Polyarticular lipoma arborescens—a clinical and aesthetical case

Abstract

Lipoma arborescens is a benign tumor, but it may be a reactive process to other disorders, and its clinical, analytical, radiological and ultrasound presentation may be redundant to any synovial tumor. Despite the characteristic feature on magnetic resonance imaging (MRI), the correct differential diagnosis in atypical presentation, and the need for timely removal of the lesion to prevent joint damage, forces, ultimately, to invasive procedures. The clinical case reported here, fourth described in English language publications on the polyarticular form, also presented other specificities related to one of the swellings, in the knee. Because of its atypical location in the popliteal fossa, recurrent episodes of joint effusion, personal history of knee trauma, pulmonary tuberculosis, and family history of rheumatoid arthritis required particular attention. This process was hampered by the refusal of knee (and ankle) surgery by the patient. He accepted surgical removal of the swellings of the wrists, for aesthetical reasons, with pathologic confirmation of the diagnosis, and clinical success in that location. MRI of the knee showed the typical image of lipoma arborescens, but also other changes that compromise the prognosis.

Synovial Lipomatosis of the Glenohumeral Joint

“…It most commonly affects the knee [ 2 ] but rarely affects the hip [ 4 , 5 ], elbow [ 6 , 7 ], wrist [ 8 ], ankle [ 1 , 9 ], tendon sheath [ 2 , 6 ], and shoulder [ 3 , 10 , 11 ]. Although synovial lipomatosis is most commonly a monoarticular condition, several cases of multifocal disease have been reported [ 12 , 13 ].…”

Surgical management of upper limb lipoma arborescens: a systematic review

“…All patients had single lesion; one has a bilateral presentation [ 26 ]. Eleven lesions (50%) were located in the shoulder [ 1 – 3 , 22 , 24 , 28 , 30 , 32 , 33 , 35 , 36 ], seven (31.82%) in the elbow [ 13 , 23 , 25 , 26 , 29 , 34 ], and four (18.18%) in the wrist [ 14 , 27 , 31 , 37 ]. All patients but one had preoperative MRI scans during the diagnostic assessment [ 27 ].…”

Lipoma arborescente, tumor poco frecuente como causa de sinovitis extensora de la mano

“…La mayor parte de los casos encontrados han sido lipomas arborescentes localizados en articulaciones grandes, siendo la más frecuente la vaina sinovial de la rodilla en la región suprapatelar 8,9 . La mayoría de las veces se presenta de manera aislada 3,10 , aunque a veces puede hacerlo de manera atípica sincrónica 11 y poliarticular (tobillo, rodilla y muñeca) 5,6 . Típicamente, se presenta en adultos, aunque hay casos descritos en niños 12 .…”

“…La patogenia del tumor es desconocida y los antecedentes del paciente poco relevantes. Sin embargo, se ha relacionado con trastornos articulares crónicos degenerativos, artritis reumatoide, artritis psoriásica, diabetes mellitus 3 , traumatismos repetitivos articulares 4 y tuberculosis pulmonar 5 . Es más prevalente en articulaciones de gran tamaño, sobre todo en el miembro inferior, siendo la articulación de la rodilla la más frecuentemente afectada, por lo general, en forma monoarticular 6 .…”