Lipoma Biopsy: When Is It Done?

Question

I had a 3rd ultrasound on Monday of this week for a benign lump (lipoma) in my chest and rec'd a call from my family doctor telling me that the lipoma that was found has grown. They want to follow up with another ultrasound in six months if the specialist does not request any further follow up ... should I be worried ? Should I request that they do a biopsy to make sure it's a lipoma that doesn't need to be removed?

Raffy Karamanoukian, MD, FACS · Answer

An excisional biopsy is usually performed for nodules that are suggestive of a lipoma.  This entails complete surgical excision and examination by a pathologist.

Robert L. Kraft, MD, FACS · Answer

It would be helpful to clarify if you have a subcutaneous or submuscular lipoma or something deeper in the chest cavity. For either of the first two types, the lesions should be excised if there is a history of growth. Lipomata over a certain size have a risk of malignant degeneration. I believe that all lipomata should be excised when small to avoid the complications which come with growth including longer scarring and greater surgical complexity. Once you have clarified the type of lipoma, you will know whether to see a plastic surgeon. Biopsy is of limited value as the tissue in one part of the mass can be benign with malignancy or dysplasia elsewhere.

Timothy Mountcastle, MD · Answer

i always just remove the lipoma and send the entire specimen for pathologic examination. and incisional or fine needle aspiration biopsy would not make much sense but could be done. ultrasound also could support a diagnosis one way or the other but an examination of the specimen under a microscope is the gold standard.

Pat Pazmino, MD, FACS · Answer

There are many reasons to receive a biopsy for a lipoma. If the mass is in a sensitive place that may affect other structures, your physician may recommend a biopsy to determine if this is a benign mass or not. If the mass is benign but is not pleasing or interfering with the year activities or function, a complete excision may be recommended to address the mass once and for all.

Arnold R. Oppenheim, MD (retired) · Answer

I would assume that the lipoma is in the chest cavity, otherwise it would have been biopsied (and excised) already.
   I would also assume that the ultrasounds are very supportive of a diagnosis of a lipoma. 
    A lipoma is one of the most common benigh mesenchymal neoplasms of the mediastinum, the central compartment of the chest. It is often quite large and usually sits right on top of the diaghragm. The fact that it is growing does not necessarily mean it is malignant. We physicians have all encountered pretty massive lipomas. Sometimes people who are overweight, on steroids or have a conditon called Cushing's Disease, too much cortisone, are prone to these benign tumors in the chest cavity. 
    Surgery in this area can be difficult and perhaps that is why you have not undergone this yet. 
     If you have not had a surgical consult yet, you might ask your family phycisian for one. 
    Good luck

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