Do Lipomas Grow Fast?

Lipoma is a cluster of fat cells, which have become overactive and distended with fat, therefore have become palpable as lumps. Lipoma is a quite common subcutaneous, non-cancerous lump. They can occur anywhere in the body, but commonly seen on the shoulders, arms, chest, neck, back and the upper thighs. They usually grow slowly for months or years before being noticed. They rarely regress. Usually the size of a lipoma is less than 2 cm. Lesions larger than 5 cm are called giant lipomas and these large lipomas can occur at any place in the body, but it is commonly seen in the upper extremity.

Even though usually lipomas grow slowly there are some cases reported of lipomas growing fast and becoming giant lipomas in a very short period. Let us see what are these cases and if any precipitating of risk factors were identified for this fast growing lipomas.

A 56-year-old man presented with a rapidly increasing, large, painless soft swelling on the third toe of his right foot. The lesion involved the whole outer side of the third toe and the web space between the third toe and the fourth toe. The lesion was about 10 cm in diameter. It was a subcutaneous lesion and the overlying skin was stretched. There was no history of trauma. The lesion has started as a small swelling on the third toe and it was there for about 3 years without any increase in the size. The patient has noticed the lesion grew rapidly to the present size in about 3 weeks. Because of the size the patient had difficulty in wearing normal footwear. It was removed surgically and the histological report confirmed it as a benign lipoma.

A 72-year-old man presented with a large lesion on the back, which prevented from him lying down in supine position, caused difficulty in sitting in a straight position and dressing. Because of the physical appearance, he has avoided going outside as well. He was diagnosed with a lipoma 10 years back and he has not undergone any surgery as the lipoma was small and it did not cause any trouble. However, the lesion has rapidly enraged in the past 2 years. He has no family history or any other medical problems.

Physical examination revealed a lesion in the center of the back extending from the neck to the waist. It had distinct contours and thickened skin on the surface. Ultrasound revealed a lipoma-like lesion, which measured 34 × 20 × 17 cm and was sharply contoured, homogenous, and isoechoic with subcutaneous fat tissue and that possibly contained fat necrosis (fat cell death) related to two calcifications (3 and 2 cm in size, respectively). It was surgically removed and histology confirmed it to be a lipoma.

There were eight cases with rapidly growing lipomas, which turned into giant lipomas of the upper extremity. There were four females and four male patients who were observed and evaluated from 2003 to 2007 in USA. The patients’ age ranged from 15 to 70 years and the tumors ranged from 14 cm ×12 cm × 2 cm to 5 cm × 4 cm × 2 cm in size. Seven cases recalled of trauma before the rapid growth of the tumor. Each patient underwent excision of the lesion and the histopathology reports revealed seven cases were benign lipomas, one case of liposacrcoma (a cancer that arises in fat cells in deep soft tissue).

Lipomas usually grow at a very slow rate and the cause for the fast growth into giant lipomas is still a matter of debate. It has been suggested that blunt trauma can cause rupture of the fibrous septa and create a connection between the skin and deep fascia allowing the fat tissue to proliferate. This can cause the accelerate growth of the lipoma. Even though some patients deny trauma there must have been some sort of trauma in that area, which the patient can’t remember as even a small injury can cause this. However, exact cause for this rapid growth is unknown, but there are several cases reported of this.

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