[Fibrocartilaginous lipoma: a clinicopathological analysis of six cases].

Objective: To investigate the clinicopathological characteristics, immunophenotype, molecular genetics and differential diagnoses of fibrocartilaginous lipomas which consist of adipose tissue, fibrocartilage and fibrous elements. Methods: The clinicopathological features, immunohistochemical profiles and molecular profiles in six cases of fibrocartilaginous lipomas diagnosed at Foshan Traditional Chinese Medicine Hospital, Fudan University Shanghai Cancer Center, the Fifth Affiliated Hospital of Zhengzhou University and the Fourth Affiliated Hospital of Harbin Medical University from January 2017 to February 2022 were included. The follow-up information, diagnosis and differential diagnoses were evaluated. Results: There were three males and three females with a median age of 53 years (range 36-69 years) at presentation. Tumors were located in the extremities, the head and neck region and trunk; and presented as painless masses that were located in the subcutaneous tissue or deep soft tissue. Grossly, three cases were well defined with thin capsule, one case was well circumscribed without capsule, two cases were surrounded by some skeletal muscle. The tumors were composed of fatty tissue with intermingled gray-white area. The tumors ranged from 1.50-5.50 cm (mean 2.92 cm). Microscopically, the hallmark of these lesions was the complex admixture of mature adipocytes, fibrocartilage and fibrous element in varying proportions; the fibrocartilage arranged in a nodular, sheet pattern with some adipocytes inside. Tumor cells had a bland appearance without mitotic activity. Immunohistochemical analysis using antibodies to SMA, desmin, S-100, SOX9, HMGA2, RB1, CD34, adipopholin was performed in six cases; the fibrocartilage was positive for S-100 and SOX9, adipocytes were positive for S-100, adipopholin and HMGA2; CD34 was expressed in the fibroblastic cells, while desmin and SMA were negative. Loss of nuclear RB1 expression was not observed. Other genetic abnormalities had not been found yet in four cases. Follow-up information was available in six cases; there was no recurrence in five, and one patient only underwent biopsy of the mass. Conclusions: Fibrocartilaginous lipoma is a benign lipomatous tumor with mature adipocytes, fibrocartilage and fibrous elements. By immunohistochemistry, they show the expression of fat and cartilage markers. No specific molecular genetics changes have been identified so far. Familiarity with its clinicopathological features helps the distinction from its morphologic mimics.

An unusual intraoral lipoma: case report and review of the literature.

Lipoma is a common tumor of soft tissue with rare occurrence in oral cavity accounting for only 1-4% of benign oral tumours. It may be noticed only during routine dental examinations. Most of them rarely cause pain, resulting in delay to seek treatment. Lipoma of the oral cavity may occur in any region. The buccal mucosa, tongue, and floor of the mouth are among the common locations. A case of large intraoral lipoma occurring in mental region in a 60-year-old female patient is reported. It was treated surgically under local anesthesia, and 6 month follow up showed excellent healing without any recurrence.

Using a Virtual Reality and Communication Intervention to Reduce Pain and Anxiety in Patients Undergoing Lipoma Excision With Local Anesthesia: A Randomized Controlled Trial.

In this randomized controlled trial, we assessed the effects of using a virtual reality (VR) and communication intervention on pain and anxiety in patients undergoing lipoma excision under local anesthesia. We conducted the study at a large hospital in Turkey between March 15 and September 15, 2019, with 100 participants. We used a pretest and posttest design to collect data with a personal information form, the Numeric Pain Rating Scale, and the State-Trait Anxiety Inventory. The intervention group participants watched a video using a VR headset during the procedure and communicated with an investigator; the control group participants only received routine surgical treatment. The intervention had a significant effect on pain during the procedure (P < .001) and a moderate effect on anxiety 60 minutes after the procedure (P = .01). Use of VR and active communication may help reduce pain and anxiety for patients undergoing procedures performed with local anesthesia.

Transcutaneous electrical stimulation therapy and genetic analysis in Dercum's disease: A pilot study.

ABSTRACT: Dercum's disease (DD), or adiposis dolorosa, is a rare condition of unknown etiology characterized by growth of painful subcutaneous adipose tissue. No specific treatment exists. Pain is often invalidating and resistant to analgesic drugs. We tested the efficacy of Frequency Rhythmic Electrical Modulation System (FREMS) therapy on pain relief. Subcutaneous biopsies were performed for genetic analysis.Nine DD patients were enrolled. Five cycles of FREMS at 3-month intervals during 1 year were administered. Visual analogue scale (VAS), Bartel Index Questionnaire and Short Form 36 questionnaire were used to measure pain and general health status at baseline, 6 and 12 months. Dual-energy X-ray absorptiometry (DEXA) quantified fat mass. Next-Generation Sequencing (NGS) was performed on adipose tissue biopsies and peripheral blood sample to search for somatic variants and specific protein pathway mutation.Seven patients were included in the final analysis. FREMS induced a reduction in VAS score (from 92 to 52.5, P = .0597) and a significant improvement in SF-36 domains (Physical functioning, Role limitation due to physical health, Body pain, Vitality, Social functioning, P < .05). No modification in anthropometrics and DEXA values was observed. The analysis of the mitochondrial Displacement loop (D-loop) region confirmed the clonality of all lipomatous lesions. The presence of the mitochondrially encoded tRNA-Lysine (MT-TK) m.8344A>G variant, occasionally identified in patients with multiple symmetric lipomatosis, was excluded in all subjects. On the other hand, we observed variants in genes belonging to signaling pathways involved in cell cycle and proliferation (Phosphoinositide 3-kinase/AKT/mTOR, MAPK/ERK, and Hippo).FREMS can be a useful tool to alleviate pain and improve overall quality of life in patients with DD. Genetic analysis highlighted the molecular heterogeneity of lipomas.

Case Report: Lipoma of the Tuber Cinereum Mimicking a Pituitary Gland Abnormality in a Girl With Central Precocious Puberty.

Introduction: Magnetic Resonance Imaging (MRI) is the best approach to investigate the hypothalamic-pituitary region in children with central precocious puberty (CPP). Routine scanning is controversial in girls aged 6-8 year, due to the overwhelming prevalence of idiopathic forms and unrelated incidentalomas. Cerebral lipomas are rare and accidental findings, not usually expected in CPP. We report a girl with CPP and an unusually shaped posterior pituitary gland on SE-T1w sequences. Case Description: A 7.3-year-old female was referred for breast development started at age 7. Her past medical history and physical examination were unremarkable, apart from the Tanner stage 2 breast. X-ray of the left-hand revealed a bone age 2-years ahead of her chronological age, projecting her adult height prognosis below the mid parental height. LHRH test and pelvic ultrasound were suggestive for CPP. Routine brain MRI sequences, SE T1w and TSE T2w, showed the posterior pituitary bright spot increased in size and stretched upward. The finding was considered as an anatomical variant, in an otherwise normal brain imaging. Patient was started on treatment with GnRH analogue. At a thorough revaluation, imaging overlap with adipose tissue was suspected and a new MRI scan with 3D-fat-suppression T1w-VIBE sequences demonstrated a lipoma of the tuber cinereum, bordering a perfectly normal neurohypophysis. 3D-T2w-SPACE sequences, acquired at first MRI scan, would have provided a more correct interpretation if rightly considered. Conclusion: This is the first evidence, to our knowledge, of a cerebral lipoma mimicking pituitary gland abnormalities. Our experience highlights the importance of considering suprasellar lipomas in the MRI investigation of children with CPP, despite their rarity, should the T1w sequences show an unexpected pituitary shape. 3D-T2w SPACE sequences could be integrated into standard ones, especially when performing MRI routinely, to avoid potential misinterpretations.

A rare case of ileo-ileal intussusception due to a bleeding lipomatous mass treated by laparoscopic ileal resection.

INTRODUCTION: Adult intussusception is a rare cause of bowel obstruction with atypical presentation. It can be associated with primary or secondary intestinal tumors and, rarely, with lipomatous masses. CASE REPORT: We report the case of a 69-year old man presenting with a history of gastrointestinal bleeding and anemia. Upper and lower endoscopies were negative for bleeding. On abdominal contrast enhanced computerized tomography (CT) scan, a trans-omental hernia in the right lower abdominal quadrant was diagnosed with no active bleeding or evidence of tumor. On exploratory laparoscopy we detected an ileo-ileal intussusception caused by a submucosal mass in the distal ileum, which was reduced and we then performed a segmental resection of the involved small bowel tract. The patient fully recovered by postoperative day 3 when he was discharged home. Final pathology confirmed an ileal lipoma. CONCLUSION: Ileal intussusception caused by lipoma is a rare condition, which can be diagnosed with endoscopy, barium enema, and abdominal ultrasound or CT scanning, but preoperative diagnosis may be difficult. The treatment of choice is the reduction of the intussusception and the resection (laparoscopic or open) of the involved tract. KEY WORDS: Intussusception, Lipoma, Ileum, Laparoscopy, Bleeding.

Tratamento cirúrgico de lipoma: relato de dois casos / Surgical Treatment of Lipoma: Report of two cases

O lipoma é um tumor mesenquimal benigno, considerado um dos mais comuns dos tecidos moles. Ocorre, principalmente, no tronco, nas porções proximais das extremidades do corpo e na região de cabeça e pescoço, com incidência de 15 a 20% dos casos. Quando apresentado em região oral e maxilofacial, é relativamente raro, tendo uma incidência relativa de 1% - 4% dos tumores que acometem essa região. Clinicamente a lesão intraoral apresenta-se como aumento de volume nodular, assintomática, bem-circunscrita, de crescimento lento, com superfície lisa e consistência macia, que pode ser séssil ou pedunculada, de tamanho diverso, com coloração variando de amarelo discreto, em lesões superficiais, a rosa, semelhante à mucosa em lesões mais profundas. O trabalho tem como objetivo relatar dois casos de lipomas em regiões maxilofaciais, tratados cirurgicamente sob anestesia local e geral. Os pacientes encontram-se em acompanhamento, sem sinais de recidiva. É importante o correto diagnóstico clínico e anatomopatológico da lesão, para que seja definido o tratamento ideal e um bom prognóstico, já que essa lesão apresenta uma baixa taxa de recidiva... (AU)

Lipoma is a benign mesenchymal tumor, considered one of the most common one in soft tissues. They mainly occur in the trunk, in the proximal portions of the extremities of the body and in the region of the head and the neck, with incidence of 15 to 20% of cases. When present in the oral and maxillofacial regions, it is relatively rare, with a relative incidence of 1% -4% of the tumors affecting this region. Clinically, the intraoral lesion presents as a nodular volume increase, asymptomatic, well-circumscribed, slow-growing, with smooth surface and soft consistency - which may be sessile or pedunculated - of different size, with a coloration ranging from discrete yellow in superficial lesions to a mucosa-like pink in deeper lesions. The aim of this study is to report two cases of lipomas in maxillofacial regions surgically treated under local and general anesthesia. Patients are being followed up without signs of relapse. The appropriate clinical and pathological diagnosis of the lesion is important to define the ideal treatment and a good prognosis, since this lesion presents a low rate of recurrence... (AU)

[Diagnosis and therapy of benign intraarticular tumors]. / Diagnostik und Therapie benigner intraartikulärer Tumoren.

Intraarticular benign tumors are rare lesions in many cases seen as incidental findings. One of the typical lesions is the diffuse or nodular form of pigmented villonodular synovitis, which needs a complete surgical removal. Magnetic Resonance Imaging (MRI) is diagnostic in most of the cases because of the intracellular iron content which shows an at least in some parts dark T2-sequence. Adjuvant therapies as radiosynoviorthesis should be considered in diffuse or recurrent lesions. Synovial Chondromatosis represents a metaplastic disorder of the synovial membrane resulting in the production of loose cartilage bodies. Also in this dissease synovectomy or, in late cases, removal of the loose bodies only, is recommended. Synovial hemangiomas are hamartomas which may lead to pain or restriction of movement. In these cases total or partial resection is justified. Alternative treatment options such as laserablation may be possible. Lipoma arborescens represents a proliferative lipoid lesion of the subsynovial region leading to villonodular synovial proliferation. If clinically symptomatic, resection by arthroscopic or open synovectomy is recommented.

Unusual Uptake of Radioiodine in a Subcutaneous Lipoma in a Patient With Differentiated Thyroid Cancer.

A 68-year-old man underwent adjuvant radioiodine therapy for follicular variant papillary thyroid carcinoma. Post-therapeutic whole-body I scan showed abnormal radioiodine uptake on the right side of back. SPECT/CT localized this abnormal activity from a small subcutaneous lesion with fat density between the right 10th and 11th rib. Under ultrasound-guided autopsy, the lesion was confirmed as lipoma.

Excision of Large Lipomas Using Tumescent Local Anesthesia.

BACKGROUND: Many large lipomas are removed under general anesthesia, because more local anesthesia than is safe to inject may be required for complete excision of such large tumors. METHODS: The authors performed total excision using tumescent local anesthesia in an outpatient clinic for 23 patients with solitary large lipomas. RESULTS: The longest diameter of the lesions on magnetic resonance imaging ranged from 10 to 22 cm. Mean length of the skin incision was 4.8 cm, and 56 mL of the tumescent solution on average was used for each patient. The postoperative courses of all patients, except for 1 patient who developed a hematoma, were uneventful. CONCLUSIONS: With judicious patient selection after physical examination and magnetic resonance imaging findings, total excision of large lipomas under tumescent local anesthesia can be performed safely in an outpatient setting.

A rare case of dysembryoplastic neuroepithelial tumor combined with encephalocraniocutaneous lipomatosis and intractable seizures / 소아과

Encephalocraniocutaneous lipomatosis (ECCL) is a rare neurocutaneous syndrome that affects ectomesodermal tissues (skin, eyes, adipose tissue, and brain). The neurologic manifestations associated with ECCL are various including seizures. However, ECCL patients very rarely develop brain tumors that originate from the neuroepithelium. This is the first described case of ECCL in combination with dysembryoplastic neuroepithelial tumor (DNET) that presented with intractable seizures. A 7-year-old girl was admitted to our center because of ECCL and associated uncontrolled seizures. She was born with right anophthalmia and lipomatosis in the right temporal area and endured right temporal lipoma excision at 3 years of age. Seizures began when she was 3 years old, but did not respond to multiple antiepileptic drugs. Brain magnetic resonance (MR) imaging performed at 8 and 10 years of age revealed an interval increase of multifocal hyperintense lesions in the basal ganglia, thalamus, cerebellum, periventricular white matter, and, especially, the right temporal area. A nodular mass near the right hippocampus demonstrated the absence of N-acetylaspartate decrease on brain MR spectroscopy and mildly increased methionine uptake on brain positron emission tomography, suggesting low-grade tumor. Twenty-four-hour video electroencephalographic monitoring also indicated seizures originating from the right temporal area. Right temporal lobectomy was performed without complications, and the nodular lesion was pathologically identified as DNET. The patient has been seizure-free for 14 months since surgery. Although ECCL-associated brain tumors are very rare, careful follow-up imaging and surgical resection is recommended for patients with intractable seizures.

Lipoma em região parotídea: relato de caso / Lipoma in the parotid region: case report

Introdução: O lipoma é um dos tumores benignos mais comuns de origem mesenquimal e constitui-se de gordura. São raramente encontrados na região de cabeça e pescoço, principalmente na região parotídea. Objetivo: Relato de caso clínico de paciente com lipoma em região parotídea direita. Caso clínico: Paciente A.S.L, gênero feminino, melanoderma, 32 anos, procurou atendimento odontológico referindo-se ao aumento de volume em região parotídea direita. Ao exame clínico observava-se uma massa de consistência macia e superfície lisa com aproximadamente 3 centímetros de diâmetro e ausência de queixas álgicas por parte da paciente. Ao exame tomográfico observou-se imagem radiolúcida circunscrita próxima ao arco zigomático e lóbulo superior de parótida direita. A paciente foi orientada a realizar biópsia diagnóstica. O procedimento cirúrgico foi realizado sob anestesia geral e através de acesso pré-auricular, o laudo histopatológico confirmou a hipótese diagnóstica. Nova intervenção cirúrgica não foi necessária uma vez que a biópsia realizada foi excisional. Conclusão: Como o diagnóstico clínico dos casos de lipoma são fáceis de realizar dado as suas características específicas e aos auxílios de exames de imagens, a biópsia excisional torna-se o tratamento definitivo e eficaz, sendo o material enviado ao laboratório de análises clínicas apenas para corroboração da hipótese diagnóstica... (AU)

Introduction: Lipoma is one of the most common benign tumors of mesenchymal origin and consists of fat. Are rarely found in the head and neck, especially in the parotid region. Objective: To report a case of a patient with a lipoma in the right parotid region. Case report: Patient A.S.L., female, melanoderma, 32-year-old, sought to dental care referring to the volume increase in the right parotid region. On clinical examination we observed a mass of soft consistency and smooth-surface with about 3 centimeters in diameter and no complaints of pain by the patient. The CT scan was observed circumscribed radiolucent image next to the right zygomatic arch and upper lobe of parotid gland. The patient was advised to diagnostic biopsy. The surgical procedure was performed under general anesthesia and through pre-auricular access, the histodiferenpathological report confirmed the hypothesis. New surgical intervention was not necessary as the excisional biopsy was performed. Conclusion: As the clinical diagnosis of lipoma cases are easy to perform given its specific characteristics and aid of imaging exams, excisional biopsy becomes final and effective treatment, the material was sent to the clinical laboratory only corroboration of the diagnosis... (AU)

Prolapsed giant sigmoid lipoma: a rare cause of adult ischaemic intussusception.

Intussusception is a rare cause of obstruction in adults and has a variable, non-specific presentation. Adult intussusception is usually associated with an underlying organic pathology, such as a benign or malignant tumour which acts as the lead point. Prolapse of the lead-point mass through the anal canal is an extremely rare presentation with very few reported cases in the literature. We describe a case of a 67-year-old man who presented with rectal prolapse of a large soft tissue mass. CT of the abdomen and barium enema revealed partial intussusception of an upper sigmoid lipomatous polyp. Examination under anaesthesia was performed and the prolapse reduced. A laparoscopic sigmoid colectomy was planned. The patient subsequently re-presented clinically unwell with a recurrent necrotic prolapsing mass. Laparotomy and sigmoid colectomy was performed and the patient recovered fully. The resected mass was a 7×4.5×4.0 cm necrotic sigmoid lipoma.

Single port laparoscopic right hemicolectomy for ileocolic intussusception.

A 36-year-old male was admitted with right lower abdominal pain and diarrhea for more than 3 mo. Colonoscopy and a barium enema study revealed a submucosal tumor over the cecum, but computed tomography showed an ileal lipoma. There was no definitive diagnosis preoperatively, but ileocolic intussusception was noted during surgery. Single port laparoscopic radical right hemicolectomy was performed because intra-operative reduction failed. The histological diagnosis of the resected tumor was lipoma. Single port laparoscopic surgery has recently been proven to be safe and feasible. There are advantages compared with conventional laparoscopic surgery, such as smaller incision wounds, fewer port site complications, and easier conversion. However, there are some drawbacks which need to be overcome, such as difficulties in triangulation and instrument clashing. If there are no contraindications to laparoscopy, single port laparoscopic surgery can be performed safely and should be considered for diagnosis and treatment of intussusception in adults. Here, we report the first case of ileocolic intussusception successfully treated by single port laparoscopic surgery.

[Development of lipoma following a single cupping massage - a case report]. / Auftreten eines Lipoms nach einmaliger Schröpfkopfmassage - ein Fallbericht.

BACKGROUND: The cupping massage is a form of bloodless cupping. This type of cupping is particularly used to treat muscular tension and musculoskeletal pain, such as chronic neck pain; however the data records on mechanisms and potential side effects are not satisfactory. CASE REPORT: In a study on the effectiveness of cupping massage in patients with chronic neck pain, one patient showed a formation of a lipoma in the cupping area after the first treatment session. CONCLUSION: Because of the short time interval between therapy and development of the lipoma, a primary cause is not realistic. This adverse event has not been described in the literature before, and the present report describes the case in summary.

Adult ileoileal intussusception induced by an ileal lipoma diagnosed preoperatively: report of a case and review of the literature.

We herein report a case of adult ileoileal intussusception induced by an ileal lipoma. A 68-year-old woman with a history of small intestinal tumors was admitted to our hospital with severe, colicky lower abdominal pain, similar to episodes experienced in the past. A barium meal enema at the initial admission demonstrated a small intestinal tumor in the ileum 30 cm proximal to the ileocecal valve. Abdominal ultrasound sonography and computed tomography showed a sausage-shaped mass presenting as a target sign in the right lower abdomen, suggestive of intussusception. There was also a round mass of fat attenuation representing a lipoma, which was considered the lead point of the intussusception. The patient underwent emergency surgery and partial resection of the ileum, including the ileal tumor, following reduction of the intussusception. The resected specimen contained a round tumor measuring 1.5 × 1.5 × 1.4 cm, which was diagnosed histopathologically as an intestinal lipoma. The patient made a satisfactory recovery and was discharged on postoperative day 10. The clinical characteristics of previously reported lipomas with intussusception are also discussed, including the relationships between the tumor size and symptoms or location.

Novel method of minimally invasive removal of large lipoma after laser lipolysis with 980 nm diode laser.

Lipomas are the most common benign tumor of the soft tissue, often presenting as soft, mobile subcutaneous masses. These lesions are often removed for cosmetic reasons, although they may be removed secondary to considerable discomfort or paresthesias. The large majority of lipomas appear as small, solitary lesions that are best removed by surgical excision. However, surgical removal of large (>10 cm) or multiple lesions may result in significant scarring. Tumescent local anesthesia and liposuction of larger lesions has been successful in a number of cases although this technique can be hindered by overly fibrous lesions. Laser lipolysis, performed alone or before liposuction, can further facilitate removal of these lesions. This technique is a minimally invasive and effective method of lipoma removal, resulting in an excellent cosmetic outcome. This report describes step-by-step removal of a large lipoma located on the back, as well as a review of currently employed techniques for minimally invasive treatment of lipomas.

A Case Report of Glomus Tumor of the Nasal Columella

PURPOSE: Glomus tumor is a benign neoplasm of the normal glomus body, occurring as painful subcutaneous nodules, frequently located in the subungual area. There are few cases of facial glomus tumor reported and we report a case of glomus tumor developing on the columella of nose. METHODS: A 68-year-old female presented with a mass of the columella grown for 2 years. The nodule was 0.6 cm in diameter, red-colored without any symptoms such as pain, tenderness and cold hypersensitivity. The pathologic result after punch biopsy was hemangiopericytoma. Excision with local anesthesia was executed. RESULTS: The postoperative recovery of the patient was uneventful, Histopathological examination indicated a glomus tumor. Immunostaining revealed positivity for vimentin, actin, and negativity for desmin, CD-34. After 8 months follow up, there is neither complication nor evidence of local recurrence on clinical examination. CONCLUSION: To accomplish an accurate diagnosis of glomus tumor, the histopathological examination is essential together with immunochemical studies. The differential diagnosis include hemangioma, lipoma, epidermal inclusion cyst, dermoid cyst and arteriovenous malformation in this region. We report a case of glomus tumor on the face with uncommon clinical features.