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1.  Osteolipoma independent of bone tissue: a case report 
Cases Journal  2009;2:8711.
Lipomas are the most common benign soft tissue tumors and appear in any part of the body. They typically consist of mature adipose tissue. Osteolipoma is an extremely rare histologic variant of lipoma that contains mature lamellar bone within the tumor and osteolipoma independent of bone tissue are very rare. We report a case of histologically confirmed osteolipoma independent of bone located in the thigh.
Case presentation
A 47-year-old male presented with a progressively enlarging, painful mass which approximately 10 cm × 8 cm over the anteromedial aspect of his right thigh. Plain films, Computerized Tomography, Magnetic Resonance Imaging and ultrasound guided needle biopsy were performed. Given the benign imaging characteristics and fine needle aspiration, an excisional biopsy was undertaken. The definitive pathologic diagnosis was intramuscular osteolipoma without evidence of malignancy. No recurrence was observed after 18 months follow up.
Although ossifying lipomas are very rare, it is important to keep them in mind when a lesion with adipose tissue in combination with ossification is encountered.
PMCID: PMC2769468  PMID: 19918398
2.  C11orf95-MKL2 is the Resulting Fusion Oncogene of t(11;16)(q13;p13) in Chondroid Lipoma 
Genes, chromosomes & cancer  2010;49(9):810-818.
Chondroid lipoma, a rare benign adipose tissue tumor, may histologically resemble myxoid liposarcoma or extraskeletal myxoid chondrosarcoma, but is genetically distinct. In the current study, an identical reciprocal translocation, t(11;16)(q13;p13) was identified in three chondroid lipomas, a finding consistent with previous isolated reports. A fluorescence in situ hybridization (FISH)-based positional cloning strategy using a series of bacterial artificial chromosome (BAC) probe combinations designed to narrow the 16p13 breakpoint revealed MKL2 as the candidate gene. Subsequent 5′ RACE studies demonstrated C11orf95 as the MKL2 fusion gene partner. MKL/myocardin-like 2 (MKL2) encodes myocardin-related transcription factor B (MRTF-B) in a megakaryoblastic leukemia gene family, and C11orf95 (chromosome 11 open reading frame 95) is a hypothetical protein. Sequencing analysis of RT-PCR generated transcripts from all three chondroid lipomas defined the fusion as occurring between exons 5 and 9 of C11orf95 and MKL2, respectively. Dual-color breakpoint spanning probe sets custom-designed for recognition of the translocation event in interphase cells confirmed the anticipated rearrangements of the C11orf95 and MKL2 loci in all cases. The FISH and RT-PCR assays developed in this study can serve as diagnostic adjuncts for identification of this novel C11orf95-MKL2 fusion oncogene in chondroid lipoma.
PMCID: PMC2904421  PMID: 20607705
3.  Giant Chondroid Lipoma of Breast 
The Indian Journal of Surgery  2012;74(4):342-343.
Lipomas are benign tumors composed of mature fat, usually encapsulated. Vast majority of lipomas are small, weighing only a few grams, and grow slowly. Lipoma occur rarely in breast causing diagnostic dilemma. Chondroid lipoma is a rare variant of lipoma which is benign in nature. We present a case of 65 year old female patient presented with lump in right breast, underwent surgical excision and histopathology reported as chondroid lipoma.
PMCID: PMC3444615  PMID: 23904731
Lipoma; Chondroid lipoma; Excision
4.  Parosteal lipoma of humerus—A rare case☆ 
Parosteal lipoma is an extremely rare benign tumor composed mainly of mature adipose tissue with a bony component.
This study reports the case of a 65-year old woman with a big mass on the posteromedial aspect of the right upper arm since 1 year. The swelling was a slow growing, painless, nontender, immobile mass which was not fixed to skin. She had no complaints of painful or restricted movements of the shoulder joint. She had no history of trauma to the upper limb.
MRI revealed a large 13 cm × 5 cm × 8 cm well defined, nonenhancing, lobulated, heterointense, predominantly fat intensity lesion with a small area of chondroid component measuring 2 cm × 1.6 cm in posteromedial aspect of proximal right humerus, seen completely separate from the adjacent muscles.
The patient underwent surgery under general anesthesia. Vertical elliptical incision was taken over the posterior border of the upper arm over the mass. The tumor was below the lower part of deltoid near the upper end of humerus, which formed the roof, and between the long and medial heads of triceps muscles. A part of tumor, measuring 6 cm × 5 cm × 5 cm, was under the long head of triceps displacing it along with radial nerve and vessels medially while the other part, measuring 7 cm × 6 cm × 3 cm, was under the medial head of triceps displacing it laterally. The tumor was excised undocking its periosteal attachment. The specimen weighed 250 g. On histopathology, the lesion was composed of mature lipocytes that had an intimate relationship with the periosteum. No cellular atypia or lipoblasts were seen.
Parosteal lipomas are rare neoplasias with no proven malignant potential. These tumors can be resected without much damage to the adjacent structures, thus preserving the function of the upper limb.
PMCID: PMC3860041  PMID: 24252389
Parosteal lipoma; Lipocytes; Humerus; Periosteum; Triceps
5.  A large parosteal ossifying lipoma of lower limb encircling the femur 
Lipoma is a benign soft tissue neoplasm that may contain mesenchymal elements, as a result of metaplastic process. Ossification in benign and malignant soft tissue tumors can also manifest due to metaplastic process.
Case presentation
A 45 year old woman presented with a large thigh mass. The mass was developed one and a half year ago which insidiously increased in size and was associated with movement restriction. Radiological findings revealed soft tissue neoplasm on antero-medial aspect of thigh encircling the femur and displacing adjacent muscles. Fine trabeculations were seen in neoplasm suggestive of ossification. Excision of the mass was performed and histopathology revealed adipocytes with mature bony trabeculae possessing prominent osteoblastic rimming suggestive of ossifying lipoma.
It is important to recognize this variant of lipoma as it is associated with a better clinical outcome in contrast to most of the deep seated soft tissue neoplasms. Secondly it should also be differentiated from myositis ossificans and heterologous differentiation in other soft tissue neoplasms. We suggest an algorithmic approach to the diagnosis of ossifying soft tissue neoplasms histopathologically. Mature bony trabeculae with prominent osteoblastic rimming in a soft tissue lesion are due to a metaplastic process and should not be confused with osteosarcoma.
PMCID: PMC3904403  PMID: 24433545
6.  Vulvar lipoma: a case report 
Vulvar lipoma is a rare tumor localization and only a few cases have been reported. The clinical characteristics of vulvar lipoma are well known. However, it is important to distinguish lipomas from liposarcomas. We report a case of vulvar lipoma and discuss its clinical features, including diagnostic aspects, with emphasis on histopathological evaluation of all excised lesions. We also report and discuss patient management and treatment outcomes.
Case presentation
We report the case of a 27-year-old Moroccan woman. Our patient presented with a painless and slow-growing right vulvar mass that had evolved over one year, which had suddenly become uncomfortable when walking. A physical examination revealed a single soft and pasty mass in her left labium majus, which could be mobilized under her skin towards her mons pubis. The largest dimension of the mass measured 6cm. Magnetic resonance imaging showed a homogenous hyperintense mass with a well-defined contour in her left labium majus; a fat-suppressed magnetic resonance image demonstrated a marked signal intensity decrease. The mass was completely removed surgically. A histological examination revealed a circumscribed benign tumor composed of mature adipocytes, confirming the diagnosis of vulvar lipoma.
Vulvar lipomas must be differentiated from liposarcomas, which demonstrate very similar clinical and imaging profiles. The final diagnosis should be based on histopathological evaluation. A precise diagnosis should allow for appropriate surgical treatment.
PMCID: PMC4077142  PMID: 24946809
Diagnosis; Lipoma; Surgical excision; Vulva
7.  Delineation of Chondroid Lipoma: An Immunohistochemical and Molecular Biological Analysis 
Sarcoma  2011;2011:638403.
Aims. Chondroid lipoma (CL) is a benign tumor that mimics a variety of soft tissue tumors and is characterized by translocation t(11;16). Here, we analyze CL and its histological mimics. Methods. CL (n = 4) was compared to a variety of histological mimics (n = 83) for morphological aspects and immunohistochemical features including cyclinD1(CCND1). Using FISH analysis, CCND1 and FUS were investigated as potential translocation partners. Results. All CLs were strongly positive for CCND1. One of 4 myoepitheliomas, CCND1, was positive. In well-differentiated lipomatous tumors and in chondrosarcomas, CCND1 was frequently expressed, but all myxoid liposarcomas were negative. FISH analysis did not give support for direct involvement of CCND1 and FUS as translocation partners. Conclusions. Chondroid lipoma is extremely rare and has several and more prevalent histological mimics. The differential diagnosis of chondroid lipomas can be unraveled using immunohistochemical and molecular support.
PMCID: PMC3087950  PMID: 21559269
8.  Management of giant intermuscular lipoma of hips: A case report and review of literature 
Molecular and Clinical Oncology  2013;1(2):369-372.
Intermuscular lipomas are rare soft tissue tumors of mesenchymal origin. They are closely correlated with other benign and malign mesenchymal tumors in clinical presentation and imaging, causing problems in diagnosis and treatment. This study examined a rare giant intermuscular lipoma of the hip and its management, allowing clinicians to become familiar with this lesion. Furthermore, the clinical data of 13 patients with pathologically confirmed giant intermuscular lipomas (1 case treated by the authors, the remaining 12 cases reported in the Chinese literature during the period from January, 1992 to May, 2012) were also reviewed and analyzed. Based on the review, intermuscular lipomas were found to be more common in males and usually presented with an asymptomatic mass, with an average patient age of 39.7 years (range, 11–70), while symptom duration was between 1 month and 10 years. The most common tumor origin sites were the thigh and forearm and the option of treatment was surgical excision. The present study showed that it is crucial for the surgeon to consider infiltrating lipomas when dealing with deep soft tissue masses, while complete removal of the lesion was vital to avoid recurrence.
PMCID: PMC3915708  PMID: 24649177
lipoma; intermuscular; management
9.  Updates on the cytogenetics and molecular cytogenetics of benign and intermediate soft tissue tumors 
Oncology Letters  2012;5(1):12-18.
Soft tissue tumors are classified according to their histological resemblance to normal adult tissues and can be grouped into the following categories based on metastatic potential: benign, intermediate (locally aggressive), intermediate (rarely metastasizing) and malignant. Over the past two decades, considerable progress has been made in our understanding of the genetic background of soft tissue tumors. Traditional laboratory techniques, such as cytogenetic analysis and fluorescence in situ hybridization (FISH), can be used for diagnostic purposes in soft tissue pathology practice. Moreover, cytogenetic and molecular studies are often necessary for prognostics and follow-up of soft tissue sarcoma patients. This review provides updated information on the applicability of laboratory genetic testing in the diagnosis of benign and intermediate soft tissue tumors. These tumors include nodular fasciitis, chondroid lipoma, collagenous fibroma (desmoplastic fibroblastoma), giant cell tumor of tendon sheath (GCTTS)/pigmented villonodular synovitis (PVNS), angiofibroma of soft tissue, myxoinflammatory fibroblastic sarcoma (MIFS) and ossifying fibromyxoid tumor (OFMT).
PMCID: PMC3525488  PMID: 23255885
cytogenetics; molecular cytogenetics; soft tissue tumor
10.  Chondromyxoid fibroma of rib with a novel chromosomal translocation: a report of four additional cases at unusual sites 
Diagnostic Pathology  2007;2:44.
Chondromyxoid fibromas (CMFs) are rare benign chondroid/myxoid matrix-producing tumors that occur in metaphyses of long tubular bones, and very rarely in small bones of hands and feet. Flat bone involvement is even more uncommon. Prior cytogenetic analyses have identified complex abnormalities involving chromosome 6 in the majority of cases.
A search for CMF over an 8-year period (1999–2006) from the surgical pathology files of our institution yielded 16 cases. Four cases occurred in relatively unusual regions, three from the small bones of distal extremities and one from the rib. The rib lesion wassubmitted forroutinecytogenetic analysis.
Radiographic studies revealed that all four lesions were well-defined expansile radiolucent lesions which expanded the bony cortices with lobulated margins, sclerotic rim, septation, and no calcification. Morphologically, all four lesions showed typical features of CMF and had low proliferative index with Ki-67. Cytogenetic analysis on the rib lesion revealed a novel chromosomal translocation, t(1;5)(p13;p13). None of the four patients had a recurrence after a mean duration of follow-up of 24 months.
CMF originating in unusual locations should be distinguished from chondrosarcomas, especially on small biopsies, and should be included in the differential diagnosis. As previously noted in the literature, the cells can be positive for actin but unlike conventional chondroid neoplasms can be negative for S-100. To our knowledge, this is the first report describing a novel chromosomal translocation, t(1;5)(p13;p13) in CMF.
PMCID: PMC2203974  PMID: 18036245
11.  Chondromyxoid fibroma of the temporal bone: A rare entity 
Chondromyxoid fibroma (CMF) is the least common benign tumor of the cartilaginous origin. It is very unusual to find these tumors in the skull bones. We report one such case involving the temporal bone. Till date, only nine such cases including this patient, involving the temporal bone have been reported to the best of our knowledge. Grant Medical College and Sir J.J Group of Hospitals, Byculla, Mumbai, Maharashtra, India. A 12-year-old female patient presented with a history of headache associated with left earache of 1 month duration. This was followed by swelling over the left preauricular region 15 days later. Imaging was suggestive of an expansile lesion involving the squamous part of the left temporal bone with calcifications suggestive of a benign chondroid lesion. The patient was operated upon with left temporal incision and complete excision of the lesion. The patient had relief from headache, earache and swelling, with no evidence of new neurological deficit in the post-operative period. CMF of the skull bone is an extremely rare tumor. Differential diagnosis should be kept in mind, especially in cases of calcified lesions and includes chordoma, chondroid chondroma, and low-grade myxoid chondrosarcoma. En-bloc complete excision should be the aim to achieve cure.
PMCID: PMC3611914  PMID: 23560012
Chondromyxoid; fibroma; temporal
12.  Giant chondroid syringoma with divergent differentiation: Cyto-histo-immuno correlation 
Chondroid syringoma is a rare benign skin adnexal tumor of eccrine/apocrine origin affecting commonly the head and neck region. It is also called as mixed tumor of skin because of the presence of both the epithelial and mesenchymal components. There are very few case reports of chondroid syringoma diagnosed on fine needle aspiration cytology (FNAC). We hereby report a case of giant chondroid syringoma occurring over the lower back in a 50-year-old male, diagnosed initially on cytology and confirmed by histopathology. This case is reported for its unusual size and site of occurrence. We describe the clinical features, cytology, histopathology, immunohistochemistry, and differential diagnosis of giant chondroid syringoma along with review of literature.
PMCID: PMC3783667  PMID: 24083150
Adnexal tumor; chondroid syringoma; fine needle aspiration cytology; immunohistochemistry
13.  A case report of an intermuscular lipoma: presentation, pathophysiology, differential diagnosis 
Journal of Chiropractic Medicine  2010;9(3):127-131.
The purpose of this report is to present the case of a 54-year-old female patient with a pathologically confirmed diagnosis of soft tissue lipoma. The clinical presentation, pathophysiology, differential diagnosis, and treatment options for lipoma are described.
Clinical Features
The patient presented to a chiropractic clinic with painful swelling in the right anterior thigh. Physical examination revealed a palpable mobile mass with minimal tenderness.
Intervention and Outcome
The initial consultation was with the primary care physician, and it resulted in a sonographic examination as the initial imaging modality to rule out deep venous thrombosis. The result of this examination was negative. Following a delay by additional incorrect diagnoses and treatments, a diagnosis of an intermuscular lipoma was established by magnetic resonance imaging and confirmed on biopsy as a soft tissue lipoma. The patient underwent complete excision of the mass.
Lipomas are common benign soft tissue masses and should be considered in the differential diagnosis of a thigh mass. Magnetic resonance imaging with contrast depicts the lipomatous mass as having a characteristic high-intensity fat signal without enhancement. It is important for clinicians to have an increased awareness in recognizing the clinical and imaging manifestations of a soft tissue lipoma to optimize an initial diagnosis and treatment.
PMCID: PMC3188344  PMID: 22027035
Lipoma; Liposarcoma; Soft tissue neoplasm; Chiropractic
14.  Transabdominal laparoscopic adrenalectomy of a large adrenal lipoma: A case report and review of literature 
The exponential increase in use of computer tomography (CT) and magnetic resonance imaging (MRI) has lead to a significant increase in the detection of asymptomatic adrenal masses. The prevalence of adrenal “incidentalomas” is approximately 4–10%. We present a case of a 55-year-old male with a large right adrenal mass that was followed by serial computer tomography scans and multiple non-diagnostic core biopsies. Due to the large size of the mass and unknown pathology, the patient underwent laparoscopic adrenalectomy. The patient's post-operative course was uneventful. Pathology revealed a very unusual finding, a large adrenal lipoma. Adrenal lipomas are rare, benign, non-functioning tumor like lesions that occur with a relative frequency of only 0–11%. Over the past decade approximately 10 cases have been reported in literature. We review the literature of the current diagnostic and surgical treatment of adrenal lipomas (Pubmed and Cochrane from 1992-current).
PMCID: PMC3199696  PMID: 22096718
Adrenal lipoma; Laparoscopic; Adrenalectomy; Incidentaloma
15.  Scapular osteochondrolipoma: Imaging features with pathological correlation 
Oncology Letters  2013;6(3):817-820.
Osteochondrolipoma is an extremely rare histological variant of lipoma with osseous and cartilaginous differentiation. The present study reports an unusual case of an osteochondrolipoma occurring in the left scapular region of a 49-year-old male. The physical examination revealed a 3-cm, hard, non-tender and minimally mobile mass. Plain radiography revealed a faintly ossified soft-tissue mass without evidence of bone erosion. Computed tomography (CT) confirmed the presence of a lesion and the normal appearance of the scapula. Magnetic resonance imaging (MRI) showed a well-circumscribed subcutaneous mass with an almost homogeneous high signal intensity on the T1- and T2-weighted sequences. Contrast-enhanced fat-suppressed T1-weighted sequences demonstrated a faint peripheral and septal enhancement of the mass. A marginal excision of the tumor was performed. Histologically, the tumor was predominantly composed of mature adipocytes mixed with thin trabeculae of mature bone. In addition, small amounts of mature hyaline cartilage and osteoid were identified in the periphery of the lesion. Based on these findings, the tumor was diagnosed as an osteochondrolipoma. The patient demonstrated no evidence of local recurrence within six months of follow-up. Although rare, osteochondrolipoma should be considered as a differential diagnosis of a well-defined, calcified/ossified, subcutaneous mass in the scapular region.
PMCID: PMC3789040  PMID: 24137417
osteochondrolipoma; scapula; magnetic resonance imaging; pathology
16.  Intraosseous lipomas: A report of six cases and a review of literature 
Polish Journal of Radiology  2011;76(4):52-59.
Intraosseous lipoma is a very rare lesion, which constitutes not more than 0.1% of bone tumors. The introduction of cross-sectional imaging, especially MRI, seems to have increased the detection rate of these lesions.
Case Report:
The authors presented 6 cases of intraosseous lipomas in bones of the lower extremities. All lesions were detected incidentally and presented radiographically as radiolucent lesions with sclerotic borders and internal trabeculations. One lesion caused bone expansion. CT and MRI identified fatty tissue in all lesions. Cystic degeneration was present in one lesion and dystrophic calcifications in two.
The radiographic appearance of intraosseous lipomas is not characteristic and requires differential diagnostics conducted for a long time. However, CT and MRI allow for a tissue-specific diagnosis. The detection of a predominant fatty component in a lesion confirms its benign character and no further diagnostic work-up is required.
PMCID: PMC3389946  PMID: 22802856
bone tumor; intraosseous lipoma; imaging
17.  Large Parosteal Lipoma without Periosteal Changes 
Parosteal lipoma is a rare tumor, accounting for approximately 0.3% of all lipomas. Bony lesions are often found in patients with this tumor (59.2%), making the differential diagnosis of malignant tumors important. Our case was a 64-year-old male patient who complained of a 25 × 15-cm mass on his right thigh that had grown rapidly over a 2-month period. On magnetic resonance imaging, a high-intensity lesion was observed on the surface of the femur beneath the vastus medialis muscle on T1 and T2 images, with low intensity on a T1 fat suppression image. No significant bony changes were detected. During total tumor resection, the tumor was found on the femur with tight continuity, with tiny areas of spiculation palpable on the bone surface. The exact tumor size was 18 × 13 × 6 cm. The pathological diagnosis was lipoma, the same result as in the former open biopsy. This case was the largest parosteal lipoma of the femur reported without periosteal changes. In cases of deep parosteal lipomas, the detection of rapidly progressive and growing pseudotumors with ossification or chondromatous changes implies malignancy. A preoperative biopsy is mandatory and must be followed by careful planning and preparation for handling in malignant cases. Plastic surgeons should therefore keep the diagnosis of parosteal lipoma in mind to provide appropriate (not too much or too little) surgical treatment.
PMCID: PMC4323391
18.  Lipoma arborescens associated with osseous/chondroid differentiation in subdeltoid bursa 
Lipoma arborescens (LA) is a rare benign lesion of unknown etiology. It is characterized histologically by villous proliferation of the synovial membrane and diffuse replacement of the subsynovial tissue by mature fat cells. This condition affects the knee joint most commonly. Cases involving other locations including glenohumeral joint,[1] hip,[2] elbow,[3] hand[4] and ankle[5] have been rarely described. Involvement of the subdeltoid bursa has also been reported, but to date no case has described LA with osseous/chondroid differentiation of this bursa. Another significant finding in our case was the coexistence of LA with intermuscular lipoma, SLAP lesion and labral cyst.
PMCID: PMC3807946  PMID: 24167404
Labral cyst; lipoma; lipoma arborescens; osseous/chondroid differentiation; shoulder; SLAP lesion; subdeltoid bursa
19.  A rare case of malignant chondroid syringoma of scalp 
Chondroid syringoma represents the cutaneous counterpart of mixed tumor (pleomorphic adenoma) of salivary glands, therefore it is also termed “mixed tumour of the skin.” It is generally accepted that there are both eccrine and apocrine variants of mixed tumors of skin. Malignant chondroid syringoma is a malignant eccrine neoplasm that is very rarely encountered in radio-pathological and clinical practice. Unlike the benign variety which occurs most often on the head and neck, malignant chondroid syringomas are most often found on the trunk and extremities. The usual presentation is that of an asymptomatic slow-growing mass in the region of head or neck. We present here a case report of histopathologically proven malignant chondroid syringoma of scalp in occipital region, with dural invasion. Malignant chondroid syringomas clinically appear as very large nodules and they metastasize at a very high rate. The treatment of these malignancies is surgical excision.
PMCID: PMC3752488  PMID: 23984246
Chondroid syringoma; pleomorphic adenoma; scalp tumors; skin tumors
20.  A comparison between histopathology and findings on magnetic resonance imaging of subcutaneous lipomatous soft-tissue tumors 
Insights into Imaging  2011;2(5):599-607.
To retrospectively analyse the magnetic resonance (MR) findings of subcutaneous lipomatous soft-tissue tumours (SLSTT) in order to define a diagnostic and therapeutic strategy.
The MR findings of 46 SLSTT were registered for the following data: area, location within the subcutaneous compartment, dimensions, shape and delineation, signal intensity (SI) on different pulse sequences, signal homogeneity, degree and pattern of contrast enhancement. The MR findings, together with patients' age and gender, were compared with histopathological findings.
Sixty-eight percent of the lipomas had a homogeneous T1-SI identical to the SI of subcutaneous fat. Heterogeneity in other lipomas was due to fat necrosis and small septa. Other lesions with homogeneous T1-SI identical to the SI of subcutaneous fat included lipoblastoma, lipomatosis and lipoma-like hibernoma. None of the liposarcomas were homogeneous and isointense to SI of subcutaneous fat on T1-weighted imaging (WI). Lipoma variants and liposarcomas showed overlapping MR characteristics.
SLSTT with homogeneous T1-SI identical to the SI of subcutaneous fat are benign. If a SLSTT has other MR characteristics, differentiation based on MRI cannot be made and biopsy is needed. We used this finding in defining a diagnostic and therapeutic strategy for subcutaneous soft tissue tumours that are hyperintense on T1-WI.
PMCID: PMC3259327  PMID: 22347979
Magnetic resonance imaging; Lipoma; Liposarcoma; Subcutaneous fat; Histopathology
21.  A comparison between histopathology and findings on magnetic resonance imaging of subcutaneous lipomatous soft-tissue tumors 
Insights into Imaging  2011;2(5):599-607.
To retrospectively analyse the magnetic resonance (MR) findings of subcutaneous lipomatous soft-tissue tumours (SLSTT) in order to define a diagnostic and therapeutic strategy.
The MR findings of 46 SLSTT were registered for the following data: area, location within the subcutaneous compartment, dimensions, shape and delineation, signal intensity (SI) on different pulse sequences, signal homogeneity, degree and pattern of contrast enhancement. The MR findings, together with patients' age and gender, were compared with histopathological findings.
Sixty-eight percent of the lipomas had a homogeneous T1-SI identical to the SI of subcutaneous fat. Heterogeneity in other lipomas was due to fat necrosis and small septa. Other lesions with homogeneous T1-SI identical to the SI of subcutaneous fat included lipoblastoma, lipomatosis and lipoma-like hibernoma. None of the liposarcomas were homogeneous and isointense to SI of subcutaneous fat on T1-weighted imaging (WI). Lipoma variants and liposarcomas showed overlapping MR characteristics.
SLSTT with homogeneous T1-SI identical to the SI of subcutaneous fat are benign. If a SLSTT has other MR characteristics, differentiation based on MRI cannot be made and biopsy is needed. We used this finding in defining a diagnostic and therapeutic strategy for subcutaneous soft tissue tumours that are hyperintense on T1-WI.
PMCID: PMC3259327  PMID: 22347979
Magnetic resonance imaging; Lipoma; Liposarcoma; Subcutaneous fat; Histopathology
22.  Subacromial Impingement Syndrome Caused by a Voluminous Subdeltoid Lipoma 
Case Reports in Orthopedics  2014;2014:760219.
Subacromial impingement syndrome is a clinical diagnosis encompassing a spectrum of possible etiologies, including subacromial bursitis, rotator cuff tendinopathy, and partial- to full-thickness rotator cuff tears. This report presents an unusual case of subdeltoid lipoma causing extrinsic compression and subacromial impingement syndrome. The patient, a 60-year-old man, presented to our institution with a few years' history of nontraumatic, posteriorly localized throbbing pain in his right shoulder. Despite a well-followed 6-months physiotherapy program, the patient was still suffering from his right shoulder. The MRI scan revealed a well-circumscribed 6 cm × 2 cm × 5 cm homogenous lesion compatible with a subdeltoid intermuscular lipoma. The mass was excised en bloc, and subsequent histopathologic examination confirmed a benign lipoma. At 6-months follow-up, the patient was asymptomatic with a complete return to his activities. Based on this case and a review of the literature, a subacromial lipoma has to be included in the differential diagnosis of a subacromial impingement syndrome refractory to nonoperative treatment. Complementary imaging modalities are required only after a failed conservative management to assess the exact etiology and successfully direct the surgical treatment.
PMCID: PMC3978388  PMID: 24778890
23.  Intraosseous angiolipoma of the mandible 
Lipoma is a common soft-tissue tumor. There are only very few reported cases of intraosseous lipoma of the jaws in the literature. Intraosseous angiolipomas are even rarer. The exact nature of these lesions is debatable, but it is widely accepted that they represent true benign tumors. These are slow-growing tumor consisting of a mass of mature fat cells. When the vascular component within these tumors is a prominent feature, they are considered to be angiolipomas. The cause of these lesions is uncertain. Clinically, intraosseous lipoma may be asymptomatic, may cause swelling, or may show neurologic signs such as hypesthesia or paresthesia, as was manifested in this case. Radiographically, the lesion usually appears as a well-circumscribed radiolucency. The diagnosis of intraosseous lipoma of the mandible may be a challenge, due to its rarity and clinical similarity with many other radiolucent jaw lesions; therefore, the histopathological examination is always required. Here, we report a case of intraosseous angiolipoma of mandible in a 21-year-old female patient.
PMCID: PMC3424950  PMID: 22923906
Angiolipoma; intraosseous; lipoma; mandible
24.  Gastric lipoma presenting as a giant bulging mass in an oligosymptomatic patient: a case report 
Lipomas of the gastrointestinal tract are a rare condition. Only 5% are of gastric origin, and this corresponds to 2% to 3% of all benign tumors of the stomach and less than 1% of all gastric neoplasms. It is our purpose to report an unusual presentation of a giant gastric lipoma in an oligosymptomatic patient and highlight the importance of discussing differential diagnosis in this situation. A review of the literature has shown that this is one of the largest gastric lipomas described.
Case presentation
We describe a rare case of a benign gastric tumor with uncommon features in a 63-year-old Caucasian woman. She was admitted with abdominal discomfort, nausea, and upper abdominal fullness after eating. The lesion was suspicious of malignancy because of its dimension and central contrast enhancement on computed tomography. Conventional upper digestive endoscopy revealed a large bulging mass in the gastric posterior wall and three ulcerated areas. In this procedure, a technical limitation due to the location of the mass in the submucosa prevented an adequate biopsy from being obtained. The fragments obtained from the ulcers revealed nothing but necrotic mucosa. Our patient underwent a subtotal gastrectomy and D1 lymphadenectomy with a Roux-en-Y reconstruction. Macroscopic findings revealed a 12 × 8 × 6cm mass with a volume of 576cm3, and the histological pattern demonstrated well-differentiated mature adipose tissue surrounded by a fibrous capsule, confirming the diagnosis of gastric submucosal lipoma.
Gastric lipoma is a rare benign disease that eventually simulates a malignant tumor.
PMCID: PMC3469329  PMID: 23006791
Neoplasms; Lipoma; Gastrointestinal tract; Stomach; Gastrectomy
25.  Synovial chondromatosis of the temporomandibular joint: MRI findings with pathological comparison 
Dentomaxillofacial Radiology  2012;41(2):110-116.
The aim of this retrospective study was to characterize MRI findings of synovial chondromatosis in the temporomandibular joint (TMJ) by correlation with their pathological findings.
22 patients with synovial chondromatosis in unilateral TMJ were referred for plain MRI prior to surgical management and pathological examinations. Parasagittal and coronal proton density-weighted imaging and T2 weighted imaging were performed for each case.
MRI demonstrated multiple chondroid nodules and joint effusion in all patients (100%) and amorphous iso-intensity signal tissues within expanded joint space and capsule in 19 patients (86.4%). On T2 weighted imaging, signs of low signal nodules within amorphous iso-intensity signal tissues were used to determine the presence of attached cartilaginous nodules in pathology, resulting in 100% sensitivity, 60% specificity and 90.9% accuracy. Signs of low and intermediate signal nodules within joint fluids were used to detect loose cartilaginous nodules and resulted in 80% sensitivity, 42.9% specificity and 68.2% accuracy.
MRI of synovial chondromatosis in TMJ was characterized by multiple chondroid nodules, joint effusion and amorphous iso-intensity signal tissues within the expanded space and capsule. The attached cartilaginous nodules in pathology were better recognized than the loose ones on MRI. Plain MRI was useful for clinical diagnosis of the disorder.
PMCID: PMC3520366  PMID: 22116129
synovial chondromatosis; tempromandibular joint; magnetic resonance imaging

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