|Year : 2016 | Volume
| Issue : 1 | Page : 12-14
Lipoma of the breast: An uncommon occurrence
Nnamdi J Nwashilli1, Ezekiel E Ugiagbe2
1 Department of Surgery, University of Benin Teaching Hospital, Benin, Edo, Nigeria
2 Department of Pathology, University of Benin Teaching Hospital, Benin, Edo, Nigeria
|Date of Acceptance||08-Jun-2016|
|Date of Web Publication||20-Dec-2016|
Nnamdi J Nwashilli
Department of Surgery, University of Benin Teaching Hospital, Benin, Edo
Source of Support: None, Conflict of Interest: None
Lipomas are benign tumors composed of mature fat and are usually encapsulated. Majority of them are small and grow slowly. They are derived from mesenchymal tissue and are usually found wherever there is fatty tissue. Lipomas rarely occur in the breast and can cause diagnostic uncertainty. We present a case of a 40-year-old female who anxiously presented with a mass in her right breast that she thought it was cancer, but later confirmed after excision on histology as lipoma.
Keywords: Breast, excision, lipoma
|How to cite this article:|
Nwashilli NJ, Ugiagbe EE. Lipoma of the breast: An uncommon occurrence. Niger J Surg Sci 2016;26:12-4
| Introduction|| |
Lipomas are the most common mesenchymal tumors.  Lipomas develop in the areas of abundant adipose tissue and can arise in any part of the body. They account for approximately 16% of all mesenchymal tumors.  Lipomas of the breast are usually small, benign tumors, which are rare. 
Increase in the size of a lipoma of the breast can cause disfiguration/asymmetry with attendant risk of malignancy. Lipomas of the breast may cause diagnostic uncertainty because of the normal fatty composition of the breast, thus making it difficult to distinguish from other breast lesions.
We present a case of a 40-year-old female who anxiously presented with a mass in her right breast that she thought it was cancer, but later confirmed after excision on histology as lipoma.
| Case Report|| |
A 40-year-old female presented with a mass in her right breast of 6 years duration and was anxious of it being cancer. The mass was painless and progressively increased in size. There was no mass in the contralateral breast. There was no history of breast trauma or family history of breast disease. There was no nipple discharge, breast ulcer, or weight loss. A review of other systems was normal.
Physical examination revealed a middle-aged woman, healthy looking, not pale, afebrile, anicteric, and no peripheral lymph node enlargement. The right breast examination revealed a round-shaped mass in the upper outer quadrant with no differential warmth, nontender, soft, 6 cm × 6 cm, lobulated, distinct edge, and unattached to the skin or underlying structure. There were no axillary lymph nodes. The left breast examination was normal.
An ultrasound of the right breast revealed a mass of 5 cm × 6 cm in the upper outer quadrant with lobulations and no axillary lymph node. Full blood count showed a hematocrit of 36% (hemoglobin = 11.8 g/dl), total white blood cell count of 6.5 × 10 3 /μL, and platelet of 160 × 10 3 /μL. Electrolytes, urea, creatinine, and urinalysis were normal.
An excision biopsy of the mass showed a round-shaped, lobulated mass with a thin capsule [Figure 1] and [Figure 2]. Histopathological examination revealed an encapsulated cream-colored oval mass measuring 9 cm × 5 cm × 3 cm, whose cut surface showed a uniform yellowish surface. Microscopy showed a benign neoplasm composed of sheets of mature adipocytes with eccentrically placed nuclei and abundant clear cytoplasm. There is a focal area of mixed inflammatory cell infiltrates [Figure 3].
|Figure 3: Sections of the breast tissue show a benign neoplasm composed of sheets of mature adipocytes with eccentrically placed nuclei and abundant clear cytoplasm. There is a focal area of mixed inflammatory cell infiltrates|
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| Discussion|| |
Lipomas can arise from any part of the body, especially in the areas of abundant adipose tissue. Lipoma of the breast presenting as a mass may cause diagnostic uncertainty, making it difficult to distinguish from other breast lesions. This was the case in this middle-aged woman who presented with a mass in her breast, which she anxiously thought it was cancer.
The exact incidence of breast lipoma is not known, being described both as a common and rare condition by different authors. Balcalbasa and Irina  reported that breast is a common place for breast lipoma while Donegan  considered breast lipoma as a rare condition.
In Nigeria, authors from different geographical regions have reported breast lipomas as rarely encountered tumors. Olu-Eddo and Ugiagbe  in a 25-year histopathological review of 1864 (72.4%) cases of breast biopsies at the University of Benin Teaching Hospital, Benin city, reported 14 (0.8%) cases of breast lipoma. In South-East Nigeria, Njeze  in a 21-year single-center clinical and histological analysis of 165 patients with breast lumps who underwent open biopsy reported only one (0.6%) case of breast lipoma. At Ibadan, South-West Nigeria, Irabor and Okolo  in an audit of 149 consecutive breast biopsies also reported only one case of breast lipoma. In the Northern part of Nigeria, Umar et al.  reported 16 (4%) cases of breast lipoma out of 395 (98%) cases in their study on the pattern of adipose tissue tumors at the Ahmadu Bello University Teaching Hospital, Zaria.
In Ghana, Ohene-Yeboah  in a 6-year prospective study of 443 cases of excised breast lumps in Ghanian women reported no case of breast lipoma. A similar study by Kemp et al.  on sonographically benign breast lesions in African women under 40 years of age in South Africa also reported no case of breast lipoma out of 73 breast lesions biopsied, further giving credence to the fact that breast lipomas are uncommon breast lesions.
Out of Africa, similar trends of lipoma being an uncommon breast lesion have been reported. Albasri  in an 8-year retrospective histopathological review of 603 cases of benign breast lesions in Saudi Arabia reported only three cases of breast lipoma. In India, Akshara et al.  in a 1 year prospective study of eighty patients with benign breast disease reported only one case of breast lipoma. In all these studies, no reason was adduced for the uncommon nature of breast lipoma despite the breast being enriched with fats.
Lipoma of the breast can gradually increase in size leading to asymmetry of the breasts. A giant breast lipoma is characterized by a lesion of at least 5 cm in one dimension and weighs more than 500 g.  The index case will be qualified for a giant lipoma based on its size. Other authors , defined giant lipoma of the breast as a mass of at least 10 cm in one dimension or a minimum weight of 1000 g.
The treatment of breast lipoma is complete excision.  The reported case had complete excision via a circumareolar incision with a good cosmetic outlook. The best cosmetic result is obtained by incisions along the Langer's lines. A cirumareolar, elliptical, or anterior axillary incision may be appropriate depending on the position and size of the mass.  Liposuction or suction-assisted lipectomy has been reported in the removal of small or large masses in particular locations where a large scar formation should be avoided. 
Breast lipomas can be misdiagnosed as carcinoma, fibroadenomas, phyllodes tumors, and duct papillomas. Other conditions that can mimic lipomas include hamartomas, angiolipomas, angiomyolipomas, atypical lipomatous tumors, and liposarcoma. 
| Conclusion|| |
Lipoma of the breast is a benign and uncommon lesion. Any mass in the breast must be thoroughly evaluated to exclude malignancy.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]