Lipoma and liposarcoma: benign and malignant fat cell tumor

Lipoma and liposarcoma: benign and malignant fat cell tumor

A slowly growing lump on the back or a fatty lump on the abdomen – such symptoms can indicate a lipoma or liposarcoma. Both are so-called soft tissue tumors and originate from fat cells that grow excessively. However, while a lipoma is benign and does not necessarily require treatment, liposarcoma is malignant and definitely requires treatment. We explain to you what the two tumors are all about, how to recognize them and when to remove them.

What is a lipoma?

A lipoma is a  benign tumor that  arises from fat cells (adipocytes). “Lip-” comes from the Greek word “Lipos” which means fat. The suffix “-om” designates a growth or tumor without giving any information about whether the growth is benign or malignant.

A lipoma develops when the fat cells in one place overproliferate, i.e. multiply too much. The exact cause of this is unclear, with genetic causes being debated. If a person has multiple lipomas, it is called  lipomatosis.

Can a lipoma be malignant?

Lipomas are always benign and cannot develop into a malignant tumor.

However, there are  malignant tumors that,  like the lipoma, originate in fatty tissue. These are called  liposarcomas  and belong to the so-called soft tissue sarcomas. They are rare in adults, tend to affect older people (the most common age at onset is around 70 years of age) and are not more common in one sex. Risk factors have not yet been found. Various subtypes of liposarcoma (well differentiated, dedifferentiated, myxoid and pleomorphic) can be distinguished on the basis of histological examinations.

Sarcomas are malignant tumors that originate either in soft tissue – for example connective tissue (fibrosarcoma) or muscle cells (leiomyosarcoma) – or in the skeletal system – such as bones (osteosarcoma) or cartilage (chondrosarcoma). Overall, sarcomas are more common in children than in adults.

Where do lipomas and liposarcomas grow?

Lipomas can appear anywhere on the body because the human body has fat cells everywhere. They usually develop in the superficial soft tissue, i.e. in the fatty tissue directly under the skin. Any part of the body can be affected.

Common locations are:

  • the trunk (back, abdomen, chest)
  • neck and neck
  • Shoulders and arms (e.g. on the upper arm, in the crook of the arm or in the armpit)

More rarely, lipomas develop on the head (e.g. on the face, forehead or  scalp ) and legs (e.g. on the thigh,  shinbone  or foot).

Lipomas can also occur on internal organs or internal fat deposits. The heart can be affected, usually the septum between the two atria. However, lipomas can also develop in the intestines, on the liver or on the bronchi.

Like lipomas, liposarcomas can occur anywhere there is fatty tissue. Liposarcomas occur particularly frequently on the extremities (here especially on the thighs) and somewhat less frequently on the back or the so-called retroperitoneal space, i.e. the fatty connective tissue in the rear abdominal cavity. Unlike lipomas, liposarcomas tend to grow in deeper fatty tissue.

Symptoms: what does a lipoma look like?

Usually, lipomas are rather small (less than two inches in size). They are noticeable as a small swelling,  lump  or bump under the skin and are clearly distinguishable from the surrounding tissue. Lipomas are soft and movable. So you can move them under the skin and in relation to the surrounding muscles or bones.

How do I recognize a liposarcoma?

Initially, liposarcomas look very similar to lipomas, they are noticeable by a painless, small swelling. However, they are more common on the legs. Only as growth progresses do they cause additional symptoms. As a result, the diagnosis is often made late, which makes healing more difficult.

Symptoms that trigger liposarcomas are usually caused by displacement of other organs and by infiltration, i.e. growing into them, or by spreading (metastasis). Then they cause pain or restrict the function of other organs.

Depending on the organ affected, this can have different effects. A liposarcoma in the intestine can, for example, cause a feeling of fullness,  nausea  and indigestion. In addition, non-specific symptoms such as  tiredness  and exhaustion, weight loss and slight  fever can occur .

How is a lipoma or liposarcoma diagnosed?

A physical examination is performed first to make the diagnosis. The doctor pays attention to the size, consistency, mobility and pain of the tumor. In addition, a search is made for  swollen lymph nodes  , which can indicate metastases in malignant tumors.

To further secure the diagnosis, an  MRI  or an ultrasound can help. Here the extent of the tumor and its exact location can be determined. If necessary, a tissue sample (a biopsy) is then taken and histologically (histologically) examined in order to determine the cell type and the so-called dignity (malignant or benign) of the tumor.

When does a lipoma need to be removed?

Since most lipomas do not cause any symptoms, removal is often not necessary. A regular examination by a doctor is sufficient. However, if a lipoma hurts, displaces surrounding structures such as muscles or nerves and possibly damages them, or if it becomes very large, removal (resection) is necessary and makes sense.

Even with cosmetic suffering, lipomas can be removed. Because some of those affected suffer greatly from the aesthetic appearance, which can result in psychological complaints such as reduced self-esteem or even  depression  . If the lipoma removal is medically necessary, the health insurance company will bear the costs.

How do you treat a lipoma?

 A lipoma cannot be treated without  surgery . You can neither express lipomas nor   remove them yourself with household remedies such as apple cider vinegar  or  honey .

Which doctor removes lipomas depends on the size and location of the lipoma. Small, easily accessible lipomas can be removed on an outpatient basis by a dermatologist. A local anesthetic is given and the lipoma is removed with an incision. Larger or deeper lipomas may require surgery under  general anesthesia  . This is usually performed by surgeons.

Aftercare after removal

In most cases, no longer sick leave is necessary after a lipoma removal. However, it is important

  • not to interfere with wound healing
  • to keep the surgical wound clean so that it does not become infected
  • not to put tension on the wound
  • to go to the doctor for regular wound checks

Once the wound has healed, no further checks are necessary. However, lipomas can recur—in the same place or a different place—and require repeat treatment.

Therapy for liposarcoma

Unlike lipoma, treatment for liposarcoma is highly recommended to prevent spread. Therapy consists of surgical removal of the liposarcoma. Here, part of the surrounding healthy tissue is removed in order to remove as many tumor cells as possible. This is followed by radiation therapy, which serves to destroy any remaining liposarcoma cells. In some cases,  chemotherapy is also  useful.

Once this so-called primary therapy has been completed, regular follow-up checks must be carried out in order to quickly detect a recurrence (recurrence) of the liposarcoma.

Prognosis: Is a liposarcoma curable?

In principle, a liposarcoma can be cured if it is detected and treated in good time. Unfortunately, however, these sarcomas are often only diagnosed at a late stage. They are then already very large or have formed metastases, often in the lungs. Then liposarcoma can be fatal.

Nevertheless, the chance of survival with liposarcoma is significantly better than with other soft tissue sarcomas, so that over 70 to 90 percent of people with liposarcoma survive more than 5 to 10 years after diagnosis. 1  However, survival varies widely by subtype of liposarcoma.


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