can lipomas cause musculoskeletal problems?

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Elsevier ClinicalKey Clinical Overview

Diagnosis Lipomas are generally discrete, soft, freely mobile, and nontender Certain histologic types and inherited syndromes have characteristic patterns of anatomical distribution; most common distributions are as follows: Simple solitary lipomas: neck, upper back, shoulders, or abdomen; may also be found on proximal extremities, including buttocks Multiple lipomas: upper back, shoulders, and upper arms. Distribution may be symmetrical, and numbers range from a few to hundreds Angiolipomas: forearm, often multiple; tender to palpation Myolipomas: abdomen, pelvis, retroperitoneum, inguinal area, and abdominal wall Chondroid lipomas: upper arms, shoulders, upper legs, and hip girdle Spindle cell/pleomorphic lipomas: back of neck, upper back, and shoulder Joint lipomas: knee; occasionally bilateral Diffuse lipomatosis: characterized by massive disfiguring lipomas on the trunk or an extremity. Often associated with hypertrophy of adjacent bone, resulting in overgrowth of affected limb or digit Symmetrical lipomatosis (Madelung disease or Launois-Bensaude syndrome): massive swelling around the neck Adiposis dolorosa: characterized by tender subcutaneous nodules, primarily in lower abdomen, buttocks, and legs Familial multiple lipomatosis: forearms, trunk, and thighs Other physical findings may relate to compression of or impingement on adjacent structures Diminished hearing: involvement of the eighth cranial nerve Respiratory distress and stridor: large lipomas in the neck or mediastinum, endobronchial lipomas Partial or complete intestinal obstruction with resulting abdominal distention and tenderness: colonic lipomas Palpable distended bladder: pelvic lipomatosis and bladder outlet obstruction

Diagnosis Most superficial lipomas are asymptomatic and are noted incidentally on inspection or palpation by the patient Pain, previous injury, or rapid growth may suggest a different diagnosis Lipomas deep to fascia often remain asymptomatic and may be discovered incidentally on imaging for evaluation of another condition; may produce symptoms as space-occupying lesions compress or impinge on other structures Central nervous system: neurologic symptoms (eg, cranial nerve deficits, focal peripheral weakness); eighth cranial nerve is a fairly common site of involvement, and patients may experience tinnitus or hearing loss Lumbosacral lipomas may result in progressive impingement or traction on the spinal cord or nerve roots, causing sensory loss and/or weakness in lower extremities, constipation, and urinary retention Large lipomas in neck/chest: difficulty swallowing or breathing Endobronchial: difficult breathing Colonic: change in bowel habits, passage of blood, pain, obstruction, intussusception Pelvic lipomatosis: fullness/discomfort, impingement on ureters, bladder, or urethra causing urinary frequency, straining, incomplete emptying Retroperitoneal: back pain, which may be unilateral Intra- or intermuscular: localized pain or discomfort and swelling Joint disease (lipoma arborescens): pain, swelling, decreased motion Pain is associated with angiolipomas, lipomas involving tendon and nerve sheaths, and the syndrome of adiposis dolorosa Patients with adiposis dolorosa have profound systemic symptoms (eg, generalized weakness, easy fatigability, depression) Family history may suggest presence of a heritable syndrome Angiomyolipomas associated with tuberous sclerosis

Synopsis Lipomas are benign encapsulated fatty tumors, sometimes admixed with other elements (eg, fibrous tissue, blood vessels, cartilage); they are the most common soft tissue tumors Usually occur in subcutaneous tissue but may occur anywhere that fat cells exist Most superficial lipomas are essentially asymptomatic and are noted incidentally on inspection or palpation by the patient Deeper lipomas may produce symptoms as space-occupying lesions compress or impinge on other structures; some are asymptomatic and noted incidentally on imaging done for another indication Most are solitary, but several syndromes of multiple and extensive lipomas have been described Ultrasonography, MRI, or CT typically shows a lesion of uniform fat density Biopsy is recommended for lesions that have atypical/heterogeneous appearance on imaging, are larger than 5 cm, deep to the fascia, or rapidly growing because of greater potential for malignancy; biopsy should be conducted by the treating physician because location and orientation can alter surgical plan Small, asymptomatic, superficial lesions do not require intervention Surgical removal is the standard of care for lipomas that are larger than 5 cm, symptomatic, or deep to the muscle fascia to fully evaluate pathologically for malignant potential Recurrence after excision of superficial lipomas is very low (1% to 2%); rates are higher for deep lipomas (12%-19%).