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Successful management of pleural lipoma by video-assisted thoracoscopic surgery.
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MedLine Citation:
PMID:  22303085     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
Pleural lipoma is an extremely rare clinical entity. Symptomatic pleural lipoma is rarer. We report a case of symptomatic pleural lipoma which was successfully managed by video-assisted thoracoscopic surgery (VATS). A brief review of relevant literature has been included in the article.
Authors:
Seetharam Prasad; Lingadakai Ramachandra; Saurabh Agarwal; Digvijay Sharma
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of minimal access surgery     Volume:  8     ISSN:  1998-3921     ISO Abbreviation:  J Minim Access Surg     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-02-03     Completed Date:  2012-08-23     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101228183     Medline TA:  J Minim Access Surg     Country:  India    
Other Details:
Languages:  eng     Pagination:  19-20     Citation Subset:  -    
Affiliation:
Department of Surgery, Kasturba Medical College, Manipal, Karnataka, India.
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Full Text
Journal Information
Journal ID (nlm-ta): J Minim Access Surg
Journal ID (publisher-id): JMAS
ISSN: 0972-9941
ISSN: 1998-3921
Publisher: Medknow Publications & Media Pvt Ltd, India
Article Information
Copyright: © Journal of Minimal Access Surgery
open-access:
Received Day: 31 Month: 8 Year: 2010
Accepted Day: 04 Month: 9 Year: 2010
Print publication date: Season: Jan-Mar Year: 2012
Volume: 8 Issue: 1
First Page: 19 Last Page: 20
ID: 3267331
PubMed Id: 22303085
Publisher Id: JMAS-8-19
DOI: 10.4103/0972-9941.91776

Successful management of pleural lipoma by video-assisted thoracoscopic surgery
Seetharam Prasadaff1
Lingadakai Ramachandraaff1
Saurabh Agarwalaff1
Digvijay Sharmaaff1
Department of Surgery, Kasturba Medical College, Manipal, Karnataka, India
Correspondence: Address for correspondence: Dr Seetharam Prasad, Department of Surgery, Kasturba Medical College, Manipal, Karnataka, India, E-mail: drprasadseetharam@yahoo.co.in

INTRODUCTION

Lipomas are benign soft tissue tumors arising from mature adipocytes. Although they can be encountered almost anywhere in the body, their occurrence within the thoracic cavity in relation to the pleura is very rare. Most reported cases of pleural lipoma are of asymptomatic lipomas, which are accidentally discovered. We report a case of symptomatic pleural lipoma, which was successfully treated by video-assisted thoracoscopic surgery (VATS).


CASE REPORT

A 45-year-old man presented to us with dry cough and mild chest discomfort since 1 year. His chest examination was unremarkable. Plain X-ray of the chest showed an abnormal spherical shadow in the upper portion of the right lung. A CT scan of the thorax revealed a 9 × 6 cm2 sized well-circumscribed lesion with fat attenuation in the upper lobe of the right lung suggestive of pleural lipoma [Figure 1]. All other haematological and biochemical investigations were within normal limits. The lesion was removed by VATS [Figure 2]. Histopathological examination of the retrieved specimen revealed that the lesion was composed of well-differentiated mature adipocytes, which is suggestive of a lipoma.


DISCUSSION

Lipomas are benign soft tissue neoplasms composed of mature adipocytes. Although lipomas are ubiquitous, they are rarely encountered in the thoracic cavity. Intrathoracic lipomas are classified as,[1]

  • Endobronchial lipoma: arising from the sub-cutaneous fat of the tracheobronchial tree.
  • Parenchymal lipoma: located peripherally within the lung parenchyma.
  • Pleural lipoma: originating from the submesothelial parietal pleura which may extend into subpleural, pleural or extrapleural spaces.[2]
  • Mediastinal lipoma.
  • Cardiac lipoma.

These slow growing neoplasms are mostly asymptomatic. Rarely they may attain a sufficient size to produce symptoms such as non-productive cough, heaviness in the chest and dyspnoea. An asymptomatic pleural lipoma may be accidentally discovered by a plain radiograph. A CT scan may be required to demonstrate the pleural origin and fatty composition.[3] In the CT scan, pleural lipomas demonstrate a homogenous fat attenuation with values of –50 to–150 HU. A heterogenous attenuation should suggest the possibility of a liposarcoma.[4]

In spite of the benign nature of the pleural lipoma, surgical treatment is recommended by most authors[5, 6] as it is very difficult to differentiate lipoma from a well-differentiated liposarcoma preoperatively. However, if the lesion is symptomatic as in our patient, surgery is the only option which offers cure. When surgery for a benign lesion-like lipoma is being contemplated, it is of paramount importance that the procedure causes least discomfort, morbidity and interference with the quality of life. VATS satisfies all these criteria and hence can be considered as the most appropriate procedure for such lesions. It avoids thoracotomy and significantly reduces the procedure related morbidity thereby assuring early return to normal activity. A literature search yields very few reports of treatment of intrathoracic lipomas by VATS.[79] To the best of our knowledge, this is the first reported case of an intrathoracic lipoma successfully treated by VATS in the English literature.

To conclude, a pleural lipoma though rare should be included in the list of differential diagnosis for a homogenous pleural mass and VATS is the most appropriate treatment option for such benign intrathoracic lesions.


Notes

Source of Support: Nil

Conflict of Interest: None declared.

REFERENCES
1. Politis J,Funahashi A,Gehlsen JA,DeCock D,Stengel BF,Choi H. Intrathoracic lipomas: Report of three cases and review of literature with emphasis on endobronchial lipomaJ Thorac Cardiovasc SurgYear: 1979775506423588
2. Gaerte SC,Meyer CA,Winer-Muram HT,Tarver RD,Conces DJ Jr. Fat-containing lesions of the chestRadiographicsYear: 200222S617812376601
3. Salahudeen HM,Hoey ET,Robertson RJ,Darby MJ. CT appearances of pleural tumorsClin RadiolYear: 2009649183019664483
4. Muller NL. Imaging of pleuraRadiologyYear: 19931862973098421723
5. Takayama T,Hirai S,Ishihara T,Kumazaki S,Sano K,Mishima H,et al. Pleural lipoma: Report of a caseSurg TodayYear: 199424173758054801
6. Chung JH,Moon DS,Oh HE,Park CS,Choi JE. A case of pleural lipoma treated with video assisted thoracic surgery (VATS)Tuberc Respir DisYear: 20055955660
7. Gotoh M,Niimi T. [Intrathoracic chest wall type lipoma with crescent-shaped mass on computed tomography; report of a case]Kyobu GekaYear: 200962340319348222
8. Hayakawa M. Pleural lipoma: Report of a caseKyobu GekaYear: 2005581185816359024
9. Furrer M,Inderbitzi R. [Case report: Endoscopic resection of a 5cm intrathoracic lipoma]PneumologieYear: 19924633451409500

Figures

[Figure ID: F1]
Figure 1 

CT scan of the thorax showing a well-circumscribed lesion with homogenous fat attenuation in the upper lobe of the right lung



[Figure ID: F2]
Figure 2 

Intraoperative photograph showing pleural lipoma being excised



Article Categories:
  • Unusual Case

Keywords: Pleural lipoma, video-assisted thoracoscopic surgery, pleura tumour.

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