Excision of a massive lipoma of the thigh following extensive weight loss and bariatric surgery

Abstract

A 52-year-old morbidly obese man with a body mass index (BMI) of 78 kg/m2 lost a great deal of weight through diet control over a 3-year period before undergoing bariatric surgery in the form of laparoscopic sleeve gastrectomy. He continued to lose weight, reducing BMI to 56 kg/m2; however, a large left medial thigh mass persisted. Differential diagnoses included lipoma, liposarcoma and hernia. An MRI scan revealed a 37 × 23 × 23 cm oedematous fatty swelling through which contained multiple enlarged inguinal lymph nodes and the great saphenous vein. Plastic surgeons excised the mass with direct closure of skin. Pathology confirmed lipoma with localised lymphoedema. This represents a case of giant lipoma, of which several reports have been described. We highlight the importance of preoperative imaging when planning resection of large masses to delineate the regional anatomy and the need for histological and genetic analysis to differentiate liposarcoma from lipoma due to their similar presentations.