Can Lipomas be Painful?
Lipomas are usually not painful. Lipoma is a cluster of fat cells seen in the subcutaneous tissue. Most of the patient does not even notice a lipoma until it grows into a considerable size. This is because it does not cause any pain or discomfort if it’s not in an area affecting the movement of the body.
When Will a Lipoma be Painful?
If a lipoma involves with the deep structures such as the muscles, nerves, blood vessels then it can cause pain with rest or movement.
There is also a type of lipoma called angiolipoma which involves the blood vessels and it’s very painful.
What is an angiolipoma? Angiolipoma is a less common type of lipoma; 5 to 17% of all lipomas are usually angiolipomas. Like the name suggests this lipoma involves blood vessels hence named as angiolipoma. The lumps usually arise after puberty and common in males, in the age group of 20 to 30 years. It’s also a benign (non-cancerous) lump.
Angiolipomas can occur in deeper structures, where they are called intramuscular hemangiomas
Causes of Angiolipoma
The exact cause is unknown; however, possible causes might be
- Genetics – if you have a family history of angiolipoma you are at increased risk of getting it too
- Local Injury – angiolipoma can occur at sites with blunt trauma
- Diabetes – it’s seen that diabetic patients are more prone to get angiolipoma
- A lump will be present.
- It is more painful than any other types of lipoma.
- Gastrointestinal angiolipomas can cause stomach pain, bleeding, even intestinal obstruction if the lesion is large. This is quite rare.
- Spinal angilipomas can cause pain, difficulty in walking and urinating according to the level of spinal involvement. This is also rare.
It looks similar to the typical lipoma (subcutaneous lipoma)
- Site – commonly seen on the forearms, upper arms and the trunk.
- Size and Shape – spherical or hemispherical in shape, size varies from.
- Surface – soft to touch, smooth surface, size varies from 1 cm to 4 cm. usually the lump is less than 4 cm.
- Edge – edges are irregular corresponding to each lobule. Because the edge is soft, compressible and thin it slips away from your fingers when you try to hold the lump.
- Local Tissue – multiple angiolipomas can be in the surrounding tissue.
Differential Diagnosis of Lipoma
Other types of lipoma: Liposarcoma – Liposarcoma is a rare type of cancer that begins in the fat cells. It is considered as a type of soft tissue sarcoma. Usually it is not noticeable until it is quite large, usually not painful. If it starts growing fast it can be painful. Commonly seen in the limbs and the abdomen. When a lipoma is suspected the important condition to rule out is liposarcoma. If you get any pain, swelling in the lump, weakness in the limbs or abdominal pain or bleeding you should consult a doctor immediately.
It is diagnosed by
- Complete history and physical examination.
- Radiographic studies – MRI or CT scan.
- Tissue biopsy – this is done mainly to rule out liposarcoma and any other malignancies. This will give a definitive diagnosis of angiolipoma.
If the pain is minimum and no other symptoms you can approach the conservative treatment. Medications to reduce the pain can be given. However, regular checkups should be done to identify any change in the lump.
If the pain is severe or any other symptoms present the angiolipoma should be surgically removed completely. If not there is a chance of recurrence.
Usually the typical subcutaneous lipomas are not painful. It can be painful if it involves with the underlying deep structures such as the muscles, nerves or blood vessels. This one type of lipoma called angiolipoma, which involves with the blood vessels is very painful. It is seen commonly in males who are in the age group of 20 to 30 years. It is a benign growth and the exact cause is unknown. The lump is similar to lipoma the difference is it is painful. Diagnosis can be made by examination, radiological investigations and tissue biopsy. Tissue biopsy is done to rule out the possibility of liposarcoma which is a cancer. Treatment is usually conservative, but can be surgically excised if there is severe pain or other symptoms or for cosmetic reasons.
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