Tratamiento quirúrgico de fibrolipoma gigante de espalda / Surgical treatment of giant fibrolipoma of the back

Introducción: Los lipomas son los tumores más numerosos de tejidos blandos. Se presenta un caso con enfermedad de Hoffman-Zurhelle asociado a lipoma gigante en región toracodorsal y lipomatosis tratado quirúrgicamente de conjunto con las especialidades de cirugía plástica y cirugía general del Hospital Ameijeiras. Objetivo: Mostrar los resultados del tratamiento quirúrgico de exéresis de tumor gigante de espalda. Caso clínico: Paciente masculino de 34 años de edad que se le realizó bajo anestesia general disección del colgajo dermograso en sentido cefálico hasta línea paravertebral y cuello. Se respetó un centímetro de grosor, abordaje a nivel de la interfase del músculo trapecio y dorsal ancho. Se identificó la cápsula del lipoma que se independizó de las fibras musculares y del plano profundo hasta realizar su exéresis y de la piel excedente con nevo lipomatoso cutáneo superficial. Cierre por planos sin tensión. Conclusiones: Se logró la resección de un fibrolipoma gigante en espalda con una planificación cuidadosa que respetó el aporte vascular de los colgajos, la cobertura cutánea sin tensión y conservó la función muscular en ausencia de complicaciones(AU)

Introduction: Lipomas are the most numerous soft tissue tumors. We present a case of Hoffman-Zurhelle disease associated with giant lipoma in the thoracodorsal region and lipomatosis treated surgically in conjunction with the plastic surgery and general surgery specialties of the Ameijeiras Hospital. Objective: To show the results of surgical treatment of excision of a giant tumor of the back. Clinical case: A 34-year-old male patient underwent dissection of the dermographic flap in cephalic direction up to the paravertebral line and neck under general anesthesia. One centimeter thickness was respected, approaching at the level of the trapezius and latissimus dorsi muscle interface. The lipoma capsule was identified and became independent of the muscle fibers and the deep plane until it was excised, as well as the excess skin with superficial cutaneous lipomatous nevus. Closure by planes without tension. Conclusions: Resection of a giant fibrolipoma on the back was achieved with careful planning that respected the vascular supply of the flaps, the skin coverage without tension and preserved muscle function in the absence of complications(AU)

Lipoma Cervicofacial Gigante: Reporte de un caso / Giant Cervicofacial Lipoma: A Case Report

RESUMEN: Los lipomas son neoplasias benignas formadas por tejido adiposo maduro y que representan los tumores mesenquimales más frecuentes. Los lipomas gigantes se definen en relación a un tamaño mayor de 10 centímetros o un peso mayor a 1 kilogramo. Su presentación a nivel de cabeza y el cuello es infrecuente. Se caracterizan por tener un crecimiento lento, progresivo, deformante y asintomático. Es necesaria la realización de pruebas de imagen para su correcta localización anatómica y establecer relaciones con las estructuras vecinas. El tratamiento de elección es la escisión quirúrgica de la masa. La planificación pre-quirúrgica en este tipo de casos debe ser minuciosa para garantizar la conservación tanto de la función como de la estética cervicofacial. Se reporta el caso de una mujer de 50 años que presenta una tumoración gigante cervicofacial de 9 años de evolución, diagnosticada como lipoma, con sus características clínicas, imageneológicas, histopatológicas y su manejo terapéutico.

ABSTRACT: Lipomas are benign neoplasms formed by mature adipose tissue and represent the most frequent mesenchymal tumors. Giant lipomas are defined in relation to a size greater than 10 centimeters or a weight greater than 1 kilogram. Their presentation at head and neck level is infrequent. They are characterized by having a slow, progressive, deforming and asymptomatic growth. Imaging tests are necessary for their correct anatomical location and the establishment of relationships with neighboring structures. The treatment of choice is surgical excision of the mass. Pre-surgical planning in this type of case must be meticulous to guarantee the preservation of both function and cervicofacial aesthetics. The case of a 50-year-old woman with a giant cervicofacial tumor of 9 years of evolution, diagnosed as lipoma, with its clinical, imaging, histopathological characteristics, and therapeutic management is reported.

An unusual case of giant multilobulated lipoma over left truncal region

Lipomas can virtually occur anywhere in the human body. They can be of varying sizes. Small lipomas are more frequently found, whereas giant lipomas are comparatively rare. These slow-growing, nearly always benign, tumors usually present as non painful, round, mobile masses with a characteristic soft, doughy feel. They are one of the most common benign tumours found in the body. Difference through histopathology and immunochemistry has to be done to rule out other conditions such as liposarcoma. In this report we present a case of a female with a large swelling with multilobulations over the anterolateral aspect of the left thigh and gluteal region. Incision biopsy revealed a lipoma for which primary excision was done safeguarding vital structures. The lipoma was unusual in its size, its appearance and site of occurrence. Histopathology and immunochemistry revealed it to be a lipoma.

Giant Vulval Lipoma in a Post Menopausal Woman.

Lipoma is the second most common mesenchymal tumour in the vulva. It is rare and not commonly seen at the Gynaecological clinic. Perineal lipomas have been reported in females with accessory labioscrotal folds. The site of the tumour and its painless nature delays patient’s presentation. Giant tumours in the perineal region can be uncomfortable and may even obstruct flow of urine and vaginal penetration. Surgical excision and cosmetic approximation of the skin is the treatment of choice for giant vulval lipomas. We present a case of giant vulval Lipoma in a 60-year-old woman. She presented because of embarrassing sexual relationship and urinary difficulties. She had surgical removal of a 900 gms mass.

Giant Lipoma of Forearm Causing Median Nerve Compression – A Case Report

Giant lipomas in the proximal upper extremity are rare. Traditionally these are slow growing tumour and cause symptoms depending upon their size, position and compression of surrounding structures. Lipoma causing compression of median nerve in the forearm is rare. Surgical excision invariably leads to complete recovery. We present a case of a giant lipoma in forearm causing neuropathy of median nerve. It is difficult to clinically judge the extent of lipoma in atypical position and findings. MRI should be used in pre-operative evaluation of these cases. Surgical excision causes complete resolution of symptoms.

Rare lesions of the breast Fibrocystic disease with chondroid metaplasia, giant lipoma and fibroadenoma with atypical ductal hyperplasia.

This paper focused on 3 rare lesions of breast - an exceedingly rare case of fibrocystic disease of breast with predominantly chondroid metaplasia. Giant lipoma of breast which is infrequently observed because of rarity in size and location, with only very few case reports available in literature and fibroadenoma with atypical ductal hyperplasia(ADH) of breast which is an unusual finding in the adolescent or young adult female.

Clinics in diagnostic imaging (169). Intermuscular lipoma in the thenar eminence of the right hand

A 54-year-old woman presented with a large mass on her right hand that was progressively enlarging over a period of a few years. She had cosmetic concerns about the enlarging mass and experienced interference with routine activity. Physical examination revealed a soft, mobile, non-tender, lobulated mass with well-defined margins. Magnetic resonance imaging showed the soft lump to be a lipomatous mass in the deep palmar space of the hand, which was subsequently surgically resected. The imaging features of deep palmar lipomas of the hand and other common benign lesions at this location are discussed.

Lipoma retroperitoneal gigante (MDM2 negativo) en una paciente joven / Giant retroperitoneal lipoma (MDM2 negative) in a young patient

Las lesiones sólidas mesenquimales del retroperitoneo son infrecuentes representando menos del 1 %. De los sarcomas retroperitoneales el 10 a 15 % corresponde a liposarcomas, los cuales representan el primer diagnóstico diferencial de lipomas benignos. La realización de inmunohistoquímica, específicamente el MDM2,dará el diagnóstico histológico certero, donde su negatividad se traduce en benignidad. El tratamiento quirúrgico de elección es la resección R-0. Caso clínico: Presentamos el caso de paciente femenino de 24 años de edad quien refiere 5 meses previos al ingreso aumento de la circunferencia abdominal y dolor a predo-minio de flanco izquierdo. Exámenes clínicos y paraclínicos indican el diagnóstico presuntivo de un tumor de aspecto graso retroperitoneal. Se realiza laparotomía exploradora con los hallazgos de tumor de aspecto graso, de superficie lisa, de gran tamaño ubicado a nivel de retroperitoneo. Se realiza resección R-0 de la lesión sin complicaciones. Tiempo operatorio: 110 minutos, sangrado estima-do: 150 cc. Tumor de aspecto graso de 11 Kg y 55 cm. Paciente es dado de alta a las 48 horas tolerando vía oral. La biopsia reporta tejido adiposo maduro sin atipias. Inmunohistoquímica reporta tumor lipomatoso, MDM2 Negativo, descartando de esta manera el diagnóstico de liposarcoma. Conclusión: Podemos concluir que los lipomas gigantes a nivel de retroperitoneo corresponden a una patología poco frecuente. Donde la resolución quirúrgica se basa en la resección R-O. La realización del MDM2 permitirá un diag-nóstico histológico confiable y por ende le brindará al cirujano la capacidad de decidir el tratamiento post-operatorio(AU)

The mesenchymal solid retroperitoneal lesions are uncommon, representing less than 1%. Liposarcomas constitute 10 to 15% of the retroperitoneal sarcomas, which represent the first differential diagnosis of benign lipomas. The immunohistochemistry, specifically the MDM2, give the accurate histological diagnosis, where their negativity translates into benignity. The treatment of choice is surgical R-0 resection. Clinical case: We report the case of 24 years old female patient who refers five months before admission increased abdominal girth and pain, predominantly at the left flank. Clinical and laboratory tests indicate presumptive diagnosis of retroperitoneal fatty tumor. Exploratory laparotomy is done with the findings of large retroperitoneal lipomatous tumor. R-0 resection of the lesion is performed without complications. Operating time: 110 minutes, estimated blood loss: 150 cc. Fatty tumor aspect of 11 kg and 55 cm. The patient's progress was satisfactory and he was discharged on the second postoperative day. Mature adipose tissue biopsy reports without atypia. Lipomatous tumor immunohistochemistry reports, MDM2 negative, discarding liposarcoma diagnosing.Conclusion:We conclude that the giant retroperitoneal lipomas corresponds a rare condition. The surgical resolution is based on R-0 resection, and the MDM2 allow a reliable histological diagnosis and thus will provide the surgeon with the capacity to decide the postoperative treatment(AU)

Giant Intramuscular Lipoma in the Back after a Blunt Trauma: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: To report a case of a giant intramuscular lipoma after a blunt trauma. SUMMARY OF LITERATURE REVIEW: Lipomas are the most frequent benign tumor of the mesenchymal tissue. Although the etiopathogenesis is not complete understood yet, it is known that lipoma develope with a 1% rate after traumas in the related localizations. Traumata induce hematoma and initiates inflammatory reactions in fatty tissue and can trigger the development of lipoma. MATERIALS AND METHODS: 2 years after a blunt trauma a 56years male patient developed a back mass. A massive lipoma was confirmed clinical and radiological. RESULTS: A total excision was performed and the result was histopathologic confirmed. CONCLUSIONS: Patients who develop hematoma after a trauma need a close lipoma progress observation which decrease the invasive treatment of post-trauma hematoma.

Giant Lipoma of the Hand: A Case Report / 대한골관절종양학회지

Lipomas are the commonest soft tissue tumor. However, those arsing in the hand are infrequent. Lipomas in the hand that exhibit a size of more than 5 cm call giant lipoma, these are very rare only case reports and small series of this entity have been described. We could experience a case about giant lipoma of the hand which cannot easily contact, we report a case including review of literatures.

Fibrolipoma gigante de la espalda / Fibrolipome géant du dos / Back giant fibrolipoma

Introducción: en el cumplimiento de una misión internacionalista en la Clínica del Colaborador, ubicada en La Paz, Bolivia, se presentó una niña de 12 años de edad, portadora de una gran tumoración en la espalda, acompañada de otras deformidades, que no había sido tratada por carecer de recursos económicos. Los médicos que la habían visto antes habían expresado que al realizar una cirugía, único modo de resolver la situación, no se garantizaba la vida de la menor y también por el hecho de residir en una región intrincada del país. El objetivo de esta comunicación es mostrar un caso poco común en la práctica diaria y el resultado de su tratamiento. Descripción: el tratamiento realizado fue eminentemente quirúrgico, apoyado en un tratamiento higiénico-dietético adecuado y la posterior rehabilitación. Los resultados fueron excelentes; finalmente pudo restituirse a la paciente a su lugar de residencia, su escuela y la sociedad. Conclusiones: la tumoración gigante de la espalda, acompañada de otras deformidades en la paciente, se resolvieron después de un tratamiento adecuado(AU)

Introducción: in the fulfilment of an internationalist mission in the Clinic of Collaboration located in La Paz, Bolivia, the Cuban physicians received the case of a girl aged 12 carrier of a big back tumor, together with other deformities, never before treated due to a lack of economic resources. The previous physicians had expressed that the surgery was the only way to solve the situation but without to guarantee the life of patient and also due to she lives in a dense region of the country. The objective of this communication is to show a uncommon case in the daily practice and the result of its treatment. Description: the treatment applied was totally surgical, supported by a proper hygienic-dietetic treatment and its latter rehabilitation. Results were excellent; finally it was possible to refer patient to her place of residence, its school and the society. Conclusions: the giant back tumor, together with other deformities in the patient, disappeared after an appropriate treatment(AU)

Introduction: pendant une mission de collaboration médicale en Bolivie, on a pu constater le cas d'une fille âgée de 12 ans atteinte d'une tumeur dorsale, accompagnée d'autres difformités, et sans traitement-faute de ressources économiques pour se faire soigner, ayant été assistée à la Clinique du collaborateur, à La Paz. D'autres médecins l'ayant vue auparavant avaient déconseillé le traitement chirurgical, seule solution à son problème, à cause du risque pour sa vie et de l'éloignement de son domicile. Le but de ce travail est de rapporter un cas peu fréquent dans la pratique quotidienne, et le résultat de son traitement. Description: le traitement a été certainement chirurgical, soutenu par une hygiène et une diète de qualité, et une bonne rééducation. Les résultats ont été excellents, la patiente a pu se réincorporer à son milieu familial, à son école et à la société. Conclusions: la tumeur géante du dos, accompagnée d'autres difformités, a disparu après l'application du traitement approprié(AU)

A Case of Giant Colonic Lipoma Endoscopically Removed Using an Unroofing Technique in Phases / 대한소화기내시경학회지

Gastrointestinal lipomas are benign adipose tumors that are usually submucosal, and most commonly found in the colon. However, they have also been discovered in the small bowel, stomach and very rarely in the esophagus. Although most of gastrointestinal lipomas are asymptomatic and are found incidentally at time of endoscopy, surgery or autopsy, large lipomas can cause acute abdominal pain, bowel habit changes, gastrointestinal bleeding, intussusception or bowel obstruction. Lipomas can be diagnosed by colonoscopy, abdominal CT, barium series and endoscopic ultrasonography (EUS). Large lipomas need to be treated using various techniques. However, the best treatment modality for large lipomas has not yet been established. A surgical resection of lipomas should be considered for a giant lipoma >2 cm in diameter due to the risk of perforation or hemorrhage. Currently, endoscopic snare polypectomy or endo-loop ligation is used to treat symptomatic lipomas, which may reduce the risk of complications associated with endoscopic treatment. We report a case of giant colonic lipoma that was diagnosed successfully with EUS and treated safely using an endoscopic unroofing technique, endoloop ligation and snare polypectomy in phases.

A Case of Giant Colonic Lipoma Showing Spontaneous Resolution after Endoscopic Partial Resection / 대한소화기학회지

Generally, colon lipoma is mildly symptomatic or asymptomatic. However, sometimes it may present with symptoms, such as pain, constipation, obstruction, or bleeding and may be the leading point for intussusception, particularly in large size (>20 mm). Giant colon lipoma may warrant the removal to exclude confusion with other lesions that have a malignant potential and to control symptoms. Currently, surgical resection should be considered for giant lipoma more than 20 mm in diameter due to the high risk of perforation or bleeding, especially when the lesion is broadly-based. We report here a case of spontaneous resolution acquired after endoscopic partial resection for the symptomatic giant colon lipoma with broad-base requiring surgery.

Giant Mesenteric Lipoma: a Case Report

Visceral lipoma originating from the mesentery is very rare in childhood. A 29-month-old male presented with painless abdominal distension. Abdominal ultrasonography and CT revealed a huge multilobulated hypodense mass in the peritoneal cavity. Exploratory laparotomy showed a 26 x 25 x 5 cm sized encapsulated, lobulated, homogenous mass, which originated from the transverse mesocolon. Histologic examination revealed a lipoma. The postoperative course was uneventful.