[Intramuscular lipomas: Large and deep benign lumps not to underestimated. Review of a series of 51 cases]

The Lipid Enigma: A Case Report Highlighting Diagnostic Challenges in Adipocytic Tumors

Infiltrating lipomas are a rare form of lipomas exhibiting unusual clinical behavior. We report a case of an adipocytic tumor of a 31-year-old male diagnosed with an infiltrating lipoma in the right submandibular region. It exhibits unusual clinical features such as invasion into surrounding structures, posing significant diagnostic challenges. The histopathological findings and differential diagnosis for this case are discussed, underscoring the importance of investigation techniques for accurate diagnosis and treatment planning. Infiltrating lipomas, while benign, can mimic malignant adipocytic tumors such as atypical lipomatous tumors (ALTs) and well-differentiated liposarcomas (WDLS), complicating diagnosis. This case underscores the importance of combining histopathology, immunohistochemistry (IHC), and molecular testing, particularly murine double minute clone 2 (MDM2) amplification, to distinguish between benign and malignant tumors.

Giant Lipoma on the Left Shoulder: A Case Report

A lipoma is a tumor of adipose tissue cells that can develop anywhere in the body, usually at the subcutaneous level without invading adjacent structures. Its most common location is on the back and extremities. According to the literature, it is considered common in both sexes; however, it is mentioned that it occurs more frequently in females. Clinically, it presents as a slow-growing, painless mass. Although the diagnosis is clinical, an imaging study is usually performed for confirmation and to obtain information about its location, relationship with adjacent structures, and surgical planning. The definitive treatment involves surgical resection with histopathological analysis, providing a definitive diagnosis to rule out malignancy. In the present case report, we will present a 45-year-old female patient, with no significant medical history, who comes for evaluation due to a tumor in her right shoulder approximately 5 cm in size with gradual growth to 20 cm over 12 years, seeking evaluation due to clinical manifestations. A surgical protocol was initiated, with magnetic resonance imaging (MRI) considered the imaging study of choice according to the literature, where a superficial location was observed. A surgical plan was made that included complete resection and histopathological analysis, with post-surgical evaluations at two, four, and six months post-surgery showing no signs of recurrence, remission of symptoms of nerve compression, and appropriate wound healing.

A Rare Case of a Giant Intramuscular Lipoma of the Upper Extremity in a Pediatric Patient

Although lipomas are the most common benign soft tissue tumors, the non-infiltrating intramuscular subtype is relatively uncommon. As these masses typically present between the ages of 40 and 70, few cases have been reported in the pediatric population. We present a case of a giant intramuscular lipoma of the biceps brachii in an adolescent. He presented with a slow-growing, tender mass and had no neurovascular compromise of the limb. MRI was utilized to visualize the mass, and a muscle-sparing excisional biopsy was performed. Histologic evaluation confirmed a diagnosis of a benign lipoma. The patient went on to heal without a functional deficit. Large, growing soft tissue masses warrant work-up to rule out malignancy. Advanced imaging and excisional biopsy are necessary to confirm the diagnosis of a benign giant intramuscular lipoma, which is especially rare within the pediatric population. We discuss the prevalence and treatment of intramuscular lipomas, including a literature review of reports in the pediatric population.

A Case Report of Forehead Subgaleal Lipoma: Diagnostic Dilemmas and Surgical Solutions

Subgaleal lipomas are an uncommon type of benign soft tissue tumour. They typically present as painless, slow-growing masses in the subcutaneous plane beneath the galea aponeurotica of the scalp. This case report presents a rare subgaleal lipoma in a 50-year-old female patient with a chief complaint of painful swelling on her forehead above the left eyebrow. Diagnostic imaging revealed a well-defined, round, fat-density mass in the subcutaneous plane of the bilateral frontal and high parietal midline region, causing a mass effect. The patient underwent successful excision of the subgaleal lipoma under local anaesthesia, leading to relief from the swelling and associated pain with no reported complications during the recovery period. Follow-up assessments confirmed the absence of recurrence.

Recurrent intramuscular lipoma at extensor pollicis brevis: A case report

BACKGROUND

This report describes and discusses recurrent intramuscular lipoma (IML) of the extensor pollicis brevis (EPB). An IML usually occurs in a large muscle of the limb or torso. Recurrence of IML is rare. Recurrent IMLs, especially those with unclear boundaries, necessitate complete excision. Several cases of IML in the hand have been reported. However, recurrent IML appearing along the muscle and tendon of EPB on wrist and forearm has not been reported yet.

CASE SUMMARY

In this report, the authors describe clinical and histopathological features of recurrent IML at EPB. A 42-year-old Asian woman presented with a slow-growing lump in her right forearm and wrist area six months ago. The patient had a history of surgery for a lipoma of the right forearm one year ago with a scar of 6 cm on the right forearm. magnetic resonance imaging confirmed that the lipomatous mass, which had attenuation similar to subcutaneous fat, had invaded the muscle layer of EPB. Excision and biopsy were performed under general anesthesia. On histological examination, it was identified as an IML showing mature adipocytes and skeletal muscle fibers. Therefore, surgery was terminated without further resection. No recurrence occurred during a follow-up of five years after surgery.

CONCLUSION

Recurrent IML in the wrist must be examined to differentiate it from sarcoma. Damage to surrounding tissues should be minimized during excision.

Trigger finger at the wrist caused by an intramuscular lipoma within the carpal tunnel: A case report

BACKGROUND

Trigger finger at the wrist, which occurs with finger movement, is an uncommon presentation. Few reports describing cases of trigger finger at the wrist have been published. Thus, we present a case of an intramuscular lipoma arising from an anomalous flexor digitorum muscle belly in a 48-year-old female patient causing painful finger triggering at the wrist and carpal tunnel syndrome (CTS).

CASE SUMMARY

A 48-year-old woman with complaints of a catching sensation during wrist motion and a progressive tingling sensation on the palmar aspect of the right hand for approximately 2 years was referred to our hospital. Triggering of the index to middle finger was evident with a palpable and audible clunk over the carpal tunnel during passive motion. Tinel’s sign was positive over the carpal tunnel of the right wrist with a positive Phalen’s test. Nerve conduction studies of the median nerve demonstrated a right CTS. Ultrasound examination revealed a 2.5 cm × 2.0 cm subcutaneous hyperechoic mass with no obvious blood flow at the wrist of the right arm. Surgical excision of the tumor and muscle mass led to a resolution of the patient’s symptoms, and any triggering or discomfort disappeared. The patient has had no evidence of recurrence at more than 1 year of follow-up.

CONCLUSION

Triggering of the fingers at the wrist is rare. It must be noted that there are many possible causes and types of triggering or clicking around the wrist. Accurate diagnosis is mandatory to avoid inaccurate treatment of patients with trigger wrist. During the diagnosis and treatment of CTS, attention should be paid to the variation of tendon tissue in the carpal tunnel, to avoid only focusing on the release of transverse carpal ligament and ignoring the removal of anomalous muscle belly.

Treatment of intramuscular lipoma of tongue with enveloped mucosal flap design: a case report and review of the literature

Background

Lipomas are benign soft tissue neoplasms of mature adipose tissue commonly occurring in the trunk or extremities. But, intraoral lipomas are rare entities which may be only noticed during routine dental examinations. Especially intramuscular lipomas on the tongue have been reported very rarely. In this study, we report a case of intramuscular lipoma on tongue, with a review of the literature from 1978 to 2019, providing data on age, gender, location, presenting symptoms, size, surgical methods, and recurrence.

Case presentation

A case of intramuscular lipoma occurring in tongue region in a 65-year-old male is reported. Surgical excision is the mainstay of treatment for the lesion. In order to decrease the deformity and discomfort after the excision, we tried to modify surgical technique using enveloped mucosal flap. This technique provided more comfortable healing procedure on the operative site without recurrence.

Conclusion

This is a rare case of large intramuscular lipoma on tongue. Surgical excision with enveloped mucosal flap design was performed to diminish postoperative raw surface and discomfort and a 24-month follow-up showed excellent healing without any recurrence. A case of intramuscular lipoma on tongue and relevant literature reviews are presented in this study.

Adipocytic tumors of orofacial region: Clinicopathologic appraisal of ten cases with a review of its variants

Lipomas are the most common benign tumors. However, their presence in oral cavity is albeit erratic. Even scarcer is the prevalence of the various histopathological variants. We, hereby, report the wide range of clinical and histopathologic presentations of these uncommon entities affecting the orofacial region. Discussed herein are six cases of lipomas, two cases of intramuscular lipomas and one case each of osteolipoma and sialolipoma.

Large intramuscular lipoma of the tongue

We describe a case of a 57-year-old man referred to an oral maxillofacial surgeon for a nontender, large intramuscular tongue mass. A computed tomography scan with contrast showed a homogenous right tongue intramuscular fatty mass measuring 3.8 cm × 2.8 cm in the axial dimension and 2.2 cm in the craniocaudal dimension. Histologic examination revealed multiple lobulated sections of mature adipocytes and occasional entrapped skeletal muscle fibers. The final pathologic diagnosis was intramuscular lipoma. Although lipomas account for approximately 50% of all soft tissue neoplasms, intramuscular (infiltrating) lipoma of the tongue is exceedingly rare.

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.

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.