Lipoma gigante na mão: um desafio cirúrgico / Giant hand lipoma: a surgical challenge

O lipoma é um tumor frequente dos tecidos moles e pode localizar-se em qualquer parte do corpo; no entanto, sua apresentação na mão é rara. São chamados gigantes quando excedem 5cm; nestes casos, o diagnóstico diferencial deve ser feito com lipossarcoma. Os lipomas devem ser caracterizados no pré-operatório com um exame de imagem, e seu tratamento é cirúrgico. Apresentamos o caso de uma paciente com um lipoma gigante da mão dominante, tratada com sucesso com uma abordagem cirúrgica modificada de Bruner

Lipomas are frequent soft tissue tumors and can be found anywhere in the body; however, their location in hand is rare. They are called giants when they exceed 5 cm. In these cases, the differential diagnosis must be made with liposarcoma. These benign tumors must be characterized preoperatively with an imaging study, and their treatment is surgical. We present the case of a patient with a giant hand lipoma successfully treated with a modified Bruner incision approach

Multiexponential T2 relaxometry of benign and malignant adipocytic tumours.

BACKGROUND: We investigated a recently proposed multiexponential (Mexp) fitting method applied to T2 relaxometry magnetic resonance imaging (MRI) data of benign and malignant adipocytic tumours and healthy subcutaneous fat. We studied the T2 distributions of the different tissue types and calculated statistical metrics to differentiate benign and malignant tumours. METHODS: Twenty-four patients with primary benign and malignant adipocytic tumours prospectively underwent 1.5-T MRI with a single-slice T2 relaxometry (Carr-Purcell-Meiboom-Gill sequence, 25 echoes) prior to surgical excision and histopathological assessment. The proposed method adaptively chooses a monoexponential or biexponential model on a voxel basis based on the adjusted R2 goodness of fit criterion. Linear regression was applied on the statistical metrics derived from the T2 distributions for the classification. RESULTS: Healthy subcutaneous fat and benign lipoma were better described by biexponential fitting with a monoexponential and biexponential prevalence of 0.0/100% and 0.2/99.8% respectively. Well-differentiated liposarcomas exhibit 17.6% monoexponential and 82.4% biexponential behaviour, while more aggressive liposarcomas show larger degree of monoexponential behaviour. The monoexponential/biexponential prevalence was 47.6/52.4% for myxoid tumours, 52.8/47.2% for poorly differentiated parts of dedifferentiated liposarcomas, and 24.9/75.1% pleomorphic liposarcomas. The percentage monoexponential or biexponential model prevalence per patient was the best classifier distinguishing between malignant and benign adipocytic tumours with a 0.81 sensitivity and a 1.00 specificity. CONCLUSIONS: Healthy adipose tissue and benign lipomas showed a pure biexponential behaviour with similar T2 distributions, while decreased adipocytic cell differentiation characterising aggressive neoplasms was associated with an increased rate of monoexponential decay curves, opening a perspective adipocytic tumour classification.

Parapharyngeal space lipoma, resection under transmandibular approach / Lipoma en espacio parafaríngeo, resección bajo abordaje transmandibular

Lipoma is a benign entity with a poor incidence in craniofacial region. The most frequent tumors in the maxillo pharyngeal space are those that occur in the major and minor salivary glands, with a higher incidence of pleomorphic adenoma, also consider a benign entity. The transmandibular approach offers a great advantage in terms of visibility during the surgery. Achieving a lower morbidity, due to the fact that anatomic structures of anterior (prestyloid) and posterior (retrostyloid) compartments are involved. Our case report has important implications: clinical, pathologic and surgical, with a good prognosis for life and good for function at 2 year of postoperatively without any recurrence reported.

El lipoma es una entidad benigna con pobre incidencia en la región craneofacial. Las tumoraciones más frecuentes en el espacio maxilofaríngeo son las que se presentan en glándulas salivales mayores y menores ectópicas, con mayor incidencia de adenoma pleomorfo, también considerado una entidad benigna. El abordaje transmandibular ofrece una gran ventaja en cuanto a la visibilidad durante el acto quirúrgico. Consiguiendo una menor morbilidad al estar involucradas estructuras del espacio preestíleo y retroestíleo. El caso clínico que se presenta tiene importantes implicaciones: clínicas, patológicas y quirúrgicas, con un pronóstico bueno para la vida y bueno para la función a dos años de posoperatorio, sin recidiva alguna.

Lipoma gigante de Membro inferior com repercussão no sistema vascular / Giant lipoma of the lower limb and its impact on the vascular system

Lipomas are the most common mesenchymal tumors, which may develop in different parts of the body. However giant lipomas are rare and sometimes difflcult to diagnose owing to their location and the presenting clinical consequences. In this report, we present the case of a patient with a giant lipoma in lhe left popliteal region that was surgícally treated after a detailed radiologícal assessment. Further, we discuss lhe preoperative diagnosis and its difficulties, often caused by the deep localization of the tumor and the impossibility of obtaining a conclusive radiological diagnosis. Moreover, we describe the successful treatment, along with the step-by-step surgical approach and the final outcome achieved.

Os lipomas são os tumores Mesenquimais mais frequentes e podem ocorrer em diversas partes do corpo. Entretanto lipomas gigantes são raros por vezes de difícil diagnóstico, em decorrência de sua localização e com consequência clinicas. Neste artigo é apresentado um caso de lipoma gigante em região poplítea esquerda tratado cirurgicamente após detalhado estudo radiológico. São discutidos o diagnóstico pré-operatório e suas dificuldades, muitas vezes causadas pela localização profunda e pela impossibilidade de diagnóstico conclusivo pela imagem. O tratamento foi concluído com sucesso, sendo descritos a abordagem cirúrgica passo a passo e o resultado final.

Lipoma intermuscular gigante: relato de caso / Giant intermuscular lipoma: case report

Introdução: Contrastando com o fato de que os lipomas são tumores mesenquimais muito comuns, a variante subfascial é bastante rara. Esta é subdividida em intermuscular eintramuscular. O tipo intermuscular é o menos comum. Os lipomas gigantes também são raramente encontrados e são caracterizados por medir, no mínimo, 10 centímetros em uma dasdimensões ou pesar ao menos 1000 gramas. Relato do caso: No presente artigo, relatamos o caso de uma paciente apresentando um lipoma intermuscular gigante localizado na coxa.

Introduction: Despite the fact that lipomas are very common mesenchymal tumors, the subfascial variant is quite rare. It is subdivided into intermuscular and intramuscular. The intermuscular type is less common. Giant lipomas are also rarely found and are characterizedby measuring at least 10 centimeters in one dimension or weigh at least 1000 grams. Case report: In this article, we describe the case of a patient presenting a giant intermuscular lipoma located in the thigh.