Case Discussion - Lipoma

Q. What is your diagnosis?
A. Subcutaneous lipoma.
Q. Why this is a lipoma?
A. Because it is a very slowly growing swelling
which is soft, pseudofluctuant with a slippery edge.
Q. Why the edge of the lipoma is slippery ?
A. Because it is present within a very loose
capsule so that pressure on one edge moves the
swelling within the capsule.
Q. Why the lipoma is pseudofluctuant ?
A. Because the fat globules constituting the lipoma
are very soft in consistency.
Q. How do you elicit fluctuation in a very
small swelling ?
A. By Paget's test; the swelling is fixed by the
index and thumb of the left hand and pressure is
applied on the center of the swelling by the index
of the right hand. If there is yeilding in the center
of the swelling, it is considered fluctuant.
Q. Why this is a subcutaneous and not a
subfascial lipoma ?
A. Because it is attached to the skin at multiple
sites while in subfascial lipoma the skin is not
attached to the swelling at all. Also, making the
fascia tense does not make the swelling smaller.
Q. How did you detect the skin attachment ?
A. There are two methods to detect skin
attachment; either by pinching or by gliding
Q. Mention the different sites of lipoma ?
A. 1. Subcutaneous lipoma
2. Subfascial lipoma,
3. Intermuscular lipoma
4. Intramuscular lipoma
5. Subperiosteal,
6. Subserous lipoma,
7. Extradural lipoma
8. Retroperitoneal lipoma
9. Subsynovial
10. Intraglandular
Q. Which site is famous for being
precancerous ?
A. Retroperitoneal lipoma.
Q. What are the multiple skin swellings ?
A. 1. Multiple Lipomata
2. Multiple Sebaceous Cysts
3. Multiple Naevi
4. Multiple Haemangiomata
5. Multiple Lymphangiomata
6. Multiple Neurofibromata
7. Multiple Papillomata
8. Multiple Warts
9. Multiple Keloids
10. Multiple Boils
11. Multiple Skin Metastases
Q. What is the commonest multiple skin
swelling ?
A. Multiple naevi.
Q. How do you treat this patient ?
A. The treatment of lipoma is usually conservative.
Excision is indicated if 1) cosmetically annoying
the patient , 2) complicated, 3) painful, or 4)
causing pressure on a surrounding structure.
Q. What are the complications of a lipoma ?
A. Pressure on a surrounding structure e.g. a
retroperitoneal lipoma compressing the ureters,
hindering the movement of a nearby joint,
calcification, myxomatous degeneration, and very
rarely malignant transformation (liposarcoma).
Q. What is Dercum's disease ?
A. It is a painful lipoma, also called "adiposa
dolorosa".