Diagnostic Considerations

Lipomas must be differentiated from other masses or tumors.

In the subcutaneous location, the primary differential diagnosis is a sebaceous cyst or an abscess. Sebaceous cysts are also rounded and subcutaneous; they originate in the dermis and reside within the skin at the dermal-epidermal junction. These cysts can be differentiated from lipomas by their characteristic central punctum and the surrounding induration. Treatment requires removal of a small ellipse of overlying skin to avoid entering the cyst. Abscesses typically have overlying induration and erythema. Incision and drainage is the appropriate management.

Hibernomas are uncommon tumors that arise from brown fat. They are also benign but with a slightly greater tendency to bleed during excision and to recur if intralesional excision is performed.

Atypical lipomatous tumors are considered to be well-differentiated liposarcomas. They have a predilection for local recurrence but do not generally metastasize. This diagnosis should be suspected when a fatty tumor is encountered in an intramuscular or retroperitoneal location.

Liposarcomas are malignant tumors that arise from adipocytes. They may recur locally and may metastasize. Fatty tumors of the retroperitoneum or in intramuscular locations should be considered to be potential liposarcomas until proven otherwise.

In the breast, a lipoma will be mammographically radiolucent. It must be differentiated from a similar benign tumor, a mammary hamartoma, and a pseudolipoma (a soft-tissue mass that may surround a small, scirrhous cancer).

Conversely, lipomatous lesions in the adrenal gland that have calcifications on radiologic examinations have been confused with teratoma. Many of these are angiomyolipomas.

In the spermatic cord, a finger of retroperitoneal fat termed a "lipoma of the cord" is frequently encountered during hernia repair. Removal is advocated to allow the internal inguinal ring to be tightened around the cord and to minimize the risk of recurrence of the hernia. During laparoscopic exploration for a palpable inguinal mass, no identifiable peritoneal orifice may be found if the inguinal mass purely consists of a lipoma of the cord.

Workup

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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.

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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.