INTRODUCTION
Lipomas are common benign soft tissue tumors.[12] It is generally of mesenchymal origin and most frequently found in the extremities and trunk. They are generally asymptomatic and most measure about 2 cm in diameter and rarely grow above 10 cm.[34] Even though small, they may produce compression symptoms depending on their location. They are rarely seen in the axilla, especially giant lipomas.
CASE REPORT
A 66-year-old male patient had been treated at various clinics for approximately 7 years with complaints of numbness and tingling in the left arm and pain in the arm and shoulder region, unresponsive to medical treatment. The patient was subsequently referred to another facility with the complaint of sudden swelling in the left supraclavicular region, and a computed tomographic (CT) scan revealed a tumor extending from the left axilla to the supraclavicular region compatible with a lipoma [Figure 1]. The patient was then referred to our center for surgical evaluation. He subsequently underwent surgical resection through a 4 cm left supraclavicular incision under general anesthesia. The tumor was encapsulated and macroscopically consistent with a lipoma [Figure 2]. It was dissected from the surrounding tissues using both blunt and sharp dissection and then removed in one piece and measured approximately 12 cm in length [Figure 3]. The pathology report confirmed a lipoma. At follow-up visit 1 month later, the patient reported resolution of all his preoperative symptoms [Figure 4]. Postoperative chest CT scan showed no residual tumor [Figure 5].
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Figure 1: Lipoma image extending from the left axilla to the supraclavicular region on computed tomography.
Figure 2: Intraoperative picture.
Figure 3: Excised tumor.
Figure 4: Postoperative image.
Figure 5: Postoperative computed tomographic scan.
DISCUSSION
Lipomas are benign tumors consisting of mature lipocytes. With an incidence of approximately 10%, they are the most common mesenchymal tumors, occurring in any part of the body.[35] They are often found on the arm and body.[6] Most of them are about 2 cm in diameter, and they rarely grow over 10 cm in cutaneous localizations. Many are asymptomatic, but large tumors can cause compression symptoms.[2] Lipomas have also been seen in organs with no adipose tissue such as lung, liver, uterus, and kidney.[7] Giant lipomas are rarely reported in different parts of the body.[8] The axilla is a rare site for lipomas and giant axillary lipomas are even rarer. Resection is indicated when symptomatic from compression of surrounding neurovascular structures.
There have been a few reports of symptomatic axillary lipomas in five patients with ages ranging from 15 to 70 years who required surgical resection.[1289]
Different imaging studies have been used in diagnosis. Magnetic resonance imaging and ultrasound have been utilized as diagnostic tools in some reports,[18] while a CT scan was diagnostic in our patient. The CT scan showed the soft tissue tumor extending from the axilla to the supraclavicular region, which was subsequently resected through a supraclavicular incision with the resolution of symptoms.
Consideration should be given to resection of giant axillary lipomas even if asymptomatic to prevent subsequent compression on surrounding neurovascular structures and to make a definitive pathological diagnosis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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