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    Lipoma Pathway: DR Rajayogeswaran DR Mike Bradley

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    Karnaini An Za
    This document provides guidance on evaluating and managing lipomatous tumors. It notes that most lipomas are benign and can be safely observed over time if small (<5cm), painless, and not growing. Deeper or atypical lipomas may require MRI and referral to a sarcoma specialist. Lipomas with typical ultrasound features and meeting certain criteria can often be managed in primary care through excision or observation. Larger (>7cm) or symptomatic lipomas still require specialist referral. Lipomas with concerning ultrasound features may warrant urgent cancer referral for further evaluation.

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    Lipoma Pathway: DR Rajayogeswaran DR Mike Bradley

    Uploaded by

    Karnaini An Za
    56 views10 pages
    This document provides guidance on evaluating and managing lipomatous tumors. It notes that most lipomas are benign and can be safely observed over time if small (<5cm), painless, and not growing. Deeper or atypical lipomas may require MRI and referral to a sarcoma specialist. Lipomas with typical ultrasound features and meeting certain criteria can often be managed in primary care through excision or observation. Larger (>7cm) or symptomatic lipomas still require specialist referral. Lipomas with concerning ultrasound features may warrant urgent cancer referral for further evaluation.

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    Lipoma Pathway

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    This document provides guidance on evaluating and managing lipomatous tumors. It notes that most lipomas are benign and can be safely observed over time if small (<5cm), painless, and not growing. Deeper or atypical lipomas may require MRI and referral to a sarcoma specialist. Lipomas with typical ultrasound features and meeting certain criteria can often be managed in primary care through excision or observation. Larger (>7cm) or symptomatic lipomas still require specialist referral. Lipomas with concerning ultrasound features may warrant urgent cancer referral for further evaluation.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    56 views10 pages

    Lipoma Pathway: DR Rajayogeswaran DR Mike Bradley

    Uploaded by

    Karnaini An Za
    This document provides guidance on evaluating and managing lipomatous tumors. It notes that most lipomas are benign and can be safely observed over time if small (<5cm), painless, and not growing. Deeper or atypical lipomas may require MRI and referral to a sarcoma specialist. Lipomas with typical ultrasound features and meeting certain criteria can often be managed in primary care through excision or observation. Larger (>7cm) or symptomatic lipomas still require specialist referral. Lipomas with concerning ultrasound features may warrant urgent cancer referral for further evaluation.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 10

    Lipoma pathway

    Dr Rajayogeswaran
    Dr Mike Bradley
     Clinical features are typical of a small
    (<5cm) subcutaneous lipoma
     Soft lipomatous consistency,
     Smooth edges,
     No pain
     No recent growth

     Reassure and asked to return if there are


    changes.
     Lipomatous tumours are common in the
    trunk and extremity.
     The majority, particularly in subcutaneous
    tissues, are simple lipomas or benign variants
    (eg angiolipomas or fibrolipomas).

     Deep lipomatous tumours (under the deep


    fascia) are most often inter- or intramuscular
    lipomas or atypical lipomatous tumours
    (ALTs).

     ALTs are indolent tumours with no capacity


    for metastatic spread without de-
    differentiation (a rare event). ALTs can be
    large (more than 5cm) at presentation
     Tumours which are lipomatous and
    subcutaneous on ultrasound are rarely
    malignant or ALTs, even if there are
    atypical features on ultrasound (eg
    vascularity or thickened septae.
     Patients can be reassured and advised to
    observe the mass for changes.
     If necessary, confirmed superficial
    lipomatous tumours can be excised by a
    non-specialist surgical team, preserving
    the underlying muscle fascia.
     In the unlikely event that such a tumour
    is malignant on histological examination,
    re-excision including the deep fascia is
    usually possible without detriment to long
    term outcomes
     Patients with scans diagnostic of a benign
    lipoma with typical* or atypical** ultrasound
    features and which are subcutaneous,
    painless and not growing can be referred
    back to primary care for further
    management.
     This could include excision by a non-specialist
    team, observation with advice to patients, or
    interval scan (for example after 6 months).
     It is reasonable, if there are ongoing
    concerns, to refer larger tumours in this
    category (>7cm) for non-urgent assessment
    by a Sarcoma Service, although the risk of
    malignancy is very low
     Patients with scans diagnostic of a benign
    lipoma with typical* or atypical**
    ultrasound features

    ◦ deep to fascia,
    ◦ painful or
    ◦ enlarging

     Investigated with an MRI scan first


     Referred to a Sarcoma Service for advice
    on a non-urgent basis (non-cancer
    referral). This may include review of the
    imaging and/or the patient.
     In the less common situation that the
    scan indicates
    ◦ A lipoma with significantly concerning
    ultrasound features,
    ◦ Or a non-lipoma with indeterminate or
    concerning ultrasound features, raising the
    possibility of malignancy.

    Urgent 2-week wait, suspected cancer,


    referral to a sarcoma service is appropriate,
    ideally with an urgent MRI if available.
     GUIDE FOR ULTRASOUND IMAGING OF LIPOMATOUS TUMOURS

     • Benign lipoma with typical ultrasound features*


     o Homogeneous mass
     o No or septal linear power Doppler flow
     o No or thin (<2mm) septa

     • Benign lipoma with atypical ultrasound features**


     o Lipoma but very thick septa (>2mm)
     o Nodular area(s) of oedema or fat necrosis in predominantly fatty lesion
     o Disorganised power Doppler flow in predominantly fatty lesion

     • Lipoma with concerning ultrasound features***


     o Nodular area of non-fat signal in a deep lipomatous mass

     • Non-lipoma with indeterminate or concerning ultrasound features****


     o Solid non lipomatous mass
     o Heterogeneous mass
     o Invasive margins
     o Disorganised power Doppler flow in solid heterogeneous lesion

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