Lipoma
A lipoma is a benign tumor made of fat tissue. They are generally soft to the touch, movable, and painless. They usually occur just under the skin, but occasionally may be deeper. Most are less than in size. Common locations include upper back, shoulders, and abdomen. It is possible to have a number of lipomas. The cause is generally unclear. Risk factors include family history, obesity, and lack of exercise. Diagnosis is typically based on a physical exam. Occasionally medical imaging or tissue biopsy is used to confirm the diagnosis. Treatment is typically by observation or surgical removal. Rarely , the condition may recur following removal, but this can generally be managed with repeat surgery. They are not generally associated with a future risk of cancer. Lipomas have a prevalence of roughly 2 out of every 100 people. Lipomas typically occur in adults between 40 and 60 years of age. Males are more often affected than females. They are the most common noncancerous soft-tissue tumor. The first use of the term "lipoma" to describe these tumors was in 1709. Types. The many subtypes of lipomas include: Causes. The tendency to develop a lipoma is not necessarily hereditary, although hereditary  conditions such as familial multiple lipomatosis might include lipoma development. Genetic studies in mice have shown a correlation between the "HMG I-C" gene (previously identified as a gene related to obesity) and lipoma development. These studies support prior epidemiologic data in humans showing a correlation between "HMG I-C" and mesenchymal tumors. Cases have been reported where minor injuries are alleged to have triggered the growth of a lipoma, called a "post-traumatic lipoma". However, the link between trauma and the development of lipomas is controversial. Other conditions. Lipomatosis is believed to be a hereditary condition in which multiple  lipomas are present on the body. Adiposis dolorosa (Dercum disease) is a rare condition involving multiple painful lipomas, swelling, and fatigue. Early studies mentioned prevalence in obese postmenopausal women. However, current literature demonstrates that Dercum disease is present in more women than men of all body types; the average age for diagnosis is 35 years. Benign symmetric lipomatosis (Madelung disease) is another condition involving lipomatosis. It nearly always appears in middle-aged males after many years of alcoholism, but nonalcoholic males and females can also be affected. Diagnosis. A physical exam is typically the easiest way to diagnose it. Rarely , a tissue biopsy or imaging may be required. The imaging modality of choice is magnetic resonance imaging (MRI) because it has superior sensitivity of distinguishing it from liposarcoma as well as mapping the surrounding anatomy. Treatment. Usually, treatment of lipomas is not necessary, unless they become painful or restrict movement. They are usually removed for cosmetic reasons if they grow very large or for histopathology to verify that they are not a more dangerous type of tumor such as a liposarcoma. This last point can be important, as the characteristics of a tumor are not known until after it is  removed and medically examined. Lipomas are normally removed by simple excision. The removal can often be done under local anesthetic and takes less than 30 minutes. This cures the great majority of cases, with about 1–2% of lipomas recurring after excision. Liposuction is another option if the lipoma is soft and has a small connective tissue component. Liposuction typically results in less scarring; however, with large lipomas, it may fail to remove the entire tumor, which can lead to regrowth. New methods under development are supposed to remove the lipomas without scarring. One is removal by injecting compounds that trigger  lipolysis, such as steroids or phosphatidylcholine. Other potential methods based on tissue-targeted heating include cauterization, electrosurgery, and harmonic scalpel. Post surgery. Patients who have a lipoma removed are usually able to return home the same day, without any need for hospitalization. Some patients may have pain, swelling, or bruising where the lipoma was removed. These symptoms usually subside after a few days. Prognosis. Lipomas are rarely life-threatening, and the common subcutaneous lipomas are not a serious condition. Lipomas growing in internal organs can be more dangerous; for example, lipomas in the gastrointestinal tract can cause bleeding, ulceration, and  painful obstructions (so-called "malignant by location", despite being a benign growth histologically). Malignant transformation of lipomas into liposarcomas is very rare, and most liposarcomas are not produced from pre-existing benign lesions. A few cases of malignant transformation have been described for bone and kidney lipomas, but it is possible that these few reported cases were well-differentiated liposarcomas in which the subtle malignant characteristics were missed when the tumor was first examined. Deep lipomas have a greater tendency to recur than superficial lipomas because complete surgical removal of deep lipomas is not always possible. The presence of multiple  lipomas, lipomatosis, is more commonly encountered in men. Some superficial lipomas can extend into deep fascia and may complicate excision. Liposarcoma is found in 1% of lipomas and is more likely to occur in lesions of the lower extremities, shoulders, and retroperitoneal areas. Other risk factors for liposarcoma include large size (>5 cm), associated with calcification, rapid growth, and/or invasion into nearby structures or through fascia into muscle tissue. Epidemiology. Around 2% of the general population has a lipoma. These tumors can occur at any age, but are most common in middle age, often appearing in people from 40  to 60 years old. Cutaneous lipomas are rare in children, but these tumors can occur as part of the inherited disease Bannayan-Zonana syndrome. Lipomas are usually relatively small with diameters of about 1–3 cm, but in rare cases they can grow over several years into "giant lipomas" that are 10–20 cm across and weigh up to 4–5 kg. Other animals. Lipomas occur in many animals, but are most common in older dogs, particularly older Labrador Retrievers, Doberman Pinschers, and Miniature Schnauzers. Overweight female dogs are especially prone to developing these tumors, and most older or overweight dogs have at  least one lipoma. In dogs, lipomas usually occur in the trunk or upper limbs. They are also found less commonly in cattle and horses, and rarely in cats and pigs. However, a pedunculated lipoma can cause entrapment and torsion of the intestine in horses, causing necrosis, colic, and possibly death. The intestine becomes twisted around the stalk of the lipoma and loses blood supply.