LIPOMA

Synonym,—Fatty tumor.

Definition.—A new growth composed of fat tissue, seated in the
corium or subcutaneous tissue.

Symptoms.—This formation, which usually comes under the
domain of surgery, is observed in two forms—the circumscribed and the
diffused. The circumscribed lipoma appears as one, several, or more
rounded, usually lobulated elevations, and covered with normal or slightly
pigmented integument, although occasionally somewhat thickened and
raised in folds. They are, as a rule, freely movable, and of soft consist­
ence. They are of various dimensions from a cherry to head size or
larger, and sometimes, in the larger growths, with a tendency to ill-
defined pedunculation. The overlying skin, if exposed to constant
rubbing, irritation, or injury, may become firmly agglutinated with the
tumor proper, and this is frequently noted as apparently a spontaneous
occurrence in those of large size; and exceptionally surface ulceration
may result. Their appearance is gradual, and after reaching variable
size, usually remain more or less stationary. They are not painful,
except when nerves are involved or they have received accidental
injury. The favorite situations are the neck, back, and buttocks.

Diffuse lipoma is less common than the circumscribed form, and
appears as soft, flattened, variously elevated, somewhat lobular forma­
tions, usually distributed over relatively large areas, and with no sharp
limitation, but gradually merging into the surrounding uninvolved
parts. A rather ill-defined or mixed variety of lipoma, lumpy and

¹ Whitehouse, “A Case of Generalized Fibroma Molluscum; Tumors Disappearing
Rapidly Under the Use of Asiatic Pills,” Jour. Cutan. Dis., 1899, P. 383 (case demon­
stration).

LIPOMA                                               701

infiltrating, involving the neck (fatty neck) and occurring in males, to
which Brodie,¹ MacCormac,² Hutchinson,³ Baker and Bowlby,⁴ and
Madelung⁵ have called attention, is exceptionally encountered. The
condition sometimes reaches enormous proportions.

In connection with lipoma the rare and independent affection known
as adiposis dolorosa (Dercum's disease), which Dercum,⁶ and subse­
quently Henry,⁷ Debove,⁸ and others, have described, may be briefly
referred to. This malady, which has been observed in middle life and
in women, is characterized by large, irregular, sometimes quite pro­
nounced, nodular and diffused, or bolster-like, fatty deposits in the sub­
cutaneous tissues. The condition is gradual in its progress, and usually
involves various portions of the body, and is finally more or less general.
With this are associated great muscular weakness, pain, nerve tender­
ness, diminution, alteration, or abolition, in certain areas, of the tactile
and temperature senses, and other nervous disturbances, together with
hemorrhages from the mucous-surfaces, but more especially from the
stomach and uterus. Pain is usually an early symptom, and headache
common. The skin is noted to be dry, with now and then periods of free
perspiratory action. In 1 of Dercum's cases purpura was noted, and in
another a herpetic eruption. In 2 of the cases in which a fatal termina­
tion ensued the thyroid gland was found small and nodular, and ex­
hibited calcareous deposits. It bears a rough, gross resemblance to myx-
edema, but differs materially, especially in the nervous disturbances and
the muscular phenomena, the muscles in adiposis dolorosa being weak,
flabby, and exhibiting other features of degeneration. Thyroid gland
extract is the most promising remedy.

Etiology and Pathology.—Lipomata are almost always ac­
quired, only exceptionally congenital cases being observed, several of
which have been recorded by Jacobi.⁹ Circumscribed forms are much
more common in women, and usually in adult age. The diffused variety

¹ Brodie, Lectures on Pathol. and Surgery, 1846, p. 202 (Amer. edit.).

² MacCormac, St. Thomas’ Hosp. Rep., 1884, vol. xiii, p. 287 (4 cases, 7 illustra­
tions).

³ Hutchinson, Trans. London Ophthal. Soc'y, 1884, vol. iv, p. 40.

⁴ Baker and Bowlby, Trans. London Med.-Chir. Soc'y, 1886, vol. lxix, p. 41.

⁵ Madelung, Archiv f. klin. Chirurg., 1888, vol. xxxvii, p. 106 (4 illustrations).

⁶ Dercum (“Myxedematoid Dystrophy”), University Med. Magazine, Dec, 1888,
and Amer. Jour. Med. Sci. (“Three Cases of a Hitherto Unclassified Affection Re­
sembling, in its Grosser Features, Obesity, but Associated with Special Nervous Symp­
toms—Adiposis dolorosa”), 1892, vol. civ, p. 521 (3 cases—former case, a second case,
and Henry's case; with illustrations).

⁷ F. P. Henry, “Myxedematoid Dystrophy (Paratrophy),” Jour. Nerv. and Mental
Dis., 1891, p. 154.

⁸ Debove, “Lipomatose douloureuse,” Gaz. de Hôp., Sept. 27, 1904; Price, “Adi-
posa Dolorosa,” Amer. Jour. Med. Sci., May, 1909 (2 cases, with necropsy, review, and
bibliography); I. P. Lyon, “Adiposis and Lipomatosis,” Archiv. Int. Med., 1910,
vol. vi, pp. 28-120 (goes fully over this and allied subjects, and especially “in reference
to their constitutional relations and symptomatology,” with a number of illustrations
and full bibliography).

⁹ A. Jacobi, “Congenital Lipoma,” Arch. Pediatrics, 1884, p. 65 (with résumé and
references of other reported cases). This observer remarks that the shape in congenital
lipoma is frequently irregular, and not spheroid, as it commonly is in the adult, nor is it
generally capsulated; the occiput and back, the abdomen, upper extremities, besides
the calves of the legs and the dorsal and plantar surfaces of the feet, are the usual seats
of the adipose deposit.

702

NEW GROWTHS

occurs almost invariably in males, and, as a rule, at about middle life.
The etiology is obscure. Anatomically the growth consists of masses
of fat-globules, more or less lobularly arranged, and enveloped in a
connective-tissue framework, which also holds the blood-vessels. The
consistence of the tumor, whether soft or moderately firm, depends
upon the relative proportions of these two constituent tissues, the fatty
mass being softer in those of loose and scant connective-tissue structure.
While the tumors may persist unchanged, in some instances the connect-
ive-tissue framework is the seat of calcareous deposits or even of ossifi­
cation. Excessive fat-tissue formation is also sometimes noted in con­
nection with nævus (nævus lipomatodes) and other growths, such as
angioma, sarcoma, etc.¹

Diagnosis.—The characteristic features of lipoma are their soft
consistence, lobular character, painlessness, and movability, and are
usually sufficient to prevent confusion with fibromata, sarcomata, or
other growths. In doubtful cases microscopic examination of the com­
ponent tissue would immediately settle the question.

Prognosis and Treatment.—Lipomata are benign growths
and do not, therefore, involve life, and beyond their appearance and
the discomfort caused by their presence or size are not cause for anxiety.
When treatment is sought or considered necessary, excision is the sole
efficient recourse; and if the tumor is completely removed, occurrence
is not probable. In several cases of “fatty neck,'’ and in one or two other
instances, Brodie brought about considerable reduction by large doses
of liquor potassæ—½ to 1 dram (2.-4.)—largely diluted, three times daily;
but Baker and Bowlby found no influence from its use.

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