Lipomatous Skin Tag
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Dr. P here with a patient, 47-year-old man,
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3 00:00:03,710 --> 00:00:06,529 complaining of pain when walking.
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His pain is on the bottom of the foot.
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Well, no joke.
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Here is the sagittal fat-suppressed image.
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There is a mass that fat suppresses.
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Here's the T2-weighted image, and the majority
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of the mass matches the signal intensity of fat.
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But it does have some septa inside.
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And then finally, the simple
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coronal T1-weighted image.
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No, that is not a lipoma.
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That is a normal fat pad.
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There's the rest of the normal fat pad.
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This is often misdiagnosed as a fatty lesion.
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But here is our mass.
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It looks like a giant gelatin
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capsule, but it isn't.
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It is a skin tag composed
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almost exclusively of fat.
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So, the communication with the
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heel pad is readily obvious.
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So what is the differential diagnosis here?
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Well, it could be a giant lipoma, but it does
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have some excessive weird septa inside, and so
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you have to consider something that's atypical.
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And we lump these into the category of
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atypical lipomatous tumors, or ALTs.
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And within the spectrum of ALTs are simple
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lipomas with some atypicality to them, so
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they're not so simple, lipomas with atypicality,
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such as a few extra septations, a few thick
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septations, a little bit of enhancement.
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Maybe a little bit of calcification.
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Large size.
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Then we get into, uh, something
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called the spindle cell lipoma, which
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we used to misname atypical lipoma.
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I don't use that term anymore.
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I use spindle cell lipoma.
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Those usually don't occur
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in the distal extremities.
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They may be associated with
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myasthenia gravis and thymoma.
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And then finally, the well-
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differentiated, slow-growing liposarcoma.
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Which sometimes can be very
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difficult to differentiate
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from the lipoma that has some atypicality to it.
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There's one other lesion that I'd like
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you to be aware of called hibernoma.
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Hibernomas are tumors of brown fat.
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They like the nape of the neck, and if you put
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your hand over them, they're a little bit warm.
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They will be hot on positron emission tomography.
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So this lesion was excised and proved to
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be a lipoma, a giant skin tag, and it just
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happened to have a few extra septations within.
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Simple diagnosis.
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Good case for arrest.
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Dr. P out.
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
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