Pelvic lipoma causing venous obstruction syndrome

Simultaneous excision of pelvic lipoma and robot-assisted radical prostatectomy

Lipoma is a benign mesenchymal tumour that can develop in any part of the body containing adipose tissue. Very few cases of pelvic lipomas have been reported in the literature. Due to their location and slow growth, pelvic lipomas are often asymptomatic for a prolonged time. Thus, on diagnosis, they are usually found to be of considerable size. Due to their size, pelvic lipomas can present causing bladder outlet obstruction, lymphoedema, abdominal and pelvic pain, and constipation, as well as present with deep vein thrombosis (DVT) like symptoms. Patients with cancer have a much higher risk of developing DVT. Here, we describe a case of an incidental finding of pelvic lipoma mimicking DVT in a patient with organ-confined prostate cancer. He eventually underwent simultaneous robot-assisted radical prostatectomy and lipoma excision.

Giant retroperitoneal lipoma presenting with abdominal distention: A case report and review of the literature

BACKGROUND

Retroperitoneal lipomas are extremely rare tumors and tend to be large in size (> 10 cm) when diagnosed, causing various clinical manifestations. Preoperative diagnosis of retroperitoneal lipomas is difficult. There is a lack of relevant information about the management and prognosis of these benign tumors due to limited reports.

CASE SUMMARY

A 53-year-old woman who complained about progressive abdominal distention and aggravating satiety was referred to the gynecological outpatient department of Peking Union Medical College Hospital. Computerized tomography (CT) revealed an immense mass with fat density, measuring 28.6 cm× 16.6 cm in size. Adjacent organs, including the intestinal tract and uterus, were squeezed to the right side of the abdomen. An exploratory laparotomy was performed with suspicion of liposarcoma. Intraoperatively, a giant yellowish lobulated mass was found occupying the retroperitoneum and it was removed by tumor debulking. Postoperative histopathological results confirmed the diagnosis of retroperitoneal lipoma.

CONCLUSION

Retroperitoneal lipoma is a very rare condition and is difficult to differentiate from well-differentiated liposarcoma. Radiographic investigations, especially CT and magnetic resonance imaging, are important for preoperative diagnosis. Surgical resection is the fundamental treatment, which is difficult due to its size and relation to neighboring structures.

Retroperitoneal lipoma, a rare cause of pelvic mass in women

Background:

Lipoma is a benign mesenchymal tumor of soft tissue that occurs in almost all parts of the body where fat normally exists. Retroperitoneal lipomas are very infrequent condition with about 20 cases represented in the literature since 1980. They usually present as an abdominal mass or with pressure symptoms to adjacent organs.

Case Presentation:

A 66-year-old, post-menopausal woman referred to Imam Hossein Medical Center due to abdominal pain. Abdominopelvic magnetic resonance imaging (MRI) revealed a large mass containing fat component without enhancement on the right side of the pelvis. Tumor markers were within normal ranges. The patient underwent laparotomy and a 12 cm retroperitoneal mass which was located on the iliopsoas muscle with extension into the inguinal canal was resected with pathology report of lipoma. There has been no recurrence after one year of follow-up since surgery.

Conclusion:

In the differential diagnosis of retroperitoneal pelvic mass at all ages, lipoma should be considered as a rare cause.

Common femoral vein obstruction secondary to femoral sheath lipoma

Common femoral vein obstruction secondary to femoral sheath lipomas are rare. We describe the case of a 49 year-old male that presented to the clinic with a 3 month history of progressive right lower extremity pain, edema and discoloration. Venous duplex imaging was consistent with proximal venous obstruction and led to Computerized Tomographic Venography (CTV) which demonstrated a large mass obstructing the external iliac vein (EIV) and common femoral vein (CFV) consistent with a femoral sheath lipoma. Surgical exploration revealed a large well encapsulated lipoma in the right femoral sheath posterior to the CFV and external iliac vein causing near occlusion. We present an overview of the diagnosis and surgical management of symptomatic femoral vein obstruction caused by a large femoral sheath lipoma.

[Giant lipomas or retroperitoneal liposarcomas? Controversies in their diagnosis and treatment]

BACKGROUND

Retroperitoneal lipomas are extremely rare tumors that must be differentiated from well-differentiated liposarcomas (WD-LPS).

OBJECTIVES

To summarize the evidence about giant retroperitoneal lipomas or liposarcomas; and to elaborate recommendations for their management.

DATA SOURCES

A systematic literature search from January 1985 to December 2019 and a review of our own cases was performed.

RESULTS

Our series comprises four patients, two females and two males. The diagnosis was incidental in two cases. The medium size was 26 cm, being two cases located exclusively in the retroperitoneum, one in the inguinal region and one in the buttock via pelvic space. All cases were surgically removed being confirmed the initial diagnosis of retroperitoneal lipomas in two cases, as the rest two cases were classified as WD_LPS after MDM2/CDK4 genetic analysis. The review of the available literature plus our own cases revealed 30 cases, of which 58% were woman. Only two cases were asymptomatic. The main symptom was abdominal mass (53%) followed by abdominal pain (40,6%). The median size of the lesions was 24,9 cm with a median weight of 4.576,3 g. All cases were surgically removed, being necessary to remove contiguous organs in only four cases (12,5%).

CONCLUSIONS

Retroperitoneal lipoma is a rare tumor which must be differentiated from WD-LPS. This is a very difficult task, being necessary to determinate MDM2 status (by FISH or MLPA), present in liposarcoma but not in lipomas, for its correct diagnosis. The treatment must be based on a complete surgical resection with negative margins.

Iliocaval Venous Obstruction, Cardiac Preload Reserve and Exercise Limitation

Cardiac output during exercise increases by as much as fivefold in the untrained man, and by as much as eightfold in the elite athlete. Increasing venous return is a critical but much overlooked component of the physiological response to exercise. Cardiac disorders such as constrictive pericarditis, restrictive cardiomyopathy and pulmonary hypertension are recognised to impair preload and cause exercise limitation; however, the effects of peripheral venous obstruction on cardiac function have not been well described. This manuscript will discuss how obstruction of the iliocaval venous outflow can lead to impairment in exercise tolerance, how such obstructions may be diagnosed, the potential implications of chronic obstructions on sympathetic nervous system activation, and relevance of venous compression syndromes in heart failure with preserved ejection fraction.

Laparoscopic resection of a dumbbell-shaped lipoma extending through the obturator foramen: A case report

Lipomas are often lightweight and small in size with few subjective symptoms. Giant lipomas are uncommon. We herein report a case involving a giant, deep-seated dumbbell-shaped intermuscular lipoma in the right thigh that extended into the pelvic region through the obturator foramen and caused obturator neuropathy. A 64-year-old man with numbness while walking was diagnosed with a 17 × 16-cm lipomatous tumor. He underwent radical surgery performed by a multidisciplinary team consisting of orthopedic and colorectal surgeons. High-definition magnified laparoscopic images of the deep pelvis confirmed that tumor had infiltrated the obturator nerve. The tumor was completely resected with the obturator nerve. Six months after surgical resection, the patient had no gait disturbance or evidence of recurrence. The laparoscopic approach for this kind of complicated deep pelvic surgery was safe and feasible when performed by colorectal surgeon with ample knowledge of the pelvic anatomy.

[Giant pelvic lipoma mimicking a liposarcoma]

Le lipome géant (LG) est une entité rare, de siège ubiquitaire. Sa localisation pelvienne est rare avec moins de 10 cas rapportés dans la littérature. Le principal diagnostic différentiel est le liposarcome bien différencié de type lipoma like. Nous rapportons le cas d'une patiente âgée de 50 ans, qui avait consulté pour une gêne pelvienne depuis 3 mois avec l'apparition d'une masse ischio rectale gauche. Le scanner abdomino-pelvien avait montré une masse lipomateuse homogène hypo dense en situation pré sacrée de 10 x18 cm. A l'imagerie par résonance magnétique (IRM), cette masse était hyper intense en pondération T1 et T2 avec des cloisons fines et atteignait la hauteur de la 2^ème vertèbre sacrée. Une exérèse totale a été réalisée par une double voie abdominale et périnéale sans rupture de sa capsule. L'examen anatomopathologique a confirmé le diagnostic de LG. Le but de ce travail était de rapporter un nouveau cas de LG pelvien pré sacré qui se prolonge dans la fosse ischio rectale gauche.

Retroperitoneal lipoma; a benign condition with frightening presentation

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Lipoma is the most frequent soft tissue tumor in adults.

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Its occurrence in the retroperitoneal region is extremely rare.

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It presents with various clinical scenarios.

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We present a case of retroperitoneal lipoma with a brief literature review.

Introduction

lipoma is the most frequent soft tissue tumor in adults. Its occurrence in the retroperitoneal region is extremely rare. The aim of this study is to report a case of retroperitoneal lipoma with a literature review.

Presentation of case

A 34-year-old female presented with abdominal distension and severe back pain for one year duration. She also reported weight loss and constipation. The examination revealed asymmetrical abdominal distension and everted umbilicus. There was a big irregular mass occupying the whole abdomen reaching into the xiphisternum, firm in consistency, smooth surface, and well defined borders. Abdominal ultrasound demonstrated a large retroperitoneal heterogeneous mass. Computed tomography (CT) scan showed a large well defined hyperechoic mass with fibrous septa extending from the left ovary up to the diaphragm. Exploratory laparotomy revealed a giant clearly demarcated fatty tumor adherent to the retroperitoneal fatty tissues. The histopathological examination of the specimen confirmed the diagnosis of the retroperitoneal lipoma.

Discussion

Retroperitoneal lipomas have been reported in various age groups; namely children, middle and old age patients. Based on the characteristic radiological features of the tumor, enormous diagnostic work-up is not justified.

Conclusion

Retroperitoneal lipoma is a very rare variant of lipoma, presents with various signs and symptoms that may be misleading. Radiologic imaging especially CT scan is the diagnostic tool of choice. Surgical resection is the main modality of management.

Practical Issues for Retroperitoneal Sarcoma

Background

Retroperitoneal sarcoma is rare. Using initial specimens on biopsy, a definitive diagnosis of histological subtypes is ideal but not always achievable.

Methods

A retrospective institutional review was performed for all cases of adult retroperitoneal sarcoma from 1996 to 2015. A review of the literature was also performed related to the distribution of retroperitoneal sarcoma subtypes. A meta-analysis was performed.

Results

Liposarcoma is the most common subtype (45%), followed by leiomyosarcoma (21%), not otherwise specified (8%), and undifferentiated pleomorphic sarcoma (6%) by literature review. Data from Moffitt Cancer Center demonstrate the same general distribution for subtypes of retroperitoneal sarcoma. A pathology-based algorithm for the diagnosis of retroperitoneal sarcoma is illustrated, and common pitfalls in the pathology of retroperitoneal sarcoma are discussed.

Conclusions

An informative diagnosis of retroperitoneal sarcoma via specimens on biopsy is achievable and meaningful to guide effective therapy. A practical and multidisciplinary algorithm focused on the histopathology is helpful for the management of retroperitoneal sarcoma.

En-bloc resection of a giant retroperitoneal lipoma: a case report and review of the literature

BACKGROUND

Retroperitoneal lipomas are an extremely rare condition with only 17 cases described in the literature since 1980. They can reach enormous size and cause significant abdominal symptoms. The most important differential diagnosis is the well-differentiated liposarcoma, which preoperatively often may not definitely be ruled out.

CASE PRESENTATION

We present the case of a 73 year-old Caucasian patient with a giant retroperitoneal lipoma of 9 kg measuring 55 cm in diameter. The patient presented with abdominal pain and swelling that had been slowly progressive for the last 15 years. On computerized tomography an immense retroperitoneal tumor was revealed. Intraoperatively, the tumor did not show any signs of infiltrative growth, therefore sole tumor extirpation was performed.

CONCLUSION

Retroperitoneal lipomas are not clearly distinguishable from well-differentiated liposarcomas on imaging and even biopsies may be misleading. Moreover, abdominal symptoms, i.e. pain, obstipation and dysphagia may occur due to mechanical displacement. Therefore, surgical exploration with complete oncological resection is the therapy of choice if malignity cannot be ruled out.

Femoral sheath lipoma causing venous obstruction syndrome

Lipomas are benign, encapsulated, soft-tissue tumours composed of well-differentiated adipocytes. They arise in the subcutaneous tissue typically on the back, shoulder and neck. Lipomas have been known to cause symptomatic obstruction to venous flow by compression. We report a case of venous obstruction syndrome due to a small lipoma within the femoral sheath.

Surgical approach to a large dumbbell-shaped pelvic lipoma extending through the obturator foramen

Lipomas are the most commonly occurring mesenchymal tumors. We report a technique used to manage a patient with a large dumbbell-shaped pelvic lipoma passing through the obturator foramen. Using the combined expertise of an orthopedic and pelvic surgeon, successful and safe removal of this benign dumbbell-shaped pelvic lipoma was achieved.