Dev Lipomların Cerrahi Tedavisi Sonrası Klinik Sonuçlar: Tek Merkez Deneyimi

Yıl 2022, Cilt: 24 Sayı: 2, 126 - 130, 30.08.2022

Ayşe Nur Toksöz Yıldırım , Tulay Zenginkinet , Erhan Okay , Arda Akkaya , Korhan Özkan

https://doi.org/10.18678/dtfd.1068051

Öz

Amaç: Lipomlar iyi huylu tümörlerdir ve genellikle küçük lezyonlar olarak ortaya çıkar. Ancak dev lipomlar daha az sıklıkta görülür. Dev lipomların cerrahi tedavisi ile ilgili çok az sayıda çalışma bulunmaktadır. Marjinal veya geniş rezeksiyon genellikle uygulanmaktadır; ancak standart bir cerrahi yaklaşım yoktur. Bu çalışmanın amacı, dev hücreli lipomların cerrahi tedavisi sonrası klinik sonuçlarını değerlendirmek ve lipomatöz tümörlerin ayırıcı tanısını sunmaktır.
Gereç ve Yöntemler: Bu çalışmaya 2015 ve 2020 yılları arasında en az 10 cm çapında dev lipom nedeniyle kliniğimize başvuran toplam 42 olgu (24 kadın, 18 erkek) dahil edildi. Tüm olgulara ameliyat öncesi biyopsi uygulandı. Tüm hastalara geniş eksizyon yapıldıktan sonra postoperatif histopatolojik inceleme yapıldı.
Bulgular: Ortalama yaş 57,5±12,9 yıl idi. Ortanca takip süresi 35 aydı. Anatomik yerleşim 16 (%38,1) hastada uyluk, 7 (%16,7) hastada omuz, 5 (%11,9) hastada kalça, 4 (%9,5) hastada sırt, 9 (%21,4) hastada kol, 1 (%2,4) hastada iliak bölge idi. Geniş rezeksiyon yapıldı ve nihai patoloji sonucu tüm hastalarda lipom ile uyumluydu. Proksimal femurda yerleşimli dev lipomun çıkarılmasından sonra bir hastada geçici nöropraksi görülmesi dışında başka bir komplikasyona rastlanmadı. Son kontrolde, tüm hastalar asemptomatikti ve nüks görülmedi.
Sonuç: Dev lipomların teşhisinde ameliyat öncesi biyopsi ve tedavisinde geniş rezeksiyon tercih edilmelidir. Geniş rezeksiyon rekürrensi önleyebilir. Muhtemel malign transformasyonun tespit edilmesi için rutin takip gereklidir.

Anahtar Kelimeler

dev lipom, geniş rezeksiyon, iyi huylu tümör

Clinical Results of Surgical Treatment of Giant Lipomas: A Single-Center Experience

Öz

Aim: Lipomas are benign tumors, and generally present as small lesions. However, giant lipomas are less frequent. There are only a few studies regarding the surgical treatment of giant lipomas. Marginal or wide resection is usually performed; however, there is no standard surgical approach. The aim of this study was to evaluate clinical results after surgical treatment of giant lipomas and to present a differential diagnosis of lipomatous lesions.
Material and Methods: A total of 42 cases (24 female, 18 male) admitted to our clinic between 2015 and 2020 due to giant lipoma with at least 10 cm dimensions were included in this study. A preoperative biopsy was performed for all cases. All patients were undergone wide excision followed by postoperative histopathological examination.
Results: The mean age was 57.5±12.9 years. The median follow-up was 35 months. Anatomic localization was thigh in 16 (38.1%) patients, shoulder in 7 (16.7%) patients, hip in 5 (11.9%) patients, back in 4 (9.5%) patients, arm in 9 (21.4%) patients, and the iliac region in 1 (2.4%) patient. Wide resection was performed, and final pathology was consistent with lipoma in all cases. There was no complication except in one patient who had transient neuropraxia after removing a giant lipoma at the proximal femur. At the latest follow-up, all cases were asymptomatic with no recurrence.
Conclusion: Preoperative biopsy and wide resection should be preferred for the diagnosis and treatment of giant lipomas. Wide resection may prevent a recurrence. Routine follow-up is necessary to detect possible malign transformation.

Anahtar Kelimeler

giant lipoma, wide resection, benign tumors

Kaynakça

• Johnson CN, Ha AS, Chen E, Davidson D. Lipomatous soft-tissue tumors. J Am Acad Orthop Surg. 2018;26(22):779-88.
• Litchinko A, Cherbanyk F, Menth M, Egger B. Giant gluteal lipoma surgical management. BMJ Case Rep. 2019;12(8):e229842.
• Ramirez-Montaño L, Lopez RP, Ortiz NS. Giant lipoma of the third finger of the hand. Springerplus. 2013;2(1):164.
• Szewc M, Gawlik P, Żebrowski R, Sitarz R. Giant lipoma in the fronto-temporo-parietal region in an adult man: Case report and literature review. Clin Cosmet Investig Dermatol. 2020;13:1015-20.
• Göçer H, Dabak N, Çıraklı A. Giant lipomas of the upper extremity. Acta Oncol Turc. 2016;49(3):192-6.
• Pakanati R, Gogineni RC, Ede NB. Recurrent giant intermuscular lipoma of thigh. J NTR Univ Health Sci. 2019;8(3):219-21.
• Morales Morales CA, González Urquijo M, Morales Flores LF, Sánchez Gallegos MN, Rodarte Shade M. Giant intramuscular thigh lipoma: A case report and review of literature. Int J Surg Case Rep. 2021;82:105885.
• Aydoǧdu E, Yıldırım S, Eker G, Aköz T. Giant lipoma of the back. Dermatol Surg. 2004;30(1):121-2.
• Gondowardojo YRB, Argie D, Arifin MZ. Giant lower back lipoma in pediatric : a case report. Bali Med J. 2017;6(3):554-6.
• Zenginkinet T, Okay E, Çelik A, Toksöz Yıldırım AN, Öztürk MB. Clinical results after surgical treatment of spindle cell lipomas. Duzce Med J. 2021;23(3):258-62.
• Endo M, Lin PP. Surgical margins in the management of extremity soft tissue sarcoma. Chin Clin Oncol. 2018;7(4):37.
• Niranjan A, Mutreja J. Review on lipoma and case studies. Eur J Mol Clin Med. 2020;7(6):1336-42.
• Cribb GL, Cool WP, Ford DJ, Mangham DC. Giant lipomatous tumours of the hand and forearm. J Hand Surg Br. 2005;30(5):509-12.
• Salam GA. Lipoma excision. Am Fam Physician. 2002;65(5):901-4.
• Silistreli OK, Durmuş EU, Ulusal BG, Oztan Y, Görgü M. What should be the treatment modality in giant cutaneous lipomas? Review of the literature and report of 4 cases. Br J Plast Surg. 2005;58(3):394-8.
• Celik C, Karakousis CP, Moore R, Holyoke ED. Liposarcomas: Prognosis and management. J Surg Oncol. 1980;14(3):245-9.
• Abdulsalam T, Osuafor CN, Barrett M, Daly T. A giant lipoma. BMJ Case Rep. 2015;2015:bcr2015212030.
• Fisher SB, Baxter KJ, Staley CA 3rd, Fisher KE, Monson DK, Murray DR, et al. The general surgeon’s quandary: Atypical lipomatous tumor vs lipoma, who needs a surgical oncologist? J Am Coll Surg. 2013;217(5):881-8.
• Gungor M, Sir E, Aksoy A, Agirbas S. Giant lipoma extending into two thigh canals: A case report. Acta Orthop Traumatol Turc. 2017;51(3):270-2.
• Clesham K, Galbraith JG, Ramasamy A, Karkuri A. Giant lipoma of the hand causing median nerve compression. BMJ Case Rep. 2017;2017:bcr2017220056.
• Toft F. Surgical resection of a giant intramuscular lipoma of the biceps brachii: a case report and review of the literature. Arch Orthop Trauma Surg. 2022;142(3):373-9.
• Lee YJ, Jeong YJ, Lee JH, Jun YJ, Kim YJ. Liposarcoma in the axilla developed from a longstanding lipoma. Arch Plast Surg. 2014;41(5):600-2.
• Altun E, Yüksel S, Kaygusuz G, Yıldız HY. Diagnostic importance of clinicopathologic features and p16, CD34, MDM2 expression in differential diagnosis of adipocytic tumors. Acta Orthop Traumatol Turc. 2020;54(1):59-65.
• Nagano S, Yokouchi M, Setoguchi T, Ishidou Y, Sasaki H, Shimada H, et al. Differentiation of lipoma and atypical lipomatous tumor by a scoring system: Implication of increased vascularity on pathogenesis of liposarcoma. BMC Musculoskelet Disord. 2015;16(1):36.
• Sheybani EF, Eutsler EP, Navarro OM. Fat-containing soft-tissue masses in children. Pediatr Radiol. 2016;46(13):1760-73.
• Bancroft LW, Kransdorf MJ, Peterson JJ, Sundaram M, Murphey MD, O'Connor MI. Imaging characteristics of spindle cell lipoma. AJR Am J Roentgenol. 2003;181(5):1251-4.
• Knebel C, Neumann J, Schwaiger BJ, Karampinos DC, Pfeiffer D, Specht K, et al. Differentiating atypical lipomatous tumors from lipomas with magnetic resonance imaging: A comparison with MDM2 gene amplification status. BMC Cancer. 2019;19(1):309.