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Updated: June 27, 2025
The distinguishing features of the lipoma are the tacking down and dimpling of the overlying skin, the lobulation of the tumour, which is recognised when it is pressed upon with the flat of the hand, and, more reliable than either of these, the mobility, the tumour slipping away when pressed upon at its margin. [Illustration: FIG.
#Varieties of Tumours.# In the following description, tumours are classified on an anatomical basis, taking in order first the connective-tissue group and subsequently those that originate in epithelium. #Lipoma.# A lipoma is composed of fat resembling that normally present in the body.
In the neck, axilla, and pubes a diffuse overgrowth of the subcutaneous fat is sometimes met with, forming symmetrical tumour-like masses, known as diffuse lipoma. As this is not, strictly speaking, a tumour, the term diffuse lipomatosis is to be preferred. A similar condition was described by Jonathan Hutchinson as being met with in the domestic animals.
#Diagnosis.# A cold abscess is to be diagnosed from a syphilitic gumma, a cyst, and from lipoma and other soft tumours. The differential diagnosis of these affections will be considered later; it is often made easier by recognising the presence of a lesion that is likely to cause a cold abscess, such as tuberculous disease of the spine or of the sacro-iliac joint.
The pure myxoma is extremely rare, and clinically resembles the lipoma. Myxomatous tissue is, however, frequently found in other connective-tissue tumours as a result of degeneration, for example, in cartilaginous tumours and in sarcomas. Myxomatous tissue is also a prominent constituent of the "innocent parotid tumour."
It also resembles a lipoma, especially the congenital variety which grows from the periosteum, and the differential diagnosis between these is rarely completed until the swelling is punctured or explored by operation. If treatment is called for, it is carried out on the same lines as for hæmangioma, by means of electrolysis, igni-puncture, or excision.
A subsynovial lipoma grows from the fat surrounding the synovial membrane of a joint, and projects into its interior, giving rise to the symptoms of loose body.
In operating the tumor had to be swung on a beam. The hemorrhage was slight and the patient was discharged in five days. The true lipoma must be distinguished from diffuse accumulations of fat in different parts of the body in the same way that fibroma is distinguished from elephantiasis. Circumscribed lipoma appears as a lobulated soft tumor, more or less movable, lying beneath the skin.
Innocent tumours, such as the fibroma, lipoma, angioma, and neuro-fibroma, are rare. Malignant tumours may be primary in the muscle, or may result from extension from adjacent growths for example, implication of the pectoral muscle in cancer of the breast or they may be derived from tumours situated elsewhere.
Before the stage of cold abscess is reached, the localised swelling is to be differentiated from a gumma, from chronic forms of staphylococcal osteomyelitis, from enlarged bursa or ganglion, from sub-periosteal lipoma, and from sarcoma. Most difficulty is met with in relation to periosteal sarcoma, which must be differentiated either by the X-ray appearances or by an exploratory incision.
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