^T^^l^D: Lipomas are slow-growing benign tumours of adipose tissue.
Lipomatosis refers to multiple contiguous lipomas that cause distortion of SC ^^ tissues (e.g. on buttock or rarely, neck).
Lipomas can be classified by location, e.g. SC, subfascial, subsynovial.
Unknown, certain chromosomal aberrations have been implicated (e.g. translocation of a gene on chromosome 12).
A rare presentation is multiple tender lipomas (Dercum's disease/ad/pos/s dolorosa).
All ages, mostly 40-60 years, rare in children. No gender preference.
Patient notices a lump, usually painless and slowly enlarging, unless subject to trauma when fat necrosis may cause it to swell and become tender.
Can occur anywhere there are adipose tissue reserves, common in the SC tissue of the upper arms.
Nontender, soft, compressible, but do not usually fluctuate or transilluminate except if large. Lipomas do not have a fluid thrill and are dull to percussion. The overlying skin is usually normal. Variable size, usually ovoid or spherical, often lobulated (a useful diagnosic feature). Local lymph nodes should not be palpable.
Can arise in any connective tissue but are most common in SC fat. Histologically, they are made up of collections of adipose cells indistinguishable from normal adipocytes divided into large lobules by thin fibrous septa.
Usually none necessary; MRI can be used for visualising deeply sited lipomas.
Conservative: May be left alone if not causing discomfort or distorting appearance.
Surgical: If troublesome or unsightly. Can be removed under local anaesthesia: an incision is made over the lipoma to expose it; a typical feature is that the lipoma can be milked out through the incision by gentle pressure on the surrounding tissue, often with minimal dissection. Haemostasis in the resulting cavity should be ensured to avoid haematoma development. Larger lipomas or those in more complicated sites will need excision under general anaesthetic.
If traumatised, may undergo fat necrosis.
Excellent; as a general rule, lipomas do not become malignant (liposarcomas usually arise de novo, e.g. in the retroperitoneum).
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