. One of the patients still has a colostomy, and two colostomies were recently closed. The bowel function was evaluated in three patients. Two patients have an ACE stoma to control constipation and soiling and one is soiling despite regular washouts. In conclusion, perineal lipomas associated with anorectal malformations are rare but may distort sphincter anatomy. Excision is best performed at time of anorectal reconstruction. Although our experience is limited, bowel function seems to be compromised by these lesions.

Adolescent↗
PubMed2004

Inguinal cord lipomas.

Fatty tissue within the internal cremasteric fascia is frequently encountered during hernia surgery, and it is called a cord lipoma in the surgical literature. Between 1997 and 2001, 128 consecutive patients with 139 indirect inguinal hernias, who underwent open repair, were evaluated. A total of 100 lipomas of the spermatic cord or round ligament were identified and resected in 92 patients. There were no reported neoplastic changes noted in histopathologic examinations of the specimens. The incidence of cord lipoma associated with indirect inguinal hernia was 72.5%. Average body mass index (BMI) was 25.7 in patients with lipoma and 24.6 in patients without lipoma ( P=0.048). The incidence of cord lipoma in large hernias (Nyhus Type II and IIIb) was higher in our patients ( P<0.005). It can be clearly seen during laparoscopic exploration of the preperitoneal space that cord lipoma is a continuation of extraperitoneal fat tissue. We believe that even if there is no peritoneal sac, the herniation of extraperitoneal fat through the inguinal canal should be counted as an inguinal hernia, and it requires treatment.

Adolescent↗
PubMed2004

Lipomas of the pineal region.

BACKGROUND: Intracranial lipomas are rare lesions, representing 0.02% of operated intracranial lesions. Lipomas of the pineal region are even rarer and are reported occasionally in the literature. This is possibly because of the fact that they may give rise to clinical symptoms rather infrequently. When they become symptomatic, some form of management must be contemplated. METHODS: Four cases of lipomas of the pineal region observed in our institute during a 5-year period were investigated, and clinical-diagnostic features were studied. Two of the cases were symptomatic and were submitted to direct surgical treatment. RESULTS: Computed tomography (CT) scanning was performed in 3 cases and magnetic resonance imaging (MRI) in all 4. MRI angiography was performed in the last case. The appearance of the lipoma was quite pathognomonic in the neuroimaging diagnostic test. The infiltrative character of the lesion was better defined by MRI. MRI angiography gave evidence of the upward displacement of the deep veins. Direct surgical approach was performed via a right occipital transtentorial approach in one case and supracerebellar route in another. Neither approach appeared to be superior to the other one. Total removal of the lesion seemed to be impossible because of the infiltrative character of the lesion. Postoperative results were satisfactory even with incomplete removal of the lesion. CONCLUSION: Lipomas of the pineal region are rare. Modern neuroimaging permits a straightforward diagnosis of the nature of intracranial lipomas in general and of these lipomas in particular. Some form of management must be contemplated when these lesions become symptomatic. Direct surgical approach, either via an occipital transtentorial or an infratentorial supracerebellar approach, is feasible. Tumor removal must be dealt with cautiously because total removal is impossible without unacceptable postoperative deficits, and generous partial removal warrants long-term symptomatic improvement.

Adult↗
PubMed2002

Multiple subpial lipomas with dumb-bell extradural extension through the intervertebral foramen without spinal dysraphism.

BACKGROUND: Intradural subpial lipomas not associated with spinal dysraphism, account for less than 1% of spinal cord tumors. The simultaneous existence of multiple intradural subpial lipomas with dumb-bell extradural extension through the intervertebral foramen in the same patient without any evidence of spinal dysraphism has not been previously reported. CASE DESCRIPTION: A 38-year-old man presented with progressive spastic paraparesis, and weakness of right elbow extension and opposition of the medial three fingers. He also had ascending paraesthesia from the C6 dermatome to the saddle region and loss of joint and position sense of both lower limbs with hesitancy and precipitancy of micturition. There was no spinal tenderness, deformity, neurocutaneous markers, or spinal dysraphism. The total duration of illness was 11 years. The oblique views of the plain radiographs of the cervical spine revealed an enlarged right C7-D1 intervertebral foramen. The T1- and T2-weighted magnetic resonance (MR) images showed two intradural, hyperintense lesions (with extensive loss of signal on fat suppression sequences), one extending from C5 to D2 and the other opposite the C3-4 disc space. The parasagittal and axial images showed the extradural component of the lesion emerging from the right C7-D1 intervertebral foramen. At surgery, a C2 to D2 laminectomy was performed. The lipoma, enclosed in a fine pial membrane, was situated on the right posterolateral aspect of the cord. The right-sided nerve roots from the C6 to D1 levels were completely enmeshed by the lipoma. There was a separate superficial subpial lipoma adherent to the posterior aspect of the cord at the C3-4 level. A distinct area of normal cord was present between the two lesions. A subtotal decompression of the lesions including the component emerging through the right C7-D1 intervertebral foramen and a duraplasty were performed. At follow-up after 18 months, the posterior column impairment, lower limb hypoaesthesia, and right upper limb paraesthesia had improved. However, residual elbow extension and lower limb weakness, mild lower limb spasticity and sphincteric dysfunction persisted. CONCLUSIONS: The multiplicity of intradural subpial lipomas without spinal dysraphism points to a dysembryogenetic basis similar to that seen in patients with spinal dysraphism that results in lipomas, but in which the defect is not severe enough to give rise to coexisting vertebral and soft tissue anomalies. The dumb-bell extradural extension through the intervertebral foramen is extremely rare. The magnetic resonance imaging and surgical principles are discussed.

Adult↗
PubMed2005

Lipomas of the head and neck: presentation variability and diagnostic work-up.

INTRODUCTION: Head and neck lipomas have seldom drawn attention in the literature, except in isolated case reports. AIMS: This study aimed to assess the presentation variability of head and neck lipomas as well as the relative importance and efficiency of pre-operative diagnostic methods used. MATERIALS AND METHODS: A retrospective review was undertaken of medical records and imaging studies of 24 patients with histopathologically proven head and neck lipomas, over a three-year period. RESULTS: The 24 patients had 26 lipomas. Men predominated (62.5 per cent). The posterior subcutaneous neck was the most common site. Three patients had deep lipomas affecting the hypopharynx, larynx and parotid gland; all were correctly diagnosed pre-operatively. Computed tomography (CT) scan with specific radiodensity recording was the preferred pre-operative investigation. CONCLUSIONS: Lipomas should be considered in the differential diagnosis of soft-tissue head and neck masses even in rare locations. A CT or magnetic resonance imaging scan can correctly diagnose a lipoma pre-operatively, thereby allowing better treatment planning.

Adolescent↗
PubMed2001

"Pot-lid" technique for aesthetic removal of small lipoma on the face.

BACKGROUND: Patients presenting with an asymptomatic subcutaneous facial lipoma desire its removal in order to restore the contour of the face. The standard treatment for lipoma is excision, with the size of the incision being about one-half of that of the tumor itself. The long linear scar resulting from simple excision may fail to improve the appearance of the patient. The removal of the lipoma through a small incision or a punch hole decreases the size of the resulting scar, but does not eliminate it completely. OBJECTIVE: To improve the aesthetic outcome of the commonly used technique for lipoma removal, known as the narrow hole extrusion technique (NHET), by modification. METHODS: Four patients (three men and one woman) with small lipomas on the face (three on the forehead and one on the cheek) were selected for the procedure. A 5-mm punch was inserted deep into the center of the lesion to create a circular hole. The punched-out piece of skin was kept in normal saline. The lipoma was extruded with the help of a hemostat and by squeezing pressure. This resulted in the formation of a subcutaneous cavity. After achieving hemostasis, two absorbable buried subcutaneous sutures were placed to create support for the graft. The punched-out piece of skin was then positioned to cover the defect, like a "lid on a pot" and dressed. RESULTS: The color and texture match of the graft with the surrounding skin were excellent in three of the four patients by the end of 6 months. The graft, which was depressed in the fourth patient, improved through spot dermabrasion. CONCLUSION: The proposed modification of the NHET for lipoma removal improves the cosmetic outcome.

Adult↗
PubMed1998

Spontaneous shrinkage of lumbosacral lipoma in conjunction with a general decrease in body fat: case report.

OBJECTIVE AND IMPORTANCE: We describe a rare case of a lumbosacral lipoma that shrank spontaneously in parallel to a general loss of body fat. Although early prophylactic surgery is generally recommended for lumbosacral lipomas, the observation made in this case may provide an important implication regarding the conservative management of this disorder. CLINICAL PRESENTATION: A 9-year-old male patient with a subcutaneous lipoma at the sacral level was found to have a lumbosacral lipoma in the spinal canal and tethered spinal cord, as revealed by magnetic resonance imaging. The patient showed no neurological or urological deficits, except for a mild pes cavus deformity. INTERVENTION: Follow-up magnetic resonance imaging performed 4 years later revealed a significant decrease in the size of the lumbosacral lipoma. The patient became very thin and showed no neurological deterioration during the follow-up period. The shrinkage of the lipoma was considered to be in association with the general loss of body fat. CONCLUSION: The control of body weight may be an important factor in the conservative management of patients with lumbosacral spinal lipomas.

Child↗
PubMed1999

Another indication for liposuction: small facial lipomas.

The treatment of facial lipomas at times requires the use of incisions that are less than satisfactory in either size or location. In an effort to minimize scarring, the authors have been removing these lesions with liposuction. The purpose of this study was to review the authors' experience in treating small facial lipomas using liposuction. Over the last 10 years, the authors treated five patients with forehead lipomas by removal with liposuction through hair-bearing scalp incisions. All patients were evaluated after the procedure for bleeding, paresthesias, recurrence, scarring, and overall satisfaction with the procedure. All of these patients had lipomas that measured 4 cm or less at the time of surgery. No patient experienced hematoma, nerve injury, or recurrence. All patients were completely satisfied with their result and scar. The literature describes an advantage to using liposuction for the treatment of medium (4 to 10 cm) and large (>10 cm) lipomas. Because small lipomas (<4 cm) can be extracted through small incisions, the literature reports no advantage to removal with liposuction. However, favorable aesthetic results can be obtained by removing small facial lipomas with liposuction through strategically placed incisions.

Adult↗
PubMedDate not supplied

Spinal lipomas in children--surgical management and long-term follow-up.

Since its introduction, MR imaging has been easy to perform on all children with lumbosacral cutaneous stigmata, and has enabled the phenomenal refinement of spinal pathology. We investigated the overall outcomes of children with spinal lipomas at the Osaka Medical Center and Research Institute for Maternal and Child Health in Osaka, Japan. Between 1991 and 2003, 76 children with a tethered cord underwent a total of 90 surgical procedures at our institutes. Of this cohort, 67 cases had spinal lipomas. The mean age of patients at first operation for asymptomatic lipoma was 22.4 months (range: 1 month to 16 years, trim mean: 10.1 months, mode: 5 months), except 4 cases. The mean total follow-up for the cohort since the first surgical procedure was 7.2 years (trim mean: 7.9 years). Since the introduction of MR imaging, the reoperation rate for symptoms or signs in our series was 16.4% (11 cases). Regarding the 13 subsequent reoperations (2 patients had 2 operations), 3 patients were reoperated on due to multiplication of the lipomas after untethering, 3 due to urologic symptoms and 5 due to orthopedic signs. There were 2 cases who also had to undergo reoperation early due to CSF leakage. Filum and conus lipomas have similar tethering pathologies, but differ in the outcome following surgery. Filum lipomas are benign, and therefore surgery is safe and effective. Conus lipomas are more difficult to manage.

Adolescent↗