Lipoma arborescens associated with osseous/chondroid differentiation in subdeltoid bursa

Severe Shoulder Pain Caused by Lipoma Arborescens in the Subdeltoid Bursa: A Case Report

Introduction

Lipoma arborescens is a tumor-like lesion that occurs inside joints and synovial bursae, especially in knee joints. It rarely occurs in the shoulder joints and this disease usually causes severe shoulder pain. This study aims to report a rare case of lipoma arborescens occurring in the subdeltoid bursa with severe shoulder pain.

Case Report

A 59-year-old woman with severe pain and restriction of range of motion (ROM) for her right shoulder consisting for 2 months was referred to our hospital. Magnetic resonance imaging (MRI) findings revealed that a tumor-like lesion exists in the subdeltoid bursa in her right shoulder and blood examinations revealed no abnormal findings. Surgical resection of the tumor-like lesion was performed and the rotator cuff was repaired because this tumor-like lesion invaded the rotator cuff partially. Pathology examination of the resected tissues was consistent with lipoma arborescens. One year after surgery, the patient's shoulder pain was diminished and its ROM recovered. There was no significant difficulty in activities of daily living.

Conclusion

Lipoma arborescens should be considered when patients present with complaints of severe shoulder pain. Even if their physical findings do not suggest rotator cuff injuries, MRI should be performed to rule out lipoma arborescens.

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.

Arthroscopic treatment of a lipoma arborescens of the elbow: A case report

INTRODUCTION

Lipoma Arborescens is a rare pathology that mainly affects the knee. Occurrences in the elbow are even more uncommon and mainly involve the bicipitoradial bursa.

CASE'S DESCRIPTION

We describe the case of a 54-year-old patient known for rheumatoid arthritis, who consulted for chronic elbow pain associated with swelling and limited extension.

DIAGNOSIS

The diagnosis of a lipoma arborescens of the elbow involving the whole joint was made using magnetic resonance imaging and confirmed during arthroscopy.

INTERVENTIONS

After a failed nonoperative treatment consisting in intra-articular cortisone injections and physiotherapy, the patient underwent arthroscopic synovectomy and arthrolysis.

OUTCOME

At 1-year follow-up, he reported no pain, satisfactory range of motion, and major improvements in clinical scores.

CONCLUSION

This is the first illustrated case report about lipoma arborescens involving the whole elbow joint. Even though it is a rare disease, awareness of its presentation, imaging patterns, and treatment options is therefore important for clinicians, radiologists, and surgeons. In this case, arthroscopic treatment resulted in satisfactory and long-lasting pain relief and functional results. It may be considered as a safe and effective option in case of failed nonoperative measures.

Femoral osteochondroma responsible for ischiofemoral impingement, bursitis, and secondary lipoma arborescens mimicking malignant transformation

We present the case of a 53-year-old woman with a known history of hereditary multiple exostosis disease referred for further imaging work-up after ultrasound and computed tomography leading to the suspicion of malignant transformation of an osteochondroma (exostosis) located on the posteromedial aspect of the right proximal femur. Imaging examinations suggested an ischiofemoral impingement resulting in a secondary bursitis associated with the development of an internal lipoma arborescens. This rare association explained the complexity of the diagnosis. Magnetic resonance imaging (MRI) played a key role in correctly identifying this benign complication of the osteochondroma and in distinguishing those observations from a secondary exostotic chondrosarcoma. MRI findings were subsequently confirmed at surgery and pathological examination.

BILATERAL LOCALIZED PIGMENTED VILLONODULAR SYNOVITIS OF THE KNEE: CASE REPORT AND REVIEW

Objectives

Several cases of bilateral diffuse pigmented villonodular synovitis (PVNS) or tenosynovial giant cell tumor have been described in the literature. Nevertheless, some presentations are rare and differential diagnoses are necessary.

Methods

The purpose of this study was to perform a systematic review of the literature related to PVNS and to report a rare supra-patellar bilateral and focal presentation. We performed a systematic data review in the Pubmed Clinical Queries database using MeSH and keywords related to PVNS and tenosynovial giant cell tumor.

Results

Two cases of bilateral and local PVNS had been previously described, but neither was localized in the supra-patellar compartment. To our knowledge, this case report is the first to describe supra-patellar bilateral and localized PVNS of the knee. This case involves a 28 -year-old woman with bilateral localized PVNS of the supra-patellar recess of the knee. MRI showed a low-signal intensity nodule in T1- and T2-weighted images. These were associated with hemosiderin pigmentation.

Conclusion

The most important finding of the case reported is related to rarity and location. Histopathology analysis confirmed a rare case of hemosiderin pigmentation in the capsular nodule with internal non-pigmented villous content. Lipoma arborescens in the supra-patellar form must be ruled out as a differential diagnosis since it occurs in the same site. Level of Evidence IV; Case series.

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.

Synovial Lipomatosis of the Glenohumeral Joint

Synovial lipomatosis (also known as lipoma arborescens) is a rare and benign lesion affecting synovium-lined cavities. It is characterized by hyperplasia of mature fat tissue in the subsynovial layer. Although the most commonly affected site is the knee joint, rarely additional locations such as tendon sheath and other joints are involved. We present a case of synovial lipomatosis of the glenohumeral joint in a 44-year-old man. The clinical data radiological studies and histopathologic results are described, as well as a review of the current literature.

Endoscopic resection of lipoma of the patellar tendon

Synovial lipoma of the patellar tendon is a very rare entity. It can be associated with rupture of the patellar tendon. We present a case of synovial lipoma that was successfully resected endoscopically. The other indications for patellar tendoscopy include chronic patellar tendinitis and tendinosis, recalcitrant bursitis around the tendon, Osgood-Schlatter disease, and jumper's knee. The major potential danger of this endoscopic procedure is iatrogenic damage to the patellar insertion during endoscopic debridement in patients with jumper's knee or the tibial insertion during endoscopic debridement in patients with Osgood-Schlatter disease.