Pleural Lipoma

Full text

International Journal of
Respiratory and Pulmonary Medicine
Mathur et al. Int J Respir Pulm Med 2017, 4:069
Volume 4 | Issue 2
DOI: 10.23937/2378-3516/1410069
• Page 1 of 3 •
ISSN: 2378-3516
Open Access
Citaon: Mathur P, Namana V, Gupta SS, Berger B, Bondi E (2017) Pleural Lipoma. Int J Respir Pulm
Med 4:069. doi.org/10.23937/2378-3516/1410069
Received: December 14, 2016; Accepted: April 10, 2017; Published: April 13, 2017
Copyright: © 2017 Mathur P, et al. This is an open-access arcle distributed under the terms of the
Creave Commons Aribuon License, which permits unrestricted use, distribuon, and reproducon
in any medium, provided the original author and source are credited
Mathur et al. Int J Respir Pulm Med 2017, 4:069
Pleural Lipoma
Pankaj Mathur1, Vinod Namana2*, Sushilkumar S Gupta2, Barbara Berger3 and Ellio Bondi4
1Department of Medicine, University of Arkansas for Medical Sciences, USA
2Department of Medicine and Cardiology, Maimonides Medical Center, USA
3Department of Medicine, Wyco Heights Medical Center, USA
4Department of Pulmonary and Crical Care, Brookdale University Medical Center, USA
*Corresponding author: Vinod Namana, MD, MPH, Department of Cardiology, Fellow in Cardiovascular Medicine, 4802
10th Avenue, Brooklyn, NY 11219, USA, Tel: +718-283-6892, E-mail: vnamana@maimonidesmed.org
Keywords
Lipoma, Pleural lipoma, Liposarcoma, Fibroma
skin and subcutaneous ssue; occurring with an annual
incidence of 1 per 1000 persons [1]. Lipomas are histolog-
ically made up of abundant mature adipose ssue with no
mitoc acvity. Lipomas are uncommonly found in viscer-
al locaons such as stomach, kidney, brain, especially in
the corpus callosum, and thoracic cavity [1,2]. Intrathoracic
lipomas were rst described by Fothergill in 1781 [3]. Clin-
ically pleural lipomas and other intrathoracic lipomas are
slow growing benign tumors, oen diagnosed coinciden-
tally. Somemes they may grow to a large size and cause
compression symptoms such as dyspnea and dysphagia.
CLINICAL IMAGE
Case Descripon
A 31-year-old male presented with complaints
of a mild non-producve cough for 2 months. He had no
history of smoking, fever, chills, rigors, weight loss, dys-
pnea, chest pain and hemoptysis. There was no histo-
ry of exposure to occupaonal hazards or medicaons
use. He was hemodynamically stable and had no signi-
cant ndings on physical examinaon. Postero-anterior
radiography of the chest showed a pleural-based mass
in the right upper lung eld (Figure 1). Computed to-
mography (CT) of the chest was suggesve of a smooth,
marginated mass in the right upper thorax, measuring
5.4 × 4.5 × 2.7 cms (Figure 2). The mass contained fat
and so-ssue density with no calcicaons; there were
no bony erosions. Fat planes between right intercostal
muscles and pectoralis muscle were intact. CT-guided
biopsy was performed and histopathology conrmed the
diagnosis of pleural lipoma. The ssue consisted of ma-
ture adipose cells (Figure 3). The eology of cough was
not aributed to the pleural lipoma; neither there were
any signs of bacterial infecons. He was inially treated
with antussive dextromethorphan syrup, followed by
inhaled corcosteroids which led to complete recovery
from the symptom.
Discussion
Lipomas are the most common benign tumors of the
Figure 1: Postero-anterior radiography of the chest showing
a pleural-based mass in the right upper lung eld (red arrow).

ISSN: 2378-3516DOI: 10.23937/2378-3516/1410069
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Mathur et al. Int J Respir Pulm Med 2017, 4:069
racoscopic surgery (VATS). The proponents of early surgi-
cal intervenon suggest that surgical procedure is easi-
er if performed earlier as there are less neighboring adhe-
sions and ssue inltraon. Besides, these tumors have
a variable growing rate and may cause compression of the
lung parenchyma and intra parenchymal bleeding [14]. In the
studies of Sakurai, et al. [2] 8 out of 10 paents were asymp-
tomac and in Jayle, et al. [14] 4 out of 5 paents were as-
ymptomac. The CT scan guided biopsy was performed in
only 1 paent by Sakurai, et al. [2] and in 2 paents by Jayle,
et al. [14]. In our case, we found that CT scan guided biop-
sy was clearly benecial as it diagnosed the benign nature of
the tumor, besides in paents undergoing surgical resecon
there is always a chance of local recurrence albeit small <
5% [2] and incomplete removal leading to the complicated
surgical procedure [2,14]. Therefore for an asymptomac
paent, we think before going for more invasive procedures
like postero-lateral thoracotomy or VATS, CT scan guided bi-
opsy should be considered. However, for large size tumors,
surgical resecon or video-assisted thoracoscopic surgery
(VATS) is preferred to prevent compressive symptoms [2].
All the opons were discussed with our paent in
detail and he chose conservave management, due to
the absence of clinical signs and symptoms secondary
to pleural lipoma, the low risk prole for malignancy,
availability of the conrmed diagnosis, and he also did
not want to take the unnecessary risk of surgery.
References
1. Rydholm A, Berg NO (1983) Size, site and clinical incidence
of lipoma. Factors in the differential diagnosis of lipoma and
sarcoma. Acta Orthop Scand 54: 929-934.
2. Sakurai H, Kaji M, Yamazaki K, Suemasu K (2008) Intratho-
racic lipomas: their clinicopathological behaviors are not as
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3. Fothergill J Medical and Philosophical Works. John Walker
Printer, London, 1781: 508-528.
4. Rao N, Dworecka F, Hermann G (1982) Cervical radiculopa-
Importantly, they have also been associated with compli-
caons such as cervical radiculopathy [4], rib fracture [5],
pneumonia and empyema [6].
Invesgaons
CT of the chest is the inial invesgaon of choice, but
biopsy of the tumor remains the gold standard. The dier-
enal diagnosis includes liposarcomas, bromas and soli-
tary brous tumor of the pleura (SFTP). Benign lipomas are
usually smooth, marginated, have uniform fay density, lo-
cated peripherally in the chest wall and usually on CT scan
have aenuaon coecients of -50 to -150 Hounseld
units [7], whereas Liposarcomas can be present anywhere
in the thoracic cavity, but more frequently are found in
the posterior mediasnum. Lipo sarcomas have aenu-
aon coecients of higher than -50 Hounseld units [7].
Histologically, pleural and intrathoracic lipomas contain
abundant mature adipose ssue with no mitoc acvity,
with normal bro-connecve ssue in between but some-
mes may contain foci of calcicaon and fat necrosis es-
pecially in large tumors [8]. Lipo sarcomas, on the other
hand, have adipose Cells of varying size with hyperchro-
mac nuclei and eosinophilic cytoplasm. Liposarcomas can
also have mitoses associated with mulnucleated hiso-
cytes and fay necrosis seen in 25% of cases [8,9]. SFTP
is a rare, usually benign and indolent growing tumor that
accounts for approximately 5% of all pleural neoplasms
[10]. More than 50% of benign tumors are asymptomat-
ic, and are incidentally discovered on roune chest x-rays
performed for paent presenng with cough, chest pain or
dyspnea [11]. Histologically they consist of ovoid or elon-
gated spindle-shaped tumor cells with varying amounts of
cytoplasm [12].
Management
Epler, et al. suggested, pleural lipomas can be man-
aged conservavely and should be followed radiological-
ly [7]. However, recently several authors such as Sakurai,
et al. [2], Chung, et al. [13], and Jayle, et al. [14] advocated re-
secon of the lipoma tumor by surgery or video-assisted tho-
[R] [L]
Figure 2: Computed tomography of the chest showing CT-
guided biopsy of a smooth, marginated mass in the right upper
thorax, measuring 5.4 × 4.5 × 2.7 cms.
Figure 3: Histology shows normal mature adipose tissue, with
no mitotic activity.

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Mathur et al. Int J Respir Pulm Med 2017, 4:069
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(2012) Pleural lipoma: a non-surgical lesion? Interact Car-
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(1988) Atypical transmural thoracic lipoma: CT diagnosis. J
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M, et al. (2009) Endobronchial lipoma a rare cause of pleu-
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