Chest wall giant lipoma with a thirty-year history
Giovanni Leuzzia,*, Alfredo Cesarioa,b, Anna Mariantonia Parisiaand Pierluigi Granonea
aDepartment of Thoracic Surgery, Sacred Heart Catholic University, Rome, Italy
bIRCCS San Raffaele Pisana, Rome, Italy
* Corresponding author. Department of Thoracic Surgery, Università Cattolica del Sacro Cuore Largo F. Vito n 1, 00168 Rome, Italy. Tel: +39-06-30156353; +39-
34-88893788; e-mail: email@example.com (G. Leuzzi).
Received 14 February 2012; received in revised form 13 March 2012; accepted 22 March 2012
Benign chest wall tumours are very uncommon and chest wall lipomas are rarely reported in literature. We report herein a case of a
68-year old man who developed a giant, symptomless mass of the chest wall. A chest computed tomography scan evidenced a solid
neoplasm measuring 27 cm in its major axis. A radical excision was performed and the histology was consistent with lipoma. To our
knowledge, this is the first case reporting a giant lipoma of the chest wall with a thirty-year history.
Keywords: Lipoma • Chest wall tumour • Liposarcoma
Benign chest wall tumours (BCWT) are very uncommon and
chest wall lipomas are rarely reported in literature. We herein
report a case of a giant, symptomless lipoma of the chest wall
developed over a period of thirty years.
A 68-year-old caucasian man developed, in over thirty years
of progressive enlargement, a giant, symptomless mass of the
chest wall [Fig. 1(A)]. His medical history included coronary
artery disease treated by percutaneous transluminal coronary
angioplasty in 2006. Laboratory data and tumoral biomarkers
were within normal limits. A computed tomography (CT) scan
of the chest evidenced a solid neoplasm measuring 27 cm in
its major axis, apparently originating from the left serratus
anterior muscle. The mass showed a homogeneous fat density
with spotted areas of calcification. No direct signs of chest
wall invasion were detected [Fig. 1(B) and (C)]. Based upon the
radiological findings, the possible diagnoses were those of a
lipoma or liposarcoma. Given the foreseeable resectability of
the mass, no biopsy was undertaken and a radical excision
was indicated and performed. Intraoperatively, the mass
was confirmed not to be infiltrating the chest wall, nor was
any regional involvement evident. At final pathology, the
tumour measured approximately 26 × 16 × 21 cm and weighed
4,570 g [Fig. 2(A)]. The histology was consistent with lipoma
(well-encapsulated adipose tissue with fat necrosis areas, fibrosis
and calcification) [Fig. 2(B)]. The patient’s postoperative course
was good; he was discharged in the third postoperative day and,
one year after surgery, as expected, there is no evidence of
BCWT may originate from vascular, peripheral nerve, osseous,
cartilaginous, or adipose tissue and are very rare lesions. In the
literature, few research studies of this group of tumours have
been reported. In particular, the imaging features of BCWT are
non-specific: only combination of imaging appearance, location
and clinical information may suggest a diagnosis .
Chest radiography can be used to determine the location,
size, and growth rate of the mass. However, CT enables a more
accurate assessment of tumour morphology, composition, loca-
tion and extent .
In the case we report, CT scan evidenced a solid neoplasm
with homogeneous fat density with spotted areas of calcification.
According to these radiological features and the absence of signs
of chest wall invasion, we did not perform a fine needle aspir-
ation biopsy preoperatively and a radical excision was indicated
Generally, chest wall lipomas occur in obese patients who are
50–70 years of age and, in most cases, are deep lesions, larger
and less well circumscribed than subcutaneous ones . In our
case, the patient was 68 years old and the tumour (an extremely
large mass measuring 27 cm in its major axis) apparently origi-
nated from the left serratus anterior muscle. Moreover, the
capsule was difficult to see clearly on CT scans.
In conclusion, chest wall giant lipomas are rarely reported in
the literature . To our knowledge, this is the first case reporting
© The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Interactive CardioVascular and Thoracic Surgery 15 (2012) 323–324
doi:10.1093/icvts/ivs159Advance Access publication 15 May 2012
CASE REPORT - THORACIC
a giant, symptomless lipoma of the chest wall developed over a
Conflict of interest: none declared.
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Figure 1: (A) Preoperative appearance of the chest wall mass. (B–C) Chest CT
scan evidenced a solid neoplasm measuring 27 cm in its major axis, appar-
ently originating from the left serratus anterior muscle. The mass showed a
homogeneous fat density with spotted areas of calcification. No direct signs
of chest wall invasion were detected.
Figure 2: (A) Macroscopic aspect of giant lipoma. The tumour measured ap-
proximately 26 × 16× 21 cm and weighed 4,570 g. (B) Final pathology con-
firmed a lipoma (well-encapsulated adipose tissue with fat necrosis areas,
fibrosis and calcification).
G. Leuzzi et al. / Interactive CardioVascular and Thoracic Surgery