LIPOMA

Agnes Dua Nurak

112016303

Pembimbing : dr. Dharma Gita

• Lipomas are the most common soft-tissue
tumor. These slow-growing, benign fatty
tumors form soft, lobulated masses enclosed
by a thin, fibrous capsule.
• These tumors usually occur on the trunk and
extremities but can occur anywhere on the
body.
SKIN ANATOMY
 Etiology
• The etiology of lipsomas is unclear.
• One theory suggests that trauma-related fat
herniation through tissue planes creates so-
called pseudolipomas.
• Abnormality in the HMGA2-LPP fusion gene
 Pathophysiology
• Lipomas are common benign mesenchymal
tumors. They may develop in virtually all
organs throughout the body. The anatomy
depends on the tumor site.
• Subcutaneous lipomas are usually not fixed to
the underlying fascia.
• In the GI tract, lipomas present as submucosal
fatty tumors
 Epidemiology
• Lipomas occur in 1% of the population. Most
of these are small subcutaneous tumors that
are removed for cosmetic reasons.
• They can present as a single swelling or
multiple swellings. About 20% occur in the
head and neck region and only 1% to 4%
involve oral cavity.
 Clinical Manifestation
• Lipomas are most often asymptomatic. When
they arise from fatty tissue between the skin
and deep fascia, typical features include a
soft, fluctuant feel; lobulation; and free
mobility of overlying skin.
• A characteristic "slippage sign" may be
elicited by gently sliding the fingers off the
edge of the tumor.
Imaging
• For most subcutaneous lipomas, no imaging
studies are required.
• Lesions in the gastrointestinal (GI) tract may
be visible on GI contrast studies
Biopsy
• Biopsies are normally not indicated for small
subcutaneous lesions, because the entire
tumor is usually removed
Lipoma of posterior neck.
 Histologic
Lipomas are benign mesenchymal tumors derived
from adipocytes. Several variants have been
described
• Adenolipomas, a variation of lipomas that may
occur in the breast, often have a marked fibrotic
component; they are best regarded as a
hamartoma
• Angiolipomas contain many small vessels
• Cardiac lipomas may calcify following fat necrosis;
microscopically, they are composed of fatty tissue
with interlacing muscle fibers
 THERAPI
Lipomas are removed for the following reasons:
• Cosmetic reasons
• To evaluate their histology, particularly when
liposarcomas must be ruled out
• When they cause symptoms
• When they grow and become larger than 5 cm
 Therapi
Surgical Therapy
• Complete surgical excision with the capsule is
advocated to prevent local recurrence. Subcutaneous
lipomas are removed for cosmetic reasons, and hence,
a cosmetically pleasing incision should be used
• Specific therapy depends on the location of the tumor.
• Liposuction is an alternative that allows removal of the
lipoma through a very small incision, the location of
which may be remote from the actual tumor
Endoscopic Therapy
• Nonsurgical therapy includes endoscopic
excision of tumors in the upper
gastrointestinal (GI) tract (ie, esophagus,
stomach, or duodenum) or the colon
 Complications
• Subcutaneous lipomas are primarily cosmetic
issues. Lipomas in other locations may cause
luminal obstruction or hemorrhage
 Prognosis
• The outcome and prognosis are excellent for
benign lipomas. Recurrence is uncommon but
may develop if the excision was incomplete.
 Atheroma Cystc
• Epidermal inclusion cysts (also known as
sebaceous cysts) are commonly asymptomatic
but may be excised for cosmetic reasons.
• Epidermoid cysts are asymptomatic, slowly
enlarging, firm-tofluctuant, dome-shaped
lesions that frequently appear on the trunk,
neck, face, scrotum or behind the ears.
 Pathophysiology
• Epidermoid cysts result from the proliferation
of epidermal cells within a circumscribed
space of the dermis. Analysis of their lipid
pattern demonstrates similarities to the
epidermis. In addition, epidermoid cysts
express cytokeratins 1 and 10, which are
constituents of the suprabasilar layers of the
epidermis
 Clinical Manifestation
• Epidermoid cysts are usually asymptomatic.
Discharge of a foul-smelling “cheeselike”
material may be described. Less frequently,
the cysts can become inflamed or infected,
resulting in pain and tenderness.
• Epidermoid cysts appear as flesh–colored-to-
yellowish, firm, round nodules of variable size.
A central pore or punctum may be present
Laboratory
• Laboratory studies are typically unnecessary
Imaging Studies
• If an epidermoid cyst is suspected in an
unusual location, such as breast, bone, or
intracranial locations, imaging with
ultrasonography, radiography, CT scanning, or
MRI is appropriate.
•
 Histologic
• Epidermoid cysts are lined with stratified
squamous epithelium that contains a granular
layer. Laminated keratin contents are noted
inside the cyst. An inflammatory response
may be present in cysts that have ruptured.
 Therapi
Medical Care
• Asymptomatic epidermoid cysts do not need to
be treated. Intralesional injection with
triamcinolone may hasten the resolution of
inflammation. Oral antibiotics may occasionally
be indicated.
Surgical Care
• Epidermoid cysts may be removed via simple
excision or incision with removal of the cyst and
cyst wall though the surgical defect. If the entire
cyst wall is not removed, the lesion may recur
 Complications
• Complications are rare, but they can include
infection, scarring from removal, and
recurrence. Malignancies in epidermoid cysts
are very rare.
 Referensi
• Prince Peter Dhas, Ravindran Ambika, Amirthagani
Arumugam, Jagan Somasundaram. International Journal of
Otolaryngology and Head & Neck Surgery, 2015, 4, 133-136.
Published Online March 2015 in SciRes.
http://www.scirp.org/journal/ijohns
http://dx.doi.org/10.4236/ijohns.2015.42023
• THOMAS J. ZUBER, M.D., Saginaw Cooperative Hospital,
Saginaw,Michigan. Minimal Excision Technique
• for Epidermoid (Sebaceous) Cysts. AMERICAN FAMILY
PHYSICIAN VOLUME 65, NUMBER 7 / APRIL 1, 2002.
www.aafp.org/afp
• https://emedicine.medscape.com/article/1294801-overview#a6
• https://emedicine.medscape.com/article/191233-treatment#d10
• https://emedicine.medscape.com/article/1061582-
medication#2