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Lipoma - Large Biopsy 3-6 cm

Biopsy
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Report in 288Hrs

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No Fasting Required

Details

Excision biopsy of fatty tumors.

₹666₹951

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Lipoma - Large Biopsy 3-6 cm

  • Why is it done?
    • Tissue diagnosis and histopathological examination of subcutaneous adipose tumors measuring 3-6 cm in diameter to confirm benign lipoma diagnosis and rule out malignant or atypical soft tissue lesions
    • Differentiating benign lipomas from liposarcomas or other malignant soft tissue neoplasms, particularly when clinical or imaging findings are equivocal
    • Assessment of lesions that have recently enlarged, show rapid growth, or present with atypical clinical features suggestive of malignancy
    • Evaluation of recurrent or multiple subcutaneous lesions to exclude syndromic conditions or infiltrative disorders
    • Performed when imaging characteristics are inconclusive or when clinical suspicion of malignancy warrants definitive tissue diagnosis
    • Prior to surgical excision if definitive diagnosis is needed or to guide treatment planning
  • Normal Range
    • Normal/Benign Finding: Mature lipocytes (fat cells) arranged in lobules separated by fibrovascular septa with intact fibrous capsule, absence of cellular atypia, mitotic figures, or necrosis
    • Key Normal Features: Uniform cell size and morphology, non-infiltrative margins, minimal or absent mitotic activity (typically <1 mitosis per 10 high power fields)
    • Interpretation Result: Diagnosis of Benign Lipoma (Lipomatosis) - Benign finding requiring no further intervention beyond possible surgical excision for symptom relief or cosmetic reasons
    • Abnormal Findings - Atypical Lipomatous Tumor (ALT)/Well-Differentiated Liposarcoma: Lipocytes with nuclear enlargement, irregularity, and hyperchromasia; increased vascularity with thick-walled vessels; presence of lipoblasts (immature fat cells with hyperchromatic nuclei and scant cytoplasm)
    • Abnormal Findings - Myxoid or Dedifferentiated Liposarcoma: Myxoid background, marked cellular atypia, increased mitotic figures (>5 per 10 high power fields), non-lipogenic malignant cells, or evidence of dedifferentiation with round cell or pleomorphic morphology
  • Interpretation
    • Benign Lipoma: Most common result; indicates a mature, well-circumscribed fatty tumor with excellent prognosis. Recurrence after complete excision is rare (<5%). No malignant potential. Observation or elective surgical removal based on patient preference and functional/cosmetic concerns
    • Angiolipoma: Variant of benign lipoma with prominent vascular component and possibly increased tendency for recurrence. Still benign but may require more aggressive surgical management
    • Atypical Lipomatous Tumor (ALT)/Well-Differentiated Liposarcoma (WDLS): Represents a spectrum of low-grade malignancy. ALT has minimal metastatic potential but high recurrence risk (20-30%) if incompletely excised. WDLS carries risk of dedifferentiation over time. Requires wide surgical excision with negative margins, imaging follow-up, and possible adjuvant radiation. Regular clinical and radiological surveillance recommended
    • Myxoid Liposarcoma: Higher grade malignancy with intermediate metastatic potential (35-50% recurrence, 5-15% distant metastasis rate). Requires aggressive surgical resection with wide margins, consideration of neoadjuvant/adjuvant chemotherapy and radiation therapy. Close follow-up with imaging every 3-6 months
    • Dedifferentiated Liposarcoma: High-grade malignancy with aggressive behavior and high recurrence/metastasis rates. Requires multimodal therapy including wide surgical resection, systemic chemotherapy, and radiation. Prognosis is guarded with 5-year survival rates of 30-40%
    • Factors Affecting Interpretation: Specimen adequacy, depth of sampling (deep biopsies more likely to capture malignant components), location of lesion (retroperitoneal/mediastinal lipomas have higher malignancy risk), patient age, lesion size and growth rate
    • Clinical Significance: Distinguishes between benign and malignant lipomatous lesions, which carry dramatically different prognoses and treatment approaches. Determines need for aggressive versus conservative management and surveillance protocols
  • Associated Organs
    • Primary Organ System: Integumentary and subcutaneous tissue system; mesenchymal tissues of adipose origin
    • Most Common Sites: Subcutaneous tissues of trunk, extremities (particularly upper back, shoulders, abdomen); less commonly deep soft tissues, muscle, or retroperitoneum
    • Associated Conditions - Benign: Simple obesity, multiple lipomatosis (familial multiple lipomatosis, Madelung disease), lipedema, Dercum's disease, metabolic syndrome, insulin resistance
    • Associated Conditions - Malignant: Liposarcomas (all grades), atypical lipomatous tumors, Li-Fraumeni syndrome, hereditary leiomyomatosis and renal cell cancer (HLRCC), familial adenomatous polyposis (FAP) associated soft tissue sarcomas
    • Potential Complications - Benign: Biopsy site hematoma, superficial infection, scar formation, nerve or vessel injury (rare with proper technique), recurrence after incomplete excision
    • Potential Complications - Malignant: Local recurrence (high risk), distant metastasis (particularly to lungs, abdomen, mediastinum), dedifferentiation of WDLS to higher grade malignancy, morbidity from extensive surgical resection, treatment-related complications from chemotherapy and radiation
    • Systemic Effects: Most benign lipomas have no systemic effects. Extensive lipomatosis can contribute to metabolic dysfunction. Liposarcomas can have systemic effects through cytokine production and cachexia in advanced cases
  • Follow-up Tests
    • If Benign Lipoma Confirmed: No further testing required in most cases; clinical follow-up with physical examination at 3-6 month intervals if lesion remains in situ; repeat imaging (ultrasound or MRI) only if rapid growth or concerning clinical change occurs
    • If Atypical Lipomatous Tumor/WDLS Diagnosed: High-resolution MRI of primary site with contrast to determine margins and extent; CT chest to exclude pulmonary metastases; baseline abdominal/pelvic CT if deep/retroperitoneal location; oncology consultation; molecular testing for MDM2/CDK4 amplification if diagnosis confirmation needed; follow-up imaging every 3-6 months for 2 years, then annually
    • If Myxoid Liposarcoma Diagnosed: Urgent oncology referral; comprehensive staging with MRI primary site, CT chest/abdomen/pelvis, PET-CT considered; molecular confirmation with t(12;16) or t(12;22) translocation testing; baseline laboratory studies (CBC, CMP, LDH); serial imaging during treatment and every 3 months post-treatment for 2 years
    • If Dedifferentiated Liposarcoma Diagnosed: Urgent multidisciplinary team consultation; comprehensive staging with high-quality MRI, CT chest/abdomen/pelvis, PET-CT for metastasis detection; complete blood work including tumor markers; genetic counseling if syndromic features present; imaging follow-up every 2-3 months during active treatment and every 3-4 months for 5 years post-treatment
    • Specimen Quality Issues or Inconclusive Results: Repeat biopsy with adequate sampling depth; consideration of open surgical biopsy or excisional biopsy for definitive diagnosis; immunohistochemistry for CDK4, MDM2 if ALT/WDLS suspected; cytogenetic analysis or FISH for relevant translocations
    • Related/Complementary Tests: Ultrasound or MRI pre-biopsy for accurate localization; immunohistochemistry (S100, MDM2, CDK4, p53); fluorescence in situ hybridization (FISH) for MDM2/CDK4 amplification; reverse transcription PCR for t(12;16) and t(12;22) in myxoid lesions; flow cytometry if round cell differentiation suspected
  • Fasting Required?
    • Fasting Required: NO - Fasting is NOT required for lipoma biopsy as this is a local tissue procedure not requiring systemic laboratory preparation
    • Pre-Biopsy Instructions: Patient may eat and drink normally prior to procedure; optimal timing is when patient is alert and able to remain still during biopsy
    • Medications - Hold Before Procedure: Anticoagulants (warfarin) - discontinue 3-5 days prior if INR can be normalized; antiplatelet agents (aspirin, clopidogrel) - hold 7-10 days prior if possible; NSAIDs - hold 3-5 days prior to minimize bleeding risk; discuss specific agents with provider 5-7 days before scheduled procedure
    • Other Patient Preparation: Bathe or shower morning of procedure with gentle cleansing of biopsy site; wear loose, comfortable clothing allowing access to biopsy site; avoid heavy lifting and strenuous activity 24 hours before procedure; arrange transportation if conscious sedation used; arrive 15 minutes early for check-in
    • Special Considerations: Diabetic patients on insulin or oral agents may proceed with normal medication schedule; patients with bleeding disorders should notify provider in advance; pregnancy is not a contraindication but defer non-urgent biopsies to post-partum period if possible; if local anesthesia used, patient may resume normal activities same day; if conscious sedation used, NPO status (nothing by mouth) 6-8 hours prior may be required and driver needed
    • Post-Procedure Instructions: Keep biopsy site dry and covered with sterile dressing for 24-48 hours; avoid showering/bathing for 48 hours; ice application to site first 24 hours to reduce swelling; avoid strenuous activity and heavy lifting for 3-5 days; normal diet and hydration encouraged; pain control with acetaminophen as needed; contact provider if excessive bleeding, severe pain, fever, or signs of infection develop

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