Lipoma is a benign tumour of the soft tissue that only consists of adipose tissue. The lipoma is a soft, oval and non tender slow growing benign tumour which is asymptomatic and diagnosed by palpation. The lipoma is 1.6cm in diameter and the skin overlying the tumor is mobile. The lipoma is usually present in the subcutaneous layer and it is present in the back, shoulder and neck as well as anywhere over the body which includes the head.
5% of patient has multiple lipoma while others may also have a single or a few lipomas. Surgically lipoma is detected to be covered by a capsule or membrane. Lipoma also has been noted to present in various anatomical positions such as breast, Palmar, endobranchial, intrathoracic, intramuscular, thigh, calf, scapular, fingers, toes, intraosseous, spinal, epidural, parapharyngeal, intraarticular (knee), adrenal, nasopharyngeal, scrotal , bladder, inguinal, intramural, ovarian, intracranial and ileum.
Lipoma is mostly present after trauma and rarely divided to be malignant. In term of epidemiology, lipoma may present at any age ranges, however it is less common in < 20 years old and commonly present in individual around 40 - 60 years of age.
Compressive neuropathy in selected structures such as forearm and ankle may occur as a result of lipoma. Most cases of lipoma are idiopathic but they tend to occur after steroid injection or trauma.
Lipoma may be associated with other tissue abnormalities which lead to angiolipomas, myolipomas and fibrolipomas. Lipoma may also be associated with a few syndrome such as adiposis dolorosa that is characterized by multiple tender, diffuse lesion or giant variety of multiple lipomatosis which is inherited and symmetrically distributed on the upper trunk. Malignant form of lipoma is rarely develop ( liposacroma). Liposacroma if present may occur mostly in the deep structure of the body.
Lipoma is mostly detected by a physician on routine examination. The patient also typically consults the physician requiring further explanation and reassurance that lipoma is benign and not dangerous. Lipoma may also be presented with pressure, pain or neuropathic symptoms. Lipoma will grow gradually and no definite data are identified when lipoma first develop.
The inspection may reveal that lipoma is oval, lobulated, homogenous in appearance, non tender to touch, soft, diameter around 1-6cm, compressible and if the lipoma is large, it will fluctuate and transilluminated. Lipoma is dull to percussion
Pathologically, lipoma mostly present in any connective tissue but the subcutaneous fat appear to be the most common sites of origin. Histological studies reveal that lipoma consist of adipose cell with similar characteristic and pattern as normal adipose tissue. These adipocytes will form into a large lobule that is separated by fibrious septa.
The investigations require are imaging technique such as an MRI scan to differentiate between liposacroma and lipoma. Excisional biopsy is the preferred tool when the diagnosis is inaccurate. The lipoma is differentiated from liposacroma as liposacroma appear to be painful and growth rapidly. (Malignancy is considered).
Lipoma may be left alone if it is not causing any trouble, distorting appearance or discomfort. Surgical can only be performed if there is an evidence of rapid growth of the lipoma, patient complains of pain, uncertainty regarding the diagnosis and poor cosmetic appearance. The treatment for this condition requires the need for surgical excision. Another technique may include liposuction and steroid injection at the particular location for example in the face.
The surgical procedure should begin initially with local anaesthesia. General anaesthesia is considered for larger lipoma on a more complicated site. The incision is then performed to expose the lipoma by carrying it out to the capsule level. This is followed later by sharp and blunt dissection to free one end of the tumor from the normal tissue.The dissection is then continue as the lobule is lifted to free the entire tumor. Besides that, gentle pressure on the surrounding connective tissue may also remove the lipoma by milking it out through the incision. Care for the Hemostasis is needed in case to avoid any hematoma on the cavity. The deep absorbable suture is used to close the deep space which is followed by closure of the skin. Some trimming of the excessive skin is required to avoid redundancy.
Bi lobar lipoma may be missed and recurrence may occur. Beside that any hematoma formation from the surgery may require a follow up. The patient is referred to the hospital for any cases of lipoma that present in a difficult anatomic region technically.
The complication of lipoma may include transformation to the liposacroma as the lipoma grows rapidly and appear to be painful. Fat necrosis is also one of the complications.
The prognosis is excellent as lipoma may not be liposacroma as liposacroma is originated de Novo in the retroperitoneum region. Besides that lipoma may grow very slowly and remain stable.
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