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

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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References

  1. Reig-Boix V, Guinot-Tormo J, Risent-Martinez F, Aparisi-Rodriguez F, Ferrer-Jimenez R. Computed tomography of intraosseous lipoma of os calcis. Clin Orthop 1987; 221:286–291.

    PubMed  Google Scholar 

  2. Barcelo M, Pathria MN, Abdul-Karim FW. Intraosseous lipoma. A clinicopathologic study of four cases. Arch Pathol Lab Med 1992; 116:947–950.

    CAS  PubMed  Google Scholar 

  3. Hanelin LG, Sclamberg EL, Bardsley JL. Intraosseous lipoma of the coccyx. Report of a case. Radiology 1975; 114:343–344.

    CAS  PubMed  Google Scholar 

  4. Gero MJ, Kahn LB. Case report 498: Intraosseous lipoma of the distal end of the fibula with focal infarction. Skeletal Radiol 1988; 17:443–446.

    CAS  PubMed  Google Scholar 

  5. Milgram JW. Intraosseous lipomas. A clinicopathologic study of 66 cases. Clin Orthop 1988; 231:277–302.

    PubMed  Google Scholar 

  6. Poussa M, Holmstrom T. Intraosseous lipoma of the calcaneus. Report of a case and a short review of the literature. Acta Orthop Scand 1976; 47:570–574.

    CAS  PubMed  Google Scholar 

  7. Zorn DT, Cordray DR, Randels PH. Intraosseous lipoma of bone involving the sacrum. J Bone Joint Surg Am 1971; 53:1201–1204.

    CAS  PubMed  Google Scholar 

  8. Latham PD, Athanasou NA. Intraosseous lipoma within the femoral head. A case report. Clin Orthop 1991; 265:228–232.

    PubMed  Google Scholar 

  9. Lauf E, Mullen BR, Ragsdale BD, Kanat IO. Intraosseous lipoma of distal fibula. Biomechanical considerations for successful treatment. J Am Podiatr Med Assoc 1984; 74:434–440.

    CAS  Google Scholar 

  10. Appenzeller J, Weitzner S. Intraosseous lipoma of os calcis. Case report and review of literature of intraosseous lipoma of extremities. Clin Orthop 1974; 101:171–175.

    CAS  PubMed  Google Scholar 

  11. Goldenhar AS, Maloney JP, Helff JR. Negative bone scan in the diagnosis of calcaneal intraosseous lipoma. J Am Podiatr Med Assoc 1993; 83:600–602.

    CAS  PubMed  Google Scholar 

  12. Goldman AB, Marcove RC, Huvos AG, Smith J. Case report 280: Intraosseous lipoma of the tibia. Skeletal Radiol 1984; 12:209–212.

    CAS  PubMed  Google Scholar 

  13. Lagier R. Fibular lipoma with areas of bone infarct calcification. Eur J Radiol 1985; 5:226–227.

    CAS  PubMed  Google Scholar 

  14. Propeck T, Bullard MA, Lin J, Doi K, Martel W. Radiologic-pathologic correlation of intraosseous lipomas. AJR Am J Roentgenol 2000; 175:673–678.

    CAS  PubMed  Google Scholar 

  15. Blacksin MF, Ende N, Benevenia J. Magnetic resonance imaging of intraosseous lipomas: a radiologic-pathologic correlation. Skeletal Radiol 1995; 24:37–41.

    CAS  PubMed  Google Scholar 

  16. Boylan JP, Springer KR, Halpern FP. Intraosseous lipoma of the calcaneus. A case report. J Am Podiatr Med Assoc 1991; 81:502–505.

    CAS  PubMed  Google Scholar 

  17. Coquerelle P, Cotten A, Flipo RM, Chastanet P, Duquesnoy B, Delcambre B. Intraosseous lipoma: role and limitations of modern imaging techniques. Rev Rhum Engl Ed 1995; 62:147–150.

    CAS  PubMed  Google Scholar 

  18. Gonzalez JV, Stuck RM, Streit N. Intraosseous lipoma of the calcaneus: a clinicopathologic study of three cases. J Foot Ankle Surg 1997; 36:306–310; discussion 329.

    CAS  PubMed  Google Scholar 

  19. Levin MF, Vellet AD, Munk PL, McLean CA. Intraosseous lipoma of the distal femur: MRI appearance. Skeletal Radiol 1996; 25:82–84.

    Article  CAS  PubMed  Google Scholar 

  20. Leeson MC, Kay D, Smith BS. Intraosseous lipoma. Clin Orthop 1983; 181:186–190.

    PubMed  Google Scholar 

  21. Ketyer S, Brownstein S, Cholankeril J. CT diagnosis of intraosseous lipoma of the calcaneus. J Comput Assist Tomogr 1983; 7:546–547.

    CAS  PubMed  Google Scholar 

  22. Pande KC, Ceccherini AF, Webb JK, Preston BJ. Intraosseous lipomata of adjacent vertebral bodies. Eur Spine J 1998; 7:344–347.

    Article  CAS  PubMed  Google Scholar 

  23. Ramos A, Castello J, Sartoris DJ, Greenway GD, Resnick D, Haghighi P. Osseous lipoma: CT appearance. Radiology 1985; 157:615–619.

    CAS  PubMed  Google Scholar 

  24. Rhodes RD, Page JC. Intraosseous lipoma of the os calcis. J Am Podiatr Med Assoc 1993; 83:288–292.

    CAS  PubMed  Google Scholar 

  25. Richardson AA, Erdmann BB, Beier-Hanratty S, et al. Magnetic resonance imagery of a calcaneal lipoma. J Am Podiatr Med Assoc 1995; 85:493–496.

    CAS  PubMed  Google Scholar 

  26. Schatz SG, Dipaola JD, D'Agostino A, Hanna R, Quinn SF. Intraosseous lipoma of the calcaneus. J Foot Surg 1992; 31:381–384.

    CAS  PubMed  Google Scholar 

  27. Tyrrell PNM, Davies AM, Beggs I. Intraosseous lipoma of the calcaneus: a report of 3 cases. Foot 1994; 4:166–170.

    Google Scholar 

  28. Williams CE, Close PJ, Meaney J, Ritchie D, Cogley D, Carty AT. Intraosseous lipomas. Clin Radiol 1993; 47:348–350.

    CAS  PubMed  Google Scholar 

  29. Milgram JW. Intraosseous lipomas with reactive ossification in the proximal femur. Report of eight cases. Skeletal Radiol 1981; 7:1–13.

    CAS  PubMed  Google Scholar 

  30. Barker GR, Sloan P. Intraosseous lipomas: clinical features of a mandibular case with possible aetiology. Br J Oral Maxillofac Surg 1986; 24:459–463.

    CAS  PubMed  Google Scholar 

  31. Lagier R. Case report 128: lipoma of the calcaneus with bone infarct. Skeletal Radiol 1980; 5:267–269.

    CAS  PubMed  Google Scholar 

  32. Child PL. Lipoma of the os calcis. Am J Clin Pathol 1955; 25:1050–1052.

    Google Scholar 

  33. Greenspan A, Raiszadeh K, Riley GM, Matthews D. Intraosseous lipoma of the calcaneus. Foot Ankle Int 1997; 18:53–56.

    CAS  PubMed  Google Scholar 

  34. Gunterberg B, Kindblom LG. Intraosseous lipoma. A report of two cases. Acta Orthop Scand 1978; 49:95–97.

    CAS  PubMed  Google Scholar 

  35. Hatori M, Hosaka M, Ehara S, Kokubun S. Imaging features of intraosseous lipomas of the calcaneus. Arch Orthop Trauma Surg 2001; 121:429–432.

    Article  CAS  PubMed  Google Scholar 

  36. Hodge JC, Sundaram M, Janney CG. Clinics in diagnostic imaging (21). Intraosseous lipoma of the calcaneum. Singapore Med J 1997; 38:41–43.

    CAS  PubMed  Google Scholar 

  37. Mohan V, Gupta SK, Cherian J, Lal S. Intra-osseous lipoma of the calcaneum. J Postgrad Med 1981; 27:126B, 127–128.

    CAS  PubMed  Google Scholar 

  38. Liapi-Avgeri G, Markakis P, Kokka H, Karajannis S, Christophidou E, Karabela-Bouropoulou V. Intraosseous lipoma. A report of three cases. Arch Anat Cytol Pathol 1994; 42:334–338.

    CAS  PubMed  Google Scholar 

  39. Rosenblatt EM, Mollin J, Abdelwahab IF. Bilateral calcaneal intraosseous lipomas: a case report. Mt Sinai J Med 1990; 57:174–176.

    CAS  PubMed  Google Scholar 

  40. DeLee JC. Intra-osseous lipoma of the proximal part of the femur. Case report. J Bone Joint Surg Am 1979; 61:601–603.

    CAS  PubMed  Google Scholar 

  41. Chow LT, Lee KC. Intraosseous lipoma. A clinicopathologic study of nine cases. Am J Surg Pathol 1992; 16:401–410.

    CAS  PubMed  Google Scholar 

  42. Kozlowski K, Welshman R. What is it? Intraosseous lipoma in a 13 year old boy. Br J Radiol 1991; 64:855–856.

    CAS  PubMed  Google Scholar 

  43. Hart JA. Intraosseous lipoma. J Bone Joint Surg Br 1973; 55:624–632.

    CAS  PubMed  Google Scholar 

  44. Moorefield WG Jr, Urbaniak JR, Gonzalvo AA. Intramedullary lipoma of the distal femur. South Med J 1976; 69:1210–1211.

    PubMed  Google Scholar 

  45. Herold ZH, Baruchin AM, Shmueli G. Intraosseous lipoma of the distal part of the femur. J Pediatr Surg 1987; 22:384–385.

    CAS  PubMed  Google Scholar 

  46. Smith WE, Fienberg R. Intraosseous lipoma of bone. Cancer 1957; 10:1151–1152.

    CAS  Google Scholar 

  47. Mueller MC, Robbins JL. Intramedullary lipoma of bone. J Bone Joint Surg Am 1960; 42:517–520.

    Google Scholar 

  48. Dickson AB, Ayres WW, Mason MW, Miller WR. Lipoma of bone of intra-osseous origin. J Bone Joint Surg Am 1951; 33:257–259.

    Google Scholar 

  49. Fox IM. Intraosseous lipoma of the fifth metatarsal. J Foot Ankle Surg 1994; 33:138–140.

    CAS  PubMed  Google Scholar 

  50. Caruolo JE, Dahlin DC. Lipoma involving bone and simulating malignant bone tumor: report of case. Mayo Clin Proc 1953; 28:361–363.

    Google Scholar 

  51. Noble JS, Leeson MC. Intraosseous lipoma of the humerus. Orthopedics 1992; 15:51–54.

    CAS  PubMed  Google Scholar 

  52. Skinner GB, Fraser RF. Medullary lipoma of bone. J Can Assoc Radiol 1957; 8:19–21.

    Google Scholar 

  53. Nakata E, Kawai A, Sugihara S, Naito N, Morimoto Y, Inoue H. Humeral lesion in a 69-year-old woman. Clin Orthop 2001; 389:248–250, 253–255.

    PubMed  Google Scholar 

  54. Yasuda Y, Tsukada S, Okada T, Haseda Y. Intraosseous lipoma of the skull: a report of two cases. Ann Plast Surg 1987; 18:74–80.

    CAS  PubMed  Google Scholar 

  55. Small ML, Green WR, Johnson LC. Lipoma of the frontal bone. Arch Ophthalmol 1979; 97:129–132.

    CAS  PubMed  Google Scholar 

  56. Tomabechi M, Sako K, Daita G, Yonemasu Y. Lipoma involving the skull. Case report. J Neurosurg 1992; 76:312–314.

    CAS  PubMed  Google Scholar 

  57. Shuangshoti S, Suwanwela C, Suwanwela N. Congenital osteolipoma of the skull. Arch Otolaryngol 1982; 108:454–457.

    CAS  PubMed  Google Scholar 

  58. Heir GM, Geron PR. Mandibular intraosseous lipoma related to trigeminal neuropathy. Clin Prev Dent 1983; 5:13–15.

    CAS  Google Scholar 

  59. Johnson EC. Intraosseous lipoma: report of case. J Oral Surg 1969; 27:868–870.

    CAS  PubMed  Google Scholar 

  60. Miller WB, Ausich JE, McDaniel RK, Longo JJ. Mandibular intraosseous lipoma. J Oral Maxillofac Surg 1982; 40:594–596.

    CAS  PubMed  Google Scholar 

  61. Oringer MJ. Lipoma of the mandible. Oral Surg Oral Med Oral Pathol 1948; 1:1134.

    Google Scholar 

  62. Newman CW. Fibrolipoma of the mandible. J Oral Surg 1957; 15:251–252.

    Google Scholar 

  63. Matsubayashi T, Nakajima M, Tsukada M. Case report 118. Skeletal Radiol 1980; 5:131–133.

    CAS  PubMed  Google Scholar 

  64. Ehara S, Kattapuram SV, Rosenberg AE. Case report 619: Intraosseous lipoma of the sacrum. Skeletal Radiol 1990; 19:375–376.

    CAS  PubMed  Google Scholar 

  65. Buckley SL, Burkus JK. Intraosseous lipoma of the Ilium. A case report. Clin Orthop 1988; 228:297–301.

    PubMed  Google Scholar 

  66. Hall FM, Cohen RB, Grumbach K. Case report 377: Intraosseous lipoma (angiolipoma) of right third rib. Skeletal Radiol 1986; 15:401–403.

    CAS  PubMed  Google Scholar 

  67. Freiberg RA, Air GW, Glueck CJ, Ishikawa T, Abrams NR. Multiple intraosseous lipomas with type-IV hyperlipoproteinemia. A case report. J Bone Joint Surg Am 1974; 56:1729–1732.

    CAS  PubMed  Google Scholar 

  68. Dohler R, Poser HL, Harms D, Wiedemann HR. Systemic lipomatosis of bone. A case report. J Bone Joint Surg Br 1982; 64:84–87.

    CAS  PubMed  Google Scholar 

  69. Szendroi M, Karlinger K, Gonda A. Intraosseous lipomatosis. A case report. J Bone Joint Surg Br 1991; 73:109–112.

    CAS  PubMed  Google Scholar 

  70. Oosthuizen SF, Barnetson JB. Two cases of lipomatosis involving bone. Br J Radiol 1947; 20:426–432.

    Google Scholar 

  71. Norman A, Steiner GC. Radiographic and morphological features of cyst formation in idiopathic bone infarction. Radiology 1983; 146:335–338.

    CAS  PubMed  Google Scholar 

  72. Simpson AH, Creasy TS, Williamson DM, Wilson DJ, Spivey JS. Cystic degeneration of fibrous dysplasia masquerading as sarcoma. J Bone Joint Surg Br 1989; 71:434–436.

    CAS  PubMed  Google Scholar 

  73. Ragsdale BD. Polymorphic fibro-osseous lesions of bone: an almost site-specific diagnostic problem of the proximal femur. Hum Pathol 1993; 24:505–512.

    CAS  PubMed  Google Scholar 

  74. Polte HW, Kolodny SC, Hooker SP. Intraosseous angiolipoma of the mandible. Oral Surg Oral Med Oral Pathol 1976; 41:637–643.

    CAS  PubMed  Google Scholar 

  75. Helms CA, Munk PL. Pseudopermeative skeletal lesions. Br J Radiol 1990; 63:461–467.

    CAS  PubMed  Google Scholar 

  76. Keats T, Anderson M. Atlas of normal variants that may simulate disease, 7th edn St Louis: Mosby, 2001:494–495.

  77. Jensen NC, Madsen LP, Linde F. Topographical distribution of trabecular bone strength in the human os calcanei. J Biomech 1991; 24:49–55.

    CAS  PubMed  Google Scholar 

  78. Van Linthoudt D, Lagier R. Calcaneal cysts. A radiological and anatomico-pathological study. Acta Orthop Scand 1978; 49:310–316.

    PubMed  Google Scholar 

  79. Michota RS, Perdiue RL, McGee TP. Aneurysmal bone cyst/lipoma of toe: case study and presentation. J Am Podiatr Med Assoc 1978; 68:725–731.

    CAS  Google Scholar 

  80. Milgram JW. Malignant transformation in bone lipomas. Skeletal Radiol 1990; 19:347–352.

    CAS  PubMed  Google Scholar 

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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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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

Keywords

  • Lipoma
  • Intraosseous
  • Intramedullary
  • Magnetic resonance imaging
  • Computed tomography