lipoma
Introduction
Introduction to lipoma Lipoma (lipoma) is a benign tumor originating from adipose tissue. There is a thin connective tissue cyst around the tumor, which contains normal fat cells that are divided into leaf-like groups by connective tissue bundles. Some lipomas contain a lot of connective tissue or blood vessels in addition to a large amount of adipose tissue, which forms a complex lipoma. Adipose tissue can occur anywhere in the body, but rarely malignant. Clinically, it occurs under the skin of the shoulders, back and buttocks. When the volume is large, surgery is needed. More common, more common in middle-aged people (50 to 60 years old). basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: skin cysts
Cause
The cause of lipoma
Hereditary (30%):
A small number of patients have a family history or after birth. Most scholars believe that connective tissue degeneration with inflammatory stimuli, fat infiltration around the glandular trabeculae in the tissue or due to tissue lymphatic supply and blood circulation disorders, leading to adipose tissue deposition Others believe that the onset of lipoma is related to the secretion of gonadotropin in the anterior pituitary gland. In addition, some people believe that the disease is caused by congenital dysplasia, systemic fat metabolism disorder and intestinal malnutrition, but the evidence is not sufficient.
Physiological lesions (30%):
Located in the deep layer of the dermis, subcutaneous layer, spherical, nodular or lobulated appearance, the tumor is mainly composed of mature fat cells, the capsule is thin and intact, and the fibrous tissue is distributed from the capsule to the tumor to form a fibrous interval. The branches of the beam divide the tumor into small leaves with different sizes than the normal fat lobules. The cut surface is light yellow, soft and fatty, and the blood vessels are distributed in the trabeculae. The capillaries enter the tumor with the trabecular branches. The blood vessel distribution of the tumor is often uneven, and there are many blood vessels on the surface or one side of the tumor.
Cell proliferation (30%):
When the fibrous tissue increases to about half of the tumor section, it is called fibroid lipoma. If the vascular component increases to about half of the tumor section, it is called angiolipoma. Microscopically, capillary endothelial cell hyperplasia, stenosis of the lumen, sometimes accompanied by thrombosis, tumor cell size, morphology, similar to normal fat cells, and sometimes focal mucinous degeneration, foam cells, small astrocytes, spindle cells With mucoid-like matrix, called mucinous lipoma, tumor occasionally bleeding, necrosis, calcification, liquefaction or xanthomatous changes.
Prevention
Lipoma prevention
Low cholesterol diet
Excessive cholesterol intake can increase the metabolism of organs, clear the burden, and cause excess cholesterol to accumulate and precipitate under the skin or viscera, thus forming lipoma. Therefore, patients with lipoma should lower their cholesterol intake, especially at night. Should avoid eating high-cholesterol foods such as: meat foods, the daily limit is less than 75g, the variety should be lean pork and peeled chicken, duck meat is better, but should avoid eating fat, chicken, duck skin and Processed meat products (such as sausage), in addition to caviar, squid, animal internal organs, such as liver, brain, kidney, lung, stomach (stomach) intestines should be strictly limited.
Complication
Lipoma complications Complications skin cysts
The vast majority of lipomas do not cause direct symptoms and complications.
Symptom
Symptoms of lipomas Common symptoms Subcutaneous nodules Skin adhesions Lateral soft and hemispherical masses of fibrous calcified nodules subcutaneous deposits appear... Subcutaneous finger to pigeon eggs... Polyps grow slowly and the outside of the legs is soft and half.. .
General lipomas, experienced doctors, can make a definite diagnosis, and general surgeons can achieve an accurate diagnosis rate of 70%-80%.
It is characterized by single and multiple subcutaneous localized masses, or coexisting with glomus tumors. In addition to the large part of the tumor affecting local movements, or the pain caused by compression of the nerves, there are generally no symptoms and few malignant changes.
1. Can occur in any part
Lesions occur in the neck, shoulders, back and abdomen, also in the retroperitoneal and visceral organs, most commonly in the subcutaneous tissue of the head, neck, arms and chest, about 7% of lesions are multiple, multiple lesions develop early, Single-shot damage is delayed in development and stops growing to a certain extent.
2. Single lipoma
Lipomas have different shapes, often spheroidal, nodular lobulated or pedunculated soft subcutaneous masses, sometimes diffuse masses, can be pushed, soft and elastic, do not adhere to the surface skin, the general boundary is clear , the growth is slow, unless the tumor is too large, compressing the local nerve branches and producing pain, generally asymptomatic, the large ones reach several kilograms. After the volume of the general mass reaches a certain size, the growth often stops, and the surface is covered. Normal, most lesions are <5cm in diameter, and the bottom is wider. When the base of the tumor is squeezed, the skin on the surface may be "orange peel", which is caused by the pulling of the fiber bundle perpendicular to the skin in the subcutaneous fat, sometimes spontaneous. Atrophy or calcification, liquefaction.
2. Multiple lipoma
Can be scattered throughout the body or limited to a part of the body surface, the number is more than two, even hundreds, different sizes, painless subcutaneous nodules, part of the symmetrical growth (Figure 3), when active growth Pain. Often associated with neurofibromatosis.
3. Angiolipoma
Has all the characteristics of a typical lipoma, more common in young men and young people, sometimes family history, slow course, good for the forearm, waist, thigh, broad bean or soybean size, sometimes self-expansion, with pain, the cause of pain Associated with glomus tumors, or for the reaction of surrounding tissues such as edema, stimulation of inflammation or compression of the surrounding tissue by the tumor.
4. Syndrome performance
Lipoma can also be seen in part of Gardner's syndrome, which is characterized by facial multiple osteoma, multiple polyps of the colon, lipoma, fibroids, fibrosarcoma and leiomyoma.
Examine
Lipoma examination
1. Histopathological examination : the tumor section is light yellow, the tumor is made up of thin fibrous membrane wrapped with mature fat leaflets, the capsule is thin, intact, fat cell size, uniform shape, trabecular-separated fat lobules, with interlobular Branches of fibrous tissue and capillaries, small blood vessels in the tissue, uneven distribution of capillaries, mixed with a small amount of scattered foam cells, sometimes visible focal mucin degeneration, calcification, ossification, hemorrhage, necrosis, liquefaction or xanthophage There are usually not many fibrous tissues. If there are more, it is called fibrolipoma. When the larger lipoma is twisted, it may be cystic like due to local blood flow disorder and liquefaction.
2. Chromosome examination : Cytogenetic studies have shown that this disease is associated with abnormal changes in chromosomes of 12q, 6p and 13q.
3. Can take B-ultrasound : B-ultrasound can judge its position, size, texture, whether it is substantial or cystic. If you use color ultrasound, you can directly see the blood supply of the tumor, blood supply is rich, may be Malignant; it is necessary to do color B-ultrasound or angiography, color Doppler ultrasound or angiography can clearly determine its boundary, whether the capsule is intact, the relationship between important blood vessels and nerves.
Diagnosis
Diagnosis and diagnosis of lipoma
diagnosis
According to the clinical manifestations, the characteristics of skin lesions and histopathological features can be diagnosed.
1. According to clinical manifestations, the disease is generally not difficult to diagnose.
2. Pathological diagnosis.
Before treatment, body masses generally do not require puncture examination. The relatively deep mass under the skin may be inaccurate by hand. You can take B-ultrasound. B-ultrasound can judge its position, size, texture, and substance. Sexual or cystic, if the color is super, you can directly see the blood supply of the tumor, the blood supply is rich, may be malignant; long in the superficial position of the sputum or powder tumor, do not do B-ultrasound, lipoma can B-ultrasound examination, hemangioma is relatively difficult to handle, generally can not be easily operated, the tumor may be rich in blood vessels, some hemangioma has no clear capsule, some roots into the muscle, must determine its scope before surgery It is necessary to do color B-ultrasound or angiography, color Doppler ultrasound or angiography can clearly determine its boundary, whether the capsule is intact, the relationship between important blood vessels and nerves.
Differential diagnosis
Sometimes it needs to be differentiated from neurofibromatosis, lymphangioma, cavernous hemangioma, dermoid cyst and skin cysticercosis, and if necessary, puncture aspiration.
1. Angiolipoma tumor tissue capillary and endothelial cells proliferate, vascular lumen is narrow, including fibrinous thrombosis.
2. Skin cysticercosis cysts are not divided into leaves, and cysticercosis can be found.
