peuterey parka donna seated lipomas of the upper extremity
All JournalsPatients and methodsWe report a retrospective study of 13 patients with deep seated lipomas of the upper extremity treated during the period from April 1997 to April 2008. We evaluated the clinical and radiological characteristics, treatment and evolution profile of these patients.
There were 10 women and three men, with an average age of 53 years (range 30 years). Seven of these lipomas were in the arm, one in the shoulder, and five in the forearm. Six lipomas were intramuscular, six intermuscular (three of them being attached to bone and labelled parosteal lipoma) and one epivaginal lipoma of the flexor tendon sheath. All patients presented a progressive slow growing mass that was associated with radial paralysis in one case and carpal tunnel syndrome in one case. Plain radiographs showed a radiolucent soft tissue image in all cases and an associated osteochondroma in one parosteal lipoma. Computer tomography (CT) or magnetic resonance imaging (MRI) suggested the lipomatous nature and benign characteristics of these deep lipomas that were giant in all cases (mean size: 7cm). Lipoma marginal excision was performed and histopathological examination demonstrated features consistent with a benign lipoma. There was good function and no clinical recurrence was observed after a mean follow up of three years.
Giant deep seated lipomas of the upper extremity are uncommon and can be intermuscular or intramuscular. A painless soft tissue mass is the most frequent chief complaint. MRI with fat suppression suggests the diagnosis and studies the extension of deep lipoma. Marginal excision is the treatment of choice and histopathology eliminates diagnosis of well differentiated liposarcoma.
ConclusionAppropriate evaluation of deep lipoma is to rule out malignancy by systematically performing MRI and biopsy. In contrast to deep seated lipomas of the lower extremity or the retroperitoneal space, the prognosis of deep seated lipomas of the upper extremity is good irrelevant of their size. Recurrence and the degeneration are very rare.
Level of evidenceLevel 4. They are less common than superficial lipomas, and they can be intramuscular or intermuscular [1WeissS., GoldblumJ. Pathologically [1WeissS., GoldblumJ.
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Patients and methods
We retrospectively reviewed medical records and images of 13 patients with confirmed deep lipomas of the upper extremity treated surgically during the period from April 1997 to April 2008. Clinical examination, mainly palpation determined the characteristics of the mass or the swelling; and neurological exam investigated deficit of motricity and sensitivity. Electromyography (EMG) was performed in two cases (observations 9 and 13). Radiologic studies performed included conventional radiography (n =13), CT (n =7), ultrasonography (n =3), and MRI (n =3).
CT or MRI determined anatomic location and relationship to surrounding structures before surgery better than X ray. CT or MRI images were assessed for lesion homogeneity, size, border definiton, relationship to neurovascular bundle and relationship to bone. CT images were assessed for density and MR images for signal intensity on T1 weighted, T2 weighted, STIR T2, and post contrast T1 STIR images. In this retrospective serie, we did not perform systematic biopsy when the lipomas had specific imaging features on CT or MRI (well circumscribed homogeneous fatty mass, no or rare thin septation, no post contrast enhancement). In lipomas that have nonspecific imaging features (cases 6 and 12), open biopsy was performed 10 days and 15 days respectively before the definitive surgery, because atypical lipomatous tumors were suspected (thick septa of 2mm in case 6 and small nodular mass of high signal adjacent to the tumor on fat suppressed T1 weighted images in case). However, since may 2008 we follow the current recommended strategy to perform systematically MRI and incisional biopsy for all deep tumors bigger than 5cm and excisional biopsy for tumors smaller than 5 cm that does not have MRI features of malignity. All patients had undergone surgery with marginal excision (shelling out) because these well circumscribed lipomas are well encapsulated and are separated easily from the surrounding tissues in contrast to infiltrative lipomas and lipoma like well differentiated liposarcomas. Post operatively, histopathologic examination has confirmed the diagnosis of lipomas and the healthy surgical margin of the tumor in all cases. Patients were followed for a minimum of 3years.