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CASE REPORT
Year : 2013  |  Volume : 40  |  Issue : 2  |  Page : 109-110

Lipoma disseminatum


1 Department of Medicine, Lady Hardinge Medical College and Smt.S.K.Hospital, New Delhi, India
2 Department of Medicine/Preventive Cardiology, Hamdard Institute of Medical Sciences and Research and HAH Centenary Hospital, Jamia Hamdard, (Hamdard University), New Delhi, India

Date of Web Publication23-Jul-2013

Correspondence Address:
Ramesh Aggarwal
Department of Medicine, Lady Hardinge Medical College and Smt.S.K.Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-5009.115484

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  Abstract 

A middle aged male patient came with multiple swellings over his body which were gradually increasing in number. He was asymptomatic for any other disease and was worried for cosmetic reasons. His examination was unremarkable except xanthelesma on all of his four eyelids and multiple swellings of varying size all over his body. His blood investigations including lipid profile, ECG and X-ray chest were normal. As this patient had xanthelesma it was presumed that the swellings on other parts of his body were a part of the same etiology namely xanthomas. However FNAC of the swellings surprisingly proved it to be lipoma. This case reports an uncommon distribution of lipomas all over the body in the presence of xanthelesma.

Keywords: Lipoma, xanthelesma, xanthoma


How to cite this article:
Aggarwal R, Dwivedi S. Lipoma disseminatum. J Sci Soc 2013;40:109-10

How to cite this URL:
Aggarwal R, Dwivedi S. Lipoma disseminatum. J Sci Soc [serial online] 2013 [cited 2019 Sep 16];40:109-10. Available from: http://www.jscisociety.com/text.asp?2013/40/2/109/115484


  Introduction Top


Lipomas are benign tumors which resemble Xanthomas morphologically. Although they are benign and may not be frequently associated with life threatening risk, they often cause disfigurement to the indivisual. Xanthomas vary in their clinical manifestations sometimes occurring as lipid deposits encircling eyelids and sometime growing to big lemon shaped swellings all over body. This case had Xanthelasma encircling his lids but unusually associated with presence of multiple lipomas spread all over his body. The morphological similarity between the xanthoma and lipoma was deceptive till Fine Needle Aspiration Cytology proved it to be lipoma rather than xanthoma.


  Case Report Top


A 50-year-old male came with multiple swellings over his body since last 20 years which were gradually increasing in number. He was non tobacco user, non-alcoholic with Body Mass Index (BMI) 27.73. He was asymptomatic for any other disease and was worried for cosmetic reasons. His examination was unremarkable except xanthelesma on all of his four eyelids [Figure 1] and multiple swellings of varying size and shape all over his body [Figure 2]. Investigations revealed Fasting Blood Sugar (FBS) 80 mg/dL, total cholesterol 250 mg/dL, triglycerides 197 mg/dL, Low density lipoprotein (LDL) 177 mg/dL, and High-density lipoprotein (HDL) 32 mg/dL. His electrocardiography (ECG) and X-Ray chest were normal. Fine needle aspiration cytology (FNAC) of the swellings showed it to be a lipoma.
Figure 1: Xanthelesma encircling all four lids

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Figure 2: Lipoma disseminatum

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  Discussion Top


As this patient had xanthelesma, it was presumed that the swellings on other parts of his body were a part of the same etiology namely xanthomas. However, FNAC of the swellings surprisingly proved it to be lipoma. [1],[2] Lipomas are frequently diagnosed benign tumors which are composed of mesenchymal preadipocytes. [3] These lesions although resemble xanthomas both morphologically and histopathologically, they are unlike xanthomas which consist foamy cells and Touton giant cells without an inflammatory or histiocytic component. [4] Xanthomas are classified into various subtypes depending on the location on the body where they are present. Examples: Xanthelasma palpebrum on eyelids, tuberous xanthomas around the pressure areas such as the knees, elbows, heels, and buttocks, tendinous xanthomas found along tendons or ligaments, eruptive xanthomas distributed over shoulders, buttocks, arms, and legs and eruptive xanthomas usually spread all over the body. Xanthomas [5],[6] may be associated with hyperlipidemia and increased risk of cardiovascular diseases in some patients. [7] Lipomas may contain different mesenchymal tissues and are classified as ossifying lipomas, myelolipomas, myxolipomas, chondrolipomas, angiolipomas, and fibrolipomas. Various factors including genetic, traumatic, and metabolic have been linked for causing lipomas. They have also been associated with various metabolic and endocrine disorders like hyperlipidemia, diabetes, thyroid dysfunctions, and Cushing syndrome. [8],[9],[10] The treatment of xanthelesma includes control of dyslipidemia, application of topical trichloroacetic acid, electrodesiccation, laser vaporization, and sometimes, excision. Surgical excision with complete removal of surrounding capsule is needed for large lipomas for cosmetic reasons. Liposuction is another option where the tumor, which is sometimes away from the actual site, is removed via small incision.


  Conclusion Top


This case is a unique case where multiple swellings were diagnosed as lipoma. It is not uncommon to find xanthoma disseminatum but rare to find lipoma disseminatum.


  Acknowledgement Top


We are thankful to Dr. Sabina Khan and Dr. Zeeba S. Jairajpuri, Asssitant Professor, Department of Pathology, HIMSR for their contributions in tissue diagnosis.

 
  References Top

1.Heymans O, Adant JP, Fissette J. Lipoma, multiple lipomas and lipomatosis. Rev Med Liege 1998;53:21-4.  Back to cited text no. 1
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2.Pascucci A, Lynch PJ. Lipedema with multiple lipomas. Dermatol Online J 2010;16:4 .  Back to cited text no. 2
    
3. Phalen GS, Kendrick JI, Rodriguez JM. Lipomas of the upper extremity: A series of fifteen tumors in the hand and wrist and six tumors causing nerve compression. Am J Surg 1971;121:298-306.  Back to cited text no. 3
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4.Bundino S, Zina AM, Aloi F. Papular xanthoma. Clinical, histological and ultrastructural study. Dermatologica 1988;177:382-5.  Back to cited text no. 4
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5.Pedace FC, Winkelmann RK. Xanthelasma Palpebrarum. JAMA 1965;193:893-894.  Back to cited text no. 5
    
6.Pandhi D, Gupta P, Singal A, Tondon A, Sharma SB, Madhu SV, et al. Xanthelasma palpebrarum: A marker of premature atherosclerosis (risk of atherosclerosis in xanthelasma). Postgrad Med J 2012;88:198-204.  Back to cited text no. 6
    
7.Dwivedi S, Jhamb R. Cutaneous markers of coronary artery disease. World J Cardiol 2010;2:262-9.  Back to cited text no. 7
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8.Weiss SW, Goldblum JR. Benign lipomatous tumors. In: Enzinger FM, Weiss SW, editors. Soft Tissue Tumors. 3 rd ed. St. Louis, MO: Mosby; 1995. p. 381-430.  Back to cited text no. 8
    
9.Sandberg AA. Updates on the cytogenetics and molecular genetics of bone and soft tissue tumors: Lipoma. Cancer Genet Cytogenet 2004;150:93-115.  Back to cited text no. 9
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10.Copcu E, Sivrioglu NS. Posttraumatic lipoma: Analysis of 10 cases and explanation of possible mechanisms. Dermatol Surg 2003;29:215-20.  Back to cited text no. 10
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    Figures

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  In this article
Abstract
Introduction
Case Report
Discussion
Conclusion
Acknowledgement
References
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