Clin Orthop Surg.  2018 Jun;10(2):234-239. 10.4055/cios.2018.10.2.234.

Intraosseous Lipoma: 18 Years of Experience at a Single Institution

• Kang HS
• Kim T
• Oh S
• Park S
• Chung SH

• KMID: 2411750
• DOI: http://doi.org/10.4055/cios.2018.10.2.234

Abstract

BACKGROUND
Intraosseous lipoma is a very rare lesion that constitutes no more than 0.1% of all bone tumors. We analyzed 21 cases of intraosseous lipoma at a single institution for clinical and radiographic characteristics.
METHODS
A retrospective study was performed on 21 pathologically confirmed intraosseous lipomas treated in our hospital from 2000 to 2017. Simple X-ray and magnetic resonance imaging findings and medical records were reviewed. Patients' age, sex, and clinical symptoms were investigated. From the radiographic images, the site of the lesion, calcification, bony expansion, and stage of the lesion were evaluated. Correlations between the degree of involution and clinical symptoms were analyzed.
RESULTS
The mean age of patients was 50 years (range, 20 to 67 years), and there were 13 males and eight females. The mean lesion size was 6.1 cm (range, 2.5 to 13.6 cm). The most common anatomical site of the lesion was the femur (seven cases), and three cases occurred in flat bones such as the ilium and scapula. Visual analogue scale score for pain was 3 to 6 in 15 patients. There were no complaints of functional limitation. There was no correlation between the degree of degeneration and clinical symptoms (p = 1.000). Curettage was performed as a surgical treatment in 20 patients, and bone graft was performed using a bone chip. Excision was performed in one patient. Pain was resolved in seven of 11 patients with a complaint of preoperative pain; intermittent pain remained in four cases. There was no local recurrence or malignant change during the follow-up.
CONCLUSIONS
There was no correlation between the degree of degeneration and clinical symptoms. Pain was the most common clinical symptom, but it was rarely accompanied by functional limitation. However, it is important to distinguish it from other pain-inducing disorders. The incidence of intraosseous lipomas is low, and detection based on various imaging findings can be difficult. Clear understanding of the radiographic findings and symptoms of intraosseous lipoma is helpful for diagnosis and differentiation.

Keyword

Bone neoplasms; Intraosseous; Lipoma

MeSH Terms

Bone Neoplasms
Curettage
Diagnosis
Female
Femur
Follow-Up Studies
Humans
Ilium
Incidence
Lipoma*
Magnetic Resonance Imaging
Male
Medical Records
Recurrence
Retrospective Studies
Scapula
Transplants

Figure

• 

  Fig. 1 A 44-year-old woman with an intraosseous lipoma (late phase) in the right ilium. (A) The anteroposterior pelvic radiograph shows a sclerotic-margined and expansile bone lesion in the right iliac bone. (B) Low power photomicrograph demonstrating fat necrosis with fine, powdery calcification and fibrosis, similar to what is seen in bone infarct. These features represent the late stage intraosseous lipoma (H&E, ×100). (C) On fat-suppressed coronal T2-weighted magnetic resonance imaging, the mass has high signal intensity centrally, indicating cystic necrotic portions. (D) On coronal T1-weighted magnetic resonance imaging, the mass demonstrates well-defined fat signal intensity with a central area of low signal intensity due to cystic change.

• 

  Fig. 2 A 20-year-old man with an intraosseous lipoma (early phase) in the body of scapula. (A) The outlet view shoulder radiograph demonstrates an expansile bone lesion at the body of the right scapula. (B) Photomicrograph of the lesion consisting of mature adipocytes, similar to fatty marrow. However, there is no evidence of bone marrow elements (H&E, ×100). (C) On fat-suppressed coronal T2-weighted magnetic resonance imaging, the mass shows signal dropout with fat suppression. (D) On coronal T1-weighted magnetic resonance imaging, the corresponding lesion is isointense to subcutaneous fat.

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