Lipoma
● Tumour arising from brown fat
● It is called universal tumour
(ubiquitous tumour) as it can occur anywhere in the body (exception brain )
● Most common benign tumour
● Two type :•Diffuse →not encapsulated
•Localized →capsulated
Types :-->
● Neurolipoma → painful
● Dercum disease →tender fat deposition on Trusac adiposis dolorosa. It is basically
neurolipomatosis.
● Fibrolipoma →lipoma with fibrous components.
● Naevolipoma →lipoma with telangiectasia.
● Lipoma arborigens → it is pedunculated lipoma
● Thigh, shoulder, retroperitoneum → may turn liposarcoma.
Sites of lipoma :-->
● Subcutaneous
● Subfascial
● Intramuscular
● Parosteal
● Submucosal
● Extradural ( not intradural )
● Intra articular
● Subsynovial
○ Subperiosteal
● Intraglandular
Clinical features :-
● Localised swelling, lobular, nontender
● Semifluctuant, non transilluminant
● Mobile, edge slipping between palpating finger
● Skin free
● Pedunculated sometime.
● Pain due to neural components.
● Trunk common site
● Single, multiple, diffuse
Complications :-
● Myxomatous change
● Calcification
● Submucosal lipoma cause intussusception
● Sarcoma.
Cyst
Cyst means "bladder ". Fluid filled sac lined by epithelium or endothelium.
Types:-
i) True →lined by epithelium or endothelium
ii) False →without epithelial lining.
Classification :-
•Congenital :- •Dermoid →sequestration
•Tubulodermoid
→thyroglossal
→postnatal
→ependymal
→urachus
•cyst of embryonic remnants
→cyst of mesonephric and
Paramesonephric duct.
Acquired :-Retention → Sebaceous cyst
Bartholincyst
Cyst of parotid
Breast
Epididymis
Distension →Lymph cyst
Ovarian cyst
Exudation cyst-> Busra, Hydrocele,
Pancreatic pseudocyst.
Cystic tumor:- Dermoid cyst of ovary,
Cystadenoma.
Traumatic cyst :->Trauma ->collected blood
accumulated ->lined by
endothelium containing brown
Coloured fluid.
Degenerative cyst :-> cystic degeneration of
of solid tumour.
Parasitic cyst : - hydatid cyst.
Effect of cysts :-
● CBD compression - choledochal cyst
● Infection
● Sinus formation
● Hemorrhage
● Torsion
● Calcification
● Cachexic- malignancy
Brilliantly transilluminant cyst :
● Ranula
● Cystic hygroma and lymph cyst
● Hydrocele
● Epididymal cyst
● Meningocele.
Types Of Dermoid :-
● Sequestration
● Tubulodermoid
● Implantation dermoid
● Teratometous dermoid
Sequestration dermoid :-
At line of embryogenic fusion, Inclusion of epithelium beneath the surface ->get sequestrated
forming cystic swelling in a deeper plan.
Common site :-
Forehead, neck, postauricular dermoid
● External angular dermoid
● Root of nose
● Sublingual
● Skull
● External angular dermoids may extend to eye.
Types of angular dermoid :-
•External angular dermoid -
Sequestration dermoid situated over the angular process of the frontal bone. Outer extremity of
eyebrows extend over some part of the swelling. This typical feature differentiate it from the
swelling arising from lacrimal gland.
•Internal angular dermoid :-
● Near the root of nose
● Sequestration Dermoid
contains:-putty like desquamated material , hair follicle, sebaceous sweat gland.
skull dermoid may extend upto cranial cavity.
bone defect may present with attachment of dura
partly outside, partly inside the skull::
dumb bell tumor
clinical feature:---painless swelling
2nd and 3rd decade
fluctuations + , soft, smooth
non transilluminating
bone indentation
cough impulse positive- if intracranial extension
Inv:: Xray- skull
CT scan Head
FNAC
Treatment:: Excision under GA
Neurosurgical intervention
( as required)
Tubulo dermoids::--
arise from embryogenic tubular structure
Thyroglossal cyst
ependymal cyst
post natal dermoid
urachal cyst
Implantation dermoid::--
Prick/ Trauma → epidermis get buried in deeper subcutaneous tissue → Reaction ) cyst
formation
Tailors, gardeners ( toe, feet, finger)
Teratomatous dermoid::- ovaries , testis, mediastinum
contains hair, teeth, cartilage, muscle
arise from all germinal layer– meso , endo, ectoderm.
Sebaceous cyst::---
● Retention cyst
● blockage of duct of sebaceous gland , causing cystic swelling
● face/ scalp/ scrotum
● not seen in palm and soles
as there are no sebaceous cyst
● sebaceous cyst contains keratin
● vad odor
● wall contains a parasite:: Demodex folliculorum
● c/f:- punctum -70%
non tender
mobile
bluish
in 30% cases :: sebaceous duct open into hair follicle -> here no punctum is seen
Fordyce's disease:: heterotopic sebaceous gland in mucosa and lips
● complications:- infection
abscess
cock peculiar tumor:- fungation / discharge
● Multiple sebaceous cyst::-
Gardner's syndrome
● multiple sebaceous cyst of scrotum::- often calcified
no punctum
partial scrotectomy
strawberry scrotum
● Treatment:- excision
Glomus tumor::-
GLOMANGIOMA::- arise from cutaneous glomus composed of tortuous arterioles which
communicate with venules . As it is surrounded by small nerves, making it painful. Common in
Nail beds
Treatment:- Excision
PAPILLOMA:: warty swelling from skin or mucous membrane
True papilloma –
● all layers of skin
● over growth
● sweat glands, sebaceous gland, hair follicle
● sessile/ pedunculated
● may turn sq. cell carcinoma
● most common cause of bloody discharge of nipples
● mucus membrane:: oral cavity
urinary bladder
rectum
larynx
gall bladder
Infective papilloma. ::- Condyloma acumminata
WARTS.::
Finger tips , face , axilla, sole of foot
dry , over growth projection , tender, disfiguring
kiss lesion can occur
MORRANT BAKER'S CYST::-
cystic swelling at popliteal fossa
it occurs due to herniation of synovial membrane of knee
joint. as a result of chronic arthritis
middle aged
cystic , transilluminated wart
disappear on flexion, increase on extension
NEUROFIBROMA::- Arise from connective tissue , nerve sheath containing ectodermal
neural and mesodermal connective tissue component
single. multiple
types:-
● Nodular
● plexiform: i. along distribution of 5th cranial nerve in skin and face
ii. enormous size
iii. myxomatous degeneration
iv. patchy dermatocele:- a variant of plexiform neurofibroma
● multiple neurofibromatosis
