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Patient Case: Lipoma

Patient Case: Lipoma

Discussion

A 45-year-old man presents to his physician with a soft, painless lump on his upper left arm that he first noticed two years ago. The lump has grown slowly over time but has never caused pain, redness, or drainage. He denies any recent trauma or other skin abnormalities.

On examination, a 3 cm, soft, mobile, and well-defined subcutaneous mass is palpable. The overlying skin is normal, and there is no tenderness or signs of infection. The physician reassures the patient that the mass is most likely a lipoma, a benign fatty tumor. Since it is asymptomatic, the patient is advised that no treatment is necessary unless it becomes painful or grows significantly, in which case surgical excision can be considered.

Questions
  1. What is the most likely diagnosis for this patient’s subcutaneous mass?
    a) Liposarcoma
    b) Epidermoid cyst
    c) Lipoma
    d) Abscess
  2. Which of the following best describes the typical characteristics of a lipoma?
    a) Hard, fixed, rapidly growing mass with overlying skin ulceration
    b) Soft, mobile, slow-growing, and painless mass
    c) Tender, fluctuant mass with erythema and purulent discharge
    d) Rough, scaly, hyperpigmented lesion with irregular borders
  3. What is the most appropriate management for an asymptomatic lipoma?
    a) Immediate surgical excision
    b) Observation unless it becomes painful or grows significantly
    c) Incision and drainage with antibiotic therapy
    d) Topical steroid application
  4. Which of the following features would raise suspicion for a malignant transformation of a lipoma?
    a) Slow growth over several years
    b) Soft, mobile texture with well-defined borders
    c) Rapid enlargement, firmness, and fixation to underlying tissues
    d) Presence of multiple, small, painless subcutaneous nodules
Reveal answers

Answers

  1. (c) Lipoma
    • The patient’s soft, mobile, slow-growing, and painless subcutaneous mass is characteristic of a lipoma, a benign fatty tumor. Unlike a liposarcoma, it does not grow rapidly or invade surrounding tissues.
  2. (b) Soft, mobile, slow-growing, and painless mass
    • Lipomas are typically soft, well-circumscribed, and mobile, differentiating them from abscesses (tender, fluctuant) and malignant tumors (hard, fixed, rapidly growing).
  3. (b) Observation unless it becomes painful or grows significantly
    • Lipomas are benign and require no treatment unless they cause discomfort, restrict movement, or grow rapidly, in which case surgical excision may be considered.
  4. (c) Rapid enlargement, firmness, and fixation to underlying tissues
    • A sudden increase in size, firmness, and fixation raises concern for liposarcoma, a rare malignant soft tissue tumor, requiring biopsy and further evaluation.