An interesting clinical case of lipoma

Bohyan

Tigran Surenovich

Experience 36 years

Surgeon of the highest category, Doctor of Medical Sciences, member of the International Association of Surgeons, Gastroenterologists and Oncologists

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Lipoma (fat) is a benign formation in the form of small nodules, the appearance of which is associated with the accumulation and compaction of excess adipose tissue. The size of the lipoma may increase or remain stable. When exposed to unfavorable factors, pockets of pathogenic microflora can form inside the wen, which makes it a source of other serious diseases of internal organs. The unaesthetic appearance of formations protruding on the surface of the skin is also important. Therefore, in most cases, a decision is made to remove the tumor and its subsequent histological examination to clarify the nature of the wen - benign or malignant.

The area of ​​localization of lipoma is the back, chest, face, limbs, mammary glands, structure of internal organs. The formation can be detected accidentally during diagnostic procedures or during palpation. The edges of the lipoma are dense and clear, the formation is mobile, and its palpation is painless. It is more difficult to detect a lipoma in the tissues of internal organs. However, it is precisely such cases that are recognized as the most dangerous, threatening disruptions in the functioning of the affected tissue area.

Classification

Depending on the internal structure there are:

• Myolipomas are formations from muscle cells.
• Angiolipomas are lipomas with the inclusion of blood vessels.
• Myxolipomas are tumors containing mucus.
• Fibrolipomas are formations containing connective tissue.

It is possible to accurately determine the nature of the formation only after a thorough diagnosis. It should not be postponed for the foreseeable future, especially if the lipoma quickly increases in size and causes discomfort.

Causes of lipoma

The general pattern of the appearance of wen is the accumulation of fat cells due to a violation of fat metabolism in the body. If measures to treat the problem are not taken in a timely manner, the formation quickly grows, pinching nearby muscles and blood vessels. Among the causes of lipoma that influence the unfavorable course of the pathology, it is worth noting:

• Hormonal disorders, a period of hormonal changes in the body.
• Metabolic failures.
• Disturbances in the diet with a predominance of food of animal origin.
• Diseases of the kidneys and liver, pancreas and thyroid gland.
• Bad habits.
• Diabetes.
• Genetic predisposition.

Also, the formation of excess adipose tissue is affected by physical inactivity, a sedentary lifestyle and refusal of full-fledged physical activity.

Reasons for the appearance of wen

The cause of lipoma formation is unknown. The risk of developing a tumor increases with a family history. Other risk factors include:

• morbid obesity (adirositas dolorosa) is a rare disease characterized by multiple lipomas);
• Cowden's syndrome;
• Gardner's syndrome;
• Madelung syndrome.

Atheromas are formed when the outflow of sebum is obstructed. Provoking factors are considered:

• compaction/thickening of the epidermis;
• hyperhidrosis – increased sweating;
• hormonal imbalances;
• use of antiperspirant deodorants;
• incorrect personal hygiene.

Symptoms

The main localization of wen is the place of deposition of adipose tissue. At first it is a soft compaction, which gradually increases in size. The only symptom of a lipoma is the formation of a noticeable tubercle with a movable structure, which can be felt when pressed. There is no pain when palpating the lipoma on the back or arms.

If the wen is localized in the structure or on the surface of internal organs, disturbances in their functioning may indicate pathology. The disease is also accompanied by characteristic symptoms:

• a lipoma in the esophagus causes coughing, nausea and vomiting;
• formations on the bronchi and trachea cause a constant dry cough of a paroxysmal nature;
• lipoma on tendons and cartilage limits their mobility and causes pain;
• a lump in the mammary gland gives pain;
• fatty deposits in the kidneys provoke colic, lower back pain, and increased blood pressure;
• a lipoma in the head causes dizziness and headaches;
• a formation in the neck makes it difficult to swallow food and also causes hoarseness;
• A lipoma in the heart area causes arrhythmia and heart failure.

Are you experiencing lipoma symptoms?

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By appearance

Based on how the tumor looks, lipomas can be divided into:

• Ring-shaped (location – neck, similar to a necklace);
• Tree-like (located inside the joints);
• Capsule-shaped (with a dense shell and clear edges);
• Diffuse (without capsule, clear boundaries);
• Ossified or petritic (when calcium deposits form inside);
• Pedicled (with a pedicle where the vessel and nerve are located);
• Dense;
• Soft.

The reasons may be as follows:

• Neutrophic;
• Lack of nutrition to the nerves in a certain area.

Lipoma contains fat cells of different sizes. Between the simple fat cells there are rudimentary ones, which affect the growth of the former.

Lipomas grow slowly. With frequent trauma, there is a risk of lipoma malignancy.

When localized superficially, the lipoma looks like a painless, mobile formation ranging in size from 0.5 to several centimeters. Lipoma can be either dense or dough-like. It does not hurt when touched, although it can compress nervous and vascular tissues. If it is located in a vulnerable place, then pus and inflammatory processes may appear from friction.

Most often, this tumor grows on the head, face, neck and waist, back, chest, but can also occur on the legs and abdomen.

The patient will complain of breathing problems if the lipoma is on the neck.

Typically complaints are cosmetic and aesthetic in nature.

During examination, a specialist doctor determines a lipoma by its location (if it is located in a place where adipose tissue accumulates), soft or compacted consistency, mobility, painlessness on palpation, tissue retraction when the skin is stretched.

Next, the puncture is taken for study.

They may prescribe ultrasound, x-rays, electroradiography of soft tissues, contrast x-rays, magnetic resonance and computed tomography.

The doctor must distinguish a lipoma from an atheroma.

You should not treat the problem yourself. After consultation with a surgeon, surgical treatment is prescribed, if required.

Prostate adenoma

Methods for diagnosing lipomas

The long period of latent progression greatly complicates the diagnosis of soft tissue lipoma in the early stages of development. More often, pathology is detected when the wen reaches a size of 1.5-2 cm and is easily palpable under the skin. To carry out differentiated diagnostics and confirm the benign nature of the formation, you can:

• Blood tests to exclude viral or bacterial infections, as well as the absence of an inflammatory process.
• X-ray of the chest, limbs or abdomen. Allows you to detect a formation, clarify its location, calculate its size and assess the condition of surrounding tissues.
• Ultrasonography. It is used as an additional diagnostic method when the presence of a lipoma is confirmed by other examination methods.
• Computed and magnetic resonance imaging. Effective methods to determine the location and size of the lipoma, as well as confirm its benign nature.
• A biopsy of wen tissue to analyze it for the risk of cells degenerating into a malignant structure.

If the patient has other diseases of the internal organs, the diagnosis of lipoma is carried out taking into account their characteristics, and deciphering the results suggests the mutual influence of pathologies, making it possible to more accurately determine the cause of the appearance of the wen.

Who is indicated for lipoma removal?

Some believe that its removal is for aesthetic purposes only. However, there are some medical indications for this procedure.

Firstly, the lipoma itself cannot “resolve”, and its growth (albeit slow) will sooner or later lead to significant discomfort (up to compression of surrounding tissues, including nerve endings). Secondly, although it is a benign tumor, there is always a risk (albeit minimal) that it can develop into a malignant tumor (liposarcoma).

Therefore, the following symptoms should be the reason for immediately contacting a doctor and subsequent removal of the lipoma:

• pain of the tumor;
• inflammation;
• changes in size, shape and color;
• watery discharge;
• discomfort caused by the tumor.

Treatment

If small lipomas are detected in a patient, a wait-and-see approach is chosen, which involves ultrasound monitoring several times a year. However, there are often cases when the doctor decides in favor of surgical intervention. Surgery is necessary if:

• The tumor grows rapidly, engulfing neighboring tissues and blood vessels.
• The lipoma rises above the surface of the skin, giving an unaesthetic cosmetic effect.
• The development of a wen gives persistent pain.
• Due to the growth of adipose tissue, the functioning of internal organs and the circulatory system is disrupted.

Removing or destroying a lipoma on the neck or back is possible in the following ways:

• Endoscopic method. It involves removing the tumor along with the capsule through a small incision in the skin.
• Liposuction is the extraction of adipose tissue by softening it and stretching it through a thin needle. Does not leave scars and does not injure the skin.
• Excision of a lipoma is the removal of a wen during a classic surgical intervention.

The optimal method is selected taking into account the general condition of the patient and the size of the lipoma.

Removal of fatty tissues (lipomas and atheromas)

It is advisable to remove lipomas and atheromas. No ointments, lotions, compresses, onions/garlic will help - the wen will not resolve. But atheroma can become inflamed.

Based on size, condition and location, atheromas are removed in one of the following ways:

1. By radio waves. Removal of atheroma using radio waves is carried out under local anesthesia. The intervention consists of opening the capsule, extracting the contents and coagulating the atheroma. Scars after the radio wave technique are minimal. In this way, formations up to 7 mm are removed.
2. Surgical intervention. Surgical removal of atheroma is the most common method. A thin incision is made along the upper part of the atheroma and the contents of the capsule are removed. Thus, the incision is significantly smaller than the original diameter of the wen. The sutures are removed after 3-12 days (depending on the location of the intervention).
3. The incision of the atheroma is carried out only when the inflammatory process has developed due to the need for cleaning and removal of purulent contents. The intervention is performed under local anesthesia, but the patient may experience discomfort. Sometimes, after the inflammation has resolved, a second operation is required to completely remove the capsule.

Any atheromas should be removed immediately after their appearance - a delay leads to additional problems. You shouldn't try to squeeze out the contents - it's not a pimple. The doctor determines whether to remove or observe the lipoma. Tactics depend on many factors:

• lipoma size;
• number of tumors;
• personal and family history of skin cancer;
• lipoma pain;
• aesthetic component.

The most common treatment for lipoma is surgical removal. The operation is relevant for large lipomas that continue to grow. The radio wave method is suitable for getting rid of small lipomas. Another treatment option is liposuction (puncture-aspiration method). The fat is “suctioned out” using a needle. If a wen forms on any part of the body, you should consult a surgeon. To get rid of fatty deposits - lipomas or atheromas - contact the surgeons of the President-Med medical centers

Diagnosis and treatment of lipoma at the JSC Meditsina clinic in Moscow

The clinic of JSC "Medicine" in the Central Administrative District of Moscow is ready to offer professional assistance to patients with suspected single or multiple cases of lipoma development. The center’s specialists have high-quality equipment and extensive practical experience in using various methods of removing a tumor focus. Each patient is guaranteed attentive attention, referral to a full course of examinations and an individual approach to developing lipoma treatment tactics. Appointments are available on the clinic’s website and by calling the numbers provided.