Lipoma ( fatty tumor , lipoblastoma , fatty tumor) - Causes, Symptoms and Treatment .MF .
Lipoma (fatty tumor, lipoblastoma, fatty tumor) - a benign neoplasm (tumor) that develops from fat tissue.
Lipoma is more common in women in the age group from 30 to 50 years.This tumor can be located wherever there is fat tissue: the skin, tissue (subcutaneous, intramuscular, perinephric, retroperitoneal), breast, lung, mediastinum (anatomical space in the middle parts of the thoracic cavity, the limited front chest and back of the spine), organsgastrointestinal tract, myocardium (heart muscle middle layer, make up the bulk of its mass), meninges, bones, in the course of the major nerves.Very rarely lipoma may be located in the cranial cavity, uterus, liver.
Depending on the cellular composition of lipomas are the following it special types:
• lipofibroma (soft lipoma, represented mainly by adipose tissue)
• fibrolipoma (dense to the touch lipoma consisting of fat and connective fibrous tissue with a predominance of the latter)
• angiolipoma(lipoma with the contents of a large number of blood ves
• miolipoma (wen containing smooth muscle fibers)
• mielolipoma (a rare species in which adipose tissue is mixed with blood-forming, can occur in the tissue of the retroperitoneal space and pelvis, as well as the adrenal glands).
Causes lipomas are now reliably and permanently unclear.Many scientists believe that a major factor in the development of lipomas is a violation of embryogenesis (inherent to the human birth of unusual fatty subcutaneous fat cells).Also, it is believed that the appearance of lipomas may be due to systemic violation of metabolic (exchange) processes occurring in adipose tissue.Also, it does not exclude the possibility of the development of these tumors as a result of hormonal reactions in the body, which include menopause in women when there is a reorganization and fading fertility and damage to the hypothalamus (a brain region), which is responsible for all metabolic processes in the body.
stimulate the development of lipomas are diseases of the pancreas and liver, decreased function of the thyroid gland and the pituitary gland (brain appendage in the form of a rounded education that produces hormones that influence growth, metabolism and reproductive function and which is the central organ of the endocrine system).
Quite often, lipomas occur against a background of alcoholism, diabetes, malignancies of the upper respiratory tract.The medical literature describes familial cases with autosomal dominant inheritance of subcutaneous lipomas.The increase in size of lipomas is not related to the general state of the patient: even with exhaustion, they do not cease to accumulate fat.
When viewed subcutaneous lipoma is a round, moving, not soldered to surrounding tissues and skin, painless education.When stretching the skin over the lipoma appear retractions due to lobular structure of the tumor.Located lipoma where there is fatty tissue, often under the skin.Typical places of localization of subcutaneous lipomas - back, upper and lower limbs, head (her hairy part of the face).Quite often happens multiple lipoma.
Dimensions lipomas can vary on the size of a pea to a child's head, but usually range from 15 to 50 mm.There are also giant lipoma: in these patients tumor droops, forming at the site of its foundation, thin legs of the skin, which can lead to stagnation of the blood, edema, ulceration and gangrene.Sometimes tumor size caused by the body weight of the patient: the patient's weight increase is increased in size and fatty tumors, but it often occurs in an uncontrolled growth, irrespective of changes in weight.
education is usually soft, soft-elastic consistency, and when expressed in the development of its connective tissue is its seal.In most cases, lipomas are asymptomatic, but can sometimes be painful, causing discomfort and compress nearby organs.Patients generally complain of a cosmetic defect, moreover, that with age there is an increase in size of lipomas.
Lipomas retroperitoneal space can reach quite large.Their clinical manifestations are due to displacement or compression (compression) nearby organs.
infiltrate or intramural, lipoma localized deep in the muscles, while having no clear boundaries.
Multiple small lipomas, which are located along the major nerves, sometimes painful due to pressure on the corresponding nerve.The diagnosis of lipoma with deep lying quite difficult, it is possible to set, as a rule, only by histological examination.
survey with lipoma
Diagnostics surfaces located lipomas are relatively simple and is based on their location, myagkoelasticheskoy consistency, mobility in relation to the surrounding tissue, painless at a palpation and formation of characteristic retraction when stretching the skin on this neoplasm.
In cases where the lipoma is in reach of probing the ground (inside the chest, joint, in the spinal canal), it is necessary to use additional methods of research: X-ray and ultrasound (US).
1. X-ray diagnosis of soft tissue wen based on the use of long-wave ( "soft") X-ray radiation, which allows an assessment of the soft tissue structures of the body.When radiography lipomas, deep-seated, for example, in muscle tissue, you need to increase the "hardness" X-ray beam.On radiographs obtained lipoma has the form of enlightenment with smooth contours, usually correct form.Such enlightenment is formed by lipoma, usually homogeneous, but occasionally there may appear small areas of calcification (calcium deposits in tissues).The form of such enlightenment depends on the density of bodies, between which concluded wen.
When placing lipoma in the abdominal cavity, retroperitoneal space or chest X-ray examination is carried out using an artificial contrast gas (creation pneumomediastinum, pnevmoretroperitoneuma et al.).
2. The most reliable method for diagnosis of deep-lipomas is the X-ray computed tomography (CT), which allows to distinguish clearly the adipose tissue, which is characterized by a low rate of absorption of X-rays from the more dense soft tissue structures.
3. Ultrasonography (US) have the form of a lipoma hypoechoic structures with thin capsule, which are located in the adipose tissue thickness.
4. If in doubt, the benign nature of the tumor resorted to needle (fine needle) aspiration biopsy followed by cytology: take a fragment of tumors, and then examine the resulting biological material under a microscope using a fine needle.
Laboratory examination at the lipoma has no independent value for diagnosis.In the case of hospitalization to perform elective surgery on the lipoma underwent clinical laboratory tests (complete blood count (KLA), urinalysis (OAM), blood chemistry (LHC), blood glucose, the study of HIV, syphilis, hepatitis B), allowingexclude contraindications to surgery.
In doubtful cases to rule out other diseases produced cytology material obtained by biopsy.To this end, the puncture obtained with substantive material is applied to glass, which is then stained by the method Romanovsky - Giemsa.Ready prparaty physician-pathologist under a microscope.When found in a smear lipoma conventional fat cells (adipocytes), which are found between the group of cells containing fat vacuoles few.
Treatment of lipomas
Treatment lipoma surgery alone.The following indications for surgical treatment of lipomas:
1. Rapidly progressive increase in size of lipomas;
2. The large size of lipomas;
3. Functional disorders manifested by compression of the surrounding organs and tissues;painful lipomas, organ dysfunction;
4. Cosmetic defect.
For small-sized tumors accessible location surgery is performed under local anesthesia in the ambulatory (outpatient) conditions.For large amounts of lipomas and lipoma localized in difficult anatomical areas (eg, lipoma of the neck, armpit), hospitalized patients, and surgical treatment is carried out in a surgical hospital.
When lipomas are three possibilities of surgical aids:
1. lipoma excision together with the capsule - is the most radical method of surgical treatment.Under local anesthesia, a wide cutaneous incision lipoma husks and removed together with the capsule, then closed with stitches in the subcutaneous fatty tissue and skin.In the case of large tumors on one or two days is placed in the drainage box remote lipomas.The advantage of this surgical technique is the high radicality and no relapse tumors, and the lack of - unsatisfactory cosmetic effect.
lipoma excision capsule
2. minimally invasive (endoscopic) removal of lipoma: through a small incision of the skin up to 1 cm is made lipoma destruction and removal of it inside the capsule, monitoring completeness removal is done by miniendoskopa (optical deviceused for the study of hollow anatomical structures).Such surgery can achieve a good cosmetic effect, but it is not radical enough.
Endoscopic removal of lipoma: 1 - lipoma;2 - capsule lipoma;3 - optical tube;4 - video camera;5 - working tool;6 - light guide.
3. Liposuction lipoma: through the skin incision is not more than 5 mm in length lipoma removed inside the capsule using lipoaspiratora without further verification of the completeness of its removal.Despite the best cosmetic effect, this surgical technique is fraught with a high probability of recurrence of a lipoma.
Liposuction lipoma: 1 - lipoma;2 - capsule lipoma;3 - glublezhaschie tissue;4 - the skin;5 - subcutaneous fat;6 - suction tube.
should be noted that Wen complications are very rare.
1. Inflammation.The tumor blushes, increases in volume, becomes painful.When pressed on the felt wen fluctuation (transmission waves), that is, the presence of fluid in the tumor.
2. In exceptional cases, wen can degenerate into a malignant tumor (liposarcoma).
3. Large, existing for a long time lipomas cause displacement of surrounding tissue.For example, lipoma peripheral nerves may cause pain, and if it is in the preperitoneal fat, may contribute to the linea alba hernia.
Specific preventive measures that could affect the cause of the lipoma, does not exist.
Lipoma long time can remain unaltered or very slow increase in size.Under the influence of an injury or for no apparent reason may be malignant lipoma - acquire the character of a malignant neoplasm (liposarcoma) with spread to nearby tissues.
Forecasts treat lipomas are usually favorable, although lipomas may recur as the on-site operation, if not removed all abnormal fat cells, and at the new location.
Surgeon Kletkin ME