Curing Lipoma Permanently
Lipomas are rare, uniformly benign, localized proliferations of submucosal fat. Like leiomyomas, they grow by slow compression of surrounding tissue and usually no true capsule can be defined. Their soft texture and sub-mucosal origin dictate that the tumors grow almost entirely into the lumen with relatively little effect on the muscle wall. As they become large they may form pe-dunculated, intraluminal, polypoid masses and may cause intussusception. The overlying mucosa is initially intact but may eventually breakdown and ulceration is one means of presentation. Their low X-ray attenuation allows a confident diagnosis on computed tomography (CT) (Fig. 12).
The consistency of a lesion is stated as being soft, medium, firm, or fluctuant. Soft lesions are easily compressible (lipomas, neurofibromas), medium lesions are slightly compressible (most inflammatory lesions), and firm lesions cannot be compress at all (fibromas). The consistency of cysts is somewhat of an exception to this grading system. A cyst may be somewhat compressible as you first start to squeeze it, but the limits of elasticity of the wall are quickly reached and the lesion then begins to feel quite firm.
Bannayan-Zonana (Bannayan-Riley-Ruvalcaba) syndrome, characterized by macrocephaly, pigmented macules of the glans penis and lipomas, in addition to hamartomatous intestinal polyposis (1), appears to be allelic to Cowden syndrome (9,10). Lhermitte-Duclos disease, which is an hamartomatous overgrowth of cerebellar tissue, is also associated with Cowden disease and
These are midline tumors, found most commonly in the posterior fossa and only rarely in the suprasellar region. Imaging reflects the high fat content of these lesions. Calcification is relatively common. CT shows a hypodense lesion. The signals on MRI reflect a higher fat content than that of the brain. These tumors with the lipomas are two uncommon causes of suprasellar bright spots Lipomas Most intracranial lipomas are considered as congenital abnormalities rather than neoplasms. The most common sites are the interhemispheric fissure (50 ), the quadrigeminal cistern and pineal region, the suprasellar cistern and cerebellopontine angle cistern. CT imaging shows attenuation values that are in the negative range, usually -30 to -100 HU, and are isodense to subcutaneous fat. MRI demonstrates lipomas high in intensity on Tl-weighted images and intermediate to low on T2-weighted images.
A metastatic lymph node from the thyroid, upper respiratory tract (e.g., nasopharynx) or postcricoid region, and swellings of neurogenous origin (chemodectomas, neurofibromas, neuroblastomas) are among the important differential diagnoses of a lateral neck swelling. The ubiquitous lipoma is also not uncommon in the neck, and in children the cystic hygroma is to be remembered. Hodgkin's disease also frequently presents with an enlarged cervical lymph node.
Bannayan-Zonana syndrome Riley-Smith syndrome Ruvalcaba-Myhre syndrome Ruvalcaba-Myhre-Smith syndrome Banna-yan syndrome Cowden Bannayan-Riley-Ruvalcaba overlap syndrome PTEN hama-rtoma tumor syndrome macrocephaly pseudopapilledema multiple hemangiom-ata syndrome multiple lipomas Disease characterized by hamartomatous polyps of the small and large intestine, macrocephaly, lipomas, hemangiomas, thyroid abnormalities, and freckling of the penis Hamartomatous polyps of the small and large intestine macrocephaly lipomas hemangiomas thyroid abnormalities penile freckling developmental delay increased risk for both benign and malignant tumors Increased breast, thyroid, and colon cancer surveillance surgical excision of lipomas and hemangiomas for cosmetic purposes only
The most common extratesticular intrascrotal neoplasm is lipoma, which arises from the spermatic cord and can often be diagnosed clinically based on palpation. Adenomatoid tumors are nearly as common as lipomas, and account for about one third of extratesticular masses. These are benign, but may be surgically removed either to establish the diagnosis or because of local pain or ten
Tumors of the small bowel are uncommon, and Minardi et al. report the incidence of lipomas in the small bowel to be 4.5 .1 They are usually submucosal but may be subserosal. When symptomatic, the most common presentation is abdominal pain due to intussusception. Bleeding which occurred in this patient is much less common and was probably due to venous congestion and ulceration on the tip of the polyp. Barium enema or CT may demonstrate the lesion.2 Newer endoscopy techniques and the small intestine camera ( pill cam ),3 should significantly improve the opportunity for preoperative diagnosis.
Lipoma in the duodenal bulb. a Smooth filling defect displacing contrast in bulb on barium upper GI study. b CT in same case showing smooth, intraluminal mass in duodenal bulb with very low attenuation measured in the rectangular area of interest Fig. 12. Lipoma in the duodenal bulb. a Smooth filling defect displacing contrast in bulb on barium upper GI study. b CT in same case showing smooth, intraluminal mass in duodenal bulb with very low attenuation measured in the rectangular area of interest
Cowden syndrome is a genetic syndrome of multiple hamartomas. Current nosology includes Lhermitte-Duclos disease, a condition of cerebellar dysplastic gangliocytomas with other findings characteristic of Cowden syndrome. Lhermitte-Duclos disease can be thought of as the neurological variant of Cowden syndrome. Also included is a syndrome of macrocephaly, multiple lipomas, and hemangiomata (Bannayan-Riley-Ruvalcaba syndrome). The phosphatase and tensin homolog deleted on chromosome ten (PTEN) gene causing Cowden syndrome is located on chromosome 10q23.31. PTEN is a widely expressed, dual-specificity phosphatase, which has actions as a tumor suppressor. The exact mechanism of PTEN action is unclear, but it may act to arrest the cell cycle and be a mediator of apoptosis.
DIFFERENTIAL DIAGNOSIS The differential diagnosis includes benign tumors such as fibrous histiocytoma, epidermal hyperplasia, neurofibroma, and spindle cell lipoma. They can also be mistaken for malignant lesions including leiomyosarcoma, fibrosarcoma, and malignant peripheral nerve sheath tumors.
DIFFERENTIAL DIAGNOSIS The differential diagnosis includes juvenile xanthogranuloma, low grade necrobiotic xanthogranuloma, Erdheim-Chester disease, xanthelasma, dermatofibroma, lipoid proteinosis, tuberous xanthoma, lipoma, fibrous histiocytoma, lymphoma, neurofibroma, and amyloidosis.
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