Lipoma( adipose, lipoblastoma, fatty tumor) - Causes, symptoms and treatment. MF.

Lipoma( adipose, lipoblastoma, fatty tumor) is a benign neoplasm( tumor) that develops from adipose tissue.

Lipoma is more common in women in the age group of 30 to 50 years. This tumor can be located wherever fatty tissue is present: in the skin, in the fiber( subcutaneous, intermuscular, peripoint, retroperitoneal), breast, lungs, mediastinum( anatomical space in the middle of the thoracic cavity, bounded in front of the sternum, and behind the spine), organsgastrointestinal tract, myocardium( the middle layer of the heart, which is the major part of its mass), the meninges, in the bones, along the course of the large nerves. Very rarely, the lipoma can be located in the cavity of the skull, uterus, liver.

Depending on the cellular composition of the lipoma, the following special types are distinguished:

• lipofibroma( soft lipoma represented mainly by adipose tissue)
• fibrolipoma( thick to the touch of lipoma, consisting of fatty and connective fibrous tissue with predominance of the latter)

• angiolipoma( lipomawith a large number of blood vessels)
• myolipoma( fatty muscle containing smooth muscle fibers)
• myelolipoma( a rare species in which the fatty tissue is mixed with the hematopoiesisSecond, tissue can occur in the retroperitoneum and pelvis, as well as adrenal gland).

Causes of the onset of lipoma

The causes of the appearance of the lime are currently not reliably and definitively determined. Many scientists believe that the leading factor in the development of the lipoma is the violation of embryogenesis( pre-human untypical fatty cells of subcutaneous fat).It is also believed that the onset of lipoma may be associated with a systemic disorder of metabolic( metabolic) processes occurring in adipose tissue. In addition, the possibility of developing these tumors due to the violation of hormonal reactions in the body, which include the climacteric period in women, when there is a restructuring and extinction of the childbearing function, and damage to the hypothalamus( the brain region), which is responsible for all metabolic processes in the body.

Stimulating the development of lipoma can pancreas and liver diseases, decreased function of the thyroid gland and pituitary gland( brain appendage in the form of rounded formation, producing hormones that affect growth, metabolism and reproductive function and is the central organ of the endocrine system).

Quite often lipomas develop against a background of alcoholism, diabetes, malignant neoplasms of the upper respiratory tract. The medical literature describes family cases with autosomal dominant inheritance of the subcutaneous lime. The increase in the size of the lime is not related to the general state of the patient's body: even when exhausted, they do not cease to accumulate fat.

Symptoms of lipoma

On examination, the subcutaneous lipoma is rounded, mobile, not soldered to surrounding tissues and skin, painless formation. When stretching the skin over the lipoma, there is an entrainment due to the lobular structure of this tumor. Lipoma is located where there is fat tissue, most often under the skin. Typical sites of localization of the subcutaneous lime are the back, upper and lower extremities, the head( its hairy part and face).Quite often the lipoma is plural.

The size of the lipoma can vary from the size of a pea to the child's head, but usually ranges from 15 to 50 mm. Giant lipomas also occur: in such patients, the tumor hangs, forming a thin foot in the skin of the base, which can lead to stagnation of blood, edema, necrosis and ulceration. Sometimes the size of the tumor is determined by the body weight of the patient: with increasing the weight of the patient, the size of the fat tumor also increases, but more often its growth takes place uncontrollably, regardless of changes in body weight.

Generally, the formation has a soft, soft-elastic consistency, and with a pronounced development of the connective tissue in it, its compaction occurs. In most cases, lipomas are asymptomatic, but sometimes they can be painful, cause discomfort, and squeeze nearby organs. Patients mainly complain about a cosmetic defect, especially as the size increases with age with age.

Lipoma of the neck

Lipoma of the retroperitoneal space can reach quite large sizes. Their clinical manifestations are caused by displacement or compression( compression) of nearby organs.

Infiltrating, or intramural, the lipoma is localized in the muscle mass, without having clear boundaries.

Multiple small lipomas, located along the course of large nerves, are sometimes painful due to pressure on the corresponding nerve. The diagnosis with deep-lying lipomas is difficult enough, it can be established, as a rule, only with histological examination.

lipodal examination The diagnosis of the superficial limes is relatively simple and is based on their location, soft elastic consistency, mobility with respect to surrounding tissues, painlessness when feeling and forming characteristic retractions when stretching the skin over this tumor.
In cases where the lipoma is inaccessible places( inside the chest, joint, spinal canal), it is necessary to use additional methods of research: X-rays and ultrasound( ultrasound).

1. Radiographic diagnosis of soft tissue fatty acids is based on the use of long-wave( "soft") X-rays, which allows an evaluation of the structure of the soft tissues of the body. At a roentgenography the lime lying deeply, for example, in a muscular fabric, is necessary increase in "rigidity" of a beam of X-ray radiation. On the obtained radiographs, the lipoma has the form of an enlightenment with smooth outlines, usually of regular shape. Such a lipid-induced bleaching, as a rule, is uniform, but occasionally in it small areas of calcification( deposits in the tissue of calcium salts) can occur. The form of such enlightenment depends on the density of the organs between which the fat is enclosed.

When the lipoma is located in the abdominal cavity, retroperitoneal space or chest, X-ray examination is performed using artificial gas contrasting( creation of pneumomediastinum, pneumoreteroperitoneum, etc.).

2. The most reliable method for diagnosing deep limes is X-ray computed tomography( CT), which makes it possible to clearly distinguish fatty tissue, which is characterized by low X-ray absorption, from denser soft tissue structures.

3. With ultrasound( ultrasound), lipomas have the form of hypoechoic formations with a thin capsule, located in the thickness of adipose tissue.

4. If there is any doubt about the benign nature of the tumor, a needle( needle needle) aspiration biopsy is used, followed by a cytological examination: a fragment of the tumor is taken up with a thin needle and the resulting biological material is examined under a microscope.

Laboratory examination:

Laboratory examination with lipoma does not have independent value for diagnosis. In the case of hospitalization, a general clinical examination( general blood test( UAC), general urine analysis( OAM), biochemical blood test( LHC), blood glucose, HIV test, syphilis, hepatitis) is performed in order to perform a planned surgical procedure for the lipoma. Eliminate contraindications to surgical intervention.

In case of doubt, to exclude other diseases, a cytological examination of the material obtained with puncture biopsy is performed. For this purpose, the material obtained with puncture is applied to the objective glasses, which are then stained using the Romanovsky-Giemsa method. Finished drugs, the cytologist examines under a microscope. With lipoma in the smear, the usual fat cells( adipocytes) are found, between which groups of cells containing several fatty vacuoles are found.

Treatment with lipid

Treatment of lipomas is only surgical. There are the following indications for operative treatment with lime:

1. Rapidly progressive increase in lipoma size;
2. Large size of the lipoma;
3. Functional disorders manifested by compression of surrounding organs and tissues;morbidity of the lipoma, impaired function of the organ;
4. Cosmetic defect.

For small tumors with an accessible location, surgery is performed under local anesthesia in outpatient( out-patient) settings. At large sizes of lipoma, as well as lipomas localized in complex anatomical regions( for example, neck lipomas, axillary fossa), patients are hospitalized, and surgical treatment is performed in a surgical hospital.

With lipomas, there are three possible surgical options:

1. Lipoma excision with the capsule is the most radical method of surgical treatment. Under local anesthesia with a wide cutaneous cut, the lipoma is removed and removed along with the capsule, after which seams are applied to the subcutaneous adipose tissue and skin. In the case of large neoplasm size, drainage is placed for one or two days in the bed of the removed lipoma. The advantage of this surgical technique is the high radicality and the absence of relapses of the neoplasm, and the disadvantage is the unsatisfactory cosmetic effect.

Excision of lipoma with

capsule 2. Minimally invasive( endoscopic) removal of lipoma: , through a small incision of skin up to 1 cm in length, the lipoma is broken and removed within the capsule, the complete elimination is checked with a miniendoscope( an optical device used to investigate hollow anatomicalformations).Such a surgical intervention can achieve a good cosmetic effect, but it is not radical enough.

Endoscopic removal of lipoma: 1 - lipoma;2 - Lipoma capsule;3 - optical tube;4 - video camera;5 - working tool;6 - lightguide.

3. Liposuction of lipoma: through a cut of the skin no more than 5 mm in length of the lipoma is removed inside the capsule using a lipoaspirator without further checking the completeness of its removal. Despite the best cosmetic effect, this surgical technique is fraught with a high probability of recurrence of the lipoma.

Liposuction of lipoma: 1 - lipoma;2 - Lipoma capsule;3 - glubose tissue;4 - leather;5 - subcutaneous tissue;6 - suction tube.

Complications of lipoma

It should be noted that complications of the wen are very rare.

1. Inflammation. The tumor turns red, increases in volume, becomes painful. When pressure is applied to the adipose, there is a fluctuation( transfer waves), that is, the presence of fluid in the tumor.
2. In exceptional cases, the adipose can degenerate into a malignant tumor( liposarcoma).
3. Large, long-standing lipomas cause displacement of surrounding tissues. For example, the lipoma of the peripheral nerves may be the cause of the pain, and if it is located in the preperitoneal tissue, it can contribute to the appearance of a hernia of the white line of the abdomen.

Lipid prophylaxis

There are no specific preventive measures that can affect the causes of lipoma.

Prognosis

Lipoma can remain unchanged for a long time or grow very slowly in size. Under the influence of trauma or without any apparent cause, the lipoma can malignise - acquire the character of a malignant neoplasm( liposarcoma) with germination into nearby tissues.
Lipoma treatment prognosis is generally favorable, although lipomas can recur both at the site of surgery if not all pathological fat cells have been removed, and at a new location.

Doctor surgeon Kletkin ME