Surgery Is Not Always Necessary in Intraosseous Lipoma

Abstract

Intraosseous lipoma is the rarest primary bone tumor, is usually asymptomatic, and is often discovered incidentally during unrelated investigations. Lipomas usually undergo varying degrees of involution, with necrosis, cyst formation, and calcification. Careful radiological-pathological correlation is required to avoid misinterpretation. This study describes 12 intraosseous lipomas in 11 patients (6 men, 5 women; mean age, 36 years [range, 25-50 years]; mean follow-up, 5 years [range, 2-11 years]). The lesions were located in the calcaneus in 7 patients (bilaterally in 1 patient), the tibia in 2, the femur in 1, and the ilium in 1. All lesions were asymptomatic and discovered incidentally except in 4 patients (5 lesions). Curettage and bone grafting were performed after biopsy in 4 lesions; and in 1 patient, curettage, bone grafting, and reconstructive surgery were performed after pathologic fracture. The remaining 7 patients were followed up conservatively. Although definite diagnosis of an intraosseous lesion is possible only by histopathologic examination, computed tomography and magnetic resonance imaging findings of intraosseous lipoma are typical, and most patients' symptoms are relieved by conservative means. For this reason, we believe that in patients with no signs of an impending pathologic fracture or suspicion of malignancy, clinical and radiological follow-up is sufficient. However, since intraosseous lipoma is an uncommon bone tumor, physicians should be familiar with the radiological features of this lesion for the correct diagnosis.

Lipoma intraóseo en la región esfenoclival: Reporte de un caso y revisión de la literatura

“…En casos dudosos, se puede realizar una RM y así caracterizar mejor la lesión 11 . Si se concluye que los hallazgos imagenológicos y los síntomas son atribuibles a un lipoma intraóseo, se recomienda realizar seguimiento con TC o RM en un año 11 , debido a la baja posibilidad de trasformación maligna, diagnóstico relativamente preciso con neuroimagen y su frecuente involución espontánea 11,20,21 . Existen reportes de casos en la literatura en los que se realizó seguimiento imagenológico, y que posterior a un año y año medio de seguimiento, no se evidenció crecimiento perceptible en la RM de control 4,5 .…”

Intraosseous Lipoma of the Sphenoid: A Case Study

“…Recently, noninvasive followup has been proposed in case of the intraosseous lipoma due to low possibility of transforming into malignant forms, a relatively precise diagnosis based on neuroimaging tests and sometimes spontaneous involution [11, 13–15]. …”

Internal fixation combined with bone grafting for large intraosseous calcaneal lipoma: A case report

“…The most appropriate treatment for intraosseous calcaneal lipoma is likely to depend on symptoms, location and size (12)(13)(14). Intraosseous calcaneal lipoma 'of critical size' has been defined as a lesion extending the full breadth of the calcaneus in the coronal plan, and occupying ≥30% of the anteroposterior length of the calcaneus (15).…”