Lipoma

Lipoma is a benign soft tissue tumor or swelling consisting of adipose tissue (body fat) enclosed in a capsule of fiber-like tissue (connective tissue). It is seen in 2 % of the general population.

It is the most common benign form of soft tissue swelling. Multiple lipomas can also be present. Mostly seen in adults from 40 to 60 years of age but can also occur in adults and children too.

Lipoma can undergo secondary infection which is painful and secondary changes such as a cancerous condition like a liposarcoma.

Lipoma: Causes

The following are the important causes of developing Lipoma −

• In most cases, the cause is idiopathic i.e., unknown. As association to a particular cause is not been found in most of the cases.

• Obesity and sudden changes in body weight over a short period can contribute to the formation of lipoma.

• Sedentary lifestyle and lack of exercise can also contribute to its formation.

• Minor injuries over the skin and minor repeated blunt trauma over fat excess areas can also lead to the formation of lipoma.

• Few hereditary conditions such as familial multiple lipomatosis, Gardeners syndrome, and Dercums syndrome have shown a strong association with the formation of single or multiple lipomatous lesions.

Lipoma: Symptoms

The patient with Lipoma mainly presents with the following symptoms that include −

• Lipomas are swelling which is soft, and small (under one centimeter) but can enlarge to sizes greater than six centimeters.

• These swellings are present just below the skin and can be found across any place in the body where fat cells are present.

• It will be localized i.e.; all the boundaries of the swelling can be made out with the finger.

• It is lobular i.e., due to the presence of fat cells covered in a round membrane it feels like a lobule on touch.

• It is fluctuant i.e. after pressing from one side the same pressure is felt on the opposite side of the swelling.

• "Mobile" (most important); means that the swelling keeps on moving below the skin and slips when we keep the finger on one edge of the swelling.

• Skin will be free of swelling and does not show any changes until infection or ulceration develops.

• It will be usually painless, soft, and non-tender (painless on pressing)

• In case of complications, it can lead to infection and ulceration.

• Interestingly it can happen inside the intestine also and cause intestinal obstruction.

• Location − Neck, Breast, Arm, Forehead, Back, Abdominal, Shoulder, Thigh, Spinal. It can also occur in internal organs like the Brain, Kidney, Colon, Pancreatic, Spermatic cord, etc.

Lipoma: Risk Factors

Several factors play an important role in the development of Lipoma which includes −

• Genetics − Lipomas can be hereditary with the same family members getting the disease is more common.

• Gender − More commonly seen in males than females.

• Obesity − due to a large amount of fat in the body there is a high chance of getting lipoma due to the overgrowth of fat cells.

• Occupation − People prone to regular trauma and injuries.

• Madelung disease − A rare fat metabolism disorder that can cause fatty tissue overgrowth.

• Adiposis Dolorosa − seen most commonly in obese women. These people develop lipomas or folds of fatty tissue, which can be painful.

• Gardner’s syndrome − a genetic disorder that leads to multiple lipomas over the body surface.

• Bannayan-Zonana syndrome − Genetic disorder in which children have multiple lipomas.

Lipoma: Diagnosis

The diagnosis of Lipoma is mainly done based on history and some of the tests may be required for confirmation and to rule out underlying causes

• Most diagnosis is done based on clinical examination. Feature such as swelling present below the skin which is soft, localized, fluctuant, and mobile, with the "slip sign" (as they slip or move when pressure is applied over the swelling)

• No difference between body temperature and swelling temperature

• Usually painless on the application of pressure also.

• Radiography such as X-Ray and CT scan can be done for confirmation before removal to differentiate from another swelling that looks the same as lipoma.

• Biopsy and FNAC (Fine Needle Aspiration Cytology) can also be done to confirm the diagnosis both before or after removing the swelling.

Lipoma: Treatment

The treatment is based on the severity of the symptoms. Your doctor may advise conservative or surgical treatment.

• Usually, treatment of lipoma is not necessary unless the swelling becomes painful or causes a problem in any joint's movement. It is usually removed for cosmetic reasons.

• Surgical excision of lipoma under the cover of local anesthesia is done which hardly takes 30-45 minutes. No or minimum post-operative complications are there. Minimum skin scarring can be present. It’s a day-care procedure and the patient can go home on the same day. Minimum discomfort or pain can be present postoperatively which eventually reduces with time.

• Lipoma growing in the internal organs can lead to a serious issue and it’s treated with specific surgery accordingly.

• Recurrence is very common after the surgical excision but it can be treated by re-excision.

• Liposuction can also be done if the swelling is small and soft. It causes no scarring.

• Newer methods are under development such as injections for lipolysis such as steroids or phosphatidylcholine.

• Modern new techniques such as Tissue-targeted heating including cauterization, electrosurgery, and harmonic scalpel are been invented and used for research purposes.

Lipoma: Prevention

No such specific measures have been described in the literature. Only prompt inspection of the swelling can lead to its diagnosis.

Individuals having Obesity should control their body weight through diet modification and strict exercise routines.

Malignant conversion of the lipoma to liposarcoma should be carefully watched and should be prevented before its conversion

If any of the above mention syndromes are present in the individual then a strong suspicion of lipoma should be kept in mind and treated as advised. In case of any doubt consultation with a General Surgeon will be advisable.

Conclusion

Lipoma is a very common benign swelling, that can occur in any age group but is common in 40-60 years. It's a soft non-tender swelling with almost no effect on daily activities. As the incidence of obesity is increasing so as the cases of lipoma is also increasing.

One should not be stressed because of the presence of lipoma as it is completely treatable with minimal intervention surgery. Surgical excision is the treatment of choice for cosmetic correction and there is no side effect to the treatment.

Complicated lipoma should be diagnosed early to prevent its secondary effect. Consultation with the General Surgeon is recommended.

Interestingly lipoma can occur in Dogs, Cattle, Horses, and Pigs too.