Giant Lipoma
A Hafeez, A Darzi, H Zargar, T Javeed
Citation
A Hafeez, A Darzi, H Zargar, T Javeed. Giant Lipoma. The Internet Journal of Plastic Surgery. 2006 Volume 4 Number 2.
Abstract
Lipoma is one of the commonest benign mesenchymal tumors in body and found almost in all organs where the fat exists. It is usually small but giant lipomas can be present in thigh, shoulder be trunk. The present study describes a 60 year old male with a huge mass right thigh which on histopathology revealed features suggestive of lipoma.
Case Report
A 60 year old male presented in out patient clinic with history of progressively increasing swelling in right thigh, which he noticed 3½ years back. Swelling was otherwise asymptomatic except that he had to wear loose fitting trousers.
On examination, right thigh girth was grossly increased as compared to the left thigh(Fig.1).
Figure 1
There were erythema ab agni over the medial aspect of both thighs (as is usual in Kashmiri people because of Kangri – “the fire pot”). The swelling was firm, non-tender and free from underlying structures.
CT scan of the right thigh was done which revealed a hypodense mass in the posterior compartment of the thigh beneath the hamstring muscles (Fig.2).
Figure 2
FNAC of the swelling revealed mature fat cells, suggestive of lipoma.
The patient was operated on under general anaesthesia, in prone position and the tumour was found beneath the hamstring muscles and was dissected out easily because of the pseudocapsule. Wound was closed in layers, leaving a suction drain inside the cavity. Healing progressed uneventfully. Histopathological examination revealed features consistent with lipoma. The tumour removed measured 21x17x14cm in size and weighed 2950gms(Fig.3).
Figure 3
Six months after surgery, the patient is symptom free and has no signs of recurrence.
Discussion
Lipoma is one of the commonest benign mesenchymal tumour in the body composed of mature adipose cells. It is found in almost all the organs(1) of the body where normally fat exists that is why it is also known as ubiquitous tumour or universal tumour.
Most of the lipomas present as small subcutaneous swellings without any specific symptom. Giant lipomas, though rare, can present in thigh, shoulder or trunk. Clinical features of these giant lipomas are mainly because of their size which includes pain because of stretching of adjacent nerves(3), restriction in movements of the part involved or social embarrassment because of mere size of the swelling.
Although definitive diagnosis of giant lipoma can be made only by histopathological examination, but once suspected, other investigations can provide additional information about the tumour. The characteristics of benign lipoms on ultrasonography(2), CT(10) and MRI(7) have been well established and even Tc99 DTPA scan have been used to confirm the diagnosis.
Surgery is the treatment of choice(9) of these giant swellings due to their tendency to recur and their potential hazard of malignant transformation(8), other option for treatment of these giant swelling is liposuction(6). The dissection of these lipomas is usually easy because of continuous pressure on the surrounding tissue, a well defined pseudocapsule is formed. Dead space created because of dissection of the giant lipomas is usually drained with the help of a suction drain to avoid collection. As already mentioned, these tumours have tendency to recur and can have malignant transformation, therefore, should be followed meticulously.