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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 1  |  Issue : 1  |  Page : 31-33

Giant lipoma of the breast: Case report and review of literature


1 Department of Surgery, Nnamdi Aziki University Teaching Hospital, Nnewi, Nigeria
2 Department of Surgery, The Institute of Oncology, Nnamdi Aziki University, Nnewi Campus, Anambra State, Nigeria

Date of Submission02-Feb-2022
Date of Acceptance30-Mar-2022
Date of Web Publication30-Aug-2022

Correspondence Address:
Odili A Okoye
Department of Surgery, Nnamdi Aziki University, Awka, Anambra State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jnam.jnam_2_22

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  Abstract 

Despite the high proportion of adipose tissues in the mature female breast, lipomas arising from the female breast are very rare lesions with a very small number being reported in the scientific literature. Giant lipomas measuring greater than 10 cm in diameter or weighing more than 1 kg are even rarer. Lipomas of the breast may mimic other breast lesions such as phyllodes tumor or mammary hyperplasia, and long neglected cases might also have significant skin changes from pressure mimicking malignancy and creating a diagnostic dilemma. Imaging studies are not usually diagnostic. Detailed clinical examination, followed by complete excision of the mass, can be both diagnostic and also serve as a treatment modality. We present a 50-year-old trader with an 8-year history of slowly growing and discomforting right breast mass with unclear preoperative diagnosis resolved at surgery and at histological examination.

Keywords: Breast, Excision biopsy, Giant lipoma


How to cite this article:
Okoye OA, Obiesie AE, Azubuike IR, Ihekwoaba EC, Anyanwu SN. Giant lipoma of the breast: Case report and review of literature. J Niger Acad Med 2022;1:31-3

How to cite this URL:
Okoye OA, Obiesie AE, Azubuike IR, Ihekwoaba EC, Anyanwu SN. Giant lipoma of the breast: Case report and review of literature. J Niger Acad Med [serial online] 2022 [cited 2023 Feb 6];1:31-3. Available from: http://www.jnam.com/text.asp?2022/1/1/31/354768




  Introduction Top


Benign breast diseases are heterogeneous group of lesions with varying presenting features.[1] Lipomas of the breast are usually solitary benign lesions that are composed of mature fat cells. They develop in areas of abundant fat cells.[2] Although about 16% of all mesenchymal tumors are lipomas,[3] they very rarely occur in the breast. A 5-year review of breast lumps in our center did not reveal any case of breast lipoma.[4] In other parts of the body, lipomas commonly occur in adults aged between 40 and 60 years and usually present as nontender well-circumscribed masses that are soft, doughy to touch, and freely mobile under the skin. They may be solitary or multiple. When lipomas occur in the breast, they may not feature high on the list of differential diagnosis because of their rarity. The clinical and radiological identification is quite challenging because of the absence of clear features.[5] A vast majority of breast lipomas grow slowly.[6] Most patients are usually anxious and concerned about the evolving asymmetry, whereas clinicians are more worried of possible malignant transformation. Giant lipomas classified as lipomas weighing more than 1000 g and with a widest diameter of at least 10 cm are exceedingly rare.[7] They are usually asymmetric with clinical signs and symptoms that may mimic other breast conditions. Diagnosis is aided by detailed clinical examination and radiological investigations, while confirmation is by histology.[8] The treatment of giant lipomas is by complete surgical excision.[9] Suction-assisted lipectomy and liposuction are effective treatment options for smaller lipomas as well.[10]


  Case Report Top


A 50-year-old woman presented to the clinic, with an 8-year history of the right breast lump that has progressively increased in size. It was initially the size of her big phalanx, but presently has grown to a size twice her head. There was no breast pain, but she felt worsening heaviness and discomfort in the right breast. There was no nipple discharge. She attained menarche at age 16 and had her first live birth at age 18. She has six children and breastfed each for an average of 12 months. The last confinement was 19 years prior to her presentation. She is 3 years postmenopausal and not on hormone replacement therapy. No past history of breast lump, breast biopsies, or breast irradiation. No family history of breast or prostate diseases. She takes alcohol occasionally but does not take tobacco in any form. She gave a history of the right breast trauma as she was hit by the husband 2 years prior to the onset of the symptoms. Physical examination revealed a middle-aged woman in emotional distress. Breast examination revealed an asymmetric and nontender right breast with a huge mass in the upper quadrants and displacing the nipple-areolar complex inferolaterally. There was an area of skin involvement with some ulceration medially [Figure 1]A and B.
Figure 1: (A) and (B) Huge right breast mass occupying the upper quadrants with displaced nipple-areolar complex

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The mass was irregular and measured 22 × 21 cm with a mostly normal overlying skin. There was no attachment to the skin or chest wall. However, there was an area of skin necrosis. There was a solitary nontender, firm, mobile, and discrete ipsilateral axillary lymph node. The left breast was essentially normal.

Breast ultrasound showed edema with a focal poorly defined mass between the 2 and 3 o’clock position of the right breast, a right axillary lymph node, associated with a displaced hilum. The sonologists suggested a diagnosis of inflammatory breast carcinoma [BIRADS 5 category]. Mammogram showed large ill-defined area of architectural distortion of the right breast without microcalcifications with BIRADS 4C category diagnosis. Computerized tomography, magnetic resonance imaging (MRI), and PET scan were not available at the time of study. An 18-gauge corecut biopsy revealed traumatic fat necrosis. Other laboratory investigations were all within normal limits.

At surgery, the examination of the nonskin-involved areas demonstrated clear slipping sign suggesting lipoma. She had complete surgical excision of a huge well-encapsulated mass occupying almost the entire quadrants of the right breast and displacing the nipple-areolar complex [Figure 2]. The breast was reconstructed with good healing [Figure 3]. Enucleated mass measured 4.5 kg. The histology of enucleated tissue revealed lipoma of the right breast. She was discharged on the second postoperative day. She had good wound healing and has been followed up without complaints.
Figure 2: Resected giant lipoma of the right breast

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Figure 3: After reconstruction of the right breast

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  Discussion Top


Lipomas of the breast are very rare and can present a diagnostic challenge because of the similarity in consistency of these lumps to the normal breast parenchyma.[11] They are usually slow-growing and cause palpable anxiety to the patient as they grow larger. Most patients present to the hospital late, as early identification is difficult especially when the lump cannot be easily distinguished from normal breast tissue.[12] The preservation of breast contour is consistent with a fatty tumor, but also characteristic of the hypertrophic breast.

Rosen has divided breast lipomas into hibernomas composed of brown fat and fibrolipomas composed of mature adipose tissue and collagenous seroma.[13] Giant lipomas may be difficult to differentiate from phyllodes tumor and from giant galactoceles or giant fibroadenoma. Degenerative changes may mislead the radiologist to consider malignancy as diagnostic options. Interestingly, a history of domestic trauma and needle corecut histological diagnosis of breast fat necrosis may further confuse the unwary clinician. Of course, giant long-standing lipomas with pressure skin changes may also have areas of fat necrosis. Computed tomography and MRI may be of diagnostic aid if available. Several studies have described the difficulty of diagnosing these masses using routine imaging and biopsy techniques.

Lipomas can also enlarge in response to hormonal stimulation, mimicking benign breast hypertrophy. Breast reconstruction usually follows the excision of giant breast lipomas as in our case. A few other cases of giant breast lipoma have been reported in the literature. Rodriguez et al.[14] reported a giant breast lipoma of 1200 g in a 28-year-old woman. This was the largest in their series, necessitating the use of de-epithelialized dermoglandular flap in breast reconstruction. Gupta et al.[15] reported that only six cases of giant lipomas have been reported in the world literature till date, with theirs measuring 19 × 16 × 10 cm and weighing 1647 g and necessitating a reduction mammoplasty. Olivier and Hof[16] reported a case of a 35-year-old man with a giant lipoma weighing 1670 g and measuring 24 × 20 × 6 cm with resultant nipple reconstruction using a cranial dermal pedicle. We may have reported the largest breast lipoma of 4500 g in the index case, with complete surgical excision and satisfactory postoperative results.


  Conclusion Top


Giant lipomas, though a rare lesion of the breast, are an important differential diagnosis in patients with a history of slow-growing breast lumps. Clinical and radiological assessments are seldom satisfactory in the diagnosis. Trucut biopsies may miss the diagnosis as well; hence, a high index of suspicion is mandatory in evaluation. The treatment remains complete surgical excision.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Guray M, Sahin AA Benign breast diseases: Classification, diagnosis, and management. Oncologist 2006;11:435-49.  Back to cited text no. 1
    
2.
Ramírez-Montaño L, Vargas-Tellez E, Dajer-Fadel WL, Espinosa Maceda S Giant lipoma of the breast. Arch Plast Surg 2013;40:244-6.  Back to cited text no. 2
    
3.
Lanng C, Eriksen BØ, Hoffmann J Lipoma of the breast: A diagnostic dilemma. Breast 2004;13:408-11.  Back to cited text no. 3
    
4.
Egwuonwu OA, Anyanwu SNC, Chianakwana GU, Ihekwoaba EC Breast lumps at NAUTH, Nnewi—A five year review. Niger J Surg 2009;15:6-9.  Back to cited text no. 4
    
5.
Donegan WL Common benign conditions of the breast. In: Donegan WL, Spratt JS, editors. Cancer of the Breast. 5th ed. Philadelphia, PA: Saunders; 2002. p. 67-74.  Back to cited text no. 5
    
6.
Jorwekar GJ, Baviskar PK, Sathe PM, Dandekar KN Giant chondroid lipoma of the breast. Indian J Surg 2012;74:342-3.  Back to cited text no. 6
    
7.
Serpell JW, Chen RY Review of large deep lipomatous tumours. ANZ J Surg 2007;77:524-9.  Back to cited text no. 7
    
8.
Eni UE, Isikhuemen ME Case report of giant breast lipoma. Niger Health J 2020;20:76-9.  Back to cited text no. 8
    
9.
Vandeweyer E, Scagnol I Axillary giant lipoma: A case report. Acta Chir Belg 2005;105:656-7.  Back to cited text no. 9
    
10.
Nichter LS, Gupta BR Liposuction of giant lipoma. Ann Plast Surg 1990;24:362-5.  Back to cited text no. 10
    
11.
Balsarkar DJ, Suryawanshi SA, Shaikh M, Dhoble S Giant lipoma of the breast—A diagnostic dilemma. Int Surg J 2021;8:752-4.  Back to cited text no. 11
    
12.
Hall FM, Connolly JL, Love SM Lipomatous pseudomass of the breast: Diagnosis suggested by discordant palpatory and mammographic findings. Radiology 1987;164:463-4.  Back to cited text no. 12
    
13.
Rosen PP Rosen’s Breast pathology. Philadelphia, PA: Lippincott-Raven Publishers; 1997. p. 652-709.  Back to cited text no. 13
    
14.
Rodriguez LF, Shuster BA, Milliken RG Giant lipoma of the breast. Br J Plast Surg 1997;50:263-5.  Back to cited text no. 14
    
15.
Gupta S, Chattopadhyay D, Gupta S, Agarwal A, Guha G Gigantomastia due to retromammary lipoma: An aesthetic management. Breast Dis 2017;37:33-7.  Back to cited text no. 15
    
16.
Olivier G, Hof K Giant lipoma of the male breast: Case report and review of literature. Eur J Plast Surg 2012;35:407-9.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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