What is the difference between lipoma and atheroma and do they need to be removed?

Lipoma and skin atheroma are two common types of benign neoplasms. They require exceptionally attentive treatment, since in some cases (though, fortunately, not often) they can degenerate into malignant tumors. The appearance of atheroma may not cause suspicion - at first it usually does not cause much inconvenience. However, even if the tumor is not painful, you should still see a doctor. Often a lump (lipoma) on the neck or scalp gradually increases in size, in this case you need to visit a doctor urgently - the new growth will need to be examined to determine whether there is a risk of developing cancer.

Lipoma and atheroma are often similar in appearance, and patients often do not distinguish them from each other, defining them under the general name “wen.” Let's try to figure out what the difference is between a lipoma and an atheroma, and also what to do if you have one of these formations.

Lipoma

This is a benign formation consisting of adipose tissue. In essence, it is a local accumulation of adipose tissue under the skin. Lipoma is a benign tumor, although in rare cases, liposarcoma, a malignant formation, can develop under its mask.

Lipomas manifest themselves in the form of soft-elastic subcutaneous formations, mobile, painless, and can slowly increase in size. The skin over lipomas is not changed and easily moves over them. Small lipomas are not visible at all; they can only be detected by palpation. Larger lipomas stand out as “bumps” of round or oval shape. The size of lipomas is very variable - from 1-2 cm to 20 cm or more. Lipomas never become inflamed or suppurate.

Causes of lipomas

Experts identify a set of prerequisites that can provoke the formation of lipomas. Among the most common:

genetic factors, hereditary predisposition;
disruption of metabolic processes in the body and fatty tissues;
insufficient level of personal hygiene;
malfunctions of the thyroid and pancreas;
chronic pathologies that significantly affect the body’s immune forces (diabetes, hepatitis, HIV, etc.);
dependence on alcohol, tobacco, drugs;
poor nutrition;
obesity, excess fatty tissue;
injuries, damage;
sedentary lifestyle, lack of physical activity.

Despite the fact that lipoma is a benign formation, there is always a risk of developing its malignant form. This probability is especially high for people who are included in the relevant risk groups: they have precancerous diseases (polyps, dysplasia), have already suffered from oncological pathologies, have a hereditary predisposition to the formation of tumors, and are under the constant influence of carcinogens, radiation and other harmful environmental factors.

Atheroma

The origin of atheroma is fundamentally different from lipomas. Atheroma develops from the sebaceous glands of the skin. For various reasons, the gland duct becomes clogged, secretion accumulates in the gland, which gradually begins to increase in size. Atheroma is defined as a small (from 0.5 to 2 - 3 cm) formation, which always rises somewhat above the skin and is always fused to it (i.e. the skin above the atheroma does not move), and can grow slowly. Atheroma always has a capsule and contains atheromatous masses resembling crushed lard.

Because The atheroma is connected to the external environment by a duct; there is always a threat that it will become infected through the duct and suppuration will occur. In this situation, moderate pain appears in the area of the previously “quiet” atheroma, the formation quickly (over several days) increases in size, redness appears around it, and body temperature may rise. Suppuration of atheroma requires urgent surgery.

Features of pathogenesis

There is no consensus among specialists about the neoplasm. Some sources consider it to be hypertrophied fatty tissue, others - a true tumor. If the process occurs in a place where there is no fatty tissue, then it is associated with a change in the structure of connective cells.

One theory states that the accumulation of adipocytes in a certain zone is due to chromosomal gene abnormalities responsible for the production of TAG lipase. The enzyme is responsible for providing energy through the breakdown of fats.

Some experts are confident that the appearance of subcutaneous wen is explained by the active deposition of lipids in adipose tissue. The prerequisites for the formation of a lipoma appear during embryonic development, during its formation. In adult patients, wen can form anywhere. In rare cases, massive development of benign neoplasms is observed.

Symptoms

Identifying the problem in both cases is usually not difficult.

Signs of lipoma:

mobile and painless, sizes can range from a few millimeters to 10-15 cm;
to the touch - doughy or dense;
not fused to the skin - the skin easily moves over the formation;
never becomes inflamed – i.e. There is no redness or swelling of the skin above the lipoma.

Most often, lipomas are located on the limbs, head and torso; they are almost never on the face.

Primary sources of lipoma development

The appearance of wen is associated with various pathologies, sometimes they arise as an independent pathology. Provoking factors for the appearance of lipoma are presented:

heredity - if the parents have the disease, the probability of a neoplasm occurring is 75%;
disorders of embryonic development - tumors arise against the background of dystopia of embryonic lipid cells;
individual diseases - Cowden, Madelung, Dercum;
endocrine disruptions – with hypofunction of the pituitary gland, pancreas, thyroid gland, altered estrogen levels, malignant neoplasms of the upper respiratory tract;
sedentary lifestyle - congestion provokes blockage of glands and fat deposits;
dysfunction of tissue trophism - due to problems with the nutrition of nerve cells, free lipids begin to accumulate next to them;
injuries - when local metabolism is disrupted due to damage;
with age - a slowdown in metabolic processes and a decrease in protective mechanisms after 40 years becomes a source of wen.

The development of lipoma is influenced by bad habits and an incorrectly selected diet. Also, pathology is formed due to diseases of the digestive organs, genitourinary tract, liver, and hormonal imbalance.

Symptoms of atheroma

The formation is in the form of a tubercle, painless, mobile, fused to the skin, you can often see the opening of the excretory duct of the gland. Most often, the “bump” is located on areas of the body where there is hair: on the face, scalp, in the genital area, on the legs, on the back, and is found on the face. If a suppurating atheroma appears, the formation increases in size over several days, the skin on the affected area may turn red and become painful, and the temperature may also rise.

Symptoms and classification

Lipomas are distinguished by anatomical location into lipomas of the head, face and neck, lipomas of the trunk, extremities, chest (mediastinum), mammary gland, gastrointestinal tract, internal organs, retroperitoneal tissue, spermatic cord. There are also rare localizations in the myocardium, lungs, and meninges.

Another classification of adipose tissue tumors involves a clinical division:

Lipoma surrounding nerve structures is called perineural . Due to compression of the nerves it can cause severe pain. Removal of perineural lipomas differs from subcutaneous lipomas and requires a highly qualified surgeon;
A tumor growing in the spinal canal (usually in the lumbar region) is called lumbosacral lipoma; Mostly occurs in children and is combined with underdevelopment of spinal structures;
Lipoma of the joint and its structures (synovium, vagina, tendons);
Intermuscular lipomas are formed from areas of adipose tissue between muscle fibers;
Angiomyolipoma is a tumor of fatty and muscle tissue, which in most cases grows in the kidneys and pancreas. Middle-aged and mature men are more predisposed to its formation;
Subcutaneous lipoma is a formation of varying sizes in the subcutaneous fat tissue. In everyday life it is usually called wen.

Lipomas usually occur alone. However, some patients discover several tumors at once. Such cases are most often associated with hereditary diseases and require careful study by specialists. The most common places for lipomas to form are the neck, back and limbs.

A subcutaneous lipoma is a mobile, elastic seal in the form of a lump or ball, which does not cause pain when pressed. A neoplasm can cause pain if it grows beyond its capsule into healthy tissue or due to compression of adjacent nerves.

For example, a wen located on the head can cause headaches, and the same formation on the neck can cause hoarseness and difficulty swallowing.

Gastrointestinal lipomas differ from their subcutaneous counterparts. Small formations in the intestine do not cause symptoms and are often discovered incidentally during an instrumental examination of the gastrointestinal tract. However, if it increases in size, this happens when the tumor reaches 2 or more centimeters in diameter, the lipoma can block part of the intestinal lumen and cause intestinal obstruction, intussusception, stool problems, abdominal pain and even bleeding.

Treatment

Now that we have figured out the difference between a lipoma and an atheroma, let’s move on to the next question: is it necessary to remove the lipoma or remove the atheroma? Let's start with the fact that conservative treatment of lipoma, as well as treatment of atheroma, is absolutely futile. Moreover, aggressive influence on these formations using various “folk” remedies can cause suppuration of atheroma, as well as malignancy (malignancy) of lipoma.

Tactical approaches to the treatment of lipoma are as follows: if the lipoma is small (2-3 cm), does not grow and does not cause any inconvenience (does not rub against clothes, is not a cosmetic defect, etc.), then it does not need to be removed. In case of growth (especially rapid growth), it is better to go for surgery. If the lipoma grows, then sooner or later you will still have to remove it, but it is better to do this while it is small in order to avoid large incisions and traumatic intervention. Any removed lipoma should be sent for histological (under a microscope) examination.

As for atheroma, it is recommended to remove it in any case, because practice shows that sooner or later they fester, and during surgery against the background of inflammation it is not always possible to completely remove the atheroma capsule, which is fraught with relapse (reappearance of the formation). In addition, when suppuration occurs, the wound is almost never sutured; it heals by secondary intention, which often leads to the formation of a rough scar. If, after removing the atheroma, it turns out that the formation does not have a capsule and does not contain atheromatous masses, it should be sent for histological examination to exclude dermatosarcoma, which is sometimes similar in appearance to atheroma.

Diagnosis of lipomas

Since the development of a neoplasm in the body practically does not cause symptoms, the patient may not be aware of its presence for a long time. Therefore, in most cases it is diagnosed accidentally during a preventive examination or treatment of other pathologies.

If the localization of the formation allows the doctor to palpate, the specialist can determine the lipoma even during a standard physical examination. However, the placement of a node does not always allow it to be detected by superficial palpation. At the same time, quite a few dangerous diseases have symptoms similar to lipoma. Therefore, diagnostics are carried out not only to identify a neoplasm, but also to exclude other diseases and clarify the benign quality of the process.

A comprehensive examination includes a number of laboratory and instrumental examinations, the need for which is determined individually by the attending physician in each medical case:

Blood tests. The most accessible method of primary assessment of the body’s condition. The results of the study allow us to identify the presence of pathological changes, inflammation, viruses or bacteria.
X-ray examination. Depending on the location of the compaction, an X-ray of the chest, abdominal cavity, and extremities is prescribed. Allows you to diagnose a formation, identify its exact location, and also analyze the condition of bone tissue and structures.
Ultrasonography. Scanning soft tissues and organs allows you to determine the size of the node, identify the clarity of its contours, and analyze the contents. Not the most informative examination method for suspected lipoma, since even in the presence of a capsule, the compaction is often difficult to visualize using ultrasound waves.
CT scan. Allows you to establish an accurate diagnosis and distinguish lipoma from malignant neoplasms if there is suspicion.
Magnetic resonance imaging. It is prescribed, if necessary, to evaluate the signs of compaction and distinguish it from malignant liposarcoma. Using this method, the diagnosis is established with maximum accuracy.
Biopsy. Tissue collection from the compaction and their further cytological and histological analysis. Allows you to exclude the possible oncological nature of the pathology.

The examination also reveals the reasons that caused the formation of a compaction in the body. If other chronic diseases are a prerequisite for the development of pathology, additional diagnostics are also carried out for an accurate diagnosis and further effective treatment.

To sum up all of the above, we can say

Lipoma and atheroma are benign formations of different natures - lipoma simply consists of altered adipose tissue, and atheroma is made of a sebaceous gland with a capsule filled with secretion - sebaceous atheromatous masses.
Conservative, incl. Treatment of lipoma with folk remedies, as well as treatment of atheroma, is absolutely ineffective and often harmful.
A small (2-3 cm) lipoma can not be operated on, but observed. In case of growth, as well as any discomfort, surgery to remove the lipoma is indicated.
Removal of atheroma is always desirable, because they tend to increase in size and fester.
If you find a subcutaneous formation in yourself, you need to consult a doctor, because... under the guise of a lipoma or atheroma, other formations can develop - dermatosarcomas, liposarcomas, hygromas, lymphadenitis, etc.

Dr. Elshansky I.V. has been involved in the diagnosis and surgical treatment of benign formations of the skin and subcutaneous tissue for many years.

Large lipoma in the oral cavity

Lipoma is a benign mesenchymal tumor of adipose tissue. It is rarely observed in the oral cavity, but at the same time is one of the most common neoplasms of the trunk, shoulders, neck and axilla. Although the etiology and pathogenesis of lipoma are not fully understood, it has been established that overweight people are more susceptible to the disease.

Clinically, oral lipomas appear as yellow (sometimes pink), soft, smooth-surfaced nodular masses less than 3 cm in size and may be pedunculated. Many patients paid attention to the formation months or years before diagnosis.

The most common location of lipoma in the oral cavity is on the buccal mucosa and in the vestibule of the oral cavity on the buccal side. The disease affects men and women with approximately equal frequency. Lipoma is not typical for childhood and mainly occurs in people over 40 years of age.

Histopathologically, most lipomas consist of mature fat cells very similar to the surrounding normal ones. Individual cells have light cytoplasm with a flat nucleus located on the periphery. The lipoma is usually well demarcated and covered by a thin fibrous capsule. Lipomas are treated with conservative excision; relapses are rare.

Description of a clinical case

A 36-year-old man without somatic pathologies was admitted to the clinic with complaints of an asymptomatic swelling on the mucous membrane of the right cheek that had existed for about 2 years.

Upon examination, a swelling was revealed in the submucosal layer, covered with unchanged mucous membrane.

The clinical picture resembled mesenchymal tumors, salivary gland tumors, or even bone tumors with soft tissue invasion. A CT scan showed a well-defined mass with a density similar to adipose tissue (Figure 1).

Figure 1: Axial CT view of the tumor

With a preliminary diagnosis of oral lipoma, surgical excision of the formation was performed under local anesthesia. A yellowish, well-demarcated soft tissue with a lobulated surface and dimensions of 4 x 3.5 x 1.2 cm was obtained, which was then sent for microscopic examination in 10% buffered formalin solution (Photos 2 and 3).

Photo 2: Surgical removal of the tumor using intraoral access

Photo 3: Macroscopic appearance of a tumor with a lobulated surface (4x3.5x1.2 cm)

In the laboratory, the tissue sample was immersed in paraffin using standard techniques. Slides were prepared and stained with hematoxylin and eosin (HE). Microscopic examination with a light microscope (Olympus, Japan) revealed a well-defined nodular mass consisting of mature adipocytes, cells with light cytoplasm and a flat dark nucleus at the periphery. Pathological cells were separated by a thin fibrous septum, forming a capsule around it. Based on the histopathological features, a final diagnosis of lipoma was made (Figure 4). During the 18-month postoperative follow-up, no complications or recurrence occurred.

Photo 4: Microscopic view of the tumor. Densely packed fat cells delimited by a thin fibrous septum. (GE x100)

Discussion

Lipoma is a very common benign tumor of fatty tissue, but it is quite rare in the oral cavity. Sometimes a lipoma can reach 5-6 cm, but more often it does not exceed 3 cm. Conservative surgical excision is the treatment of choice; relapses are rare.

As already mentioned, lipoma affects men and women in equal proportions. Although Furlong data indicate a slight predominance of men, and Freitas – women. The described location for the occurrence of lipoma is the most typical location.

There are only a few cases of large lipomas reported in the English literature. The average size of intraoral lipoma in 450 cases was 1.66 cm (0.2 – 10 cm) in diameter.

In the Iranian population, only 5 cases of intraoral lipoma ranging in size from 1 cm to 1.8 cm were found.

The lesion described in this report is much larger than previously reported cases. Also, the age of the described patient does not exceed 40 years.

Conclusion

Although intraoral lipoma is rare, the authors recommend being clinically alert for this disease during oral examination.

Authors: Ahmad Motagi , Department of Oral and Maxillofacial Surgery, University School of Dentistry, Iran Atousa Aminzadeh , Department of Dental Pathology, University School of Dentistry, Iran Seyed M.Razavi , Oral and Maxillofacial Pathology Dental Research Center, University School of Dentistry, Iran