Lipoma is a common benign mesenchymal tumor consisting of mature fat cells. It is a rounded or oblong formation of a soft-elastic consistency, covered with unchanged skin. The tumor slowly increases in size without causing unpleasant sensations. When localized in the immediate vicinity of blood vessels and nerves, it can squeeze them, provoking the development of complications. Diagnosis includes visual examination and biopsy, with deep-seated formations, ultrasound or MRI is shown. Treatment is surgical removal of the tumor.
ICD 10
D17 Benign neoplasm of adipose tissue
General information
Lipomas are detected in about 1 in 100 people. Men and women get sick equally often. The average age of patients who went to the surgeon about the adipose is 40-60 years. For children, the formation of lipomas is uncharacteristic. In 98% of cases, neoplasms are located in the thickness of subcutaneous fat, 2% of cases are lipomas of the brain, heart, gastrointestinal tract organs. In 94% of cases, adipose cells are represented by single nodes. The frequency of occurrence of CNS lipomas is 0.5% of the number of all neoplasms of the brain and spinal cord. Lipomas account for 60% of all non-epithelial intestinal tumors.
Causes
The tumor may be an independent neoplasm or one of the manifestations of some dermatological, neurological and other diseases. Lipomatosis is a polyethological pathology, the development of which requires a combination of several causal factors. Among the main circumstances that increase the risk of formations are::
- Genetic predisposition. The literature describes family cases of the formation of adipose veins. Familial lipomatosis is inherited by autosomal dominant type, in the presence of pathology in parents, the probability of the appearance of formations in children is 75%. The frequency of detection of tumors does not depend on gender.
- Disorders of embryogenesis. The detection of lipomas in uncharacteristic places for them is due to the dystopia of rudimentary fat cells. For example, in the central nervous system, adipocytes develop when adipocytes move into the primary neural tube. At the same time, accumulations of adipose tissue are often part of a complex of congenital anomalies.
- Some diseases and syndromes. There are a large number of pathological processes that are accompanied by the formation of multiple lipomas. This is Derkum’s disease with numerous painful formations, Madelung’s disease, which is characterized by the appearance of a fat “yoke” in the neck, Cowden’s syndrome and others.
The probability of lipoma is increased by endocrine disorders, primarily hypofunction of the pituitary gland, thyroid and pancreas, chronic alcoholism, drug abuse, malignant neoplasms of the upper respiratory tract. Multiple lipomas are more common in women, which may indicate a link between lipomatosis and changes in estrogen levels, diseases of the female genital area.
Pathogenesis
A key role in the development of a local accumulation of adipocytes is assigned to chromosomal abnormalities affecting the long arm of the 12th chromosome. Here are the genes responsible for the synthesis of TAG-lipase, an enzyme that regulates the process of splitting fats and providing the body with energy. According to another theory, the appearance of adipose cells is due to excessive deposition of lipids in adipose tissue cells.
Prerequisites for the formation of lipomas are created at the stage of embryonic development, when the fatty tissue of the embryo is laid. The tumor is surrounded by a loose capsule, which weakly separates the adipose from the surrounding unchanged tissues. The deeply located lipoma has numerous pseudopod-like processes that penetrate into the spaces between the muscles and tendon sheaths, destroy aponeuroses.
Classification
Lipomas differ in location, anatomical and histological structure, and a number of concomitant pathological changes. All of the above determines the features of the clinical course of the disease, the choice of the preferred treatment method, and the prognosis. The current classification includes eight clinical varieties of lipomas:
- Perineural. In 90% of cases, it develops at the site of the median nerve passage. Often accompanied by macrodactyly.
- Lumbosacral. It is associated with malformations of the spine, non-infection of the vertebral arches, a violation of the formation of the spinal cord. It often appears simultaneously with the adipose located in the spinal canal.
- Intra- or intermuscular. It is located in the spaces between the individual muscles. It has no clear boundaries, which makes it difficult to completely remove it. It often recurs.
- Spilled. Externally, it is a cluster-like accumulation of fat without a clear separation from the surrounding tissues, significantly increases the volume of the anatomical area in which it is localized.
- Lipoma of the tendon vagina. Clusters of adipocytes grow in the sheaths of tendons and on the synovial membranes of joints.
- Myolipoma of soft tissues. It has a certain amount of muscle fibers in its composition.
- Angiolipoma. In patients of both sexes, it is usually detected in the kidneys. In men over 50 years of age, it occurs in the subcutaneous adipose tissue of the upper and lower extremities.
- Adenolipoma. It contains components of the sweat gland.
Symptoms
Zhirovik can develop on any part of the body except for the palms and feet. It has the appearance of a jelly density seal or a soft elastic knot that is not soldered to the surrounding tissues, easily shifts relative to the skin and underlying muscles. The formation grows slowly, reaching 5-20 cm in diameter. The skin covering the node has not been changed. The patient’s body weight and the thickness of the subcutaneous tissue layer do not affect the volume of the neoplasm. All lipomas, with the exception of perineural, are painless. Palpation of the nodes does not cause unpleasant sensations.
Lipoma in the internal organs for a long time does not manifest itself in any way, it often becomes an accidental finding during an examination conducted for another reason. When the neoplasm reaches a significant size, it can disrupt the work of the organ, which is accompanied by symptoms characteristic of this anatomical area. Manifestations, as a rule, increase gradually, due to the slow growth of the tumor.
Complications
Superficially located fat cells do not cause problems. An exception may be large subcutaneous lipomas located in the projection of large vessels and nerve trunks, since compression of these anatomical structures leads to impaired blood flow and innervation. A lipoma localized in open areas of the body, head or neck causes a noticeable cosmetic defect. A node growing next to large joints can restrict limb movements.
Brain lipomas provoke the appearance of neurological symptoms: seizures, persistent headaches, pelvic organ disorders. Fatty accumulations in the submucosal layer of the intestine disrupt the passage of intestinal contents. Fatty cells in the chambers of the heart can potentiate arterial hypertension, circulatory insufficiency. Cases of malignant degeneration are described.
Diagnostics
The diagnosis of subcutaneous lipoma is made by a dermatologist. The characteristic appearance, absence of complaints, indication of slow growth give the doctor the opportunity to determine the type of neoplasm during the patient’s first treatment. Additional examinations are carried out to differentiate lipomas with other benign tumors of the skin and subcutaneous fat. Diagnostics of internal organ fat cells is carried out by doctors of the appropriate profile. Patients can be assigned:
- Histological examination. When examining a tissue sample taken during a node biopsy, mature adipocytes of different sizes are detected. The capillary network is well developed inside the neoplasm. A long-existing large lipoma may include areas of atrophy. The presence of lipoblasts indicates a myxoid liposarcoma.
- Ultrasound examination. Soft tissue ultrasound is used to determine the size of the node, identify intermuscular cords, differential diagnosis of a fatty with an epidermoid cyst, and other benign soft tissue neoplasms. Ultrasound of the heart allows you to detect fat nodes in the ventricles and atria.
- Magnetic resonance imaging. MRI of the brain helps to identify clusters of adipocytes in the cranial cavity. Abdominal MRI makes it possible to visualize volumetric formations in hollow organs. Chest CT, the fatty cells in the walls of the esophagus are clearly visible.
Treatment
Removal of superficially located fat cells is carried out for cosmetic purposes and to restore the impaired functions of the affected segment. Lipomas of considerable size, fast-growing nodes squeezing internal organs, painful and dense formations soldered to the underlying tissues require special attention from the surgeon. Removal of such tumors is carried out immediately.
Conservative therapy
Medical removal of adipose cells is applied to neoplasms located under the skin. For this purpose, drugs that break down lipids accumulated in adipocytes are injected by injection. Glucocorticosteroids and some mesotherapeutic agents have lipolytic activity. The method is effective against surface adipose cells whose diameter does not exceed 3 mm. Lipolytics reduce the volume of the node, but do not change the nature of metabolic processes in tumor cells, so after a while the lipoma may recur.
Surgical treatment
Surgical removal of the adipose is the preferred method of treatment, since it allows you to eliminate a tumor of any localization and size. Fragments of the capsule and altered adipose tissue that remain after removal of the neoplasm can cause a relapse. In this regard, the node during the operation must be completely hatched, with all structural components. Excision of subcutaneous lipoma is carried out in the following ways:
- Endoscopic surgery. Removal of small surface nodes is performed using endoscopic techniques. With its help, you can carry out all manipulations through small punctures of the skin without the risk of forming large scars at the site of incisions. The disadvantage of the technique is the difficulty of determining the boundaries of a node with a loose capsule.
- Open operation. To prevent the reappearance of the adipose allows its complete excision together with the capsule, which is possible only with sufficient length of surgical incisions. In the breast area, the removal of tumors is performed by the method of sectoral resection in order to preserve the correct shape of the female breast.
Subcutaneous nodes are excised under local anesthesia on an outpatient basis, do not require a long recovery period. Operations on the heart, internal organs and intestines are performed in a hospital after a thorough examination, preliminary preparation, under anesthesia. Indications for surgical removal are determined taking into account the degree of dysfunction of the affected organ and the risk of complications for the patient.
Prevention and prognosis
The prognosis for life and health is favorable. Preventive measures have not been developed. Existing subcutaneous neoplasms are recommended to be observed by a dermatologist or dermatooncologist with a frequency of visits 1 time per year. This is necessary for the timely detection of possible complications of initially benign neoplasia. Accumulations of fat in the central nervous system, heart, kidneys, liver, intestines should be removed immediately after detection in order to prevent dysfunction of the affected organs.
