intramuskuläres Lipom

Intramuscular lipomas are deep-seated lipomas located within a muscle.

Terminology

Intramuscular lipomas share the term ‘infiltrating lipoma’ with intermuscular lipomas.

Epidemiology

Intramuscular lipomas account for about 1% of all lipomas and occur in all age groups with the most occurring between the 5 to 7 decades of life. There seems to be a female predominance .

Clinical presentation

Patients might present with unspecific swelling of the tumor might be found incidentally. Rare presentations are pain or paresthesias due to nerve entrapment .

Pathology

Intramuscular lipomas consist of mature adipocytes identical to normal adult fatty tissue , the exact etiology remains unclear.

Subtypes
  • infiltrative
  • well defined or circumscribed
Location

They can occur at any anatomical site but are believed to occur mainly in the large muscles of the limbs and the trunk, an exact anatomical distribution, however, has not been established. Intramuscular lipomas of hand and feet are rare though .

Macroscopic appearance

Intramuscular lipomas are usually yellowish are located within muscle and may show a capsule at the extra muscular margin can show interdigitations and muscle fibers passing through .

Microscopic appearance

Mature adipocytes irregularly infiltrate and replace muscle fibers and bundles in the infiltrative type . There is no fatty infiltration of adjacent muscle typically observed in the well-defined or well-circumscribed type.

Radiographic features

Plain radiograph

An intramuscular lipoma can appear as lucency, especially if large and can show radioopaque streaks.

Ultrasound
  • hyperechoic well-defined mass with fine internal echoes or striated appearance due to interdigitations of muscular tissue
CT

Intramuscular lipomas usually show the following features :

  • hypodense soft tissue mass within the musculature
  • typically with Hounsfield measurements in the negative range
  • can show striated appearance
  • can show thick intramuscular septae and interdigitations
  • usually, oval or fusiform shape but can vary
MRI

Usually shows either a fat-containing mass within a muscle, which is isointense to subcutaneous fat in all sequences sometimes with septae. Septae should not enhance avidly however or show nodules . Interlocked or intermingled muscular tissue and fibers can be observed in the infiltrative type . If a capsule is present and found outside the intramuscular lipoma, there should not be muscular fibers in the main mass .

Treatment and prognosis

Treatment depends on tumor size location and symptoms, and include watchful waiting or wide resection.

Differential diagnosis

  • well-differentiated liposarcoma (dumb-bell shaped, should be suspected if septae markedly enhance)

See also