Dermatologic Manifestations of Lipomas Workup

  • Author: Robert A Moraru, MD; Chief Editor: William D James, MD   more...
 
Updated: Jan 12, 2012
 

Imaging Studies

  • CT scanning is indicated in suspected liposarcoma. CT scanning is useful for distinguishing between lipomas and liposarcomas.[8]
  • Ultrasonography reportedly is a useful modality for the diagnosis of lipomas; compared with palpation, diagnostic accuracy rates were 54.8% versus 88.1% with ultrasonography (P < .01).[9]
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Procedures

  • Fine-needle aspiration is indicated when the diagnosis of liposarcoma is suspected.
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Histologic Findings

Lipomas histologically resemble normal fat. When completely excised, a thin fibrous capsule surrounding the aggregate of adipocytes may be seen. Without a clinical or gross description, it often is impossible to distinguish between tumor cells and mature adipocytes.

One report describes the diagnostic challenge when encountering low-fat or fat-free pleomorphic lipomas. The authors suggested that identifying the classic nonlipogenic components and considering the clinical context are essential to ensuring diagnostic accuracy in pleomorphic lipomas.[10]

Lipomas differ biochemically from normal mature fat. Lipomas have increased levels of lipoprotein lipase.

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Contributor Information and Disclosures
Author

Robert A Moraru, MD  Staff Physician, Department of Dermatology, St Luke's/Roosevelt Hospital Center, Columbia Presbyterian Medical Center

Robert A Moraru, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Janet Fairley, MD  Professor and Head, Department of Dermatology, University of Iowa, Roy J and Lucille A Carver College of Medicine

Janet Fairley, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Federation for Medical Research, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References

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  2. Economides NG, Liddell HT. Benign symmetric lipomatosis (Madelung's disease). South Med J. Aug 1986;79(8):1023-5. [Medline].

  3. Gomes da Silva R, Detoffol Bragança R, Ribeiro Costa C, Torres de Melo L, Weiss Telles R, Costa Silva L. Multiple symmetric lipomatosis. J Cutan Med Surg. Jul-Aug 2011;15(4):230-5. [Medline].

  4. Bonatus TJ, Alexander AH. Dercum's disease (adiposis dolorosa). A case report and review of the literature. Clin Orthop Relat Res. Apr 1986;251-3. [Medline].

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  8. Wolfe SW, Bansal M, Healey JH, Ghelman B. Computed tomographic evaluation of fatty neoplasms of the extremities. A clinical, radiographic, and histologic review of cases. Orthopedics. Oct 1989;12(10):1351-8. [Medline].

  9. Kuwano Y, Ishizaki K, Watanabe R, Nanko H. Efficacy of diagnostic ultrasonography of lipomas, epidermal cysts, and ganglions. Arch Dermatol. Jul 2009;145(7):761-4. [Medline].

  10. Sachdeva MP, Goldblum JR, Rubin BP, Billings SD. Low-fat and fat-free pleomorphic lipomas: a diagnostic challenge. Am J Dermatopathol. Jul 2009;31(5):423-6. [Medline].

  11. Juhlin L. Long-standing pain relief of adiposis dolorosa (Dercum's disease) after intravenous infusion of lidocaine. J Am Acad Dermatol. Aug 1986;15(2 Pt 2):383-5. [Medline].

  12. Reggiani M, Errani A, Staffa M, Schianchi S. Is EMLA effective in Dercum's disease?. Acta Derm Venereol. Mar 1996;76(2):170-1. [Medline].

  13. Gonciarz Z, Mazur W, Hartleb J, et al. Interferon alfa-2b induced long-term relief of pain in two patients with adiposis dolorosa and chronic hepatitis C. J Hepatol. Dec 1997;27(6):1141. [Medline].

  14. Matarasso A, Pfeifer TM. Mesotherapy for body contouring. Plast Reconstr Surg. Apr 15 2005;115(5):1420-4. [Medline].

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  18. Berntorp E, Berntorp K, Brorson H, Frick K. Liposuction in Dercum's disease: impact on haemostatic factors associated with cardiovascular disease and insulin sensitivity. J Intern Med. Mar 1998;243(3):197-201. [Medline].

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  20. Rubenstein R, Roenigk HH Jr, Garden JM, Goldberg NS, Pinski JB. Liposuction for lipomas. J Dermatol Surg Oncol. Nov 1985;11(11):1070-4. [Medline].

  21. Held JL, Andrew JA, Kohn SR. Surgical amelioration of Dercum's disease: a report and review. J Dermatol Surg Oncol. Dec 1989;15(12):1294-6. [Medline].

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  23. Ruzicka T, Vieluf D, Landthaler M, Braun-Falco O. Benign symmetric lipomatosis Launois-Bensaude. Report of ten cases and review of the literature. J Am Acad Dermatol. Oct 1987;17(4):663-74. [Medline].

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