[Lipoma arborescens of the bicipital bursa]

Surgical management of upper limb lipoma arborescens: a systematic review

Background

Lipoma arborescens (LA) is a rare benign synovial tumour characterized by the proliferation of mature adipocytes within the synovial cells. Given its rarity, current evidence is mainly based on case reports and case series, and no guidelines are available. The present study investigated the current surgical management and related outcomes of LA in the upper limb.

Methods

This systematic review was conducted following the PRISMA guidelines. PubMed, Scopus, and Virtual Health Library were accessed in September 2021. Clinical studies evaluating patients with LA undergoing surgical treatment were considered eligible for this systematic review. Only studies which reported data on LA located in the upper limb with histopathological confirmation were considered. Articles that reported data from nonsurgical management were not considered.

Results

A total of 21 studies reporting 22 lesions in 21 patients were assessed. The mean age of the patients was 48.48 years (range 22–77). Most studies evaluated the restoration of range of motion and symptom resolution for the functional outcome assessment. Open or arthroscopic excision and synovectomy were the most common surgical procedures for LA. The concomitant lesions were treated in a single-stage procedure. All patients had satisfactory outcomes after open or arthroscopic excision and synovectomy without recurrence at a mean follow-up of 21.14 months (range 2–60). One patient developed postoperative cellulitis (4.55%).

Conclusion

Open and arthroscopic excision combined with synovectomy should be considered the standard treatment option of upper limb LA. Concomitant pathologies can be addressed in a one-stage procedure. Although LA was recognized as a clinical entity decades ago, there is a lack of evidence based guidelines and long term outcome data are unavailable.

Intra-articular lipoma arborescens of the knee: A report of two cases with bilateral localization

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The unilateral form of lipoma Arborescens affecting the knee is the most common, with a predilection for supra patellar recess.

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The clinical examination finds symptoms of chronicity, such as progressive soft swelling, pain, stiffness and episodes of joint blockage.

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MRI is the examination of choice showing multiple villous proliferation of the synovial and frond-like structures with a fatty signal.

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Treatment with intra-articular injections of radioactive compounds, such as Yttrium 90 or steroids, relieves symptoms during moderate periods.

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Early synovectomy offers the best functional outcome.

Introduction

Lipoma arborescens is a very rare pseudo-tumoral lesion of unknown etiology, characterized by lipomatous infiltration of subsynovial stroma, bilateral involvement is exceptional, only eight cases are reported in the literature.

Presentation of case

We report the very rare case of two men presented at our department with complaints of swelling of both knees and intermittent joint effusion, Surgical biopsy revealed Lipoma arborescens in both cases. Open total synovectomy was performed. Follow-up evaluation showed no signs of recurrence.

Discussion and conclusion

Lipoma arborescens is a rare entity, the unilateral form affecting the knee is the most common, with a predilection for suprapellar recess. Magnetic resonance imaging (MRI) is the examination of choice showing multiple villous proliferation of the synovium and fat-like cells, with a fatty signal on all sequences. Treatment by open or arthroscopic synovectomy offers the best outcomes.

Lipoma arborescens of the bicipitoradial bursa

Lipoma arborescens (LA) is a rare, benign articular lesion that is most commonly found within the suprapatellar recess of the knee. An extremely rare case of LA involving unilateral bicipitoradial bursa is described in this study. A 58-year-old male presented with a superficial soft mass on the volar aspect of the left forearm. The magnetic resonance imaging (MRI) examination demonstrated a lobulated complex mass containing multiple frond-like fatty nodules, along the distal biceps tendon in the bicipitoradial bursa. Ultrasound-guided biopsy of the lesion confirmed the diagnosis of LA and patient was scheduled for surgical excision. Recognizing the characteristic imaging of LA, particularly on MRI, is essential for accurate pre-procedural diagnosis.

Endoscopic Resection of the Bicipitoradial Bursa

The bicipitoradial bursa lies at the insertion of the biceps tendon on the radial tuberosity. It is an unusual site for chronic bursitis. It can be treated conservatively with aspiration and steroid injection. Surgical excision of the bursa is indicated in case of infection cause, failed conservative treatment with recurrence of the enlarged bursa and pain after aspiration, the presence of nerve compression with neurological impairment, mechanical limitation to flexion and extension of the elbow or biceps tendon degeneration, and/or functional impairment. Open resection through the anterior approach requires extensive dissection to expose the radial tuberosity and the radial neck, which increases the risk of neurovascular injury. Endoscopic resection is possible through distal biceps tendoscopy and endoscopy around the radial neck. It is technically demanding and should be reserved to the experienced elbow arthroscopist.

Bicipitoradial Bursitis: A Review of Clinical Presentation and Treatment

The bicipitoradial bursa lies at the insertion of the biceps tendon on the radial tuberosity. It is an unusual site for chronic bursitis and most often results from repetitive mechanical trauma or overuse. Other causes include tuberculosis, immunological complications of rheumatological disease and synovial chondromatosis. Accurate diagnosis requires imaging studies and sometimes histological study. It can be treated conservatively with aspiration and steroid injection. Surgical excision of the bursa is indicated in the case of infection cause, failed conservative treatment with recurrence of the enlarged bursa and pain after aspiration, presence of nerve compression with neurological impairment, mechanical limitation to flexion, and extension of the elbow or biceps tendon degeneration and/or functional impairment.