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Hospital Clínic i Provincial de Barcelona Barcelona 08036, Spain
We present a case of fat necrosis in a symptomatic chest wall lipoma. Our patient was a 66-year-old man with acute pleuritic pain in his right hemithorax. He had a history of dislipemia under drug therapy and previous resection of cutaneous lipomas. A chest radiograph showed an abnormal nodular shadow with extrapleural features in the lower field of the right hemithorax. A CT scan (Fig. 4) revealed the presence of a chest wall fat-density mass containing nonadipose solid areas. This inhomogeneous appearance suggested the possibility of well-differentiated liposarcoma, and consequently resection of the tumor was performed. The final histologic diagnosis was chest wall lipoma with large fat necrosis areas and no evidence of malignancy.
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When a lipomatous tumor shows nonadipose solid areas, liposarcoma must be considered and excluded. However, histologic examination infrequently shows these solid areas correlating with areas of fat necrosis.
Few cases of fat necrosis areas in a lipomatous tumor have been reported [1–3] and, to our knowledge, only one [4] describes imaging features of fat necrosis in a thoracic lipoma.
The spectrum of appearances of fat necrosis in lipomatous tumors seems to be wide [2] and difficult to distinguish from malignant changes [2, 3]. Kransdorf et al. [1] described imaging features that favor a diagnosis of liposarcoma as the presence of either globular or nodular nonadipose areas or masses. In the cases reported by Chan et al. [2] and the one described by Geis et al. [4], the areas of fat necrosis did not appear globular or nodular. Our patient showed a central nodular area in the tumor suggesting a liposarcomatous origin. However, the pathologic examination of the lesion revealed changes consistent with fat necrosis and no evidence of malignancy. Thus, although CT and MRI criteria have been established to distinguish benign lipoma variants from well-differentiated liposarcomas, lesion removal proves to be the most prudent decision because of the limited reliability of imaging features in distinguishing these tumors.
Finally, we would like to point out the similarity between our patient and the only previous one reported [4] with fat necrosis in a symptomatic thoracic lipoma. Both necrosed lipomas were painful, and neither seems to be related to trauma, which is one of the most proven causes of fat necrosis.
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