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e (A) Frontal and (B) lateral knee radiographs demonstrate an area of ossification (arrows) anteromedial to the medial femoral condyle. No underlying osseous involvement is identified.
Source publication
A case of a right knee intra-articular osteolipoma in a 64-year-old man is reported. The patient presented for evaluation of a 1-year history of nontraumatic, mechanically-exacerbated, medial-sided right knee pain. Radiographs demonstrated a partially calcified 3.0 cm mass anterior to the distal medial femur at the suprapatellar fossa. Magnetic res...
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Citations
... However, our review of the English-language literature using the keywords "osteolipoma" and "ossifying lipoma" and "elbow" on PubMed and Google Scholar finds no cases reported. Described cases of intra-articular osteolipoma were rare; the most common intra-articular location is the knee (Yabe et al., 2006;Huynh et al., 2017;Fritchie et al., 2012;Pudlowski et al., 1979;Zaizi et al., 2020;Demark, 2021) ( Table 1). ...
... Osteolipomas have the same prognosis as simple lipomas and no recurrence has been reported (Yabe et al., 2006;Huynh et al., 2017;Fritchie et al., 2012;Pudlowski et al., 1979;Zaizi et al., 2020;Demark, 2021). The review of the literature confirms the benign evolution for this lesion. ...
Introduction
Lipomas are the most common benign mesenchymal tumors. The intra-articular localization is exceptional.
We report the first case of an intra-articular osteolipoma at the elbow.
Case report
A 36-year-old patient with no pathological history, presented to the emergency room with a two weeks history of a painless, progressively left elbow swelling in a context of apyrexia.
Physical examination revealed a hot, edematous left elbow. The gentle mobilization of the joint was painless. Biologie was normal. Initial radiograph showed a well-defined lobular image. Ultrasound revealed an anechoic intra-articular collection associated to a synovium hyperaemia and the MRI shows an aspect of synovitis. An arthrotomy was done via an internal approach of the elbow. Joint fluid was red. A free ossified intraarticular mass was discovered. Bacteriological samples were sterile. Histological examination concluded to an osteolipoma with no histological signs of malignancy. At the last 3-year follow-up, the patient didn't report any pain or functional discomfort. Elbow mobility was complete, with the absence of recurrences.
Discussion
Osteolipoma is defined as a histological variant of lipoma having undergone bone metaplasia. Allen found 06 cases in a series of 635 lipomas over five years. Pain has not been reported in the literature. In our case the pain was explained by the interposition of the tumoral mass between the articular surfaces. Histological examination confirms the diagnosis and recurrences are rare.
Conclusion
Osteolipoma is an extremely rare entity of mesenchymal tumors whose intra-articular location, although exceptional, does not worsen the prognosis.
... Here, they can be diagnosed on computed tomography scans with the central fat attenuation and peripheral calcification [6]. Involvement of distal extremities is extremely rare and only less than 10 cases are reported in distal femur/knee region on a thorough literature search [7]. The presence of these non-fatty elements may lead to a wide differential diagnosis in radiology including benign and malignant lipomatous and non-lipomatous entities [8]. ...
Lipomas are the most common, subcutaneous, and slow-growing tumors composed of fat (adipose tissue). Out of many types of these benign tumors, ossifying lipoma (osteolipoma) is the rarest subtype. Here, randomly distributed trabeculae of lamellar bone are seen within mature adipose tissue. They are featured only as isolated case reports and small case series, thus the true incidence is not known. The most common site for osteolipoma is the head and neck region and they are rarely reported in the lower extremities. Herein, we discuss the case of a 19-year-old man who presented with a progressively enlarging painful mass in the left leg. Radiology was typical of osteoid osteoma. Excision was performed and histopathological examination confirmed the lesion as osteolipoma with no evidence of malignancy. No recurrence of the tumor was observed after 2 years of follow-up. Although osteolipoma is a rare entity, the differential diagnosis of the lesion can be kept in mind whenever we encounter ossification within the adipose tissue.
... When osteolipoma presents in intra-articular or just joint location, mechanical symptoms can lead to early symptomatology. 3 Due to the absence of specific radiological findings, the differential diagnosis for lesions with fatty and bone components is broad, such as teratoma, liposarcoma, and osteosarcoma. 3 We demonstrated a case of osteolipoma in the deep soft tissues of the left cervical-thoracic transition near the brachial plexus with imaging evaluation treated with marginal resection. ...
... 3 Due to the absence of specific radiological findings, the differential diagnosis for lesions with fatty and bone components is broad, such as teratoma, liposarcoma, and osteosarcoma. 3 We demonstrated a case of osteolipoma in the deep soft tissues of the left cervical-thoracic transition near the brachial plexus with imaging evaluation treated with marginal resection. ...
Resumo
O osteolipoma é uma rara variante benigna do lipoma e constitui menos de 1% de todos os lipomas, se apresentando como uma massa indolor bem circunscrita. É um tumor conhecido por ocorrer em várias regiões, comumente intraósseas ou adjacente ao tecido ósseo, cuja patogênese ainda não está clara. Os exames de imagem são úteis em sua avaliação e, principalmente, no planejamento cirúrgico, que consiste na exérese tumoral. Contudo, o diagnóstico definitivo do osteolipoma é realizado pelo exame histopatológico. Apesar de benigno, o osteolipoma pode comprimir estruturas ao seu redor, levando a importante sintomatologia como neste caso relatado em que está em contato com o plexo braquial.
... Lipoma with metaplastic bone (also referred to as osteolipoma) is a rare variant of lipoma in which both mature adipose tissue and mature lamellar bone are present [1,39,40]. Patients usually present with a soft tissue mass, which may be painful [39][40][41][42][43][44]. Lipoma with metaplastic bone may arise in several anatomic locations, including the soft tissues in the neck [43], the oral cavity [42], and extremities [39][40][41]. ...
... Patients usually present with a soft tissue mass, which may be painful [39][40][41][42][43][44]. Lipoma with metaplastic bone may arise in several anatomic locations, including the soft tissues in the neck [43], the oral cavity [42], and extremities [39][40][41]. Notably, it is considered a different entity than parosteal lipoma, which is also a lipoma variant but contiguous with periosteal bone and commonly associated with reactive changes in the underlying cortex [44,45]. Prognosis of lipoma with metaplastic bone is similar to simple lipoma and no recurrences after surgical excision have been reported in the literature, to our knowledge [39,[42][43][44]. ...
... Intratumoral non-fatty components such as bone and cartilage (note that lipomas can also exhibit chondroid matrix calcification and not just ossification) may confound the imaging diagnosis and mimic chondroma or extraskeletal osteochondroma, another rare, benign soft tissue tumor [46]. Lipomas with metaplastic bone may show intense and heterogeneous enhancement (Fig. 13) [39,41]. In these cases, the possibility of a soft tissue sarcoma (particularly liposarcoma with calcifications and ossification [47]) should be included in the differential diagnosis and pathological evaluation is warranted. ...
The purpose of this article is to review calcified or ossified benign soft tissue lesions that may simulate malignancy. We review the clinical presentations, locations, imaging characteristics, and differential diagnostic considerations of myositis ossificans, tophaceous gout, benign vascular lesions, calcific tendinopathy with osseous involvement, periosteal chondroma, primary synovial chondromatosis, Hoffa’s disease, tumoral calcinosis, lipoma with metaplasia, calcifying aponeurotic fibroma, calcific myonecrosis, ancient schwannoma, and Castleman disease.
... Imaging features that may favor malignancy include large size, deep location in soft tissues, internal thickened septa, presence of nodular nonadipose regions, contrast enhancement, and decreased proportion of fat composition. [10] Definitive diagnosis of osteolipoma is made by histopathological examination, which would reveal a tumor with diffuse, mature ossification within fatty tissues. The mature bone tissue is usually irregular in distribution. ...
A case of left distal forearm and wrist osteolipoma in a 56 year old female is reported. The patient presented with a 3 year history of nontender left wrist mass. Radiographs demonstrated a lobulated mass of mixed low density and calcifications, not adjacent to and with no connection to underlying bone. Ultrasound showed a spheroid hyperechoic lesion with internal heterogeneity and rim of calcifications. Magnetic resonance imaging revealed a lesion with predominantly fat characteristics on T1 weighted and T2 weighted sequences, with rim of peripheral calcification and specks of internal calcification. Histological examination after excision of the mass showed the lesion to be an osteolipoma. Osteolipoma is a rare variant of lipoma with osseous metaplasia and should be considered in the differential of a fat containing mass with ossification.
... For example, neurological deficits may occur if the tumor compresses a nerve [2]. Additionally, an ossifying lipoma in an intra-articular or juxtaarticular location can produce mechanical symptoms which lead to earlier presentation as well as a wider differential diagnosis including calcified synovitis, myositis ossificans, or a degenerative joint condition if the mass erodes the nearby joint tissue [13]. Ossifying lipomas of the head and neck may resemble malignant neoplasms based on their clinical presentation [3]. ...
... As with classic lipomas, lipomas with ossifications may be found in any part of the body, but are usually found in the head, neck region. Only 6 cases of osteolipoma arising in connection with knee joint have been described [3]. Here, we present a case of an osteolipoma in the left knee region. ...
... The age of these 6 patients ranged from 21 to 64 years (mean of 41.2 years), involving 4 men and 2 women. Symptoms were described in all 6 cases, with 4 reporting joint pain ranging from 3-36 months in duration, exacerbated by activity, and causing difficulty while performing simple tasks such as walking [3,9]. Two of the 4 patients reported joint pain at rest [3,10]. ...
... Symptoms were described in all 6 cases, with 4 reporting joint pain ranging from 3-36 months in duration, exacerbated by activity, and causing difficulty while performing simple tasks such as walking [3,9]. Two of the 4 patients reported joint pain at rest [3,10]. Our case was a 61 year old female with similar symptomatology. ...
Lipomas are the most common benign soft tissue tumors and appear in any part of the body. They typically consist of mature adipose tissue. Osteolipoma is an extremely rare histologic variant of lipoma that contains mature lamellar bone within the tumor and osteolipoma independent of bone tissue are very rare. We report a case of histologically confirmed osteolipoma independent of bone located just above left knee. A 61 year old female presented with medial sided left knee pain of 6 month duration. X-ray demonstrated a partially calcified 3.5 cm diameter mass located in anterior to the distal medial femur. Histologic examination of an excisional biopsy showed the lesion to be an osteolipoma. Osteolipoma is a rare histologic variant of lipoma with osseous metaplasia, but should be considered in the differential of a fat-containing neoplasm with ossification.
DOI: 10.21276/AABS.2017.1320
Intra-articular masses affecting the knee joint are uncommon lesions that encompass a range of neoplastic and nonneoplastic disorders. A joint mass limited to a single articulation is most commonly related to neoplastic or focal proliferative disease, whereas masses affecting multiple articulations are typically caused by underlying inflammatory arthritides, metabolic abnormalities, or systemic deposition disorders. This article focuses on those masses that present in a monoarticular fashion, emphasizing the lesions that most commonly affect the knee joint. MR imaging is the modality of choice for evaluation of knee masses, allowing specific diagnosis in most cases.
Osteolipoma are uncommon benign soft tissue tumors, deriving from fat cells metaplasia. We report a case of 47-year-old female with a progressively enlarging, painless mass over the anteromedial aspect of left ankle, explorations showed a calcified masse and histopathologic diagnosis was in favor of osteolipoma, which was resected surgically without any recurrence after 2 years follow up. This tumor can affect different regions of the body but ankle location is very rare and must be distinguished from other diagnosis essentially sarcoma.
