Lymphedema, Lipoma and Lipomas

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Lymphedema, Lipoma and Lipomas

Postby patoco » Sat Jun 10, 2006 4:32 pm

Lymphedema and Lipoma/Lipomas

Our Home Page: Lymphedema People

http://www.lymphedemapeople.com

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Lymphedema and Lipoma

Both of these conditions involve the subcutaneous tissues. So what exactly the difference?

Lymphedema is the collection of fluids in the interstitial tissues caused by a malfunctioning or damaged lymph system. The result is limb or body swelling in the affected areas. One complication of lymphedema is called fibrosis. This is where the actual tissue texture changes. It becomes damaged and begins to harden. You can have isolated spots or sections of hardness that may not involve the entire limb. This may appear to be a lump or feel like some time of growth. This fibrosis (hardness) can be treated, reduced and even in its early stages eliminated by correct lymphatic massage treatment.

A lipomaon the other hand is actually a soft tissue tumor located within the subcutaneous tissue areas. It is composed of fat cells or fatty tissue. When biopsied it reveals a growth that has increased compact collagen, thinning of the dermis (skin), and the tissue is generally more of a yellow discoloration.

The overwhelming percentage are simply benign growths which can be removed surgically.

Symptomsinclude a skin lump, a soft painless lump under the skin. These can occur almost anywhere but a more frequently found in the legs or arm.

Causesof lipomas are not well understood. It is believed that there is a genetic predisposition for lipomas, but the specific genetic marker has not been identified.

Lipomas can also arise as a secondry symptoms involving othere conditions.

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Lipoma

Introduction

The lipoma is a very common benign tumor of adipose tissue, but its presence in the oral and oropharyngeal region is relatively uncommon, with a prevalence rate on only 1/5,000 adults (Table 1). The first description of an oral lesion was provided in 1848 by Roux in a review of alveolar masses; he referred to it as a "yellow epulis." While most lesions are developmental anomalies, those which occur in the maxillofacial region usually arise late in life and are presumed to be neoplasms of adipocytes, occasionally associated with trauma. As with all fatty tissue, a lipoma will float on the surface of formalin rather than sink to the bottom of a biopsy specimen jar.

Clinical Features

The lipoma is a slowly enlarging, soft, smooth-surfaced mass of the submucosal tissues (Figures 1 & 2). When superficial, there is a yellow surface discoloration. When well-encapsulated, tumors are freely movable beneath the mucosa, but less well-demarcated lesions are not movable. The lesion may be pedunculated or sessile and occasional cases show surface bosselation. The tumor has a less dense and more uniform appearance than surrounding fibrovascular tissues when it is transilluminated. MRI scans are very useful in the clinical diagnosis; CT scans and ultrasound are less reliable.

Few oral or pharyngeal lesions occur before the third decade of life and there is no gender predilection. Once present, a mucosal oral lipoma may increase to 5-6 cm. over a period of years, but most cases are less than 3 cm. in greatest dimension at diagnosis. Rarely, a lipoma will occur within maxillary bones or sinuses, but usually this entity is found in the buccal, lingual or oral floor regions. Multiple head and neck lipomas have been observed in neurofibromatosis, Gardner syndrome, encephalocraniocutaneous lipomatosis, multiple familial lipomatosis, and Proteus syndrome. Generalized lipomatosis has been reported to contribute to unilateral facial enlargement in hemifacial hypertrophy.

Pathology and Differential Diagnosis

The lipoma is composed predominantly of mature adipocytes, possibly admixed with collagenic streaks, and is often well demarcated from the surrounding connective tissues (Figures 3 & 4). A thin fibrous capsule may be seen and a distinct lobular pattern may be present. Quite often, however, lesional fat cells are seen to "infiltrate" into surrounding tissues, perhaps producing long, thin extensions of fatty tissue radiating from the central tumor mass (Figure 5). When located within striated muscle this infiltrating variant is called intramuscular lipoma (infiltrating lipoma), but extensive involvement of a wide area of fibrovascular or stromal tissues might best be termed lipomatosis.

Occasional lesions exhibit excessive fibrosis between the fat cells (fibrolipoma), excess numbers of small vascular channels (angiolipoma), a myxoid background stroma (myxoid lipoma, myxolipoma), or areas with uniform spindle-shaped cells interspersed between normal adipocytes (spindle cell lipoma, Figure 6). When spindle cells appear somewhat dysplastic or mixed with pleomorphic giant cells with or without hyperchromatic, enlarged nuclei, the term pleomorphic lipoma is applied. When the spindled cells are of smooth muscle origin, the term myolipoma may be used, or angiomyolipoma when the smooth muscle appears to be derived from the walls of arterioles.

Rarely, chondroid or osseous metaplasia may be seen in a lipoma (osteolipoma, ossifying lipoma, chondroid lipoma, ossifying chondromyxoid lipoma). When bone marrow is present, the term myelolipoma is used. Also on rare occasions, isolated ductal or tubular adnexal structures are scattered throughout fat lobules, in which case the term adenolipoma is applied. Perineural lipoma has also been reported.

On occasion, lipoma of the buccal mucosa cannot be distinguished from a herniated buccal fat pad, except by the lack of a history of sudden onset after trauma. Otherwise, lipoma of the oral and pharyngeal region is not difficult to differentiate from other lesions, although spindle cell and pleomorphic types must be distinguished from liposarcoma. When metaplastic calcified tissue is present, the lesion may be confused with soft tissue chondroma or soft tissue osteoma.

The benign neoplasm of brown fat, hibernoma, has been reported in the oral/pharyngeal region only rarely. This childhood tumor is comprised of lobules of highly vascular stroma admixed with three types of adipocytes: a large, univacuolated fat cell with a peripheral nucleus; a moderate-sized multivacuolated fat cell with scanty granular, eosinophilic cytoplasm and a centrally located rounded nucleus; and a smaller cell with the same cytoplasm but with only small circular spaces representing fat microvacuoles.

A fat tumor comprised of a central core of mature adipocytes and a peripheral envelope of cells containing variably sized fat vacuoles is called lipoblastoma (Figure 7). Affected cells are smaller than normal, with 1-4 vacuoles, perhaps with a light, wispy cytoplasm between vacuoles. Some cells have nuclei centrally located, as seen in the moderately-sized cells of hibernoma, while others show the nucleus to be pushed toward the cytoplasmic membrane (signet-ring cell). Mitotic activity is extremely rare and fibrous septa separate fat lobules in this tumor. An abnormality of the long arm of chromosome 8q11-13 is a rather consistent finding in the lesional cells.

Treatment and Prognosis

Conservative surgical removal is the treatment of choice for oral lipoma, with occasional recurrences expected. An infiltrating lipoma often must be simply debulked, a portion of the infiltrating fat being deliberately allowed to remain in order to preserve as much normal tissue as possible.

References (Chronologic Order)

Roux M. On exostoses: there character. Am J Dent Sc 1848; 9:133-134.

Shear M. Lipoblastomatosis of the cheek. Br J Oral Surg 1967; 5:173-179.

de Visscher JGAM. Lipomas and fibrolipomas of the oral cavity. J Maxillofac Surg 1982; 10:177-181.

Rapidis AD. Lipoma of the oral cavity. Int J Oral Surg 1982; 11:263-275.

Chen SY, Fantasia JE, Miller AS. Myxoid lipoma of oral soft tissue: a clinical and ultrastructural study. Oral Surg Oral Med Oral Pathol 1984; 57:300-307.

McDaniel RK, Newland JR, Chiles DG. Intraoral spindle cell lipoma: case report with correlated light and electron microscopy. Oral Surg Oral Med Oral Pathol 1984; 57:52-57.

Guillou L, Dehon A, Charlin B, et al. Pleomorphic lipoma of the tongue: case report and literature review. J Otolaryngol 1986; 15:313-316.

Rigor VU, Goldstone SE, Jones J, et al. Hibernoma: a case report and discussion of a rare tumor. Cancer 1986; 57:2207-2211.

Macmillan ARG, Oliver AJ, Reade PC, et al. Regional macrodontia and regional bony enlargement associated with congenital infiltrating lipomatosis of the face presenting as unilateral facial hyperplasia. Int J Oral Maxillofac Surg 1990; 19:283-286.

Fujimura N, Enomoto S. Lipoma of the tongue with cartilaginous change: a case report and review of the literature. J Oral Maxillofac Surg 1992; 50:1015-1017.

Zelger BWH, Zelger BG, Plorer A, et al. Dermal spindle cell lipoma – plexiform and nodular variants. Histopathol 1995; 27:533-540.

Tallini G, Dalcin P, Rhoden KJ, et al. Expression of Hmgi-C and Hmgi (Y) in ordinary lipoma and atypical lipomatous tumors – immunohistochemical reactivity correlates with karyotypic alterations. Amer J Pathol 1997; 151:37-43.

Kang N, Ross D, Harrison D. Unilateral hypertrophy of the face associated with infiltrating lipomatosis. J Oral Maxillofac Surg 1998; 56:885-887.

http://www.maxillofacialcenter.com/Bond ... html#Quick

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Diagnostic Images

http://dermatlas.med.jhmi.edu/derm/resu ... 1623404710

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Lipomas

Synonyms and related keywords: liposarcomas, pseudolipoma, teratoma, adenolipomas, angiolipomas, hamartoma, cardiac lipomas

http://www.emedicine.com/med/topic2720.htm

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Lipoma: Tumor of fat cells usually just under the skin

http://www.wrongdiagnosis.com/l/lipoma/intro.htm

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Support - The Lipoma Forum

http://www.lipomaforum.com/forum/

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Medline Plus Links Page for Lipomas

http://search.nlm.nih.gov/medlineplus/q ... TER=lipoma

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Pub Med - Links page for Lipomas

http://www.ncbi.nlm.nih.gov/entrez/quer ... d=15766470

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Lipoma

What is it?

Lipoma is a common soft-tissue tumor found under the skin but also can appear in deeper tissues and even in various body organs, such as the heart, brain, and lung. They can vary from walnut size to that of a large baseball and usually have a soft, rubbery feel. Types of lipomas include the superficial subcutaneous lipoma, the intramuscular lipoma, the spindle cell lipoma, the angiolipoma, the benign lipoblastoma, and the lipomas of tendon sheaths, nerves, synovium, periosteum, and the lumbosacral area. The most common type is the superficial subcutaneous lipoma.

Who gets it?

Superficial subcutaneous lipomas occur more frequently in women than men, usually on the trunk, nape of the neck, and forearms. They are found more commonly in people who are overweight, although losing weight will not make lipomas smaller.

Deep intramuscular lipomas usually affect adults 30 to 60 years of age, with more men being affected than women. It is commonly found in the large muscles of the extremities.

Spindle cell lipomas are seen typically in men 45 and 64 years of age in the posterior neck and shoulder areas.

Angiolipoma lipomas are usually found in young adults, typically on the forearm.

Lumbosacral lipomas occur in the trunk posterior to a spina bifida defect. They usually occur in infants, but can be seen in adults.

An extremely rare variation of lipoma is diffuse lipomatosis. Symptoms include multiple superficial and deep lipomas that involve one entire extremity or the trunk and usually have their onset during the first 2 years of life.

Benign lipoblastoma and diffuse lipoblastomatosis usually affect the extremities of infants. The lesions can be solitary or multiple and can be superficial or deep in muscle tissue.

What causes it?

No one knows why lipomas occur. Usually they are inherited.

What are the symptoms?

Symptoms of lipoma include soft, moveable lumps under the skin that are sometimes painful to the touch.

How is it diagnosed?

The doctor may be able to make a diagnosis of lipoma based on a visual examination of the patient. The doctor may also do a biopsy on the lesion to determine the type of lipoma.

What is the treatment?

Treatment for lipomas may not be required, however in most cases they can be surgically removed if they are very large, painful, or cosmetically unattractive. The doctor may remove them by surgical excision. Liposuction can sometimes be performed and may result in less scarring.

Sometimes it is impossible to remove a diffuse lipomatosis if the involved limb becomes massive in size. In this extreme case, amputation of the limb may be recommended.

Self-care tips

Lipomas generally grow to a limited size and usually are not painful. Surgery to treat lipomas for cosmetic reasons is usually successful, with a recurrence rate for most lipomas at less than five percent.

This information has been designed as a comprehensive and quick reference guide written by our health care reviewers. The health information written by our authors is intended to be a supplement to the care provided by your physician. It is not intended nor implied to be a substitute for professional medical advice.
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