Lipomas: Recognising the Symptoms, Causes, and Best Treatment Methods

Lipomas are benign tumours formed by adipose cells, often surrounded by a thin layer of fibrous tissue. They typically develop in the subcutaneous tissues and appear predominantly on the head, neck, shoulders, and back. They are most frequently observed soft tissue neoplasms in clinical practice. Most of the lipomas grow slowly and are considered harmless unless they present multiple times, which may indicate any syndrome. It is indicated that 1 in every thousand persons will develop lipoma at a certain point in their lifetime.

Types of lipomas

The variants of lipomas include:

• Adenolipoma: This kind of lipoma is well encapsulated, making it a mixture of fat cells and glandular tissue. The lesions are commonly found in the parathyroid glands, the thyroid gland, and the parotid gland. 
• Angiolipoma: It contains fat and blood vessels and is often painful.
• Fibrolipoma: It is formed from the fat and fibrous tissue.
• Spindle cell lipoma: It contains fat cells that are longer than those in traditional lipomas.
• Hibernoma: It is composed of brown fat cells, which burn more calories than white fat cells.

Symptoms

• The clinical features and symptoms of lipoma include
• The feel of a soft oval-shaped lump beneath the skin
• The size of the lump can be 5 to 10cm
• The growth of the lump is slow and painless
• Pain is evident only if the size of the lump increases.
• The symptoms of lipoma become evident depending on the location and size.  

As per experts, most lipomas are benign and do not turn into cancer. If it develops at a deeper plane of the skin, it may not be visible and press the internal organs, causing different symptoms due to the pressure on organs or nerves. For example,  

• If the lipoma is present near the bronchioles, it can cause respiratory distress.  
• The development of a lipoma in the region where pressure can be applied to the bowel can lead to feelings such as nausea, vomiting, or constipation. Though deep lipomas are rare, they may affect body functions, requiring medical attention.

Causes

The exact cause of lipomas is unknown. Below are some of the associated risk factors of lipoma development:

• The incidence of trauma is linked to lipoma formation as injury stimulates the release of cytokines, which then cause fat cells to develop and grow into lipoma.
• Genetics and gene mutation play a role in individuals who are diagnosed with multiple lipomas.
• Genetic syndromes, such as multiple hereditary lipomatosis, Dercum’s disease, and Gardner syndrome, include lipomas as a clinical feature.
• Other underlying conditions for lipoma formation include obesity, hyperlipidaemia, and diabetes mellitus.

Diagnosis

It’s important to rule out other conditions when diagnosing lipomas, as certain lumps resemble lipomas, which may actually be cancerous tumours called liposarcomas. In some cases, lumps can be cysts that are not lipomas and are common in most people in their lifetime. The right diagnosis by a healthcare provider is essential to evaluate the lump type and recommend the treatment plan.  

The doctor will perform a complete physical examination and check the medical history. If the doctor suspects lipomas, he may advise further tests, which include:

• Computer tomography
• Magnetic resonance imaging
• Biopsy

Treatment

Lipomas generally don’t require treatment unless it is bothersome. When there is severe pain or symptoms from the lipoma, the doctor may advise removal for the following reasons:

• It is suspectable to become cancerous
• is aggressive or rapidly growing  
• Manifest symptoms such as pain and discomfort and decrease the quality of life
• Affects with normal body functions
• Feels unpleasant due to cosmetic reasons

Lipoma treatments include:

• Surgical removal: Most lipomas are removed by breaking them. The surgical extract enables the complete removal of lipoma without recurrences. The surgery may be minimally invasive and involves less scarring.
• Intralesional sodium deoxycholate injections: In this method, sodium deoxycholate, which is sometimes mixed with phosphatidylcholine, is administered into the lipoma. This solution aids in the dissolution of the fat cells within the tumour, gradually reducing its size.  
• Intralesional steroid and isoproterenol injections: In this method, steroids are injected into the lipoma along with isoproterenol, a beta-2 adrenergic agonist. This combination works to shrink the lipoma by reducing inflammation and promoting fat breakdown.
• Liposuction: This involves using a needle and a large syringe or a suction device to remove the fatty tissue. Liposuction can be a less invasive option than surgery and may leave minimal scarring.

Conclusion

Lipomas are generally harmless and painless. However, those that are worrisome and cause symptoms that interfere with regular body function require treatment. For any doubts or concerns, seeking a healthcare provider is essential to rule out the cause.