Lipoma #

• This is a cluster of fat cells that have become overactive and so distended with fat.
• They are never malignant.

History #

• Duration - months to years
• Symptom - often have multiple lipomas
• Multiplicity - Often Multiple

Tip

• Multiple lipomatosis (Dercum’s disease)

  • lipomas of all shapes and sizes.
  • can be painful - angiolipomas.

• Lipomatosis

  • is Multiple contiguous lipomas cause enlargement and distortion of the subcutaneous tissues.

Examination #

• Site - most common in upper limbs, chest, neck and shoulders.
• Colour - Normal. Veins crossing the lipoma visible as faint blue streaks.
• Tenderness - not usually tender, but angiolipomas are.
• Temperature is normal.
• Shape and size
  • usually spherical, but subcutaneous lipomas are discoid or hemispherical.
  • Most lipomas are lobulated.
• Surface - Smooth, but firm palpation of squeezing reveals the depressions between the lobules.
• Edge is not circular. Distinct irregular curves corresponding to each lobule.
• ‘slip sign’ - it slips away from the examining finger. It is not a very useful or diagnostic feature.
• Composition - jelly-like, soft but solid.
• Fluctuation - Pseudo-fluctuation. Lipomas often give the impression of fluctuating, they are just yielding to pressure, spreading out in all directions because they are soft.
• Transillumination - Lipomas do not transilluminate. but they may light up if light is shone directly across them.

Note

Diagnostic feature of lipoma

• Evidence of lobulation on the surface and at the edge is the most significant physical sign.

• Relations
  • may arise within deep structures, such as muscles.
  • These are fixed deeply
  • Contracting the muscle may make them prominent.
• Lymph drainage - Normal.
• Local tissues - Multiple lipomas.

Danger

Pseudo-cystic appearance

• The physical signs of pseudo-fluctuation and transillumination make them appear cystic, a false impression that emphasizes the diagnostic importance of finding lobulation.
• They do not have a fluid thrill.