Giant lipofibromatous hamartoma of median nerve in a child

Lipofibromatous hamartoma (LFH) is a rare fibrofatty tumor of adipocytes within peripheral nerves, affecting mainly children. It typically presents as a palpable mass surrounding the nerves of the upper limbs, causing pain and neurological deficits in the affected nerve distribution. We report the case of a child with a 2-years presentation of a mass in the right wrist associated with pain and paresthesia, who underwent investigation with magnetic resonance imaging (MRI). It showed thickening of the median nerve with spaghetti-like appearance associated with lipomatous tissue in a coaxial cable-like pattern, both features characteristic of LFH. This case illustrates the importance of MRI in the differential diagnosis of limb masses in the pediatric population.

Lipomielomeningocele y médula anclada en un neonato: a propósito de un hallazgo cutáneo / Lipomyelomeningocele and tethered cord in neonate: a cutaneous finding / Lipomielomeningocele e medula ancorada em rescem nacido: um achado cutâneo

Introducción: el disrafismo espinal oculto comprende las anomalías congénitas caracterizadas por la fusión incompleta del tubo neural, en las que la lesión se encuentra cubierta por piel sin observarse exposición del tejido nervioso. Existen estigmas cutáneos que se asocian a su presencia, siendo los lipomas congénitos en la línea media posterior altamente sugerentes de lesión espinal. Su principal complicación es la asociación con el síndrome de médula anclada, que puede causar un daño neurológico irreversible. Caso clínico: recién nacida de sexo femenino, durante la exploración en Maternidad detectamos un estigma cutáneo del tipo lipoma en la región sacra sospechoso de disrafismo espinal oculto, confirmándose posteriormente, mediante estudio con ecografía y resonancia magnética, la presencia de lipomielomeningocele y médula anclada. Conclusiones: el reconocimiento de los marcadores cutáneos, que constituyen a veces la única manifestación de la enfermedad en pacientes asintomáticos, posibilitaría un diagnóstico precoz y manejo individualizado con posible corrección quirúrgica según el caso, que podría prevenir el daño neurológico irreversible asociado a la médula anclada.

Introduction: hidden spinal dysraphism involves congenital anomalies characterized by an incomplete fusion of the neural tube, where the lesion is covered by skin and the nervous tissue is not exposed. Some skin stigmas are linked with this spinal injury, mainly congenital lipomas in the posterior midline of the lesion. Hidden spinal dysraphism's main complication could be tethered cord syndrome, which can cause irreversible neurological damage. Clinical case: female newborn showing a lipoma-like skin stigma in the sacral region, looking like hidden spinal dysraphism, which was later confirmed through ultrasound and magnetic resonance imaging, which showed lipomyelomeningocele and a tethered cord. Conclusions: early detection of these skin markers is sometimes the only tool to early diagnosis and personalized treatment in asymptomatic patients. It enables a possible surgical remediation and may prevent the irreversible neurological damage linked to the tethered cord.

Introdução: o disrafismo espinhal oculto envolve anomalias congênitas caracterizadas por uma fusão incompleta do tubo neural, onde a lesão é coberta por pele e o tecido nervoso não fica exposto. Alguns estigmas de pele estão relacionados a essa lesão espinhal, principalmente lipomas congênitos na linha média posterior da lesão. A principal complicação do disrafismo espinhal oculto pode ser a síndrome da medula ancorada, a qual pode causar danos neurológicos irreversíveis. Caso clínico: recém-nascida apresenta estigma cutâneo semelhante a lipoma na região sacral, semelhante a disrafismo espinhal oculto, posteriormente confirmado por ultrassonografia e ressonância magnética, o que evidenciou lipomielomeningocele e medula ancorada. Conclusões: a detecção precoce desses marcadores cutâneos às vezes é a única ferramenta para o diagnóstico precoce e tratamento personalizado em pacientes assintomáticos. Permite uma possível correção cirúrgica e pode prevenir os danos neurológicos irreversíveis ligados à medula ancorada.

Omental lipoma in pediatric age group: clinical presentation, image findings and management

ABSTRACT A 2-year-old female patient, admitted in the emergency room, presented diarrhea for 5 days and bloody stools in the last 24 hours. Physical examination revealed no significant findings. Ultrasound was initially performed, showing an elongated, well delimited and solid mass occupying since right hypocondrium until left iliac fossa, displacing adjacent structures. In sequence, magnetic resonance imaging was performed for confirmation of findings suggestive of omentum lipoma. After 1 week, the surgical resection was performed by videolaparoscopic acess. During 2-year follow-up, there was no sign of recurrence.

Lipoma no Septo Interventricular ­ Relato De Caso / Lipoma in the Interventricular Septum ­ Case Report

Tumores cardíacos primários consistem em patologia rara, sendo encontrados em até 0,03% das autópsias e a maioria benigna. Dentre os benignos, os lipomas apresentam incidência de 8,5%, localizando-se mais frequentemente no septo interatrial. Quando localizado no septo interventricular, é considerado patologia ainda mais incomum, com prevalência real desconhecida. Na maioria dos casos, o diagnóstico ocorre de forma incidental, por exame de imagem cardiovascular, e pode ser confirmado por exame histopatológico. Apresentam-se mais comumente de forma assintomática ou com sintomas inespecíficos, mas podem evoluir com arritmias, disfunção valvar, insuficiência cardíaca e óbito, o que ressalta a importância dos métodos de imagem cardiovascular no diagnóstico diferencial e na orientação da terapêutica adequada. O presente trabalho relata o caso de um paciente com achado ecocardiográfico incidental de massa cardíaca localizada no septo interventricular, seguindo da realização de ressonância magnética cardíaca, para melhor caracterização da lesão e demonstração de características compatíveis com lipoma.(AU)

Lipoma de bola adiposa de Bichat: un caso atípico / Bichat's fat pad lipoma: an atypical case

Los lipomas son tumores benignos compuestos por adipocitos maduros. Si bien representan la neoplasia más común en el cuerpo humano, su aparición en la región de la cabeza y el cuello es relativamente rara. No muestra predilección por sexo y afecta a individuos en la cuarta década de vida. Clínicamente, puede observarse un aumento de volumen nodular, de consistencia blanda y superficie lisa. Su etiopatogenia aún es desconocida, aunque algunos autores han sugerido factores endócrinos, inflamatorios, hereditarios y traumáticos. El diagnóstico se realiza a través de la evaluación clínica, con la ayuda de pruebas de imagen como la tomografía computarizada y la resonancia magnética. Sin embargo, solo puede ser confirmado mediante análisis histopatológico de la lesión, considerado el examen por excelencia. El tratamiento de los lipomas y todas sus variantes consiste en la extirpación quirúrgica total, con lo cual se disminuye la posibilidad de recidivas, que es rara de por sí. El objetivo de esta publicación es informar un caso clínico de lipoma localizado en la región de la mucosa yugal, con extirpación quirúrgica completa de la lesión de manera ambulatoria (AU)

Lipomas are benign tumors composed of mature adipo- cytes. Although they represent the most common neoplasia in the human body, their occurrence in the head and neck region is relatively rare. Regardless of gender, they affect individu- als from the fourth decade of life on. Clinically, an increase of the nodular volume with softened consistency and smooth surface can be observed. Although its etiopathogenesis is still uncertain, some authors have suggested endocrinal, inflam- matory, hereditary and traumatic factors. The diagnosis is made through clinical evaluation, with the aid of imaging ex- aminations, such as computerized tomography and magnetic resonance. However, it can only be confirmed through the histopathological analysis of the lesion, which is considered the gold standard examination. The treatment of the lipomas and all their variations consists of complete surgical exci- sion, thus diminishing the possibility of recurrence, which in turn is rare. The aim of this publication is to report a clin- ical case of lipoma, located in the jugal mucosa region and treated through complete surgical removal of the lesion on an outpatient basis (AU)

Compressive Neuropathy of the Ulnar Nerve in the Hypothenar Region by Lipoma: Case Report

Lipomas are well-defined tumors of the adipose tissue that often occur in the torso or the extremities of adult patients. These tumors usually develop painlessly and insidiously, but theymay compress adjacent structures. The objective of the present study is to describe the case of a 68-year-old female patient with a giant lipoma located at the hypothenar region, with manifestation of compression of the common palmar digital nerves, the ulnar nerve, andthe abductormuscle of theVfinger. Regarding the symptoms, the patient feltmoderate pain in the hypothenar region, with no Tinel sign, and no changes in the motor function or sensibility of the digits innervated by the ulnar nerve. Lipomasmay present a varied range of histological characteristics, and malignant tumors may be a differential diagnosis. An imaging exammay aid in the diagnosis, which is confirmed by a histopathological study. For the present case, as recommended in the literature, a surgical procedure was performed for the resection of the tumor, which resulted in the control of the symptoms.

Lipoma intraóseo en la región esfenoclival: reporte de un caso y revisión de la literatura / Intraosseous lipoma in the sphenoclival region: case report and review of the literature

RESUMEN El lipoma intraóseo es un tumor mesenquimatoso poco frecuente que se presenta principalmente en el esqueleto apendicular. La localización dentro del cráneo, es aún más rara, y hasta la fecha solo se han descrito 6 casos en la literatura de lipomas intraóseos que comprometen la región esfenoclival. Por lo general, no presenta ningún síntoma y es un hallazgo incidental en el estudio de imágenes. Presentamos el caso de un paciente de 22 años de edad que consulta por obstrucción nasal y rinorrea mucosa de tres semanas de evolución. La tomografía computarizada y resonancia nuclear magnética evidenciaron una lesión en la región esfenoclival con características sugerentes de lipoma intraóseo. No se realiza estudio histopatológico. Con respecto al manejo, se decide hacer seguimiento radiológico. Se realizó una segunda resonancia magnética 4 meses después, sin cambios significativos.

ABSTRACT Intraosseous lipoma are a rare mesenchymal tumor that occurs primarily in the appendicular skeleton. Skull presentation is a rare finding, and only 6 cases have been described in literature so far of lipomas that compromise the sphenoclival region. In general, they are asymptomatic and occur as incidental findings in imaging studies. We present the case of a 22-year-old patient who consulted for nasal obstruction and mucous rhinorrhea of three weeks of evolution. Computed tomography and magnetic resonance imaging showed a lesion in the sphenoclival region suggestive of intraosseous lipoma. Histopathological study was not performed. Regarding management, radiological follow-up was decided. A second MRI was taken 4 months later, with no significant changes.

Tumor de grasa parda: Hibernoma / Brown fat tumor: Hibernoma

Se presenta el caso de un paciente de 45 años para realización de RMN de hombro por tumoración. La RMN permite detectar un hibernoma, tumor benigno derivado del tejido adiposo pardo. Se describen los hallazgos derivados de la RMN, el tratamiento empleado por el médico tratante y los métodos de imágenes aplicables

The case of a 45-year-old patient for performing NMR of the shoulder by tumor is described here. NMR allows the detection of a hibernoma, a benign tumor derived from brown adipose tissue. The findings derived from NMR, the treatment used by the attending physician and the applicable imaging methods are described

Lipoma intraoral: reporte de un caso clínico / Intraoral lipoma: report of a clinical case

Dentro de las neoplasias más frecuentes de tejidos blandos mesenquimáticos, el lipoma es el de mayor frecuencia. A nivel de cabeza y cuello, su incidencia es inferior, siendo de 2 a 4 por ciento. En la cavidad bucal, la ubicación más usual es en la lengua. Histológicamente, se observan adipocitos separados por tabiques fibrosos. El diagnóstico diferencial se realiza con tumor de células granulares, neurofibroma, fibroma traumático y malformaciones de las glándulas salivales. En el siguiente artículo se describirá un caso clínico con su técnica quirúrgica.

Among the most frequent neoplasms of soft mesenchymal tissues, lipoma is the most frequent. At head and neck level, the incidence is lower, being 2 to 4 percent. In the oral cavity, the most usual location is on the tongue. Histologically, adipocytes are seen separated by fibrous septa. The differential diagnosis is made with granular cell tumor, neurofibroma, traumatic fibroma and malformations of the salivary glands. The following article will describe a clinical case with its surgical technique.

Quadrigeminal cisterna lipoma: report of two cases and literature review / Lipoma da cisterna quadrigeminal: relato de dois casos e revisão da literatura

Intracranial lipomas are congenital, benign and slow-growing tumors. The incidence were 0.1 to 0.5 percent of all primary brain tumors and are often diagnosed in incidental findings of neuroradiological investigation. Lipoma in quadrigeminal region occurs in 25 percent of intracranial lipomas and has been reported as lipomas in quadrigeminal cistern (perimesencephalic cistern), quadrigeminal plate, ambiens cistern or superior medullary velum. MRI is the most major exam. The treatment is conservative in most cases, surgical removal is hampered by their deep location and contiguous with adjacent neurovascular structures. The authors report two cases of lipoma in the quadrigeminal region, incidental findings and discuss the clinical findings, neuroimaging and treatment.

Lipomas intracranianos são tumores congênito, benigno e de crescimento lento. Sua incidência é de 0.1 a 0.5 por cento de todos os tumores cerebrais primários e são frequentemente diagnosticados em achados incidental de investigação neuroradiológica. Lipoma na região quadrigeminal ocorre em 25 por cento dos lipomas intracranianos e tem sido relatados como lipomas na cisterna quadrigeminal (cisterna perimesencefálica), placa quadrigeminal, cisterna ambiens ou véu medular superior. O exame de eleição é ressonância magnética. O tratamento é conservador na maioria dos casos, a remoção cirúrgica é dificultada pela sua localização profunda e da contiguidade com estruturas neurovasculares adjacentes. Os autores relatam dois casos de lipoma na região quadrigeminal achados incidentalmente e discutem os achados clínicos, imagem e tratamento.

Onychogryphosis in tuberous sclerosis complex: an unusual feature

Abstract Onychogryphosis is an acquired nail plate change. It often affects the toenail and is characterized by an opaque, yellow-brownish nail plate that is distorted, grossly thickened, elongated, and partly curved resembling a ram's horn. Tuberous sclerosis complex is a multisystem disorder associated with high rates of mental retardation, autism, cognitive impairment, behavioral problems, or seizures. Nail disease can also be associated, which is a concern to patients due to pain and nail distortion. We reported a typical tuberous sclerosis complex patient with distinctive clinical features of a ram's horn nails, which presented a great challenge to surgical treatment and nail restoration.

What is your diagnosis?

Abstract: CLOVES syndrome is a rare, newly described, and relatively unknown syndrome, related to somatic mutations of the PIK3CA gene. Clinical findings include adipose tissue overgrowth, vascular malformations, epidermal nevi, scoliosis, and spinal deformities. This report deals with a characteristic phenotype case, highlighting peculiar cutaneous and radiological changes.

Diagnóstico en tomografía computarizada de tumores endobronquiales de estirpe lipomatosa / Computed tomography diagnosis of lipomatous endobronchial tumors lineage

We describe two cases of lipomatous endobronquial tumors diagnosed by CT. The first case showed a homogeneous fat density endobronquial nodule in the right intermediate bronchus compatible with lipoma. The second patient underwent a CT under the suspicion of a endobronquial lesion after two episodes of pneumonia localized in left lower lobe. The TC demonstrated a fat predominant nodule in the left lower lobe bronchus. The anatomopathologic study confirmed a lipomatous hamartoma with areas of mature cartilage.

. Describimos 2 casos de tumores lipomatosos endobronquiales diagnosticados mediante TC. El primer caso mostró un nódulo homogéneo de densidad grasa de 11 mm localizado en el bronquio intermediario derecho, que correspondió a un lipoma. El segundo paciente se sometió a una TC por la sospecha de lesión endobronquial luego que cursara con 2 episodios de neumonías localizadas en el lóbulo inferior izquierdo. En esta se demostró un nódulo de predominio graso con pequeñas áreas de densidad de partes blandas en el bronquio inferior izquierdo. El estudio patológico confirmó que se trataba de un hamartoma lipomatoso con áreas de cartílago maduro.

Qualitative and Quantitative Analysis with Contrast-Enhanced Ultrasonography: Diagnosis Value in Hypoechoic Renal Angiomyolipoma

OBJECTIVE: To evaluate the value of enhancement features and quantitative parameters of contrast-enhanced ultrasonography (CEUS) in differentiating solid hypoechoic renal angiomyolipomas (AMLs) from clear cell renal cell carcinomas (ccRCCs). MATERIALS AND METHODS: We analyzed the enhancement features and quantitative parameters of CEUS in 174 hypoechoic renal masses (32 AMLs and 142 ccRCCs) included in the study. RESULTS: Centripetal enhancement pattern was more common in AMLs than in ccRCCs on CEUS (71.9% vs. 23.2%, p < 0.001). At peak enhancement, all AMLs showed homogeneous enhancement (100% in AML, 27.5% in ccRCCs; p < 0.001). Quantitative analysis showed no significant difference between rise time and time to peak. Tumor-to-cortex (TOC) enhancement ratio in AMLs was significantly lower than that in ccRCCs (p < 0.001). The criteria of centripetal enhancement and homogeneous peak enhancement together with TOC ratio < 91.0% used to differentiate hypoechoic AMLs from ccRCCs resulted in a sensitivity and specificity of 68.9% and 95.8%, respectively. CONCLUSION: Both qualitative and quantitative analysis with CEUS are valuable in the differential diagnosis of hypoechoic renal AMLs from ccRCCs.