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Intraosseous lipoma: report of 35 new cases and a review of the literature

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Abstract

Objective

To identify the common imaging features of intraosseous lipomas on radiographs, magnetic resonance imaging (MRI) and computed tomography (CT), and review their histological features.

Design and patients

Thirty-five previously unreported cases of intraosseous lipoma were reviewed and a meta-analysis was performed of another 110 cases identified from the English language literature.

Results

The mean age at presentation is 43 years. Sex distribution is nearly equal. Lipomas occur most frequently in the lower limb (71% overall), particularly in the os calcis (32%). Other common sites include the metaphyses of long bones, where lesions are typically eccentric. Lipomas are usually well defined, but marginal sclerosis is commoner in lesions of the os calcis (61%) than at other sites (38%). Calcification is also more frequent in the os calcis (62%), and almost invariably centrally located. Calcification at other sites is less common (30%), and is more variable in appearance. Bone expansion is less common (30%), and usually minimal. Fat necrosis and cyst formation identified on MRI is common (67%), and more frequent in the os calcis.

Conclusions

Although there is correlation between the histological and radiological features of intraosseous lipomas in general, some discrepancies occur in the radiological appearances of lipomas in different sites. The evidence that these lesions are true benign tumours of fat is controversial. Several aetiological factors have been implicated in their development. The constant location of os calcis lesions at the critical angle suggests an aetiology that may be related to biomechanical lines of stress. In other instances it is possible that involution of pre-existing lesions may lead to the development of lipomas.

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Acknowledgements

We thank the other BSSR radiologists who contributed cases for this study: Dr David Ritchie, Liverpool; Dr Bryan Preston, Nottingham; Dr Charles Wakeley, Bristol; Dr John Addison, Elgin, Scotland; Dr Andy Jones, Gwent, Wales. Thanks also go to Dr Dennis Stoker and Dr Victor Cassar-Pullicino for personal communications and comments.

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Authors and Affiliations

  1. Department of Radiology, The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK

    R. S. D. Campbell

  2. Department of Radiology, Leeds General Infirmary, Leeds, LS1 3EX, UK

    A. J. Grainger

  3. Department of Pathology, Royal Orthopaedic Hospital, Woodlands, Birmingham, B31 2AP, UK

    D. C. Mangham

  4. Department of Radiology, Royal Infirmary, Edinburgh, Scotland, EH3 9YW, UK

    I. Beggs

  5. Department of Radiology, Nuffield Orthopaedic Centre, Headington, Oxford, OX3 7LD, UK

    J. Teh

  6. Department of Radiology, Royal Orthopaedic Hospital, Woodlands, Birmingham, B31 2AP, UK

    A. M. Davies

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  1. R. S. D. Campbell
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  3. D. C. Mangham
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Correspondence to R. S. D. Campbell.

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Campbell, R.S.D., Grainger, A.J., Mangham, D.C. et al. Intraosseous lipoma: report of 35 new cases and a review of the literature. Skeletal Radiol 32, 209–222 (2003). https://doi.org/10.1007/s00256-002-0616-7

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  • DOI: https://doi.org/10.1007/s00256-002-0616-7

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