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LETTER TO THE EDITOR
Year : 2020  |  Volume : 28  |  Issue : 2  |  Page : 130-131

A rare tumor of the toes: Lipoma


Department of Plastic Reconstructive and Aesthetic Surgery, Ankara University Faculty of Medicine, Ankara, Turkey

Date of Submission10-Jun-2019
Date of Acceptance10-Jun-2019
Date of Web Publication18-Mar-2020

Correspondence Address:
Dr. Burak Kaya
Department of Plastic Reconstructive and Aesthetic Surgery, Ankara University Faculty of Medicine, 06590, Dikimevi, Ankara
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjps.tjps_11_19

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How to cite this article:
Ozdemir A, Ozden NS, Aydinli Y, Kaya B. A rare tumor of the toes: Lipoma. Turk J Plast Surg 2020;28:130-1

How to cite this URL:
Ozdemir A, Ozden NS, Aydinli Y, Kaya B. A rare tumor of the toes: Lipoma. Turk J Plast Surg [serial online] 2020 [cited 2020 May 27];28:130-1. Available from: http://www.turkjplastsurg.org/text.asp?2020/28/2/130/280984



Dear Editor,

Lipomas are benign masses that originate from adipose tissue.[1] Lipomas are reported to be frequent in the general population, with an incidence rate of 1%.[1] Lipomas often favor fat-rich anatomic sites.[2],[3] They are most often seen in the back, the arms, the thighs, and the frontal wall of the chest.[2] Lipomas can rarely develop into liposarcomas through malignant transformation, in which case the treatment is excision.[4]

A 34-year-old male patient presented to our clinic with a mass in his left big toe that first appeared 5 years earlier. Physical examination revealed a softish, painless palpable, nonfluctuating mass measuring 3 cm × 3 cm at the level of the metatarsophalangeal joint, on the plantar side of the left big toe. Views of the case at presentation are shown in [Figure 1]. Magnetic resonance imaging (MRI) was requested to identify the relation of the mass with the metatarsophalangeal joint. MRI reported “lipomatous mass of 2.3 cm × 4 cm × 3.5 cm in the subcutaneous tissue, with lobulated contours and thin septa with no distinct contrast enhancement, encompassing the flexor tendon by 270° and extending to the medial, lateral, and dorsal starting from the plantar ligament level and adjacent to the proximal phalanx of the left big toe.” MRI view of the mass prediagnosed as lipoma is shown in [Figure 2]. The mass was excised under local anesthesia through a 2-cm incision cut over the medial side of the metatarsophalangeal joint of the left big toe. View of the mass immediately after excision is shown in [Figure 3]. Pathological examination reported lipoma. The patient had no complaints or complications in the follow-up period. [Figure 4] shows the view of the patient immediately after the local excision.
Figure 1: The view of the mass on the 1. toe of the left foot at the first presentation of the patient. (a) Dorsal aspect, (b) plantar aspect

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Figure 2: The MR images of the mass on the 1. toe of the left foot with a preliminary diagnosis of a lipoma

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Figure 3: The intraoperative macroscopic view of the mass which was preliminarily diagnosed as a lipoma

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Figure 4: The view after the excision of the mass

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Although lipomas are frequently seen in the adult population, the big toe is a very rare location. In the literature, there are studies reporting of lipoma cases in the lateral plantar heel, the dorsal foot, the second toe, the fourth toe, the calcaneal region, between the second and the third toes, the fifth metatarsal region, and the first metatarsophalangeal joint.[3] Differential diagnosis of other subcutaneous soft tissue masses include liposarcomas, angiolipomas, giant cell tumors of the tendon sheath, epidermoid cysts, nodular fasciitis, and erythema nodosum. Excision and histopathological diagnosis gain importance if lipomas and lipoma variants cannot be radiologically discriminated from liposarcomas, especially on imaging for diagnosis. Rate of recurrence after excision is <5%.[3] In our case, liposarcoma was not considered in the preliminary diagnosis since the mass was not large, was superficial, and did not present an aggressive growth pattern. Liposarcoma, the most significant type of mass in the differential diagnosis of lipomas, usually localizes to deeper regions such as the intramuscular or the retroperitoneal plane.[1],[2]

Another soft tissue tumor that is often seen in the hands and the feet is the giant cell tumor of the tendon sheath. These masses serve as differential diagnosis to lipomas with their benign and often solitary structures and slow growth. Giant cell tumors of the tendon sheath are most often seen in the hands and between the ages of 30–50 years. Giant cell tumors of the tendon sheath have a tendency to involve the dorsal foot rather than the plantar foot and are more commonly seen in women.[5] In the presented case, this diagnosis was not initially considered because of the localization (plantar foot) of the mass and the gender (male) of the patient.

The essential reason for excising lipomas is to differentiate these type of masses from malignant soft tissue sarcomas such as liposarcoma.[4] While large and deeply localized lipomas are known to carry a higher risk of malignant transformation, excision and pathological diagnosis of the mass are fundamental in the treatment of masses preliminarily diagnosed as lipoma.[2] Lipomas should be borne in mind in the differential diagnosis of subcutaneous masses of the foot, even if in a rare localization.

Informed consent

All images were taken with our clinic's camera and are shared with the written consent of the patient.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.



Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Aust MC, Spies M, Kall S, Gohritz A, Boorboor P, Kolokythas P, et al. Lipomas after blunt soft tissue trauma: Are they real? Analysis of 31 cases. Br J Dermatol 2007;157:92-9.  Back to cited text no. 1
    
2.
Azam A, Rajagopalan S, Niezywinski WA. A rapidly expanding massive lipoma of the toe. J Foot Ankle Surg 2007;46:499-501.  Back to cited text no. 2
    
3.
Akgün RC, Circi E, Demirörs H, Tuncay IC. A lipoma causing separation of toes in the second web space of the foot. Eklem Hastalik Cerrahisi 2012;23:52-4.  Back to cited text no. 3
    
4.
Johnson CN, Ha AS, Chen E, Davidson D. Lipomatous soft-tissue tumors. J Am Acad Orthop Surg 2018;26:779-88.  Back to cited text no. 4
    
5.
Özkur E, Kiremitçi Ü, Erdemir AV, İncel P, Leblebici C. Giant Cell Tumor of the Tendon Sheath Involving the Plantar Surface of the Foot: Case Report. Turk Klinikleri J Case Rep 2015;23:166-8.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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