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There may be an overgrowth of the fatty fringes of the synovial sheath, a condition described as "arborescent lipoma." The clinical features vary with the tendon sheath affected. There is little or no pain, but the fingers tend to be stiff and weak, and to become flexed.
It sometimes reaches enormous size and assumes the shape of a pendulous tumor. Diffuse lipoma, occurring in the neck, often gives the patient a grotesque and peculiar appearance. It is generally found in men addicted to the use of alcohol, and occurs between thirty-five and forty-five years of age; in no case has general obesity been described.
The treatment consists in the removal of the tumour along with the overlying skin. The exuberant masses on the nose known as "rhinophyma," "lipoma nasi," or "potato nose" are of the nature of sebaceous adenoma, and are removed by shaving them off with a knife until the normal shape of the nose is restored Healing takes place with remarkable rapidity.
#Tumours of Tendon Sheaths.# Innocent tumours, such as lipoma, fibroma, and myxoma, are rare. Special mention should be made of the myeloma which is met with at the wrist or ankle as an elongated swelling of slow development, or over the phalanx of a finger as a small rounded swelling.
During the secondary period the lesion usually consists in effusion into the sheath; gummata are met with during the tertiary period. Arborescent lipoma has been found in the sheaths of tendons about the wrist and ankle, sometimes in a multiple and symmetrical form, unattended by symptoms and disappearing under anti-syphilitic treatment.
In one of Madelung's cases a large lobe extended downward over the clavicle. The growth has been found between the larynx and the pharynx. Black reports a remarkable case of fatty tumor in a child one year and five months old which filled the whole abdominal cavity, weighing nine pounds and two ounces. Chipault mentions a case of lipoma of the parietal region, observed by Rotter.
The subserous lipoma arises from the extra-peritoneal fat in the posterior abdominal wall, in which case it tends to grow forwards between the layers of the mesentery and to give rise to an abdominal tumour; or it may grow from the extra-peritoneal fat in the anterior abdominal wall and protrude from one of the hernial openings or through an abnormal opening in the parietes, constituting a fatty hernia.
The affection is frequently bilateral, and may be associated with lymph scrotum, with elephantiasis, and with chyluria. The diagnosis is to be made from such other swellings in the groin as hernia, lipoma, or cystic pouching of the great saphenous vein. It is confirmed by finding the recently dead or dying worms in the inflamed lymph glands. Treatment.
The fringes of synovial membrane may also undergo a remarkable development, like that observed in arthritis deformans, and described as arborescent lipoma. Both these types are almost exclusively met with in the knee. The Contents of Tuberculous Joints. In a large proportion of cases of synovial tuberculosis the joint is entirely filled up by the diffuse thickening of the synovial membrane.
Hypertrophied fringes and pedunculated or loose bodies often co-exist with hydrops, and give rise to characteristic clinical features, particularly in the knee. The fringes, especially when they assume the type of the arborescent lipoma, project into the cavity of the joint, filling up its recesses and distending its capsule so that the joint is swollen and slightly flexed.
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