Lipoma or liposarcoma? A cautionary case report

Femoral canal lipoma presenting as chronic venous insufficiency

Lower limb venous obstruction secondary to a lipoma is a rare occurrence. Patients with these benign soft tissue tumors can be asymptomatic, or may experience symptoms of pain, parasthesia, paralysis and swelling secondary to compression on adjacent neurovascular structures. Duplex ultrasound examination is the first-line investigation, but has its limitations. We report on a case of venous obstruction syndrome misdiagnosed as chronic venous insufficiency on duplex ultrasound examination, from a deep-seated giant lipoma compressing on the common femoral and distal external iliac vein in a patient with Dercum's disease.

Intraosseous lipoma of the jaws: Review of the literature and rare case report

BACKGROUND

Lipoma is a benign tumor that arises at the expense of mature adipose tissue, it can occur anywhere in the body that contains adipose tissue. However, the intraosseous lipoma is considered a rare bone tumor, that affects the long and flat bones, but it is uncommon in the jaws. Usually, diagnosis based on clinical and radiographic features is insufficient and histopathology analysis is of utmost importance for the final diagnosis.

CASE PRESENTATION

In this article, we present a case report of a 28-year-old female patient who visited the dentist with the intention of extracting an impacted tooth. She had no medical history with medications or genetic diseases. The tooth was extracted with a small soft mass that was subjected to histological analysis and it was found to be an intraosseous lipoma.

DISCUSSION

Intraosseous lipoma is a rare tumor of the oral cavity, and it can be difficult to diagnose when only clinical and radiographic features are based, and the definitive diagnosis is based on histological examination. The treatment is complete surgical excision.

CONCLUSIONS AND LITERATURE REVIEW

30 cases were discovered and archived since 1948 until now, most of them were in the posterior region of mandibular, and the infection of females is higher than males with different final sub-diagnosis of types of intraosseous lipoma.

Removal of subcutaneous lipomas: Interest of liposuction

Subcutaneous lipomas are very common tumors. We report our experience of treatment by liposuction in carefully selected patients, initially referred for conventional surgical excision.

Upper extremity sarcoma: impact of current practice guidelines and controversies on reconstructive approaches

The goals of sarcoma management include both a cure and the functional preservation of involved tissues and adjacent critical structures with common opinions favoring immediate reconstruction. The question arises whether these goals are contradictory. This paper discusses the question based on the experience of 28 patients with different types of extremity sarcoma, with 24 surgically treated by the University of California San Diego (UCSD) orthopedic and plastic surgery team (2011–2016) and the collection of evidence from published practice guidelines, reviews, case studies, and clinical trials. Included are the impact of limb-sparing and functional reconstructive concepts, efforts regarding the adequacy of surgical margins, and the rationale of immediate versus delayed reconstructive approaches, and the disease-free status of sarcoma management.

Subcortical DNET in a Patient With an Enzymatic Deficiency: A Rare Case and Review of the Literature

PURPOSE

This case report describes a toddler with a medical history of biotinidase deficiency who presented with atypical seizures due to a brain tumor.

METHODS

This is a case report.

RESULTS

Electroencephalogram revealed a frontal lobe mass, with magnetic resonance imaging confirmation of a mass extending from the frontal lobe into the genu and anterior corpus callosum. She underwent a near-total resection, and pathology identified a dysembryoplastic neuroepithelial tumor. The patient is now seizure free and clinically doing well.

CONCLUSIONS

Children with biotinidase deficiency and atypical seizures should receive a full electroencephalogram evaluation, as brain tumors continue to be on the differential for seizures in this patient population.

Evaluation and management of fibrofatty tumors of the extremities: case report

Patients presenting with enlarging fibrofatty masses in the extremities pose an interesting dilemma to clinicians, as the differential diagnosis in such cases ranges from benign to malignant, and from lesions optimally managed operatively to those managed nonoperatively. The differential diagnosis includes benign lipoma, liposarcoma, lipoblastoma, and fibrolipomatous hamartoma (lipomatosis) of the nerves. The authors present the case of a 14-year-old girl with an enlarging fibrofatty mass of the forearm, initially thought, based on diagnostic imaging, to be a fibrolipomatous hamartoma of the median nerve, but found to be a lipoblastoma without direct nerve involvement based on histopathological examination of the operative specimen. This case serves to illustrate the diagnostic predicament that can exist with such masses. The authors advocate the need to establish a tissue diagnosis while having a contingency plan for each of the diagnostic possibilities because the management of each lesion is markedly different. In this report, the authors consider the differential diagnosis of fibrofatty masses of the extremities that the peripheral nerve surgeon may encounter, and they highlight the significant differences in management strategies for each possible diagnosis.

Paratesticular liposarcoma and contralateral angiolipoma in a 60-year-old patient

We present the case of a 60-year-old man who was referred with a 1-year history of a slow-growing right scrotal lump. Following surgical excision together with a radical orchidectomy, the histological diagnosis was of a paratesticular dedifferentiated liposarcoma. Radiological staging showed no metastatic disease. Six months later the patient presented with a new left scrotal lump, which was felt to be separate from the testis. Owing to the previous history of a liposarcoma and indeterminate ultrasound findings, this was surgically excised without orchidectomy. Histological analysis showed this to be an angiolipoma. The patient remained on clinical and radiological surveillance. Paratesticular tumours are rare neoplasms and liposarcomas of the spermatic cord only represent 7% of these lesions. Any link between lipomatous tumours and liposarcomas remains controversial and is still under investigation. This is the first case to report a paratesticular liposarcoma and a contralateral angiolipoma in the same patient.

Giant lipoma of the back affecting quality of life

Lipomas are benign tumours composed of adipose tissue. They may be localized in almost all body parts and may be in a giant form. Some of these giant lipomas may transform malignity and cause problems in daily living and detoriate quality of life. Mass localization also restrict body functions. In the present study, a 72-year-old man who presented with a mass enlarged in a time period of two years and because of this could not lie in the supine position, sit in an erect position and dress easily, go outside because of his physical appearance. With surgical treatment a 38 × 22 × 21 cm mass weighing 3575 g was successfully resected. Postoperative early phase complications did not occur. During 48 months of postoperative period, any recurrence was not detected and the patient was free of all his complaints. Cosmetic and functional results of the surgery and patient satisfaction were excellent. After surgery patient's quality of life was improved and restriction of body function was disappeared.

•

The most common mesenchymal neoplasms in humans are lipomas.

•

Lipomas are typically slow-growing tumours; only a few grow to an exceptionally large size.

•

The effects of giant lipomas on daily living and quality of life should be evaluated as an indication for surgery.

A massive posterior neck mass: lipoma or something more sinister?

Lipomas are slow-growing benign soft-tissue tumors which are typically asymptomatic and occur in approximately 1% of the population. A lipoma is considered to be of excessive size when it is greater than 10 cm in length (in any dimension) or weighs over 1000 g (Kransdorf (1995)). We describe a case of a man presenting with a giant posterior neck mass which greatly reduced the sagittal range of cervical spine. A discussion of the pathophysiology of lipomas and a literature review regarding giant lipomas versus malignancy follows.

The m.3291T>C mt-tRNA(Leu(UUR)) mutation is definitely pathogenic and causes multisystem mitochondrial disease

Mitochondrial tRNA point mutations are important causes of human disease, and have been associated with a diverse range of clinical phenotypes. Definitively proving the pathogenicity of any given mt-tRNA mutation requires combined molecular, genetic and functional studies. Subsequent evaluation of the mutation using a pathogenicity scoring system is often very helpful in concluding whether or not the mutation is causing disease. Despite several independent reports linking the m.3291T>C mutation to disease in humans, albeit in association with several different phenotypes, its pathogenicity remains controversial. A lack of conclusive functional evidence and an over-emphasis on the poor evolutionary conservation of the affected nucleotide have contributed to this controversy. Here we describe an adult patient who presented with deafness and lipomas and evidence of mitochondrial abnormalities in his muscle biopsy, who harbours the m.3291T > C mutation, providing conclusive evidence of pathogenicity through analysis of mutation segregation with cytochrome c oxidase (COX) deficiency in single muscle fibres, underlining the importance of performing functional studies when assessing pathogenicity.