Abstracts
CONTEXT:
Intramuscular lipomas are benign tumors that infiltrate the muscles.
CASE REPORT:
We describe the case of a 58-year-old female patient with an axillary lump. The lump was a lipoma inside the subscapularis muscle. It is important to differentiate these lesions from liposarcomas and from other diseases that may present as axillary lumps. The most accurate imaging method for differentiating benign lipomatous tumors from liposarcomas is magnetic resonance imaging, but surgical removal of these intramuscular lesions to confirm the diagnosis is recommended.
CONCLUSION:
Intramuscular lipomas are a rare cause of benign axillary lumps and should be considered in making differential diagnoses on axillary masses.
Lipoma; Rotator cuff; Axilla; Diagnosis, differential; Magnetic resonance imaging
CONTEXTO:
Lipomas intramusculares são tumores benignos que infiltram os músculos.
RELATO DE CASO:
Descrevemos o caso de uma paciente de 58 anos com nódulo axilar. O nódulo era um lipoma na intimidade do músculo subescapular. É importante diferenciar essas lesões de lipossarcomas e outras doenças que podem acometer a axila. O método de imagem mais eficaz para diferenciar lesão lipomatosa benigna do lipossarcoma é a ressonância magnética, mas é recomendada a remoção cirúrgica dessas lesões intramusculares para confirmar o diagnóstico.
CONCLUSÃO:
Lipomas intramusculares são causas raras de nódulos axilares benignos e devem ser considerados no diagnóstico diferencial dessas lesões.
Lipoma; Bainha rotadora; Axila; Diagnóstico diferencial; Imagem por ressonância magnética
INTRODUCTION
Intramuscular lipomas are benign tumors that infiltrate the muscles.11. Kind M, Stock N, Coindre JM. Histology and imaging of soft tissue sarcomas. Eur J Radiol. 2009;72(1):6-15. They are larger than superficial lipomas and are most common in the lower extremities and trunk.11. Kind M, Stock N, Coindre JM. Histology and imaging of soft tissue sarcomas. Eur J Radiol. 2009;72(1):6-15. , 2 2. Murphey MD, Carroll JF, Flemming DJ, et al. From the archives of the AFIP: benign musculoskeletal lipomatous lesions. Radiographics. 2004;24(5):1433-66.
We report the case of a 58-year-old patient with a painless axillary lump and discuss possible diagnoses.
CASE REPORT
A 58-year-old woman visited the breast disease clinic of the Public Servants' Social Security Institute of the State of Minas Gerais (Instituto da Previdкncia dos Servidores do Estado de Minas Gerais, IPSEMG) in November 2010 and reported a lump. On clinical examination, she was found to have a left axillary lump with hard consistency, close to the border of the latissimus dorsi muscle. The cytological analysis (using material obtained through an ultrasound-guided procedure) suggested that this was a lipoma. Magnetic resonance imaging (MRI) showed a lesion in the left axilla suggestive of a lipoma inside the subscapularis muscle (Figure 1).
Magnetic resonance imaging. A: T1-weighted axial image; B: T2-weighted coronal image. Arrow, intramuscular lipoma. Asterisk, subscapularis muscle.
In March 2011, the patient underwent surgery to remove the lesion, and the pathological examination confirmed the hypothesis of an intramuscular lipoma (Figure 2), measuring nine centimeters.
DISCUSSION
Intramuscular lipomas are an entity comprising slowly growing benign tumors that
infiltrate the muscles.11. Kind M, Stock N, Coindre JM. Histology and imaging of soft tissue
sarcomas. Eur J Radiol. 2009;72(1):6-15. They have been called infiltrating lipomas. It is important to differentiate
them from liposarcomas and, in the axillae, from other axillary diseases (such as lymph
node infiltration due to malignant, infectious and immunological diseases).33. Copeland EM, McBride CM. Axillary metastases from unknown primary
sites. Ann Surg. 1973;178(1):25-7.
4. de Andrade JM, Marana HR, Sarmento Filho JM, et al. Differential
diagnosis of axillary masses. Tumori. 1996;82(6):596-9.
5. Feigenberg Z, Zer M, Dintsman M. Axillary metastases from an unknown
primary source. Isr J Med Sci. 1976;12(10):1153-8.
-
66. Pangalis GA, Vassilakopoulos TP, Boussiotis VA, Fessas P. Clinical
approach to lymphadenopathy. Semin Oncol. 1993;20(6):570-82. Specifically, in this case, a thorough investigation of the breast was carried
out to rule out carcinoma. Nowadays, the most accurate imaging examination for
differentiating a benign from a malignant lipomatous tumor is magnetic resonance
imaging. Infiltration of the muscle bundles, homogenous appearance, lack of peripheral
capsule and presence of few fine, regular septa distinguish benign lipomas from
liposarcomas.11. Kind M, Stock N, Coindre JM. Histology and imaging of soft tissue
sarcomas. Eur J Radiol. 2009;72(1):6-15.
,
22. Murphey MD, Carroll JF, Flemming DJ, et al. From the archives of the
AFIP: benign musculoskeletal lipomatous lesions. Radiographics. 2004;24(5):1433-66.
,
77. Kransdorf MJ, Bancroft LW, Peterson JJ, et al. Imaging of fatty
tumors: distinction of lipoma and well-differentiated liposarcoma. Radiology.
2002;224(1):99-104.
,
88. Jaovisidha S, Suvikapakornkul Y, Woratanarat P, et al. MR imaging of
fat-containing tumours: the distinction between lipoma and liposarcoma. Singapore Med
J. 2010;51(5):418-23. Surgical removal and histological examination should be performed after imaging
of the lesion, since neither method is infallible.11. Kind M, Stock N, Coindre JM. Histology and imaging of soft tissue
sarcomas. Eur J Radiol. 2009;72(1):6-15.
,
22. Murphey MD, Carroll JF, Flemming DJ, et al. From the archives of the
AFIP: benign musculoskeletal lipomatous lesions. Radiographics. 2004;24(5):1433-66.
,
99. Crim JR, Seeger LL, Yao L, Chandnani V, Eckardt JJ. Diagnosis of
soft-tissue masses with MR imaging: can benign masses be differentiated from
malignant ones?. Radiology. 1992;185(2):581-6.
,
10 10. Berquist TH, Ehman RL, King BF, Hodgman CG, Ilstrup DM. Value of MR
imaging in differentiating benign from malignant soft-tissue masses: study of 95
lesions. AJR Am J Roentgenol. 1990;155(6):1251-5.
We found some case reports in PubMed, Lilacs and Embase, reporting lipomas located in
the rotator cuff (Table 1), but none of them was
located in the subscapularis muscle.1111. Dawson JS, Dowling F, Preston BJ, Neumann L. Case report: lipoma
arborescens of the sub-deltoid bursa. Br J Radiol. 1995;68(806):197-9.
12. Nisolle JF, Blouard E, Baudrez V, et al. Subacromial-subdeltoid
lipoma arborescens associated with a rotator cuff tear. Skeletal Radiol.
1999;28(5):283-5.
13. Hazrati Y, Miller S, Moore S, Hausman M, Flatow E. Suprascapular
nerve entrapment secondary to a lipoma. Clin Orthop Relat Res.
2003;(411):124-8.
-
1414. Benegas E, Ferreiro Neto AA, Teodoro DS, et al. Lipoma arborescens:
caso raro de ruptura do manguito rotador associado à presença de lipoma arborescens
na bursa subacromial-subdeltoidea e glenoumeral [Lipoma arborescens: rare case of
rotator cuff tear associated with the presence of lipoma arborescens in the
subacromial-subdeltoid and glenohumeral bursa]. Rev Bras Ortop.
2012;47(4):517-20.
Case reports retrieved from the review of the medical databases. Search date: February 28, 2013
CONCLUSION
Intramuscular lipomas are a rare cause of benign axillary lumps and should be considered in making differential diagnoses on axillary masses.
Acknowledgements:
The authors thank Elisa Balabram for her review of the manuscript in English
REFERENCES
-
1Kind M, Stock N, Coindre JM. Histology and imaging of soft tissue sarcomas. Eur J Radiol. 2009;72(1):6-15.
-
2Murphey MD, Carroll JF, Flemming DJ, et al. From the archives of the AFIP: benign musculoskeletal lipomatous lesions. Radiographics. 2004;24(5):1433-66.
-
3Copeland EM, McBride CM. Axillary metastases from unknown primary sites. Ann Surg. 1973;178(1):25-7.
-
4de Andrade JM, Marana HR, Sarmento Filho JM, et al. Differential diagnosis of axillary masses. Tumori. 1996;82(6):596-9.
-
5Feigenberg Z, Zer M, Dintsman M. Axillary metastases from an unknown primary source. Isr J Med Sci. 1976;12(10):1153-8.
-
6Pangalis GA, Vassilakopoulos TP, Boussiotis VA, Fessas P. Clinical approach to lymphadenopathy. Semin Oncol. 1993;20(6):570-82.
-
7Kransdorf MJ, Bancroft LW, Peterson JJ, et al. Imaging of fatty tumors: distinction of lipoma and well-differentiated liposarcoma. Radiology. 2002;224(1):99-104.
-
8Jaovisidha S, Suvikapakornkul Y, Woratanarat P, et al. MR imaging of fat-containing tumours: the distinction between lipoma and liposarcoma. Singapore Med J. 2010;51(5):418-23.
-
9Crim JR, Seeger LL, Yao L, Chandnani V, Eckardt JJ. Diagnosis of soft-tissue masses with MR imaging: can benign masses be differentiated from malignant ones?. Radiology. 1992;185(2):581-6.
-
10Berquist TH, Ehman RL, King BF, Hodgman CG, Ilstrup DM. Value of MR imaging in differentiating benign from malignant soft-tissue masses: study of 95 lesions. AJR Am J Roentgenol. 1990;155(6):1251-5.
-
11Dawson JS, Dowling F, Preston BJ, Neumann L. Case report: lipoma arborescens of the sub-deltoid bursa. Br J Radiol. 1995;68(806):197-9.
-
12Nisolle JF, Blouard E, Baudrez V, et al. Subacromial-subdeltoid lipoma arborescens associated with a rotator cuff tear. Skeletal Radiol. 1999;28(5):283-5.
-
13Hazrati Y, Miller S, Moore S, Hausman M, Flatow E. Suprascapular nerve entrapment secondary to a lipoma. Clin Orthop Relat Res. 2003;(411):124-8.
-
14Benegas E, Ferreiro Neto AA, Teodoro DS, et al. Lipoma arborescens: caso raro de ruptura do manguito rotador associado à presença de lipoma arborescens na bursa subacromial-subdeltoidea e glenoumeral [Lipoma arborescens: rare case of rotator cuff tear associated with the presence of lipoma arborescens in the subacromial-subdeltoid and glenohumeral bursa]. Rev Bras Ortop. 2012;47(4):517-20.
Publication Dates
-
Publication in this collection
2014
History
-
Received
14 May 2013 -
Accepted
31 July 2013