eMedicine Specialties > General Surgery > Abdomen

Lipomas: Workup

Author: Todd A Nickloes, DO, Assistant Professor of Surgery, Division of Trauma/Critical Care, University of Tennessee Medical Center
Coauthor(s): Daniel D Sutphin, MD, Chief Resident, Department of General Surgery, University of Tennessee Memorial Medical Center; Klaus Radebold, MD, PhD, Research Associate, Department of Surgery, Yale University School of Medicine
Contributor Information and Disclosures

Updated: Jan 15, 2009

Workup

Imaging Studies

  • For most subcutaneous lipomas, no imaging studies are required.
  • Lesions in the gastrointestinal tract may be seen on GI contrast studies (see image below and Image 2).
  • Imaging studies for lipomas in atypical locations (or where the differential diagnosis includes sarcoma) include ultrasonograms, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans.6
  • MRI has been recommended as a reliable preoperative investigation.7,8,9,10
    • It has been employed in intramuscular lipoma, pediatric lipoblastomas, and others. The findings of intramuscular lipomas, for example, vary from small, homogeneous masses to large, inhomogeneous lesions with infiltrative margins.
    • However, similar to CT scanning, MRI does not allow an absolute, reliable distinction between a lipoma and a liposarcoma.11
  • When CT scanning is employed, Hounsfield units less than 50 are indicative of a soft-tissue tumor composed of fat, although no discrimination can be made between a benign lipoma and a malignant liposarcoma.
  • Because lipomas are radiolucent, soft-tissue radiographs may sometimes be useful.
Duodenal lipoma resected through a duodenotomy. O...

Duodenal lipoma resected through a duodenotomy. Overlying mucosa with central ulceration removed and lobulated fatty tumor shelled out intact with capsule. The mucosa was then sutured closed, and the duodenotomy closed. The stitch was placed to orient the specimen for pathologic examination.

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Duodenal lipoma resected through a duodenotomy. O...

Duodenal lipoma resected through a duodenotomy. Overlying mucosa with central ulceration removed and lobulated fatty tumor shelled out intact with capsule. The mucosa was then sutured closed, and the duodenotomy closed. The stitch was placed to orient the specimen for pathologic examination.


Diagnostic Procedures

  • Biopsies are normally not indicated for small subcutaneous lesions, because the entire tumor is usually removed.
  • All imaging techniques have been combined with fine-needle aspiration; this combination increases the accuracy of diagnosis.
  • Obtaining tissue samples from different tumor components is important, because it provides samples for histopathologic analysis by means of various techniques, including fluorescence in situ hybridization (FISH).

Histologic Findings

  • Lipomas are benign mesenchymal tumors derived from adipocytes. Several variants have been described, including the following:
    • Adenolipomas, a variation of lipomas that may occur in the breast, often have a marked fibrotic component. They are best regarded as a hamartoma.
    • Angiolipomas contain many small vessels.
    • Cardiac lipomas may calcify following fat necrosis. Microscopically, they are comprised of fatty tissue with interlacing muscle fibers.
  • Fine-needle aspiration biopsies of a lipoblastoma contain multivacuolated lipoblasts, myxoid areas, and a plexiform capillary network.

More on Lipomas

Overview: Lipomas
Workup: Lipomas
Treatment: Lipomas
Follow-up: Lipomas
Multimedia: Lipomas
References
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References

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Further Reading

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Keywords

lipoma, lipomas, liposuction, liposarcoma, fatty tumor, fatty tumors, lipoma removal, angiolipoma, lipomatous, pseudolipoma, teratoma, adenolipomas, hamartoma, cardiac lipomas, soft-tissue tumor, benign tumors of fatty tissue, benign small neoplasms, submucosal tumors of adipose tissue, duodenal lipomas, colonic lipomas, lipoblastomas, hibernomas, esophageal lipomas, intussusception, intestinal lipomas, intestinal obstruction, intramuscular lipoma, pediatric lipoblastomas, benign mesenchymal tumors, lipomas of the lung, breast lipomas, subcutaneous lipomas, lipomas of the vulva, frontalis-associated subfascial lipoma

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Contributor Information and Disclosures

Author

Todd A Nickloes, DO, Assistant Professor of Surgery, Division of Trauma/Critical Care, University of Tennessee Medical Center
Todd A Nickloes, DO is a member of the following medical societies: American College of Osteopathic Surgeons, American Medical Association, American Osteopathic Association, Association for Academic Surgery, Eastern Association for the Surgery of Trauma, Society of Critical Care Medicine, Society of Laparoendoscopic Surgeons, Southeastern Surgical Congress, and Southern Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Daniel D Sutphin, MD, Chief Resident, Department of General Surgery, University of Tennessee Memorial Medical Center
Disclosure: Nothing to disclose.

Klaus Radebold, MD, PhD, Research Associate, Department of Surgery, Yale University School of Medicine
Klaus Radebold, MD, PhD is a member of the following medical societies: American Gastroenterological Association and New York Academy of Sciences
Disclosure: Nothing to disclose.

Medical Editor

Juan B Ochoa, MD, Assistant Professor, Department of Surgery, University of Pittsburgh
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David L Morris, MD, PhD, Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other; AstraZeneca Grant/research funds Other

 
 
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