Subpleural lipoma: Management of a rare intrathoracic tumor

Abstract

This clinical entity needs attention due to difficult preoperative differentiation. Complete surgical excision of these lesions with the appropriate surgical approach is mandatory, for both diagnosis and treatment.

Large Pleural Lipoma: An Incidental Finding During a Metastatic Workup

“…Pure intrathoracic lipoma is rare [1,5]. It is classified according to the origin of the tumor into: a) endobronchial lipoma which originate from the submucosal fat of tracheobronchial tree, b) parenchymal lipoma which are located peripherally within the lung parenchyma, c) mediastinal lipoma, d) Cardiac lipoma and e) pleural lipoma which arise from submesothelial parietal pleura and may extend into the subpleural, pleural or extrapleural spaces [3,6].…”

“…It is usually asymptomatic or presented with nonspecific symptoms due to the compression by large lipoma. Symptoms include: hacking cough, chest pain or dyspnea [3]. Local complications can be caused by: bone erosion or hyperostosis and peritoneal irritation [8].…”

“…Presence of a well-defined homogenous fatty lesion (-50 to -150 HU) with the displacement of the adjacent lung and vascular structures to make an obtuse angle with the chest wall, which is also not enhanced by an injected contrast medium are considered the diagnostic criteria of pleural lipoma [1,3]. Presence of infiltration of the adjacent structures, mass heterogeneity or greater attenuation more than-50 HU are considered as alarming signs of liposarcoma [1].…”

“…Transthoracic ultrasound helps in the definitive diagnosis of pleural lipoma, as it can determine whether the lesion is cystic or solid, the density of the adipose tissue, the lesion's homogeneity and it also help guide the intervention using fine needle aspiration cytology (FNAC) or tru cut biopsy [2,3].…”

“…Mostly because, PL is an incidental finding in the chest radiology in asymptomatic patients. [2] Nevertheless, nonspecific and compressive symptoms were also described [3]. A final pathological examination for the differentiation between lipoma and liposarcoma is essential [2].…”