Rajani Amyn M, Mittal Anmol R S, Kulkarni Vishal U, Rajani Khushi A, Rajani Kashish A
Department of Orthopaedics, OAKS Clinic, Mumbai, Maharashtra, India.
Department of Clinical Research, OAKS Clinic, Mumbai, Maharashtra, India.
J Orthop Case Rep. 2022 Oct;12(10):30-33. doi: 10.13107/jocr.2022.v12.i10.3354.
Lipomas are the most common benign mesenchymal tumor. The solitary subcutaneous lipoma accounts for approximately onequarter to one-half of all soft-tissue tumors. Giant lipomas involving the upper extremities are rare tumors. This case report presents a subcutaneous giant lipoma in the upper arm weighing 350 g. Due to its long-term presence, the lipoma caused discomfort and pressure effects in the arm. Gross underestimation on magnetic resonance imaging (MRI) made its removal challenging and difficult.
Through this case, we report a 64-year-old female who consulted us in the clinic with complaints of discomfort, feeling of heaviness, and a mass in the right arm since 5 years. On clinical examination, there was asymmetry in her arms with her right upper arm showing a visible swelling (8 cm × 6 cm) over its posterolateral aspect. On palpation, the mass was soft, boggy, not attached to the underlying bone or muscle, and not involving the skin. A provisional diagnosis of lipoma was made and the patient was asked to undergo plain and contrastenhanced MRI for the confirmation of the diagnosis, the extent of the lesion, and infiltration into the surrounding soft tissue. The MRI revealed a lobulated deep lipoma in the subcutaneous plane with pressure effects over the posterior fibers of the deltoid muscle. Surgical excision of the lipoma was carried out. The cavity was closed using retention stitches to prevent the formation of a seroma or hematoma. Complaints of pain, weakness, heaviness, and discomfort completely subsided by the 1st month follow-up. The patient was then followed up every 3 months for 1 year. No complication or recurrence was noted throughout this period of time.
The extent of lipomas can be underestimated on radiological imaging. It is common to find a bigger lesion than reported and to plan and execute the incision and surgical approach accordingly. Blunt dissection should be preferred when there are chances of neurovascular involvement or injury.
脂肪瘤是最常见的良性间叶组织肿瘤。孤立性皮下脂肪瘤约占所有软组织肿瘤的四分之一至二分之一。累及上肢的巨大脂肪瘤是罕见肿瘤。本病例报告了一例上臂皮下巨大脂肪瘤，重达350克。由于其长期存在，该脂肪瘤导致手臂不适和压迫效应。磁共振成像（MRI）对其大小严重低估，使得脂肪瘤的切除具有挑战性且困难。
通过本病例，我们报告一名64岁女性，她自5年前起因右臂不适、沉重感和肿块前来我院门诊就诊。临床检查发现，她的双臂不对称，右上臂后外侧可见肿胀（8厘米×6厘米）。触诊时，肿块质地柔软、有波动感，未附着于下方骨骼或肌肉，未累及皮肤。初步诊断为脂肪瘤，并要求患者接受平扫及增强MRI检查，以确诊、明确病变范围及是否浸润周围软组织。MRI显示皮下平面有一个分叶状深部脂肪瘤，对三角肌后纤维有压迫效应。对脂肪瘤进行了手术切除。使用保留缝线关闭切口，以防止形成血清肿或血肿。在术后1个月随访时，疼痛、无力、沉重感和不适的症状完全消失。随后对患者进行了为期1年的每3个月一次的随访。在此期间未发现并发症或复发。
脂肪瘤的范围在影像学检查中可能被低估。常见的情况是发现比报告的更大的病变，并据此规划和实施切口及手术入路。当有神经血管受累或损伤的可能时，应首选钝性分离。
