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CASE REPORT
Year : 2019  |  Volume : 8  |  Issue : 3  |  Page : 219-221

Recurrent giant intermuscular lipoma of thigh


Department of General Surgery, Dr PSIMS and Research Foundation, Chinoutpalli, Gannavaram, Krishna District, Andhra Pradesh, India

Date of Submission10-Jan-2019
Date of Acceptance06-Sep-2019
Date of Web Publication17-Oct-2019

Correspondence Address:
Dr. Rajababu Pakanati
303, Vemula Residency, Chalasani Venkata Krishnaiah Street, Suryaraopet, Vijayawada, Krishna District, Andhra Pradesh - 520 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JDRNTRUHS.JDRNTRUHS_4_19

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  Abstract 


Lipomas are ubiquitous tumors which can occur anywhere in the body. They are usually small-sized, but giant lipomas are rare. This report presents a female with a recurrent large swelling over the posteromedial aspect of the right thigh. Investigations revealed a giant intermuscular lipoma for which excision was done in toto safeguarding vital structures.

Keywords: Angiolipoma, giant lipoma, recurrent lipoma


How to cite this article:
Pakanati R, Gogineni RC, Ede NB. Recurrent giant intermuscular lipoma of thigh. J NTR Univ Health Sci 2019;8:219-21

How to cite this URL:
Pakanati R, Gogineni RC, Ede NB. Recurrent giant intermuscular lipoma of thigh. J NTR Univ Health Sci [serial online] 2019 [cited 2019 Nov 13];8:219-21. Available from: http://www.jdrntruhs.org/text.asp?2019/8/3/219/269484




  Introduction Top


Lipomas are the most common benign tumors of the adipose tissue and can be located in any region of the body, and hence called ubiquitous tumor or universal tumor. Most lipomas are small, weighing only a few grams; however, those weighing up to 200 g have occasionally been encountered. For a lipoma to be referred to as “giant,” it should be 10 cm or more at least in one dimension or weigh a minimum of 1000 g.[1] Giant lipomas are rare.

We report a rare case of recurrent giant lipoma of size 25 cm × 20 cm over the posteromedial aspect of the right thigh, weighing 2760 g.


  Case Report Top


A 45-year-old female presented with a complaint of recurrent swelling on the posteromedial aspect of the right thigh since 1 year. The patient initially noticed a lemon-sized swelling on the medial aspect of the right thigh which progressively increased and attained the present size. The patient had dragging type of pain on walking and functional impairment. She had a history of swelling at the same site 7 years back for which she was operated at a local hospital and the swelling recurred after 3 years for which she was again operated at the same hospital.

A vertically ovoid swelling of 28 cm × 22 cm with an overlying vertical scar was occupying the posteromedial aspect of the right thigh [Figure 1]. There was no local increase in temperature over the swelling, and it was nontender. Its extension was 8 cm from the pubis (superiorly), to 4 cm above the medial aspect of the knee joint region (inferiorly). The surface was lobular with variegated consistency. The swelling was not fixed to the skin or the underlying structures, being freely mobile from side to side and restricted mobility in the craniocaudal axis.
Figure 1: Pre-op image of right thigh swelling

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There was no pulsatality/bruit over the swelling and no venous engorgement in the right lower limb. No significant inguinal lymphadenopathy was noted.

Routine laboratory tests were normal. Magnetic resonance imaging (MRI) of the right thigh revealed a large well-defined fatty signal intensity lesion between the adductor and hamstring group of muscles suggestive of a lipoma [Figure 2]. Cytology and core cut biopsy were suggestive of lipoma.
Figure 2: (a) Mri scan-coronal image showing large lesion in subcutaneous and intermuscular plane, (b) Mri scan-axial image showing large lesion in subcutaneous and intermuscular plane, (c) Mri scan-coronal images showing extent of lesion in subcutaneous and intermuscular plane

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An elliptical incision was given to include the previous scar site and the core cut biopsy site. Intraoperative findings revealed a giant lipomatous tumor of size 25 cm × 20 cm, well-encapsulated and lobulated in appearance, in the intermuscular plane between the adductor group of muscles and hamstring muscles without any infiltration to the surrounding muscles or vital structures [Figure 3]a and [Figure 3]b. Excision was done in toto safeguarding the vital structures including the sciatic nerve [Figure 3]c. The patient had an uneventful recovery and was discharged on the 14th postoperative day [Figure 4]. The histopathology revealed an angiolipoma. The patient is on regular follow-up and is doing well.
Figure 3: (a) Intra-op image showing giant swelling in right thigh, (b) Intra-op image after excising the giant swelling, (c) Giant swelling specimen after excision

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Figure 4: Post-op image of right thigh

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  Discussion Top


Lipomas are the most common benign tumors of the adipose tissue. They are well-differentiated neoplasms, consisting of adult adipocytes[2] surrounded by a fibrous capsule. Clinically, lipomas appear as well-delineated asymptomatic lesions,[3] and in some cases they can reach a considerable size.[4] In the literature, giant lipomas have been described as measuring up to 10 cm and weighing up to 1000 g.[5] Giant lipomas, although rare, have been described in different anatomic locations such as thigh, buttock, scapular region, and abdominal area.[5] The largest cutaneous lipoma reported in the literature was 24,950 g and located on the right thigh of a 48-year-old woman with morbid obesity.[6]

Giant lipomas represent a real diagnostic and therapeutic challenge. The main concern in the diagnostic procedure for huge lipomas should be to rule out malignancy.[1] Features that suggest malignancy include old age, large size, presence of thick septa, presence of nodular and/or globular or nonadipose mass-like areas, and decreased percentage of fat composition. Fine-needle aspiration biopsy, computed tomography, and MRI scans can aid in establishing a preoperative diagnosis.[6],[7] However, certain preoperative diagnosis is almost impossible, because of the limitations in the distinction between lipomas and well-differentiated liposarcoma by computed tomography or MRI.[7] In addition, fine-needle aspiration biopsy may come up short to offer sufficient samples due to huge dimensions of the mass.

There are several histological variants of lipoma, namely, spindle cell lipoma, pleomorphic lipoma, angiolipoma, and intramuscular lipoma. There are two types of angiolipoma (noninfiltrating and infiltrating)[8],[9] and they have different biological behaviors. Angiolipomas comprise sheets of mature fat cells separated by a branching network of small vessels. Fibrinous microthrombi are distinctive features that differentiate angiolipomas from other lipomas.

Here, we have reported a recurrent giant lipoma on the posteromedial aspect of the right thigh (measuring 25 cm × 20 cm and weighing 2760 g) which is rare.

The histopathological examination of the specimen revealed an angiolipoma.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zografos GC, Kouerinis I, Kalliopi P, Karmen K, Evagelos M, Androulakis G. Giant lipoma of the thigh in a patient with morbid obesity. Plast Reconstr Surg 2002;109:1467-8.  Back to cited text no. 1
    
2.
Kshirsagar AY, Nangare NR, Gupta V, Vekariya MA, Patankar R, Mahna A, et al. Multiple giant intraabdominal lipomas: A rare presentation. Int J Surg Case Rep 2014;5:399-402.  Back to cited text no. 2
    
3.
Sanchez MR, Golomb FM, Moy JA, Potozkin JR. Giant lipoma: Case report and review of the literature. J Am Acad Dermatol 1993;28:266-8.  Back to cited text no. 3
    
4.
Whittle C, Cortés M, Baldassare G, Castro A, Cabrera R. Subgaleal lipomas: Ultrasound findings. Rev Med Chil 2008;136:334-7.  Back to cited text no. 4
    
5.
Aydoǧdu E, Yýldýrým S, Eker G, Aköz T. Giant lipoma of the back. Dermatol Surg 2004;30:121-2.  Back to cited text no. 5
    
6.
Zaroo MI, Bashir SA, Mohsin M, Baba PU, Farooq SS, Zargar HR. Giant lipoma: A case report. J IMA 2011;43:77-9.  Back to cited text no. 6
    
7.
Kransdorf MJ, Bancroft LW, Peterson JJ, Murphey MD, Foster WC, Temple HT. Imaging of fatty tumours: Distinction of lipoma and well-differentiated liposarcoma. Radiology 2002;224:99-104.  Back to cited text no. 7
    
8.
Dionne GP, Seemayer TA, infiltrating lipomas and angiolipomas revisited. Cancer 1974;33:732-8.  Back to cited text no. 8
    
9.
Lin JJ Lin F. Two entities in angiolipoma. A study of 459 cases of lipoma with review of literature on angiolipoma. Cancer 1974;34:720-7.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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