Prim. dr Milos Pocekovac
Dr Dragan Stojanovic
What is lipoma?
Lipomas are benign mesenchymal tumors that are developed in the area rich in fatty tissue. Due to the fatty build they are a diagnostic problem, as well as treatment and reconstruction problems.
Lipoma in the breast
Lipomas are one of the most common benign neoplasms from the fatty tissue. The occurrence is around 16% of all mesenchymal tumors. Usually there is well demarcated thin capsule around benign tumors and they are freely movable underneath the skin. They can appear at any body part. Patients can be worried due to breast growth, asymmetry, or fear of a malignant disease. Asymmetry can be the result of unequal hypertrophy or neoplastic growth, which can lead to a problem with the diagnostics. Large or gigantic lipomas are defined as lesions that have a diameter less than 10cm or weight under 1.000 grams.
Lipomas can appear in any part of the body with a prevalence of 2,1 on 1000 people. 20% is located on the chest. They are typically small and asymptomatic. Most cases of breast asymmetry are a result of unequal widening of the breast, resulting from physiologic hypertrophy, but one must suspect a neoplastic process when the change in size is followed by significant asymmetry which presents a difficulty in diagnostics.
We can conclude that lipomas are benign tumors with very little and limited risk for malignant transformation. After a successful excision they have an excellent prognosis despite the fact that some patients present a big reconstructive challenge, especially when regarding symmetry and esthetic. Evaluation performed before surgery includes careful diagnostic testing due to similarities of lipomas to other conditions, those connected to breast asymmetry and benign hypertrophy.
Female patient 71 years old with palpable soft tissue change in the upper outer quadrant. Ultrasound diagnosis- lipoma. No symptoms, maintained sensibility in the breast and left arm.
Even though the tumor was 23,5 cm in diameter, the incision was made close to the left axillar region and there was no need to reconstruct the breast, volume and symmetry was maintained.
Stone in the lipoma
Female patient, 60 years old, referred from screening and mammography program with BI RADS LD 2 (see image bellow), with palpable lipomatous change in the left breast and a had tumor present inside it. Change was located under the areola in the left sulcus of the breast. US BI RADS LD3 lipoma 45 x 21 cm with a 35mm calcification.
Total excision was performed and sent to ex tempore histology.
In the fatty tissue 105×36 mm in diameter there is a calculus (white arrow on the image) 35x22x20 mm in diameter with surrounding surfaces of necrosis of the fatty tissue.