First, Rule Out Cancer: Giant Lipoma

A Challenging "Achy" Neck

Lipomas are common benign mesenchymal tumours that may occur in many regions of the body. Giant neck lipomas are uncommon, especially when they arise from the neck and extend into the thorax. In this case report, we present a unique case of a giant submuscular lipoma involving the posterior neck triangle extending down to the scapular tip. A 43-year-old male presented with a six-month history of two slow-growing masses involving the left neck and scapular region. MRI demonstrated a single large fat suppressing lesion underlying the left trapezius muscle extending down to the scapula with homogenous signal return and smooth outline measuring 4.5x7.5 cm by 16 cm. Histology showed features consistent with lipoma. Giant lipomas in the neck post a significant diagnostic and surgical challenge. The importance of pre-operative planning and patient involvement in decision-making are essential.

Giant Lipoma of the Anterior Neck Causing Dyspnea

Lipomas are the most common benign mesenchymal tumors, composed of mature adipocytes, and may occur anywhere in the body where fatty tissue is present. Neck lipomas are rare and usually appear as solitary, small (<5 cm), and asymptomatic lesions located in the subcutis of posterior neck. Giant anterior neck lipomas are exceptionally rare and, other than cosmetic concerns, seldom present with respiratory symptoms. A 37-year-old female patient was referred for a long-standing anterior and right-sided neck swelling, which had markedly increased in size causing cosmetic disfigurement, neck discomfort, and transient episodes of dyspnea when lying on the side opposite the neck mass. Under general anesthesia, the lesion was completely dissected and removed through the elliptical cervical incision over the right supraclavicular fossa, while carefully preserving the surrounding neck structures. The postoperative recovery was uneventful and the patient was satisfied with the cosmetic outcome and relief of her respiratory symptoms.

Excision of a massive lipoma of the thigh following extensive weight loss and bariatric surgery

A 52-year-old morbidly obese man with a body mass index (BMI) of 78 kg/m² lost a great deal of weight through diet control over a 3-year period before undergoing bariatric surgery in the form of laparoscopic sleeve gastrectomy. He continued to lose weight, reducing BMI to 56 kg/m²; however, a large left medial thigh mass persisted. Differential diagnoses included lipoma, liposarcoma and hernia. An MRI scan revealed a 37 × 23 × 23 cm oedematous fatty swelling through which contained multiple enlarged inguinal lymph nodes and the great saphenous vein. Plastic surgeons excised the mass with direct closure of skin. Pathology confirmed lipoma with localised lymphoedema. This represents a case of giant lipoma, of which several reports have been described. We highlight the importance of preoperative imaging when planning resection of large masses to delineate the regional anatomy and the need for histological and genetic analysis to differentiate liposarcoma from lipoma due to their similar presentations.