- Еуромедик, Булевар уметности 29, Београд
Fat tissue of the breast - LIPOMA
Прим др Милош Почековац
др Драган Стојановић
What is lipoma?
Lipomas are benign mesenchymal tumors that develop in areas rich in adipose tissue. Due to the fatty structure of the breast, there are often problems in diagnosis, treatment and reconstruction.
Lipoma in the breast
Lipomas are one of the most common benign neoplasms arising from adipose tissue. The frequency is approximately 16% of all mesenchymal tumors (1). They usually develop as well-circumscribed benign tumors surrounded by a thin capsule that are mobile under the skin. They can appear in any part of the body. Female patients may be concerned about breast growth, asymmetry, as well as fear of a malignant disease. Breast asymmetry may result from uneven hypertrophy or neoplastic growth, leading to diagnostic problems (2). Large or giant lipomas are defined as lesions that are at least 10 cm in diameter or weigh more than 1,000 g (3).
Lipomas can occur in almost any part of the body with a prevalence of 2.1 per 1,000 inhabitants (4). Twenty percent is located on the chest (5). It is characteristic that they are small and asymptomatic (6).
Most cases of breast asymmetry and unilateral breast enlargement are the result of unequal physiological hypertrophy, but a neoplastic process should also be suspected when changes in size are accompanied by obvious asymmetry, which makes diagnosis difficult (7).
We can conclude that breast lipomas are benign tumors with a very limited risk of malignant transformation. After successful excision, they have an excellent prognosis despite the fact that in some patients they can represent a major reconstructive challenge, especially in terms of symmetry and aesthetics. Preoperative evaluation requires careful diagnostic workup due to the similarity of lipoma to other conditions, especially those associated with breast asymmetry and benign hypertrophy (8).
Presentation of cases
A 71-year-old female patient with a palpable soft tissue change in the upper outer quadrant of the left breast and an ultrasound-diagnosed lipomatous change. There are no complaints, the sensibility of the breast and left hand is preserved.
Although the tumor was 23.5 cm, the incision was made close to the left axillary region and there was no need for additional breast reconstruction, as the volume and symmetry of the breast were preserved.
A 60-year-old female patient was referred from screening and mammographic grade BI RADS LD2 (image below), with a palpable lipomatous change in the left breast and solid swelling within the lipoma. The change is located inframammary to the left or in the sulcus of the left breast. UZ BI RADS LD3 – lipoma 45×21mm with calcification 35mm.
The complete change was excised and sent for ex tempore biopsy.
In the fatty tissue with a diameter of 105×36 mm, there is a calculus (white arrow in the picture) with a diameter of 35x22x20 mm with surrounding small fields of fatty tissue necrosis.
Литература
1. Lanng C, Eriksen BO, Hoffmann J. Lipoma of the breast: a diagnostic dilemma. Breast. 2004;13:408–411.
2. Hall FM, Connolly JL, Love SM. Lipomatous pseudomass of the breast: diagnosis suggested by discordant palpatory and mammographic findings. Radiology. 1987;164:463–464. [PubMed]
3. Sanchez MR, Golomb FM, Moy JA, et al. Giant lipoma: case report and review of the literature. J Am Acad Dermatol. 1993;28:266–268.
4. Silistreli OK, Durmus EU, Ulusal BG, et al. What should be the treatment modality in giant cutaneous lipomas? Review of the literature and report of 4 cases. Br J Plast Surg. 2005;58:394–398.
5. Salvatore C, Antonio B, Del Vecchio W, et al. Giant infiltrating lipoma of the face: CT and MR imaging findings. AJNR Am J Neuroradiol. 2003;24:283–286.
6. Hakim E, Kolander Y, Meller Y, et al. Gigantic lipomas. Plast Reconstr Surg. 1994;94:369–371.
7. Dooms GC, Hricak H, Sollitto RA, et al. Lipomatous tumors and tumors with fatty component: MR imaging potential and comparison of MR and CT results. Radiology. 1985;157:479–483.
8. Luis Ramírez-Montaño, Erik Vargas-Tellez, Walid L Dajer-Fadel, and Silvia Espinosa Maceda, Giant Lipoma of the Breast Arch Plast Surg. 2013 May; 40(3): 244–246. Published online 2013 May 16