The lipoma is a mesenchymal tumor that occupies the first place in frequency among soft tissue tumors, which varies between 16 to 50%. It represents, in turn, 1% of benign tumors. It usually appears after 20 years of age, being a very rare finding in children. Its greatest presentation in the female sex is cited, which many attribute to the consultation for aesthetic reasons.
What is Sacral Lipoma?
The sacrococcygeal region closes the posterior wall of the lower pelvis and is the site of insertion of muscles and ligaments. It is worth mentioning that sacral lipomas are not very common. They must be qualified as a marker of dysraphism that means that its presence requires discarding an underlying bone and/or neurological abnormality.
The sacral lipoma is asymptomatic masses, symmetrical, slow-growing, of regular shape and rounded to ovoid or discoid, pasty or cystic consistency, usually lobed surface. They have good mobility and can lead to the formation of dimples on the surface when exercising their passive movement. The consistency may increase after the application of ice, a maneuver used on certain occasions to favor its diagnosis. The palpation is painless and when there is a feeling of discomfort, it is due to compression of peripheral nerves or special varieties of the same tumor.
It has also been postulated it’s most common presence in obese individuals, although significant weight loss does not reduce the size of sacral lipomas. They grow slowly or are stationed, but any sudden variation in it must alert doctors to its malignant transformation, an event that is considered very rare. Likewise, its spontaneous regression is extremely infrequent.
By its location, there are distinguished two types of solitary lipoma:
- Cutaneous or superficial whose presentation is, in general, on the back, shoulders, and neck and with less frequency on the arms, buttocks, and thighs.
- Deep: located in different places, such as hands and feet, chest, mediastinum, paratesticular area, perioteal, juxta-articular, etc. They can be in the oral mucosa, although it is not common. In this case, it is located in the gums, tongue, mucosal folds, among others. The diameters they present are variable, although in 80% of the lesions they are less than 5 cm, while the giant sacral lipomas are larger than 25 cm and will be detailed later.
Between 6 and 7% of patients with sacral lipoma have multiple lesions. In the macroscopic study of a surgical piece, experts see that it presents a thin pale-yellow capsule, as well as the lipomatous section cut.
The histological study shows a capped formation, well delimited and formed by lobes of mature adipocytes, between which there are vascular connective septa of little thickness. Sometimes the fatty elements present a clear intranuclear space that not only lacks pathological meaning but its existence has been reported in normal fatty tissue. The size of lipocytes is usually equal to or slightly greater than normal adipocytes. The vascular network is important but its visualization is scarce, given the compression performed by the same cellular components.
Its chemical examination reveals the quantitative differences in relation to common fatty tissue.
The “monotony” of its semiological elements is contrasted with a multiplicity of forms of presentation and histological variations.
- Multiple lipomas
- Multiple lipomatosis (LM)
- Classical or usual.
- Subgaleal: also designated as a subfacial lipoma.
- Periungual and subungual.
- Association with HIV and its treatment.
Syndromes of multiple lipomas: Multiple subcutaneous lipomas, indistinguishable from solitary, but with special clinical interests:
a) Multiple Familial Lipomatosis: It appears between 30 to 60 years, it has an initial stage with moderate pain, which after one to two years disappears as its growth stabilizes, reaching values close to 5 cm in diameter per tumor.
b) Multiple Symmetric Lipomatosis: It predominates in a ratio of 4: 1 and up to 15: 1 in the male sex. Fat deposits have been classified into two types: circumscribed, in the form of a “horse collar” arranged in the neck and shoulder girdle (strikingly there is also reduction of uncommitted adipose tissue) and diffuse, respecting distal extremities, of value to differentiate it of obesity.
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