Humeral Intra-Osseous Lipoma with Hemorrhage-A Case Report

                        http://mathewsopenaccess.com/orthopedics-current-issue.html

Intraosseous lipoma has a 1% incidence among the primary tumors of the bone, and it frequently occurs in the calcaneous. As it is rare, it may be mistaken for nonossifying fibroma, aneurysmal bone cyst, simple bone cyst, bone infarct and chondroid tumors. Intraosseous lipomas are usually followed up conservatively due to their spontaneous involution. However, surgery is required in the presence of fracture risk, malignant transformation potential and/or extensive pain. Herein we report a case with intraosseous lipoma involving the proximal left humerus, causing cortical expansion. This presentation is unusual for this type of tumor both in terms of localization and radiology. Conventional radiography was not successful in the initial diagnosis of the condition. Advanced modalities including CT and MRI proved to have a pivotal role in diagnosis of the patient.

The intraosseous lipoma is the most common lipogenous lesion of bone. Intraosseous lipoma is found most frequently in the calcaneus and intertrochanteric region of the proximal femur. The symptoms may result from remodeling of bone due to expansion, or due to intralesional ischemia, noted to be a common consequence of a longstanding calcaneal intraosseous lipoma. Intraosseous lipoma is an uncommon benign bone tumor which, as it slowly expands and remodels adjacent osseous structures, acquires a typical appearance that should be readily diagnostic on plain radiographs and MRI. Intraosseous lipomas may present with bone pain up to 66% of the time from chronic expansion, or with acute symptoms related to pathologic (insufficiency) fracture. Although there exists a differential diagnosis, including bone infarct, unicameral bone cyst, aneursymal bone cyst, chondromyxoid fibroma, osteoblastoma and giant cell tumor, the presence of patently obvious fat signal intensity on T1-weighted MR images should allow a near 100% sensitivity and specificity in the diagnosis of calcaneal intraosseous lipoma .

A 21-year-old man presented with a 3-months history of gradually increasing left shoulder and arm pain with vague history of old trauma. The pain increased with movements, lifting any objects and reduced with rest. On clinical examination revealed tenderness at the upper left arm; still no definite swelling identified.