Latest Treatment of Lipoma
Lipomas may display an increasing size with time due to hypertrophy of the lipomatous tissue whenever there are changes of body fat in general. In other words, it maybe possible to reduce the size of a lipoma by instigating a low-fat diet and weight reduction 79 . They have also been shown to increase during steroid therapy 2 .
Lipoma-Liposarcoma Lipoma is a benign mesenchymal neoplasm of fat and is most common in the subcutis. In the usual type, it resembles mature fat, surrounded by a delicate capsule. It is exceedingly rare in the trachea, with only approximately 10 cases reported in the literature. Lipomas produce a polypoid mass covered by respiratory epithelium. One of the reported cases did not produce any symptoms and was found on autopsy,23 whereas 2 other cases caused airway obstruction.23-25 Microscopically, tracheal lipomas are composed of lobules of mature adipocytes, separated by delicate fibrous bands. One case of a well-differentiated liposarcoma in the trachea occurred in a 76-year-old man.26 It produced a 1 cm polyp, which was histologically composed of mature adipocytes with foci of atypicality. Recurrence or metastasis did not occur in 12 months of follow-up. The current trend is to classify these tumors as atypical lipoma, because although recurrence occurs, they do not metastasize.27...
Tarsal tunnel syndrome is caused by entrapment of the posterior tibial nerve under the flexor retinaculum or at the site of either of its branches, the medial or lateral plantar nerves. The tunnel is formed by the flexor retinaculum, which is located behind and distal to the medial malleolus. Pain and paresthesias radiate along the plantar aspect of the foot from the medial malleolus and increase with activity. A positive Tinel's sign (paresthesias with percussion over the inflamed nerve) may be found along with increased discomfort from prolonged manual compression of the posterior tibial nerve behind the medial malleolus. There are many causes of this disorder, including posttraumatic deformities, tortuous veins, ganglion, lipoma, edema, the presence of accessory muscles, and synovial hypertrophy. Careful selection of candidates for resection of a space-occupying lesion has the best chance of success because of the high rate of complications
The incidence of this trisomic syndrome, which occurs primarily in the offspring of older mothers, is approximately 1 in 7000, and it affects mainly females. M It should be noted that translocation can also result in this syndrome, but mothers of these children are usually younger. The clinical characteristics of this syndrome include multiple congenital anomalies with varying degrees of mid-facial anomalies. Infants may have ophthalmic abnormalities including anophthalmia, cyclopia, microphthalmia, and colobomas. Facial defects, such as cleft palate and lip and micrognathia, can also occur. A variety of congenital cardiac abnormalities such as ventricular or atrial septal defects and patent ductus arteriosus may be present. Intestinal malrotation, Meckel's diverticulum, and a spectrum of urogenital structural abnormalities are commonly seen. Polydactyly, with the third and fifth fingers overlapping the fourth, occurs in most affected infants. Neurologically, patients have...
Intramedullary lesions causing enlargement of the cord or conus with concomitant narrowing of the adjacent subarachnoid space include primary cord neoplasms such as ependymomas, astrocytomas, and hemangioblastomas metastases inflammatory conditions such as sarcoidosis and abscess formation cord hematomas and infarcts vascular malformations and congenital lipomas, dermoids, and epidermoids. Although these groups of lesions will most certainly cause widening of the silhouette of the cord or conus, the intrinsic pathology and extent of these intramedullary lesions are far better imaged with MRI.
Sagittal (a) and axial (3) T1-weighted images (without contrast) of an intramedullary lipoma at L1 in a 32-year-old patient with an additional tethered cord related to a low conus position. The typical hyperdense signal of the lesion is apparent Fig. 3.24. Sagittal (a) and axial (3) T1-weighted images (without contrast) of an intramedullary lipoma at L1 in a 32-year-old patient with an additional tethered cord related to a low conus position. The typical hyperdense signal of the lesion is apparent
Miscellaneous benign tumors are encountered in the larynx and trachea. These include neurogenic tumors, pleomorphic adenoma, oncolytic tumor, granular cell tumor, paraganglioma, lipoma, fibrous histiocytoma, rhabdomyoma, and hamartomas (Figure 4-53).64-72 Conventional radiographs do not usually reveal any characteristic features that allow a specific histopathologic diagnosis. CT can identify fatty attenuation within hamartomas and lipomas and increased contrast enhancement within paragangliomas. A chondroid matrix can be identified within chondromas and chondrosarcomas.
Lipoma Difficult to differentiate clinically more firm, lobulated no cheesy material extrudes on incision removal is by complete excision or by liposuction clinically similar to hibernoma. 3. If, during incision by any technique, a solid tumor is found instead of a cyst, the lesion should be excised completely and the material studied histologically. This diagnostic error is common because of the clinical similarity of cysts, lipomas, and other related tumors.
Benign tumors of the gallbladder are uncommon and consist of benign neoplasms (adenomas, leiomyomas, lipomas, granular cell tumors, hemangiomas) and hyperplastic or inflammatory pseudotumors (adenomatous hyperplasia, cholesterol polyps). They may present as polypoid lesions or as thickening of the gallbladder wall. Cholesterol Polyps
Chest and back seborrheic keratosis, angioma, nevi, ephelides, actinic keratosis, lipoma, basal cell carcinoma, epidermal cyst, keloid, lentigo, cafe-au-lait spot, squamous cell carcinoma, melanoma, hemangioma, histiocytoma, steatocystoma multiplex, eruptive vellus hair cyst, blue nevus, nevus of Ito, Becker's nevus. Arms and Legs seborrheic keratosis, lentigo, wart, histiocytoma, actinic keratosis, squamous cell carcinoma, melanoma, lipoma, xanthoma, clear cell acanthoma (legs), Kaposi's sarcoma (legs, classic type).
The intramedullary part of a spinal lipoma does not display a cleavage plane toward the spinal cord tissue. Therefore, attempts ofradical resection are not recommended. As the lipoma does not display proliferative potential, decompression is all that is required. This may involve a partial resection of the extramed-ullary component in some cases. Usually, we just perform a laminotomy with a duraplasty (Fig. 3.51). As lipomas may be associated with arachnoid scarring 73, 171, 281 we prefer to leave the arachnoid membrane intact if no debulking is required. Fig. 3.51. T1-weighted sagittal (a) and axial (b) MRI images of an intramedullary lipoma at C7-Th1 in a 42-year-old woman with a 4-year history of severe pain and a moderate parapa Fig. 3.51. T1-weighted sagittal (a) and axial (b) MRI images of an intramedullary lipoma at C7-Th1 in a 42-year-old woman with a 4-year history of severe pain and a moderate parapa Fig. 3.51. (Continued) There is no major space-occupying effect detectable...
Although the CO2 laser was the initial laser used for tracheobronchial laser therapy (Figure 37-5), its use in the treatment of patients with malignant obstruction is severely limited by poor hemostatic proper-ties.47,48 The hypervascularity of many malignant endobronchial tumors, such as carcinoids, adenoid cystic carcinomas, and metastasis from renal cell, thyroid, breast, and esophageal carcinomas, is best treated with the Nd YAG laser because of its excellent coagulation properties (Figures 37-6, 37-7 Color Plate 9 ). Tracheo-bronchial obstruction caused by endobronchial metastasis constitutes the second most common indication for Nd YAG laser bronchoscopy, accounting for 10 to 18 of laser bronchoscopies. The Nd YAG laser has also been used successfully in the treatment of benign conditions causing tracheobronchial obstruction, such as amyloidomas, lipomas, fibromas, and hamartomas.49,50 Some cases of tracheal stenoses are also amenable to treatment with the Nd YAG laser. However,...
Round cell liposarcoma Atypical lipomatous tumours Lipoma Lipoblastoma Spindle cell and pleomorphic lipomas Angiolipoma with the previous morphological classification schemes. Of the common types of lipomas only angiolipomas have a normal karyotype. The common fatty lipomas of adults often have rearrangements involving 12ql3-15. The breakpoint on chromosome 12 involves a gene, HMGIC, that codes for a member of the high-mobility group of proteins. These are small, acidic, nonhistone chromatin associated proteins that bind to AT-rich regions of the DNA. They have no inherent transcriptional activity but function by altering the nuclear chromatin, probably through interactions with other proteins. This alters the DNA structure and facilitates the assembly of transcrip-tional complexes. Spindle cell pleomorphic lipomas usually have abnormalities of chromosome 16q or 13q, validating their histological separation from common lipomas and atypical lipomatous tumours.
Underlying neuromuscular condition spinal dysraphism (spina bifida, lipoma, tethered cord, diastematomyelia), Charcot-Marie-Tooth disease, Friedreich's ataxia, or cord tumor. Occasionally, cases are familial or idiopathic. When unilateral, a spinal disorder is almost always the cause. All cavus feet demonstrate excessive plantar flexion of the first ray with pronation of the forefoot in relation to the hindfoot. The workup includes family and neurological history and exam, weight-bearing radiographs of the feet, and strong consideration of a referral to the orthopedist. Corrective shoes and inserts are not effective for treating cavus feet. Surgical management, best undertaken after age 4 or 5 years, is directed toward medial and plantar release (plantar fascia, short flexors, adductor hallucis) followed by weekly cast changes to gain full correction.13
Benign lesions include hamartoma, lipoma, hemangioma, lymphangioma, and hemangioendothelioma. Although hemangiomas and lymphangiomas have been mentioned under the discussion of splenic cysts, they are often more solid than cystic. Most of these lesions, including hamartomas, are small and of no clinical significance, but on rare occasions they can produce splenomegaly and occasionally hypersplenism. Operative removal of the spleen is required occasionally for definitive diagnosis of ill-defined splenomegaly or hypersplenic manifestations.
We have observed four dermoid cysts, four lipomas, and one patient with a combination of both in this category of intramedullary tumors. Whereas hamar-tomas are not tumors in a strict sense - they do not contain proliferating cells - they are space occupying and displace spinal cord tissue. Quite regularly, they are not completely surrounded by cord substance and protrude out of the cord. The overwhelming majority of spinal hamartomas are located extramedullarly. We have only classified them as intramedullary if the major component of the lesion was embedded inside the spinal cord. Therefore, a more detailed discussion is provided in the section on extramedullary tumors. Among intramedullary hamartomas, one dermoid cyst and four lipomas were associated with a tethered-cord syndrome.
Defined as a defect in the posterior bony components of the vertebral column without involvement of the cord or meninges. These defects are often found incidentally on radiographic studies or are picked up because of a subtle clinical finding such as a tuft of hair or a cutaneous angioma or lipoma in the midline of the back marking the location of the defect. On rare occasions, a sinus tract may communicate from the skin to the underlying dura. The clinical presentation is largely dependent on the level and content of the defect. Pure meningoceles may be asymptomatic. Neurological disability is greatest in patients with myelomeningoceles. Infants with defects at or above L2 are more likely to have skeletal deformities, including kyphosis and scoliosis, dislocated hips, and clubfeet (see later). The degree of motor paresis is equally dependent on the level of the neural tube closure defect and is discussed in more detail under management and prognosis. Involvement of the kidneys,...
Patients who present with very small or superficial tumors do not necessarily require an imaging study, as excisional biopsy and pathologic evaluation may be the most reasonable diagnostic study. Either a CT scan or MRI is appropriate in the evaluation of all other patients with a soft tissue mass of the extremity or trunk. MRI is increasingly utilized however, if cost or availability are not an issue. While both studies are useful in the measurement of tumor size and assessment of depth, several benign tumors have characteristic MRI appearances that may facilitate the correct preoperative diagnosis. These include lipomas, hemangiomas, nerve sheath tumors and myxomas. A soft tissue mass of the extremity that does not appear characteristic of one of the benign tumors listed above, is heterogeneous in appearance, does not involve bone, and displaces surrounding structures is highly suggestive of a
With dermoid cysts the situation is different they contain cells that produce some kind of gradually accumulating product. This will increase the size of the cyst with the potential of progressive pressure on the spinal cord. The history is considerably shorter compared to lipomas - 29 51 months in this series, ranging from 1 month to 10 years. Even acute presentations related to aseptic meningitis 65, 296 or abscess formation 49 have been described. The average age was 32 6 years (range 25-42 years), with pain in three patients and motor weakness in two patients as the major clinical problems (Table 3.27) 197 .
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