Surgical resection of a giant intramuscular lipoma of the biceps brachii: a case report and review of the literature
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ORTHOPAEDIC SURGERY
Surgical resection of a giant intramuscular lipoma of the biceps brachii: a case report and review of the literature Felix Toft1 Received: 27 April 2020 / Accepted: 30 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Lipomas are frequent benign soft-tissue tumors mainly located in the subcutis. Occasionally, subfascial or inter- or intramuscular lipomas are encountered. This case report describes the surgical management of a very rare giant intramuscular lipoma of the right biceps brachii muscle in a 71-year-old male patient. Preoperative magnetic resonance imaging as well as intraoperative photographs depict the complexity of this case and aid in the discussion about indications for surgery, as management guidelines of these deep-seated tumors are still inconsistent. Keywords Lipoma · Giant lipoma · Intramuscular lipoma · Biceps brachii · Soft tissue tumor
Introduction
Case report
Lipomas are the most common benign soft-tissue tumors in adults, generally located in the subcutaneous fat layer, whereas subfascial or intramuscular lipomas are far less frequently encountered [1, 2]. Intramuscular lipomas of the upper extremity have been predominantly localized in the deltoid—as well as the pectoralis—and forearm muscles. Single case reports also confirmed lipomas in the rotator cuff musculature [3]. To the best of our knowledge and according to a literature review, only 5 intramuscular lipomas in the biceps brachii muscle have been reported in the English literature to date, with 3 reports from Morocco, one from Taiwan and another report from Tunisia [4–8]. Know-how concerning the management of these tumors in this rare location is, therefore,, very limited and motivated us to report on the first European case of a giant intramuscular lipoma of the biceps brachii muscle and its surgical treatment.
A 71-year-old patient was referred to our clinic with an indolent mass in the upper right arm, which had already been diagnosed as an intramuscular lipoma of the biceps brachii muscle by ultrasound (US) and complementary magnetic resonance imaging (MRI) (Fig. 1). The patient had had surgical removal of a subcutaneous lipoma in the same area (histologically confirmed) 8 months before. The patient did not complain about any pain or functional restrictions related to the mass, but considered the tumor cosmetically disturbing. Therefore, he requested surgical resection of the presumable lipoma. The MRI showed a 7 × 3 × 1 cm mass entirely located in the musculature of the biceps brachii with fat equivalent signals, corresponding to an intramuscular lipoma (Figs. 2, 3, 4). The exact location was between the short and the long head of the biceps tendons proximally, extending distally between the muscular parts to the mid of the upper arm. The cephalic vein was located directly adjacent to the encapsulated mass, where the lipoma divided the muscle bellies and lied directly subfascial. There were no morphological signs of malignancy. Apart from the suspected lipoma of th
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