Lipoma: Causes, symptoms, diagnosis and removal

What is lipoma?

A lipoma is caused due to growth of fat cells under the skin. Lipomas are usually considered benign (non-tumorous). It can occur anywhere in the body where there is deposition or growth of fat cells.

Lipomas should be removed when it causes unnecessary complications and pain. Most people remove lipoma due to cosmetic reasons.

Lipomas can appear on any body part. However, the growth is commonly found in the trunk, neck, chest, armpits and thighs. The growth of lipomas can also occur in bones, muscles and internal organs. However, lipoma growth in these parts is rare.

The presence of lipoma usually feels soft, and when you touch them, it moves away slightly under the skin. The growth of lipoma is usually slow, which can take about months to years. The size of lipoma will usually be 2-3 cm. In rare cases, giant lipoma growths can be seen, which grow more than 10 cm.

According to NCBI, one in thousand people will have lipoma at some point of time in their life. The cause of lipoma is still unknown. There is a hypothesis that states trauma can induce cytokine release, which can trigger preadipocyte maturation and differentiation.

Additionally, genetics is also linked to the formation of lipoma. Accordingly, 2–3% of the affected people have an inherited lesion in a familial pattern. Another report by NCBI states that males are more susceptible to lipoma when compared to females. They can occur at any age, but the common occurrence is reported to be during the fourth to sixth decades of life.

Causes of lipoma

The cause of lipoma is still unclear. The benign lipoma can affect any part of the body. If a person in the family is affected by lipoma, there are chances that it can be inherited.

Some health conditions can cause lipoma. The conditions that cause lipoma are listed below.

• Dercum’s disease

Dercum’s disease is characterised by the painful growth of fatty tissues. These growths are seen in multiple areas and are considered rare disorders. This kind of lipoma usually occurs near the trunk, upper arms and legs.

They are usually found just below the skin, and in rare cases, they can occur deeper in the body coupled to ligaments, muscles, tendons and bones. The pain caused due to Dercum’s disease is usually severe.

• Gardner syndrome

Gardener’s syndrome causes multiple colorectal polyps and is considered a rare condition. According to research, people with Gardener syndrome have an increased risk of getting developing colorectal cancer later in life.

Currently, there is no cure for Gardner syndrome. However, there are medications to manage the pain.

• Madelung’s disease

Madelung’s disease is a disorder that causes an unusual accumulation of subcutaneous fat. Fat deposition is commonly seen around the neck, shoulders, hips, upper arms, thighs and trunk.

The progression of mass can occur over months to years. In some cases, Madelung’s disease can be mistaken for obesity.

Types of lipoma

Lipomas are usually fat cells, and in some cases, lipomas may contain tissues and blood vessels. Some of the common types of lipomas include

• Angiolipoma

Angiolipoma is a benign tumour that grows under the skin. The tumour is usually small and is made of fat cells and blood vessels. This type of lipoma is common in the ’20s and ’30s. Angiolipoma has a genetic cause.

Angiolipoma commonly occurs in the areas of

• Trunk
• Upper arms and
• Forearms

In most cases, angiolipoma will not cause any painful symptoms. However, it can be removed easily if they cause any symptoms.

• Conventional

The common type of lipoma is the conventional type. It is usually well-circumscribed and composed of mature adipocytes. They usually arise from soft tissues, bone surfaces and subcutaneous tissues.

• Fibrolipoma

Fibrolipoma commonly affects the buccal cavity. Fibrolipoma is an intermix of both fibrous components and adipose tissues. Fibrolipoma is commonly seen in people aged between 40-60.

• Hibernoma

Hibernoma is a benign tumour that affects the soft tissues. Hibernoma generates brown fat cells and regulates body temperature.

This kind of lipoma usually affects males, and the peak of the lipoma is seen during the third and fourth decades of life. Hibernoma is caused due to certain mutations.

• Myelolipoma

Myelolipoma usually affects the adrenal glands. Myelolipoma is composed of haematopoietic elements and adipose tissues. In most cases, they are asymptomatic. However, in some cases, it can lead to chronic pain.

• Spindle cells

It is one of the rarest forms of lipoma and slows growing type. They commonly affect males aged between 40-70 years. They are not cancerous, and in most cases, specific treatment will not be required. It affects the neck, shoulders and upper back.

• Pleomorphic

It is a rare neoplasm that affects elderly people. It is a type of spindle cell lipoma. They are usually fat cells and resemble any shape or size.

Symptoms of lipoma

When the lipoma is present in the gastrointestinal tract, it appears as submucosal fatty tumour.

The lipoma that affects the gastrointestinal tract becomes symptomatic when bleeding or luminal abstraction. When there is mucosal erosion due to lipoma, severe bleeding in the bowel is also seen.

Lipomas are usually seen just under the skin and occur near the neck, back, shoulders, thighs and arms. When we touch them, they will be able to move easily to some extent.

They are generally small in size and less than 5 cm in diameter. However, they can grow more than 5 cm up to 10 cm. In most cases, they are not painful. However, in some cases, they can be painful and requires treatment.

Diagnosis of lipoma

The primary step of diagnosis will be a physical examination. The doctor will examine your lipoma by touching it. The pain factor will also be tested. A tissue biopsy will also be required to confirm that the lipoma is benign.

A small sample of the tissue will be removed and sent to the laboratory and tested for the cancerous nature of the tissue.

A CT scan and MRI will also be required to confirm whether it is a lipoma or a cyst. In some cases, cysts are mistaken for lipoma and vice versa.

These imaging techniques will also help to determine the exact location of the lipoma and how deep the lipoma has been rooted. Whether it has affected any of the blood vessels and muscles will also be tested.

Risk factors of lipoma

Lipomas affect males more when compared to females. People aged between 40 to 60 are prone to lipoma formation. Anyone can get lipoma. However, lipomas can be transferred genetically.

Physical activity may also play a role in lipoma formation. Being physically inactive increases the risk of lipoma formation.

Can lipoma be removed?

Most lipomas can be removed with the help of surgery. In most cases, they are removed for cosmetic reasons.

Lipomas do not cause any pain or discomfort. However, if it causes pain, it should be removed with surgery. After removing the lipomas, there is less or no chance of the lipomas reoccurring.

When they are cut during the surgery, it can cause bruising and scarring. Minimal excision can be less invasive, and bruising and scarring are less.

Liposuction is also used to remove or suck the fatty lump. It requires a needle and a large syringe where the fats will be sucked.

When to consult a doctor?

Consult your doctor when you have symptoms like

• Accumulation of fat cells that cause pain.
• Immovable lump.
• A lump that is growing slowly.
• Swelling that is hot and red colour.

Conclusion

Lipomas are common, and many people choose to live with them. In most cases, it will not cause any discomfort or pain. If it causes pain, consult your doctor and get it removed.

Lipoma removal surgery can be done on the same day, and you can go home. Regrowth of lipoma is less after they get removed. However, it can appear in another spot.

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