Department of Orthopaedic Surgery, Ibn Sina Hospital, Souissi, Rabat, BP 10105, Morocco.
Orthop Traumatol Surg Res. 2011 Apr;97(2):152-8. doi: 10.1016/j.otsr.2010.09.019. Epub 2011 Feb 26.
The purpose of this study is to determine if giant size is of bad prognosis in deep lipomas of the upper extremity.
We report a retrospective study of 13 patients with deep-seated lipomas of the upper extremity treated during the period from April 1997 to April 2008. We evaluated the clinical and radiological characteristics, treatment and evolution profile of these patients.
There were 10 women and three men, with an average age of 53 years (range 30-79 years). Seven of these lipomas were in the arm, one in the shoulder, and five in the forearm. Six lipomas were intramuscular, six intermuscular (three of them being attached to bone and labelled parosteal lipoma) and one epivaginal lipoma of the flexor tendon sheath. All patients presented a progressive slow-growing mass that was associated with radial paralysis in one case and carpal tunnel syndrome in one case. Plain radiographs showed a radiolucent soft-tissue image in all cases and an associated osteochondroma in one parosteal lipoma. Computer tomography (CT) or magnetic resonance imaging (MRI) suggested the lipomatous nature and benign characteristics of these deep lipomas that were giant in all cases (mean size: 7 cm). Lipoma marginal excision was performed and histopathological examination demonstrated features consistent with a benign lipoma. There was good function and no clinical recurrence was observed after a mean follow-up of three years.
Giant deep-seated lipomas of the upper extremity are uncommon and can be intermuscular or intramuscular. A painless soft-tissue mass is the most frequent chief complaint. MRI with fat suppression suggests the diagnosis and studies the extension of deep lipoma. Marginal excision is the treatment of choice and histopathology eliminates diagnosis of well-differentiated liposarcoma.
Appropriate evaluation of deep lipoma is to rule out malignancy by systematically performing MRI and biopsy. In contrast to deep-seated lipomas of the lower extremity or the retroperitoneal space, the prognosis of deep-seated lipomas of the upper extremity is good irrelevant of their size. Recurrence and the degeneration are very rare.
Level 4.
本研究旨在确定上肢深部脂肪瘤中巨型肿瘤是否为预后不良的指标。
我们报告了一项回顾性研究，纳入了 1997 年 4 月至 2008 年 4 月期间治疗的 13 例上肢深部脂肪瘤患者。我们评估了这些患者的临床和影像学特征、治疗方法和随访结果。
患者中 10 例为女性，3 例为男性，平均年龄 53 岁（范围 30-79 岁）。7 例脂肪瘤位于手臂，1 例位于肩部，5 例位于前臂。6 例为肌内脂肪瘤，6 例为肌间脂肪瘤（其中 3 例附着于骨，被标记为骨旁脂肪瘤），1 例为位于屈肌腱鞘的滑膜脂肪瘤。所有患者均表现为进行性缓慢生长的肿块，其中 1 例伴有桡神经麻痹，1 例伴有腕管综合征。所有病例的 X 线片均显示为透亮的软组织影像，1 例骨旁脂肪瘤伴有骨软骨瘤。CT 或 MRI 提示这些深部脂肪瘤为脂肪瘤性且为良性病变，所有病例均为巨大脂肪瘤（平均大小为 7cm）。行脂肪瘤边缘切除术，组织病理学检查结果符合良性脂肪瘤特征。平均随访 3 年后，患者功能良好，未见临床复发。
上肢深部巨型脂肪瘤较为罕见，可为肌间或肌内脂肪瘤。最常见的主要症状是无痛性软组织肿块。MRI 加脂肪抑制可提示诊断，并有助于了解深部脂肪瘤的延伸范围。边缘切除术是首选治疗方法，组织病理学可排除分化良好型脂肪肉瘤的诊断。
通过系统地进行 MRI 和活检，可以排除恶性肿瘤，从而对深部脂肪瘤进行适当评估。与下肢或腹膜后深部脂肪瘤不同，上肢深部脂肪瘤的预后与肿瘤大小无关，无论肿瘤大小，其复发和恶变均较为罕见。
4 级
