Extension patterns of giant lipomas arising from the brachial plexus: giant lipomas from brachial plexus.

Abstract

Purpose: Benign adipose tumors in close proximity to the major nerves are termed troublesome lipomas and are indicated for resection because of neurological impairment. Until now, however, limited cases of giant lipoma arising from the brachial plexus region have been reported. We discussed our experience with cases of giant lipomas arising from the brachial plexus region.

Methods: We reviewed six cases treated in our hospital. There were four males and two females with the mean age of 55 years. On its greatest dimension, the size of the giant tumor ranged from 14 to 30 cm with an average of 21.6 cm. Based on MRI findings, the tumor extension patterns were divided, (1) lateral type, (2) posterior type and (3) inferior type. The symptoms were characteristic according to extension patterns of the tumor.

Results: Five patients who underwent tumor resection showed improvement in subjective symptoms early after surgery. An asymptomatic case with inferior type underwent only open biopsy. The histopathology in all cases confirmed ordinary lipomas. There was no local recurrence postoperatively.

Conclusion: Brachial plexus lipoma has potential to grow unexpectedly large due to repetitive microtrauma. The indication for tumor resection surgery should be considered in each type of tumor extension. The lateral type, which directly causes neurological symptoms, is the most indicative for tumor resection, while the posterior type is more suitable for surgery due to stubborn shoulder stiffness and symptom with thoracic outlet syndrome. In the case with inferior extension type, the patient was asymptomatic and the operative indication should be less.