History and Physical Examination

Lipomas are most often asymptomatic. When they arise from fatty tissue between the skin and deep fascia, typical features include a soft, fluctuant feel; lobulation; and free mobility of overlying skin. A characteristic "slippage sign" may be elicited by gently sliding the fingers off the edge of the tumor. The tumor will be felt to slip out from under, as opposed to a sebaceous cyst or an abscess that is tethered by surrounding induration. The overlying skin is typically normal.

Symptoms in other sites depend on the location and can include the following:

Lipomas in the major airways can cause respiratory distress related to bronchial obstruction; patients may present with either endobronchial or parenchymal lesions
Previously undiagnosed lipomas of the oropharynx may also lead to airway difficulty at the time of intubation
Patients with esophageal lipomas can present with obstruction, dysphagia, regurgitation, vomiting, and reflux; esophageal lipomas can be associated with aspiration and consecutive respiratory infections
Cardiac lipomas are located mainly subendocardially, are rarely found intramurally, and are normally unencapsulated; they appear as a yellow mass projecting into the cardiac chamber
Intramediastinal lipomas may impinge on the superior vena cava, thereby leading to superior vena cava syndrome
Intestinal lipomas may manifest as classic obstruction, intussusception, volvulization, or hemorrhage
Lipomas arising from fat in the intramuscular septa cause a diffuse, palpable swelling, which is more prominent when the related muscle is contracted
Lipomas in intra-articular joint spaces or intraosseous sites (eg, the calcaneus) may lead to joint dysfunction and pain that preclude normal ambulation
Lipomas may also arise in the dural or medullary components of the spinal cord, thereby leading to cord compression and attendant sequelae ^[7]
Lipomas occur frequently in the breast but not as frequently as would be expected on the basis of the extent of fat that is present
Lipomas may arise from the subcutaneous tissues of the vulva; they usually become pedunculated and dependent

Complications

Subcutaneous lipomas are primarily cosmetic issues. Lipomas in other locations may cause luminal obstruction or hemorrhage. The images below show a duodenal lipoma that caused gastrointestinal hemorrhage and required removal.

Upper gastrointestinal series shows duodenal lipoma with central ulceration where the overlying mucosa has thinned, ulcerated, and bled.

View Media Gallery

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.

View Media Gallery

Differential Diagnoses

Chiang JM, Lin YS. Tumor spectrum of adult intussusception. J Surg Oncol. 2008 Nov 1. 98 (6):444-7. [QxMD MEDLINE Link].
Sakurai H, Kaji M, Yamazaki K, Suemasu K. Intrathoracic lipomas: their clinicopathological behaviors are not as straightforward as expected. Ann Thorac Surg. 2008 Jul. 86 (1):261-5. [QxMD MEDLINE Link].
Erdem HR, Nacır B, Özeri Z, Karagöz A. [Episacral lipoma: a treatable cause of low back pain]. Agri. 2013. 25 (2):83-6. [QxMD MEDLINE Link].
Lee HK, Hwang SB, Chung GH, Hong KH, Jang KY. Retropharyngeal spindle cell/pleomorphic lipoma. Korean J Radiol. 2013 May-Jun. 14 (3):493-6. [QxMD MEDLINE Link]. [Full Text].
Jain P, Chakrabarty B, Kumar A, Gupta N, Kabra M, Gulati S. Encephalocraniocutaneous lipomatosis with neurocutaneous melanosis. J Child Neurol. 2014 Jun. 29 (6):846-9. [QxMD MEDLINE Link].
Choi JW, Kim HJ, Kim J, Kim HJ, Cha JH, Kim ST. Spindle cell lipoma of the head and neck: CT and MR imaging findings. Neuroradiology. 2013 Jan. 55 (1):101-6. [QxMD MEDLINE Link].
Koyanagi I, Hida K, Iwasaki Y, Isu T, Yoshino M, Murakami T, et al. Radiological findings and clinical course of conus lipoma: implications for surgical treatment. Neurosurgery. 2008 Sep. 63 (3):546-51; discussion 551-2. [QxMD MEDLINE Link].
Gourineni P, Dias L, Blanco R, Muppavarapu S. Orthopaedic deformities associated with lumbosacral spinal lipomas. J Pediatr Orthop. 2009 Dec. 29 (8):932-6. [QxMD MEDLINE Link].
Signorini M, Campiglio GL. Posttraumatic lipomas: where do they really come from?. Plast Reconstr Surg. 1998 Mar. 101 (3):699-705. [QxMD MEDLINE Link].
Italiano A, Ebran N, Attias R, Chevallier A, Monticelli I, Mainguené C, et al. NFIB rearrangement in superficial, retroperitoneal, and colonic lipomas with aberrations involving chromosome band 9p22. Genes Chromosomes Cancer. 2008 Nov. 47 (11):971-7. [QxMD MEDLINE Link]. [Full Text].
Pang D, Zovickian J, Oviedo A. Long-term outcome of total and near-total resection of spinal cord lipomas and radical reconstruction of the neural placode, part II: outcome analysis and preoperative profiling. Neurosurgery. 2010 Feb. 66 (2):253-72; discussion 272-3. [QxMD MEDLINE Link].
Pang D, Zovickian J, Oviedo A. Long-term outcome of total and near-total resection of spinal cord lipomas and radical reconstruction of the neural placode: part I-surgical technique. Neurosurgery. 2009 Sep. 65 (3):511-28; discussion 528-9. [QxMD MEDLINE Link].
Yoshiyama A, Morii T, Tajima T, Aoyagi T, Honya K, Mochizuki K, et al. D-dimer levels in the differential diagnosis between lipoma and well-differentiated liposarcoma. Anticancer Res. 2014 Sep. 34 (9):5181-5. [QxMD MEDLINE Link].
Einarsdottir H, Söderlund V, Larsson O, Mandahl N, Bauer HC. 110 subfascial lipomatous tumors. MR and CT findings versus histopathological diagnosis and cytogenetic analysis. Acta Radiol. 1999 Nov. 40 (6):603-9. [QxMD MEDLINE Link].
Hung EH, Griffith JF, Ng AW, Lee RK, Lau DT, Leung JC. Ultrasound of musculoskeletal soft-tissue tumors superficial to the investing fascia. AJR Am J Roentgenol. 2014 Jun. 202 (6):W532-40. [QxMD MEDLINE Link].
Bakshi R, Shaikh ZA, Kamran S, Kinkel PR. MRI findings in 32 consecutive lipomas using conventional and advanced sequences. J Neuroimaging. 1999 Jul. 9 (3):134-40. [QxMD MEDLINE Link].
Matsumoto K, Hukuda S, Ishizawa M, Chano T, Okabe H. MRI findings in intramuscular lipomas. Skeletal Radiol. 1999 Mar. 28 (3):145-52. [QxMD MEDLINE Link].
Reiseter T, Nordshus T, Borthne A, Roald B, Naess P, Schistad O. Lipoblastoma: MRI appearances of a rare paediatric soft tissue tumour. Pediatr Radiol. 1999 Jul. 29 (7):542-5. [QxMD MEDLINE Link].
Lee TJ, Collins J. MR imaging evaluation of disorders of the chest wall. Magn Reson Imaging Clin N Am. 2008 May. 16 (2):355-79, x. [QxMD MEDLINE Link].
Einarsdottir H, Söderlund V, Larson O, Jenner G, Bauer HC. MR imaging of lipoma and liposarcoma. Acta Radiol. 1999 Jan. 40 (1):64-8. [QxMD MEDLINE Link].
Thornhill RE, Golfam M, Sheikh A, Cron GO, White EA, Werier J, et al. Differentiation of lipoma from liposarcoma on MRI using texture and shape analysis. Acad Radiol. 2014 Sep. 21 (9):1185-94. [QxMD MEDLINE Link].
Yang Y, Zhou Y, Zhou C, Ma X. Novel computer aided diagnostic models on multimodality medical images to differentiate well differentiated liposarcomas from lipomas approached by deep learning methods. Orphanet J Rare Dis. 2022 Apr 7. 17 (1):158. [QxMD MEDLINE Link]. [Full Text].
Araki Y, Isomoto H, Tsuji Y, Matsumoto A, Yasunaga M, Hayashi K, et al. Endoscopic removal with clipping for colonic lipomas. Kurume Med J. 1998. 45 (4):341-3. [QxMD MEDLINE Link].
Al Absi E, Karim T, Colterjohn N, Ghert M. A novel surgical approach to lipomatous tumours of the deltoid region. Sarcoma. 2010. 2010:495834. [QxMD MEDLINE Link]. [Full Text].
Goldman A, Wollina U. Lipoma treatment with a subdermal Nd:YAG laser technique. Int J Dermatol. 2009 Nov. 48 (11):1228-32. [QxMD MEDLINE Link].
Al-basti HA, El-Khatib HA. The use of suction-assisted surgical extraction of moderate and large lipomas: long-term follow-up. Aesthetic Plast Surg. 2002 Mar-Apr. 26 (2):114-7. [QxMD MEDLINE Link].
Berenguer B, de la Cruz L, de la Plaza R. Liposuction in atypical cases. Aesthetic Plast Surg. 2000 Jan-Feb. 24 (1):13-21. [QxMD MEDLINE Link].
Ilhan H, Tokar B. Liposuction of a pediatric giant superficial lipoma. J Pediatr Surg. 2002 May. 37 (5):796-8. [QxMD MEDLINE Link].
Wilhelmi BJ, Blackwell SJ, Mancoll JS, Phillips LG. Another indication for liposuction: small facial lipomas. Plast Reconstr Surg. 1999 Jun. 103 (7):1864-7. [QxMD MEDLINE Link].
Saray A, Ocal K, Berberoglu M. Endoscopic balloon dissection for removal of lipomas via transaxillary route. Aesthetic Plast Surg. 2001 Nov-Dec. 25 (6):463-7. [QxMD MEDLINE Link].
Abner ML. Lipoma of the abdomen after suction lipectomy. Plast Reconstr Surg. 2001 Jan. 107 (1):293. [QxMD MEDLINE Link].
Oliveira AM, Nascimento AG, Lloyd RV. Leptin and leptin receptor mRNA are widely expressed in tumors of adipocytic differentiation. Mod Pathol. 2001 Jun. 14 (6):549-55. [QxMD MEDLINE Link]. [Full Text].
Alberti D, Grazioli L, Orizio P, Matricardi L, Dughi S, Gheza L, et al. Asymptomatic giant gastric lipoma: What to do?. Am J Gastroenterol. 1999 Dec. 94 (12):3634-7. [QxMD MEDLINE Link].
Azumi N, Curtis J, Kempson RL, Hendrickson MR. Atypical and malignant neoplasms showing lipomatous differentiation. A study of 111 cases. Am J Surg Pathol. 1987 Mar. 11 (3):161-83. [QxMD MEDLINE Link].
Bassett MD, Schuetze SM, Disteche C, Norwood TH, Swisshelm K, Chen X, et al. Deep-seated, well differentiated lipomatous tumors of the chest wall and extremities: the role of cytogenetics in classification and prognostication. Cancer. 2005 Jan 15. 103 (2):409-16. [QxMD MEDLINE Link]. [Full Text].
Büttner A. Lipoma of the adrenal gland. Pathol Int. 1999 Nov. 49 (11):1007-9. [QxMD MEDLINE Link].
Carilli S, Alper A, Emre A. Inguinal cord lipomas. Hernia. 2004 Aug. 8 (3):252-4. [QxMD MEDLINE Link].
Corbi P, Boufi M, Thierry G, Menu P. Giant pleural lipoma. Eur J Cardiothorac Surg. 1999 Aug. 16 (2):249-50. [QxMD MEDLINE Link]. [Full Text].
Cribb GL, Cool WP, Ford DJ, Mangham DC. Giant lipomatous tumours of the hand and forearm. J Hand Surg Br. 2005 Oct. 30 (5):509-12. [QxMD MEDLINE Link].
Einarsdóttir H, Skoog L, Söderlund V, Bauer HC. Accuracy of cytology for diagnosis of lipomatous tumors: comparison with magnetic resonance and computed tomography findings in 175 cases. Acta Radiol. 2004 Dec. 45 (8):840-6. [QxMD MEDLINE Link].
Fernandez-Flores A, Juanes F. Value of cytological imprints in the diagnosis of atypical lipomatous tumor. Diagn Cytopathol. 2005 Jan. 32 (1):51-2. [QxMD MEDLINE Link].
Fukushima KK, Mitani T, Hashimoto K, Hosogi S, Emori T, Morita H, et al. Ventricular tachycardia in a patient with cardiac lipoma. J Cardiovasc Electrophysiol. 1999 Aug. 10 (8):1161. [QxMD MEDLINE Link].
Furlong MA, Fanburg-Smith JC, Miettinen M. The morphologic spectrum of hibernoma: a clinicopathologic study of 170 cases. Am J Surg Pathol. 2001 Jun. 25 (6):809-14. [QxMD MEDLINE Link].
Gersin KS, Heniford BT, Garcia-Ruiz A, Ponsky JL. Missed lipoma of the spermatic cord. A pitfall of transabdominal preperitoneal laparoscopic hernia repair. Surg Endosc. 1999 Jun. 13 (6):585-7. [QxMD MEDLINE Link].
Hizawa K, Kawasaki M, Kouzuki T, Aoyagi K, Fujishima M. Unroofing technique for the endoscopic resection of a large duodenal lipoma. Gastrointest Endosc. 1999 Mar. 49 (3 Pt 1):391-2. [QxMD MEDLINE Link].
Kamiyoshihara M, Kawashima O, Ishikawa S, Morishita Y. [Retroperitoneal lipoma through the foramen of Bochdalek detected as a mass of chest roentgenogram: report of a case]. Kyobu Geka. 1999 Dec. 52 (13):1141-3. [QxMD MEDLINE Link].
Kaniklides C, Frykberg T, Lundkvist K. Paediatric mesenteric lipoma, an unusual cause of repeated abdominal pain. A case report. Acta Radiol. 1998 Nov. 39 (6):695-7. [QxMD MEDLINE Link].
Kooby DA, Antonescu CR, Brennan MF, Singer S. Atypical lipomatous tumor/well-differentiated liposarcoma of the extremity and trunk wall: importance of histological subtype with treatment recommendations. Ann Surg Oncol. 2004 Jan. 11 (1):78-84. [QxMD MEDLINE Link].
Lam KY, Lo CY. Teratoma in the region of adrenal gland: a unique entity masquerading as lipomatous adrenal tumor. Surgery. 1999 Jul. 126 (1):90-4. [QxMD MEDLINE Link].
Nilsson M, Domanski H, Mertens F, Mandahl N. Atypical lipomatous tumor with rare structural rearrangements involving chromosomes 8 and 12. Oncol Rep. 2005 Apr. 13 (4):649-52. [QxMD MEDLINE Link].
Ogilvie CM, Torbert JT, Hosalkar HS, Stopyra GA, Lackman RD. Recurrence and bleeding in hibernomas. Clin Orthop Relat Res. 2005 Sep. 438:137-43. [QxMD MEDLINE Link].
Pereira JA, Schonauer F. Lipoma extraction via small remote incisions. Br J Plast Surg. 2001 Jan. 54 (1):25-7. [QxMD MEDLINE Link].
Raju GS, Gomez G. Endoloop ligation of a large colonic lipoma: a novel technique. Gastrointest Endosc. 2005 Dec. 62 (6):988-90. [QxMD MEDLINE Link].
Raymond GS, Barrie JR. Endobronchial lipoma: helical CT diagnosis. AJR Am J Roentgenol. 1999 Dec. 173 (6):1716. [QxMD MEDLINE Link].
Salasche SJ, McCollough ML, Angeloni VL, Grabski WJ. Frontalis-associated lipoma of the forehead. J Am Acad Dermatol. 1989 Mar. 20 (3):462-8. [QxMD MEDLINE Link].
Samad L, Ali M, Ramzi H, Akbani Y. Respiratory distress in a child caused by lipoma of the esophagus. J Pediatr Surg. 1999 Oct. 34 (10):1537-8. [QxMD MEDLINE Link].
Sarioğlu AC, Kaynar MY, Hanci M, Uzan M. Sylvian fissure lipomas: case reports and review of the literature. Br J Neurosurg. 1999 Aug. 13 (4):386-8. [QxMD MEDLINE Link].
Skubitz KM, Cheng EY, Clohisy DR, Thompson RC, Skubitz AP. Differential gene expression in liposarcoma, lipoma, and adipose tissue. Cancer Invest. 2005. 23 (2):105-18. [QxMD MEDLINE Link].
Sommerville SM, Patton JT, Luscombe JC, Mangham DC, Grimer RJ. Clinical outcomes of deep atypical lipomas (well-differentiated lipoma-like liposarcomas) of the extremities. ANZ J Surg. 2005 Sep. 75 (9):803-6. [QxMD MEDLINE Link].
Trabut JB, Duong Van Huyen JP, Artru B, Bruneval P. [Intravascular lipoma of the superior vena cava]. Ann Pathol. 1999 Dec. 19 (6):529-31. [QxMD MEDLINE Link].
van Heel DA, Panos MZ. Colonoscopic appearances and diagnosis of intussusception due to large-bowel lipoma. Endoscopy. 1999 Aug. 31 (6):508. [QxMD MEDLINE Link].
Weiss SW. Lipomatous tumors. Monogr Pathol. 1996. 38:207-39. [QxMD MEDLINE Link].

Media Gallery

Upper gastrointestinal series shows duodenal lipoma with central ulceration where the overlying mucosa has thinned, ulcerated, and bled.
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.

of 2

Author

Todd A Nickloes, DO, FACOS Associate Professor, Department of Surgery, Division of Trauma/Critical Care, University of Tennessee Medical Center-Knoxville

Todd A Nickloes, DO, FACOS is a member of the following medical societies: American Medical Association, American Osteopathic Association, Association for Academic Surgery, Society of Critical Care Medicine, Society of Laparoscopic and Robotic Surgeons, Southeastern Surgical Congress, Southern Medical Association, Eastern Association for the Surgery of Trauma, American College of Osteopathic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Daniel D Sutphin, MD, FACS Attending Plastic and Reconstructive Surgeon, Yuma Regional Medical Center

Daniel D Sutphin, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

David L Morris, MD, PhD, FRACS Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia

David L Morris, MD, PhD, FRACS is a member of the following medical societies: British Society of Gastroenterology

Disclosure: Received none from RFA Medical for director; Received none from MRC Biotec for director.

Chief Editor

John Geibel, MD, MSc, DSc, AGAF Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, Professor, Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow; Fellow of the Royal Society of Medicine

John Geibel, MD, MSc, DSc, AGAF 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, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Additional Contributors

Juan B Ochoa, MD Assistant Professor, Department of Surgery, University of Pittsburgh School of Medicine; Medical and Scientific Director, HCN, Nestle Healthcare Nutrition

Disclosure: Nothing to disclose.

Acknowledgements

Klaus Radebold, MD, PhD Former Research Associate, Department of Surgery, Yale University School of Medicine

Disclosure: Nothing to disclose.

Carol E H Scott-Conner, MD, PhD Professor, Department of Surgery, University of Iowa College of Medicine

Disclosure: Nothing to disclose.