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词条 Lipoma
释义

  1. Types

  2. Causes

     Other conditions 

  3. Diagnosis

  4. Treatment

  5. Prognosis

  6. Epidemiology

  7. Other animals

  8. References

  9. External links

{{Infobox medical condition (new)
| name = Lipoma
| image = Lipoma 02.jpg
| caption = Lipoma on forearm
| field = Dermatology, general surgery
| symptoms = Soft, movable, usually painless lump[1]
| complications =
| onset = 40 to 60 years old[1]
| duration =
| types = Superficial, deep[3]
| causes = Unclear[1]
| risks = Family history, obesity, insufficient exercise[1][6]
| diagnosis = Based on physical exam[1]
| differential = Liposarcoma, hibernoma, lipomatosis[8]
| prevention =
| treatment = Observation, surgery[1]
| medication =
| prognosis = Good[1]
| frequency = ~2%[3]
| deaths =
}}

A lipoma is a benign tumor made of fat tissue.[1] They are generally soft to the touch, movable, and painless.[1] They usually occur just under the skin, but occasionally may be deeper.[1] Most are less than 5 cm in size.[2] Common locations include upper back, shoulders, and abdomen.[3] A few people have a number of lipomas.[6]

The cause is generally unclear.[1] Risk factors include family history, obesity, and lack of exercise.[1][4] Diagnosis is typically based on a physical exam.[1] Occasionally medical imaging or tissue biopsy is used to confirm the diagnosis.[1]

Treatment is typically by observation or surgical removal.[1] Rarely, the condition may recur following removal, but this can generally be managed with repeat surgery.[1] They are not generally associated with a future risk of cancer.[1]

About 2% of people are affected.[2] Lipomas typically occur in adults between 40 and 60 years of age.[1] Males are more often affected than females.[1] They are the most common noncancerous soft-tissue tumor.[5] The first use of the term "lipoma" to describe these tumors was in 1709.[6]

Types

The many subtypes of lipomas include:[7]{{Rp|624–5}}

  • Adenolipomas are lipomas associated with eccrine sweat glands.[8]{{rp|627}}
  • Angiolipoleiomyomas are acquired, solitary, asymptomatic acral nodules, characterized histologically by well-circumscribed subcutaneous tumors composed of smooth muscle cells, blood vessels, connective tissue, and fat.[7]{{rp|627}}
  • Angiolipomas are painful subcutaneous nodules having all other features of a typical lipoma.[7]{{rp|624}}[9]
  • Cerebellar pontine angle and internal auditory canal lipomas[10]
  • Chondroid lipomas are deep-seated, firm, yellow tumors that characteristically occur on the legs of women.[7]{{rp|625}}
  • Corpus callosum lipoma is a rare congenital brain condition that may or may not present with symptoms.[11] This occurs in the corpus callosum, also known as the calossal commissure, which is a wide, flat bundle of neural fibers beneath the cortex in the human brain.
  • Hibernomas are lipomas of brown fat.
  • Intradermal spindle cell lipomas are distinct in that they most commonly affect women and have a wide distribution, occurring with relatively equal frequency on the head and neck, trunk, and upper and lower extremities.[7]{{rp|625}}[9]
  • Neural fibrolipomas are overgrowths of fibro-fatty tissue along a nerve trunk, which often leads to nerve compression.[7]{{rp|625}}
  • Pleomorphic lipomas, like spindle-cell lipomas, occur for the most part on the backs and necks of elderly men and are characterized by floret giant cells with overlapping nuclei.[7]{{rp|625}}
  • Spindle-cell lipomas are asymptomatic, slow-growing, subcutaneous tumors that have a predilection for the posterior back, neck, and shoulders of older men.[7]{{rp|625}}
  • Superficial subcutaneous lipomas, the most common type of lipoma, lie just below the surface of the skin.[12] Most occur on the trunk, thigh, and forearm, although they may be found anywhere in the body where fat is located.

Causes

The tendency to develop a lipoma is not necessarily hereditary, although hereditary conditions such as familial multiple lipomatosis might include lipoma development.[13][14] 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.[15]

Cases have been reported where minor injuries are alleged to have triggered the growth of a lipoma, called a "post-traumatic lipoma".[16] However, the link between trauma and the development of lipomas is controversial.[17]

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.[18]

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.{{Citation needed|date=June 2008}}

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.[19]

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.[12] 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.[57] 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.[22] 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.[23]

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.[57][24]

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).[25][26] Malignant transformation of lipomas into liposarcomas is very rare, and most liposarcomas are not produced from pre-existing benign lesions.[22] A few cases of malignant transformation have been described for bone and kidney lipomas,[27][28] 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.[29] Deep lipomas have a greater tendency to recur than superficial lipomas because complete surgical removal of deep lipomas is not always possible.[29][30]

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.[31]

Epidemiology

Around 2% of the general population has a lipoma.[2] These tumors can occur at any age, but are most common in middle age, often appearing in people from 40 to 60 years old.[32] Cutaneous lipomas are rare in children, but these tumors can occur as part of the inherited disease Bannayan-Zonana syndrome.[33][34]

Lipomas are usually relatively small with diameters of about 1–3 cm,[35] 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.[36][37]

Other animals

Lipomas occur in many animals, but are most common in older dogs, particularly older Labrador Retrievers, Doberman Pinschers, and Miniature Schnauzers.[78] Overweight female dogs are especially prone to developing these tumors, and most older or overweight dogs have at least one lipoma.[38][39] In dogs, lipomas usually occur in the trunk or upper limbs.[40] They are also found less commonly in cattle and horses, and rarely in cats and pigs.[39][41] However, a pedunculated lipoma can cause entrapment and torsion of the intestine in horses, causing necrosis, colic, and possibly death. The intestine becomes wound around the stalk of the lipoma and loses blood supply.[42]

{{Clear}}

References

1. ^1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 {{cite web|title=Lipoma-OrthoInfo - AAOS|url=http://orthoinfo.aaos.org/topic.cfm?topic=a00631|website=orthoinfo.aaos.org|accessdate=8 November 2017|date=May 2012}}
2. ^1 2 3 4 {{cite book|last1=Kransdorf|first1=Mark J.|last2=Murphey|first2=Mark D.|title=Imaging of Soft Tissue Tumors|date=2006|publisher=Lippincott Williams & Wilkins|isbn=9780781747714|page=81|url=https://books.google.ca/books?id=0ZA6ntBA76MC&pg=PA81|language=en}}
3. ^1 {{cite book|last1=Lindberg|first1=Matthew R.|title=Diagnostic Pathology: Soft Tissue Tumors E-Book|date=2015|publisher=Elsevier Health Sciences|isbn=9780323400411|page=44|url=https://books.google.ca/books?id=aSZACgAAQBAJ&lpg=RA1-PR15&dq=Lipoma%20%22differential%20diagnosis%22&pg=PA44|language=en}}
4. ^1 2 {{cite book|last1=Fletcher|first1=Christopher D. M.|last2=Unni|first2=K. Krishnan|last3=Mertens|first3=Fredrik|title=Pathology and Genetics of Tumours of Soft Tissue and Bone|date=2002|publisher=IARC|isbn=9789283224136|page=20|url=https://books.google.ca/books?id=dg9am0g4EP8C&pg=PA20|language=en}}
5. ^{{cite journal |vauthors=Bancroft LW, Kransdorf MJ, Peterson JJ, O'Connor MI |title=Benign fatty tumors: classification, clinical course, imaging appearance, and treatment |journal=Skeletal Radiol. |volume=35 |issue=10 |pages=719–33 |date=October 2006 |pmid=16927086 |doi=10.1007/s00256-006-0189-y}}
6. ^{{cite book|last1=Olson|first1=James Stuart|title=The History of Cancer: An Annotated Bibliography|date=1989|publisher=ABC-CLIO|isbn=9780313258893|page=15|url=https://books.google.ca/books?id=oAX8jOJ9uO0C&pg=PA15|language=en}}
7. ^1 2 3 4 5 6 7 {{cite book| edition = 10th| publisher = Elsevier| isbn = 0-7216-2921-0| last = James| first = William D.| first2 = Timothy G. |last2=Berger|first3= Dirk M.|last3= Elston| title = Andrews' Diseases of the Skin: Clinical Dermatology|location=London|year=2005}}
8. ^{{cite book| edition = 11th| publisher = Elsevier| isbn = 9781437703146| last = James| first = William D.| first2 = Timothy G. |last2=Berger|first3= Dirk M.|last3= Elston| title = Andrews' Diseases of the Skin: Clinical Dermatology|location=London|year=2011}}
9. ^1 {{cite book |author1=Rapini, Ronald P. |author2=Bolognia, Jean L. |author3=Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |pages=1838 |isbn=1-4160-2999-0 |oclc= |doi= |accessdate=}}
10. ^{{cite journal |vauthors=Crowson MG, Symons SP, Chen JM | year = | title = Left cerebellopontine angle lipoma with mild brainstem compression in a 13-year-old female | url = | journal = Otology & Neurotology | volume = | issue = | page = | doi=10.1097/mao.0b013e3182814d6e}}
11. ^{{cite journal |author=Wallace D |title=Lipoma of the corpus callosum |journal=J Neurol Neurosurg Psychiatry |volume=39 |issue=12 |pages=1179–85 |date=December 1976 |pmid=1011028 |pmc=492562 |doi= 10.1136/jnnp.39.12.1179|url=}}
12. ^1 {{EMedicine|med|2720|Lipomas}}
13. ^{{cite journal |vauthors=Leffell DJ, Braverman IM |title=Familial multiple lipomatosis. Report of a case and a review of the literature |journal=J. Am. Acad. Dermatol. |volume=15 |issue=2 Pt 1 |pages=275–9 |date=August 1986 |pmid=3745530 |doi=10.1016/S0190-9622(86)70166-7}}
14. ^{{cite journal |author=Toy BR |title=Familial multiple lipomatosis |journal=Dermatol. Online J. |volume=9 |issue=4 |pages=9 |date=October 2003 |pmid=14594582 |url=http://dermatology.cdlib.org/94/NYU/Jan2002/2.html}}
15. ^{{cite journal |vauthors=Arlotta P, Tai AK, Manfioletti G, Clifford C, Jay G, Ono SJ |title= Transgenic mice expressing a truncated form of the high mobility group I-C protein develop adiposity and an abnormally high prevalence of lipomas |journal=J Biol Chem|volume=275|issue=19 |pages=14394–400|date=May 2000 |pmid=10747931 | doi=10.1074/jbc.M000564200}}
16. ^{{cite journal |vauthors=Signorini M, Campiglio GL |title=Posttraumatic lipomas: where do they really come from? |journal=Plast. Reconstr. Surg. |volume=101 |issue=3 |pages=699–705 |date=March 1998 |pmid=9500386 |doi=10.1097/00006534-199803000-00017}}
17. ^{{cite journal |vauthors=Aust MC, Spies M, Kall S, Jokuszies A, Gohritz A, Vogt P |title=Posttraumatic lipoma: fact or fiction? |journal=Skinmed |volume=6 |issue=6 |pages=266–70 |year=2007 |pmid=17975353 |url=http://www.lejacq.com/articleDetail.cfm?pid=SKINmed_6;6:266 |doi=10.1111/j.1540-9740.2007.06361.x}}
18. ^http://www.lipomadoc.org/uploads/5/0/4/8/5048532/dd_white_paper.pdf
19. ^{{cite web|url=https://radiopaedia.org/articles/lipoma|title=Lipoma|author=Rohit Sharma |author2=Frank Gaillard |display-authors=etal|accessdate=2018-09-27|website=Radiopaedia}}
20. ^1 {{Cite journal|author=Chernev I, Tingey S.|title=Thenar intramuscular lipoma: A case report.|journal=J Med Cases|year=2013|volume=4|issue=10|pages=676-8}}
21. ^1 Content originally copied from: {{cite journal|last1=Mak|first1=Chee-Wai|last2=Tzeng|first2=Wen-Sheng|title=Sonography of the Scrotum|year=2012|doi=10.5772/27586}} from {{cite web|url=https://www.intechopen.com/books/sonography/sonography-of-the-scrotum |title=Sonography|author=Kerry Thoirs |isbn=978-953-307-947-9}}, Published: February 3, 2012, under the [https://creativecommons.org/licenses/by/3.0/ CC-BY-3.0 license].
22. ^1 {{cite journal |vauthors=Dalal KM, Antonescu CR, Singer S |title=Diagnosis and management of lipomatous tumors |journal=J Surg Oncol |volume=97 |issue=4 |pages=298–313 |date=March 2008 |pmid=18286473 |doi=10.1002/jso.20975}}
23. ^{{cite journal |vauthors=Al-basti HA, El-Khatib HA |title=The use of suction-assisted surgical extraction of moderate and large lipomas: long-term follow-up |journal=Aesthetic Plast Surg |volume=26 |issue=2 |pages=114–7 |year=2002 |pmid=12016495 |doi=10.1007/s00266-002-1492-1}}
24. ^{{cite journal |vauthors=Bechara FG, Sand M, Sand D, etal |title=Lipolysis of lipomas in patients with familial multiple lipomatosis: an ultrasonography-controlled trial |journal=J Cutan Med Surg |volume=10 |issue=4 |pages=155–9 |year=2006 |pmid=17234112 |doi=10.2310/7750.2006.00040}}
25. ^{{cite journal |author=Thompson WM |title=Imaging and findings of lipomas of the gastrointestinal tract |journal=AJR Am J Roentgenol |volume=184 |issue=4 |pages=1163–71 |date=1 April 2005|pmid=15788588 |url=http://www.ajronline.org/cgi/pmidlookup?view=long&pmid=15788588 |doi=10.2214/ajr.184.4.01841163}}
26. ^{{cite journal |vauthors=Taylor AJ, Stewart ET, Dodds WJ |title=Gastrointestinal lipomas: a radiologic and pathologic review |journal=AJR Am J Roentgenol |volume=155 |issue=6 |pages=1205–10 |date=1 December 1990|pmid=2122666 |url=http://www.ajronline.org/cgi/pmidlookup?view=long&pmid=2122666 |doi=10.2214/ajr.155.6.2122666}}
27. ^{{cite journal |author=Milgram JW |title=Malignant transformation in bone lipomas |journal=Skeletal Radiol. |volume=19 |issue=5 |pages=347–52 |year=1990 |pmid=2165632 |doi=10.1007/BF00193088}}
28. ^{{cite journal |vauthors=Lowe BA, Brewer J, Houghton DC, Jacobson E, Pitre T |title=Malignant transformation of angiomyolipoma |journal=J. Urol. |volume=147 |issue=5 |pages=1356–8 |date=May 1992 |pmid=1569683}}
29. ^1 {{cite book |author1=Goldblum, John R. |author2=Weiss, Sharon W. |author3=Enzinger, Franz M. |title=Enzinger and Weiss's soft tissue tumors |publisher=Mosby Elsevier |year=2008 |isbn=0-323-04628-2 |edition=5th}}
30. ^{{cite book |author=Fletcher, C.D.M., Unni, K.K., Mertens, F. |title=Pathology and Genetics of Tumours of Soft Tissue and Bone |publisher=IARC Press |location=Lyon |year=2002 |isbn=92-832-2413-2 |series=World Health Organization Classification of Tumours |volume=4}}
31. ^E.J. Mayeaux Jr. (2009). [https://books.google.com/books?id=d-wNb7eyonMC&pg=PA386&lpg=PA386&dq=can+lipoma+penetrate+fascia&source=bl&ots=MWiVe3ZS4R&sig=1a5ULhG78-1QQ2Gq6JPXutxM3h0&hl=en&sa=X&ei=nOf_UpC8I43Ksga9kYCoDw&ved=0CCYQ6AEwAA#v=onepage&q=can%20lipoma%20penetrate%20fascia&f=false The Essential Guide to Primary Care Procedures], p.386, Wolters Kluwer Health. {{ISBN|978-0-7817-7390-4}}.
32. ^1 2 {{cite journal |author=Salam GA |title=Lipoma excision |journal=Am Fam Physician |volume=65 |issue=5 |pages=901–4 |date=March 2002 |pmid=11898962 |url=http://www.aafp.org/afp/20020301/901.html}}
33. ^{{cite journal |vauthors=Buisson P, Leclair MD, Jacquemont S, etal |title=Cutaneous lipoma in children: 5 cases with Bannayan-Riley-Ruvalcaba syndrome |journal=J. Pediatr. Surg. |volume=41 |issue=9 |pages=1601–3 |date=September 2006 |pmid=16952599 |doi=10.1016/j.jpedsurg.2006.05.013}}
34. ^{{cite journal |vauthors=Gujrati M, Thomas C, Zelby A, Jensen E, Lee JM |title=Bannayan-Zonana syndrome: a rare autosomal dominant syndrome with multiple lipomas and hemangiomas: a case report and review of literature |journal=Surg Neurol |volume=50 |issue=2 |pages=164–8 |date=August 1998 |pmid=9701122 |doi= 10.1016/S0090-3019(98)00039-1|url=http://linkinghub.elsevier.com/retrieve/pii/S0090-3019(98)00039-1}}
35. ^Lipoma—topic overview at webmd.com
36. ^{{cite journal |vauthors=Hakim E, Kolander Y, Meller Y, Moses M, Sagi A |title=Gigantic lipomas |journal=Plast. Reconstr. Surg. |volume=94 |issue=2 |pages=369–71 |date=August 1994 |pmid=8041830 |doi=10.1097/00006534-199408000-00025}}
37. ^{{cite journal |vauthors=Terzioglu A, Tuncali D, Yuksel A, Bingul F, Aslan G |title=Giant lipomas: a series of 12 consecutive cases and a giant liposarcoma of the thigh |journal=Dermatol Surg |volume=30 |issue=3 |pages=463–7 |date=March 2004 |pmid=15008886 |doi=10.1111/j.1524-4725.2004.30022.x}}
38. ^Lipomas Veterinary & Aquatic Services Department, Purina
39. ^1 Lipoma Virginia Polytechnic Institute and State University
40. ^1 Adipose Tissue Tumors The Merck Veterinary Manual, (9th ed.)
41. ^Lipomas (Fatty Tumors) Veterinary Q & A
42. ^{{cite book|title=The Merck Veterinary Manual|edition=9th |date=2005|publisher=Merial|isbn=0911910506}}

External links

{{Medical resources
| DiseasesDB = 7493
| ICD10 = {{ICD10|D|17||d|10}} (ILDS D17.910)
| ICD9 = {{ICD9|214}}
| ICDO = {{ICDO|8850|0}}
| OMIM =
| MedlinePlus = 003279
| eMedicineSubj = med
| eMedicineTopic = 2720
| eMedicine_mult = {{eMedicine2|derm|242}}
| MeshID = D008067
}}{{Commons category}}
  • humpath #2626
{{Diseases of the skin and appendages by morphology}}{{Soft tissue tumors and sarcomas}}

5 : Dermal and subcutaneous growths|Soft tissue disorders|Benign neoplasms|Soft tissue tumor|RTT
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