Lipoma

Lipomas, also known as lipofibromatous hamartomas or neural fibrolipomas, are benign tumors arising from the proliferation of adipose or fibrous tissues. Grossly, they are well circumscribed and encapsulated and have a fusiform and yellowish appearance in the subcutaneous layer.92 Histologically, lipomas can be intimately associated with functioning nerve fibers from which they cannot be easily separated. The median nerve is most commonly affected. Larger lipomas can envelop, infiltrate, or compress important nerves such as the brachial plexus when located in the supraclavicular fossa.61 Overall, lipomas are the most common soft-tissue tumors in adults, occurring in 1 out of 1000 individuals.131 They occur mostly in children or during early adulthood. Treatment includes biopsy of the tumor and decompression of the involved nerve when it becomes entrapped by surrounding structures such as the carpal tunnel. Complete resection of these tumors when involving a nerve is usually not possible without loss of neurologic function mediated by the involved nerve. Several treatment strategies therefore need to be considered. The tumors can be followed and managed conservatively if they do not grow or produce painful symptoms or loss of function. Alternatively, they can undergo biopsy, be decompressed, and be either partially resected while sparing functioning nerve fibers or fully resected with graft repair of cut and functionally important nerve fibers. The more completely the tumor is resected, the less likely it is to recur.3,55,68 Malignant transformation has not been reported.

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