Lipomas Workup: Laboratory Studies, Imaging Studies, Biopsy

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Lipomas

Workup

Laboratory Studies

A study by Yoshiyama et al suggested that the plasma D-dimer level could contribute to the differentiation between lipoma and well-differentiated liposarcoma, two lesions that are similar in terms of clinical, radiologic, and pathologic characteristics.^[13]

Imaging Studies

For most subcutaneous lipomas, no imaging studies are required.

Lesions in the gastrointestinal (GI) tract may be visible on GI contrast studies (see the image below).

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

View Media Gallery

Imaging studies for lipomas in atypical locations (or those for which the differential diagnosis includes sarcoma) include ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI).^[14]

In a retrospective review of the use of US by two musculoskeletal radiologists to evaluate 714 superficial soft-tissue tumors, Hung et al reported a sensitivity of 95.2% and a specificity of 94.3% for lipoma.^[15]

When CT is employed, a radiodensity of less than 50 Hounsfield units is indicative of a soft-tissue tumor composed of fat, though no reliable distinction can be made between a benign lipoma and a malignant liposarcoma.^[6]

MRI has been recommended as a reliable preoperative investigation.^{[16, 17, 18, 19, 6]}It has been employed in intramuscular lipoma, pediatric lipoblastomas, and others. The findings of intramuscular lipomas, for example, range from small, homogeneous masses to large, inhomogeneous lesions with infiltrative margins. However, like CT, MRI does not allow an absolute, reliable distinction between a lipoma and a liposarcoma.^[20] A study by Thornhill suggested that the addition of computer-assisted diagnosis may improve the ability of MRI to make this distinction.^[21]

Because all lipomas are radiolucent, soft-tissue radiography can be diagnostic, but it is indicated only when the diagnosis is in doubt.

Biopsy

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 (FNA); 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 composed of fatty tissue with interlacing muscle fibers

FNA biopsies of a lipoblastoma contain multivacuolated lipoblasts, myxoid areas, and a plexiform capillary network.

Treatment & Management

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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 Laparoendoscopic 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.

Lipomas Workup

Laboratory Studies

Imaging Studies

Biopsy

Histologic Findings

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