Well-circumscribed deep-seated lipomas of the upper extremity. A report of 13 cases

Forearm Lipoma Causing PIN Compression: Literature Review and Meta-Analysis of Predictors for Motor Recovery

BACKGROUND

Lipomas are a rare cause of posterior interosseous nerve (PIN) compression. A systematic review of predictors for motor recovery has not been performed. This study sought to evaluate whether patient or lipoma characteristics are associated with motor recovery and could be used to determine when immediate tendon transfers at the time of excision should be performed.

METHODS

Articles describing patients with forearm lipomas resulting in PIN compression with motor weakness were included. Patient age, gender, symptom duration, laterality and largest dimension of lipoma, surgical intervention, and motor recovery were identified. Article quality was assessed via the Methodological Index for Non-Randomized Studies criteria.

RESULTS

Thirty articles reporting on 34 patients were identified. Average age was 58.2 years. Average largest lipoma dimension was 5.7 cm. All patients underwent lipoma removal, and 2 had concomitant tendon transfers. In all, 73.5% of patients had complete motor recovery at an average of 9.7 months. Patient age and largest dimension of lipoma, and duration of symptoms were not significant predictors of motor recovery. Symptom duration was a significant predictor of motor recovery in binary regression, particularly if < 18 months.

CONCLUSIONS

The majority of patients with PIN weakness secondary to lipoma are likely to have complete motor recovery after excision alone. Concomitant tendon transfers should be considered for patients symptomatic for greater than 18 months. Further, adequately powered, studies are required to stratify risk factors and evaluate other modalities to identify the minority of patients who would benefit from immediate tendon transfer.

Endoscopic En-Bloc Resection of Intra-Muscular Lipoma of the Flexor Digitorum Profundus: A Uniportal Technique

Deep-seated lipomas can be intramuscular, intermuscular, and rarely, parosteal lipomas. Intramuscular lipoma can be divided into infiltrative, well-circumscribed, and mixed types. Marginal excision is the treatment of choice for well-circumscribed intramuscular lipoma, and histopathology eliminates diagnosis of well-differentiated liposarcoma. The purpose of this technical note is to describe the details of endoscopic en-bloc resection of intramuscular lipoma of the flexor digitorum profundus. This minimally invasive approach allows en-bloc resection of the lipoma for histopathological study, with minimal risk to the surrounding neurovascular structures.

Extraprostatic incidental findings on prostate mpMRI: A pictorial review from the ESUR junior network

The role of multiparametric MRI (mpMRI) in prostate cancer setting is increasingly consolidated and, as a result, its usage in clinical practice is in exponential growth. However, beyond the prostate gland, several key structures are included in the field of view of mpMRI scans. Consequently, various extra-prostatic incidental findings (IFs) belonging to different anatomical systems can be accidentally recognized. Therefore, it is mandatory for a radiologist to be familiar with the wide range of pathologies potentially encountered, to guide management and avoid patient anxiety and costs due to additional work-up prompted by clinically insignificant extra-prostatic findings. With this pictorial review, we aim to illustrate a wide range of IFs that can be detected when performing mpMRI of the prostate, focusing on their imaging characteristics, differential diagnosis, and clinical relevance. Additionally, we propose the CheckDEEP, the Checklist for DEtection of ExtraProstatic findings, to be used for a thorough evaluation of target areas within each anatomical system.

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.

Upper extremity mass with lipomatous axillary involvement and multiple level encasement of the brachial plexus

A 40-year-old female presented for surgical consultation of an upper extremity soft tissue mass. Initial ultrasound report recorded a 5.5 cm mass, consistent with a subcutaneous lipoma. Intra-operative visualization revealed an intramuscular lipoma emerging from brachialis muscle. Post-excision MRI was ordered for continued axillary fullness which revealed lipomatous extension into axilla and posterior arm with multiple level encasement of the brachial plexus. Lipomas with brachial plexus involvement are rare and can present with a range of symptoms and distortion of local anatomy. Surgical debulking is challenging requiring microsurgical expertise for adequate removal and to minimize long-term neurological deficits.

Surgical resection of a giant intramuscular lipoma of the biceps brachii: a case report and review of the literature

Lipomas are frequent benign soft-tissue tumors mainly located in the subcutis. Occasionally, subfascial or inter- or intramuscular lipomas are encountered. This case report describes the surgical management of a very rare giant intramuscular lipoma of the right biceps brachii muscle in a 71-year-old male patient. Preoperative magnetic resonance imaging as well as intraoperative photographs depict the complexity of this case and aid in the discussion about indications for surgery, as management guidelines of these deep-seated tumors are still inconsistent.

Epidemiological, clinical and histological features of adipose tumors in the hand and wrist: Findings from a continuous series of 37 cases

INTRODUCTION

Adipose tumors are the most common soft tissue tumor in adults; however, their epidemiology and histology in the hand and wrist are not well-defined. The aim of this study was to describe the histology and treatment strategy for this type of tumor at a specialized cancer center.

HYPOTHESIS

The frequency of these tumors is underestimated, and their histology signature varies.

MATERIALS AND METHODS

The clinical and paraclinical data of adults treated for an adipose tumor lesion in the hand or wrist were analyzed retrospectively: age, clinical history, time elapsed between discovery and treatment, type of treatment. The dimensions, location and histology of the tumor were collected. The patients were contacted to inquire about persistent symptoms and sequelae.

RESULTS

Thirty-seven tumors (37 patients) were included between January 2003 and December 2018, thus making up 7.5% of all the soft tissue tumors in the hand or wrist. The mean patient age was 59years (28-84years). Except for one fortuitous discovery, the tumors were discovered because the patient had an unusual lump. The lump was associated with distal paresthesia in six cases. The mean time to treatment was 47.5months (1-240months). The lesion was a conventional lipoma (31 cases) or one of its benign variants (6 cases). The mean size was 3.76cm in the long axis (1-11.5cm) and the mean weight was 9.8g (3-60g). The mean follow-up was 73.5months (2-177months). Tumors in the fingers were smaller and lighter than those in the wrist (p=0.004 and p=0.034).

DISCUSSION

The prevalence of adipose tumors is underestimated within hand and wrist tumors. The most common way these tumors are discovered is due to compressive neuropathy with paresthesia and/or dysesthesia. While these tumors are nearly always benign, this does not justify ignoring the opinion of the multidisciplinary tumor board or underestimating the small possibility of the lesion being a liposarcoma.

LEVEL OF EVIDENCE

IV, retrospective, single-center study.

A rare case of inter-compartmental giant lipoma of right distal forearm dorsal compartment invading anterior compartment via breaching inter-osseous membrane

Lipomas are benign soft masses of adipose cells, which are often encapsulated by a thin layer of fibrous tissue and are most commonly present in head, neck, shoulders, and backs of patients. The tumors typically lie in the subcutaneous tissues of patients. Inter-muscular lipomas however, are rare and always occur deep within muscle compartments comprising 0.3% of all lipomas. Deep lipomas are most commonly found in the lower limbs followed by trunk, shoulders and arm. We present a rare case of deep dorsal inter-compartmental inter-muscular giant lipoma (>8cm) of right distal forearm leading to the formation of ganglion in the tendon sheath of Flexor Carpi Radialis (FCR) of anterior compartment as a result of breaching of inter-osseous membrane. MRI findings were indicative of a benign inter-compartmental lipoma of dorsal aspect of right distal forearm that erodes through distal inter-osseous membrane to enter the distal volar aspect of the wrist and therefore we did an excision biopsy and histo-pathological examination of the swelling reported an encapsulated tumour composed of mature adipose cells, which were uniformly arranged without high variations in size, consistent with benign lipoma. To the best of our knowledge, after an extensive search of literature we present this rare case of deep dorsal inter-muscular lipoma of forearm crossing over to the volar compartment resulting in ganglion formation in FCR tendon sheath.

CT and MRI features of tumors and tumor-like lesions in the abdominal wall

Masses involving the abdominal wall are common in clinical practice and have many etiologies, including tumors and tumor-like lesions. Abdominal wall tumors include primary and secondary tumors, the former of which constitute a heterogeneous group of soft tissue tumors with their own unique spectrum. Tumor-like lesions, such as hernias, are more common and must be distinguished from true tumors. Medical imaging is valuable for discovering, diagnosing, and evaluating the extent of abdominal wall masses. With the increasing application of computed tomography (CT) and magnetic resonance imaging (MRI), determining a diagnosis or narrowing the differential diagnosis is often possible, thus facilitating effective management. In this article, we comprehensively review the spectrum of common abdominal wall masses and present the CT and MRI features of typical cases in our hospital. A systematic stepwise diagnostic approach is also proposed for clinical practice.

Distribution of intramuscular giant lipomas in the functional compartments of the forearm: a report of 12 cases

PURPOSE

The aim of this study was to investigate the distribution of intramuscular giant lipomas in the functional compartments of the forearm and to compare their clinical, radiological and histopathological features with those reported in the current literature.

METHODS

The study included 12 patients who were surgically treated for intramuscular lipomas > 5 cm in size located in the forearm that had been confirmed histopathologically between April 2006 and March 2017. Data about the patients with respect to age, sex, affected side, localisation of the lipomas in the forearm functional compartments, size, histopathological features and recurrence were collected. According to the clinical complaints, direct radiography and magnetic resonance imaging were applied.

RESULTS

The average diameter was 6.5 cm (range: 5.5-9 cm). All lipomas had a well-defined border. All the patients presented with soft-tissue masses that were painless in seven patients. Five patients had nerve compression symptoms. When the lipomas were classified according to the functional compartments of the forearm, six of them were located in the superficial volar compartment, two in the deep volar compartment, two in the deep dorsal compartment and two in the lateral compartment. All lipomas were surgically removed by marginal excision. None had complications or recurrence at a mean of 6.5 years follow-up (range: 1-12 years) after surgery.

CONCLUSIONS

Intramuscular lipoma is a relatively uncommon tumour, especially in the forearm. Because of the proximity to the neurovascular structures in the forearm, excision of lipomas should be performed with care and include wide incisions. Additionally, knowing the anatomical features of the compartment where the lipoma is localised in the forearm is important in planning surgery to enable easier dissection of the lipoma and lessen the risk of damage to adjacent neurovascular structures.

LEVEL OF EVIDENCE

Level 4.

Intramuscular Lipoma within a Free Myocutaneous Flap: Systematic Review and Management

Lipomas are a common finding often of little clinical significance, but they can pose a challenge to the microsurgeon if discovered during flap harvesting, especially if found within the muscle along the pedicle or perforators. Here the authors report a case in which a well-circumscribed intramuscular lipoma was discovered within the muscle of a free myocutaneous right anterolateral thigh (ALT) vastus lateralis free flap. To the authors' knowledge, the management of lipoma during flap harvesting has not been previously discussed in the literature. A systematic review was performed, and an approach for the management of myocutaneous flaps containing a lipoma was described. Underappreciated considerations including lipoma location, growth pattern, and proximity to pedicle and perforators must be taken into account when evaluating a lipoma during flap harvest.

Spectrum of Fat-containing Soft-Tissue Masses at MR Imaging: The Common, the Uncommon, the Characteristic, and the Sometimes Confusing

Fat-containing tumors are the most common soft-tissue tumors encountered clinically. The vast majority of fat-containing soft-tissue masses are benign. Lipomas are the most common benign fat-containing masses and demonstrate a characteristic appearance at magnetic resonance (MR) imaging. Less common benign soft-tissue masses include lipoblastoma, angiolipoma, spindle cell lipoma/pleomorphic lipoma, myolipoma, chondroid lipoma, lipomatosis of nerve, lipomatosis, hibernoma, and fat necrosis. Well-differentiated liposarcomas (WDLPSs)/atypical lipomatous tumors (ALTs) are locally aggressive soft-tissue masses that do not metastasize. Biologically more aggressive liposarcomas include myxoid, pleomorphic, and dedifferentiated liposarcomas. At MR imaging, lipomas typically resemble subcutaneous fat but may contain a few thin septa. The presence of thick, irregular, enhancing septa and nonfatty soft-tissue mass components suggests liposarcoma rather than lipoma. However, benign lipomatous lesions and WDLPS/ALT often have overlapping MR imaging findings. Distinguishing WDLPS/ALT from a benign lipomatous lesion or from fat necrosis at imaging can be challenging and often requires histologic evaluation. We present the spectrum of fat-containing masses, using the World Health Organization classification of adipocytic tumors, with an emphasis on commonly encountered lesions, characteristic MR imaging findings associated with specific tumors, and overlapping MR imaging findings of certain tumors that may require histologic sampling. We also briefly discuss the role of molecular markers in proper characterization and classification of fat-containing soft-tissue masses. (©)RSNA, 2016.

Painful Intramuscular Lipoma of the Infraspinatus: Unusual Location and Presentation

Intramuscular lipomas are considered a rare type of benign lipomas. They are usually located deeper and are less palpable than subcutaneous lipomas. A painful presentation with no palpable mass will make clinical diagnosis difficult; in these cases, further imaging should be considered. Only a small number of cases of intramuscular lipomas present with pain; these are located in the supraspinatus and deltoid muscles. To the authors' knowledge, there have been no previous reports of painful intramuscular lipomas involving the infraspinatus muscle. This article describes a case of intramuscular lipoma uniquely located in the infraspinatus muscle and presenting with shoulder pain. A 49-year-old woman presented with 2 months of left shoulder pain. There was no history of preceding trauma. Pain was aggravated by lying on the left shoulder and by the hand behind the back similar to Crass position. On the physical examination, her shoulder joint range of motion was slightly decreased. Simple radiography showed no significant abnormality, but ultrasonography revealed a hyperechogenic mass within the infraspinatus muscle. There was focal tenderness over the mass, but definite palpation of the mass was not possible. Magnetic resonance imaging revealed a well-circumscribed, homogeneous lesion measuring 43 × 28 × 16 mm within the infraspinatus muscle, leading to a diagnosis of intramuscular lipoma. Her pain was not improved with medication, suprascapular nerve block, and steroid injections. Finally, surgical intervention was done and intramuscular lipoma was confirmed by specimen. After excision, her shoulder pain was improved and resolved.

Giant Lipoma of the Arm and Axilla

A lipoma is a common tumor arising from fat cells and can occur anywhere in the body.

How to cite this article

Shishodia A Sharan J Chahal MS. Giant Lipoma of the Arm and Axilla. Int J Adv Integ Med Sci 2016;1(1):18-19.

Arthroscopic Marginal Resection of a Lipoma of the Supraspinatus Muscle in the Subacromial Space

Subacromial impingement syndrome is a common cause of shoulder pain in young adults and seniors at present. The etiology of this syndrome is associated with several shoulder disorders, most related to aging, overhead activities, and overuse. The subacromial space is well circumscribed and limited in size, and soft-tissue growing lesions, such as tumors, can endanger the normal function of the shoulder girdle. We present a case of shoulder impingement syndrome caused by an intramuscular lipoma of the supraspinatus muscle in the subacromial space in a 50-year-old male bank manager. Radiographs, magnetic resonance imaging, and a computed tomography scan showed a well-circumscribed soft-tissue tumor at the supraspinatus-musculotendinous junction. It was arthroscopically inspected and dissected and complete marginal excision was performed through a conventional augmented anterolateral portal, avoiding the need to open the trapezius fascia or perform an acromial osteotomy. Microscopic study showed a benign lipoma, and the shoulder function of the patient was fully recovered after a rehabilitation period of 4 months. This less invasive technique shows similar results to conventional open surgery.

Intramuscular lipoma: a review of the literature

Lipomas are the most common type of soft tissue mesenchymal tumors. They are typically located subcutaneously and consist of mature fatty tissue. When they occur under the enclosing fascia, they are called deep-seated lipomas. Infrequently, lipomas can arise inside the muscle and are called intramuscular lipomas. Intramuscular lipomas have been commonly investigated and categorized in the same group as other deep-seated and superficial lipomatous lesions. Their clinical, histological and imaging characteristics may resemble well-differentiated liposarcomas, further adding to the difficulties in the differential diagnosis. This article summarizes the available literature and describes the typical epidemiological, pathological and clinical features of intramuscular lipomas, as well as delineating their treatment and prognosis.

Subdeltoid lipomas: a consecutive series of 13 cases

We describe 13 consecutive cases of patients presenting with shoulder mass and limited function, and to whom we formulated a diagnosis of subdeltoid lipoma. Between 2002 and 2010, 14 patients had a diagnosis of subdeltoid lipoma. Of these, one was excluded from this review because of a concomitant cuff tear. Shoulder was evaluated with X-ray, MRI, EMG and pre-/post-operatively with constant score (CS) and subjective shoulder value (SSV). All patients had complete excision of the mass. Minimum follow-up was 12 months. In 14 cases, the lipoma was causing slight pain or discomfort, and in four cases (28.57 %), it was causing limitation of joint movement. EMG showed axillary nerve neuro apraxia in two cases (14.28 %). Preoperative CS and SSV were on average 80 and 80, respectively. At one-year follow-up, CS and SSV were meanly 92 and 95, respectively (p = 0.034). No recurrence of the lesion was noted. Subdeltoid lipomas quickly grow up and may cause compression of axillary nerve. Surgery is the treatment of these lesions if symptomatic. After complete excision, subdeltoid lipomas do not recur, and clinical signs disappear. Level of evidence Case series, Level IV.