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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 7  |  Issue : 2  |  Page : 65-67

Giant lipoma of posterior neck


Department of General Surgery, Jawahar Lal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India

Date of Web Publication4-Apr-2018

Correspondence Address:
Dr. Sandeep K Varshney
Department of General Surgery, Jawahar Lal Nehru Medical College, Aligarh Muslim University, Aligarh - 202 001, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ais.ais_38_17

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  Abstract 


Lipoma is one of the most common benign mesenchymal tumors and is found almost in all sites where fat exists. This lesion is often asymptomatic except in cases of enormous masses compressing neurovascular structures. They are found relatively rarely on the posterior part of the neck. Surgical intervention in these tumors is very challenging because, sometimes, extension to the spinal cord and malignant transformation may occur especially in old age. Precise knowledge of the anatomy and meticulous surgical techniques are needed while operating such giant lipomas.

Keywords: Giant lipoma, posterior neck, upper back


How to cite this article:
Alam J, Aslam M, Varshney SK, Varshney A. Giant lipoma of posterior neck. Arch Int Surg 2017;7:65-7

How to cite this URL:
Alam J, Aslam M, Varshney SK, Varshney A. Giant lipoma of posterior neck. Arch Int Surg [serial online] 2017 [cited 2018 Aug 16];7:65-7. Available from: http://www.archintsurg.org/text.asp?2017/7/2/65/229189




  Introduction Top


Lipomas are slow-growing benign soft-tissue tumors which are typically asymptomatic and occur in approximately 1% of the population.[1] Lipomas are often small and solitary lesions and can grow in any area of the body where adipose tissue is present. Whereas most lipomas grow on the extremities and trunk, only 13% are reported to form on the neck and the head.[2] The tissue in a lipoma is mature, typically adipose, which often forms septated lobules encased in fibrous connective tissue. A lipoma is considered to be huge when it is greater than 10 cm in length in any dimension or weighs over 1000 g.[3] The diagnosis is mostly clinical. Imaging tools are useful to confirm the adipose nature of the lesion and to define its anatomic border. Surgical excision of lipoma is the definitive treatment. We describe a case of a 60-year-old female who presented with a huge lipoma at the nape of neck for the past 20 years. The 3.04 kg mass was successfully removed with excellent results and no functional impairment. This is the second largest lipoma present at the nape of neck, which is being reported.


  Case Report Top


A 60-year-old female of body mass index 24.67 kg/m 2 presented to our surgical outpatient department with a lump of size 18 × 15 cm at the nape of neck; she had this since last 20 years. The lump grew progressively in size. The lump was so big that it resulted in discomfort when she slept. It was non-tender, nontrans-illuminating, fluctuating, and soft to firm in consistency. There was no regional lymphadenopathy. There was no neurological involvement in the form of headache, vertigo, sensory, or motor deficit in the extremities [Figure 1].
Figure 1: (a) Lipoma at posterior neck (posterior view). (b) Lipoma at posterior neck (oblique view)

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Ultrasonography of upper back showed a large well-defined oval shaped hyperechoic lesion with few echogenic setae involving the subcutaneous plane of left upper back extending superiorly up to nape of neck with minimal internal vascularity. Fine needle aspiration cytology suggested mature lipocytes indicative of lipomatous lesion. After general anesthesia, the patient was positioned in prone position. An elliptical transverse incision was made at the apex of the lump. The superior and inferior skin flaps were raised. Separation of lipoma from the surrounding tissues was performed with sharp and blunt dissection. The lipoma was adherent to the overlying muscle. The redundant skin was removed [Figure 2] and the upper and lower skin flaps were stitched together after placing a suction drain. The resected mass weighed 3.04 kg and 18 cm × 15 cm in dimension [Figure 3].
Figure 2: After excision of lipoma

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Figure 3: Specimen

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The postoperative period was uneventful. Patient was discharged on the 2nd postoperative day after removing the drain. Pathological analysis of the resected mass revealed mature, proliferative lipocytes with no cellular atypia [Figure 4], and it was diagnosed as benign giant lipoma.
Figure 4: Histopathological examination figure of lipoma

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  Discussion Top


Lipoma is one of the most common benign mesenchymal tumors in the body composed of mature adipose cells. It is found in almost all the organs of the body where normally fat exists, and that is why it is also known as ubiquitous tumor or universal tumor.[4] Common locations for lipomas are the back, arm, shoulder, anterior chest wall, breast, thigh, abdominal wall, legs, forehead and face, in decreasing order of frequency.[5] Only approximately 25% of the lipomas and their variants arise in the head and neck region.[1] Most of the lipomas present as small subcutaneous swellings without any specific symptom. Giant lipomas, though rare, can present in thigh, shoulder, trunk, or neck. Clinical features of these giant lipomas are mainly because of their size, which includes pain because of stretching of adjacent nerves, restriction in movements of the part involved or social embarrassment because of mere size of the swelling.[6] Most lipomas pose no diagnostic dilemmas. However, when presented with large (>10 cm) or rapidly growing masses, especially of the head and neck region, one should be concerned about a malignancy. The liposarcoma on ultrasonography has heterogenous echotexture and has more than minimal colour Doppler flow.[7],[8] These ultrasonography features were not present in this patient. Usually large size of this swelling raise suspicion of liposarcoma but fine needle aspiration cytology of this patient showed features that were consistent with lipoma.[7],[8] Owing to the specific location of head and neck tumors, it is necessary to perform proper diagnostic tests to confirm the assumed nature of the tumors and exclude possible communication with the spinal canal. Improved diagnostic imaging technology such as computed tomography (CT) or magnetic resonance imaging (MRI) has increased the utility of these imaging techniques in the diagnosis of complex or unusual neck masses. Removal of these tumors is not difficult because of a clear demarcation of the surrounding tissues. Complete excision is the treatment of the choice for giant lipoma although liposuction for such tumors has also been reported. Although reports of giant lipoma weighing 5.5 kg are there in literature but to our best knowledge this is the second largest and heaviest lipoma involving the neck region.[9]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kransdorf MJ. Benign soft-tissue tumors in a large referral population: Distribution of specific diagnoses by age, sex, and location. AJR Am J Roentgenol 1995;164:395-402.  Back to cited text no. 1
[PUBMED]    
2.
El-Monem MH, Gaafar AH, Magdy EA. Lipomas of the head and neck: Presentation variability and diagnostic work-up. J Laryngol Otol 2006;120:47-55.  Back to cited text no. 2
[PUBMED]    
3.
Copcu E, Sivrioglu N. Posterior cervical giant lipomas. Plast Reconstr Surg 2005;115:2156-7.  Back to cited text no. 3
[PUBMED]    
4.
Devis C Jr, Gruhn JG. Giant lipoma of the thigh. Arch Surg 1967;95:151.  Back to cited text no. 4
    
5.
Rapidis AD. Lipoma of the oral cavity. Int J Oral Surg 1982;11:30-5.  Back to cited text no. 5
[PUBMED]    
6.
Gluscek S. Giant lipoma of thigh. WiadLek 1987;40:845-8.  Back to cited text no. 6
    
7.
Inampudi P, Jacobson JA, Fessell DP, Carlos RC, Patel SV, Delaney-Sathy LO, et al. Soft-tissue lipomas: Accuracy of sonography in diagnosis with pathologic correlation. Radiology 2004;233:763-7.  Back to cited text no. 7
[PUBMED]    
8.
DiDomenico P, Middleton W. Sonographic evaluation of palpable superficial masses. Radiol Clin North Am 2014;52:1295-305.  Back to cited text no. 8
[PUBMED]    
9.
Hirshowitz B, Goldan S. Giant Lipoma of the Back and Neck: A case report. J Plast Reconstr Surg 1973;52:312-4.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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