Painful angiolipomatosis: evaluation of the extended subcutaneous lipectomy and the immunohistochemical and histological analysis compared to other benign lipomatous tumors

Painful angiolipomatosis: evaluation of the extended subcutaneous lipectomy and the... Angiolipomas are benign subcutaneous tumors that usually develop in young adults. Few reports describe cases with more than 200 of these extremely painful tumors found in a single patient. We report two cases of adult men suffering from painful angiolipomas with a similar history. Oral salbutamol and lidocaine infusion did not help, and analgesics gave only slight relief. Both patients retired from work early. The two patients were treated by subcutaneous lipectomy; 574 angiolipomas were removed in one case and 215 in the other. Painless lipomas of ten patients (10), painless angiolipomas in two patients (10), and ten painful angiolipomas of each of the described patients were analyzed histologically and by immunohistochemistry (S-100, CD34). We compared the quantity of vessels, nerves, and thrombi. Postoperative complications were hematoma (3/11) and seroma (5/11) formations. Pain relief and low incidence of recurrence were achieved. The highest concentration of vessels was found in angiolipomas (+++), with no difference between painful and painless tumors, less in ordinary lipomas (−/+). In angiolipomas the vessel location was more typically in the subcapsular region. Nerves were found to a slight degree in the painful angiolipomas (−/+), but none were found in the painless angiolipomas and lipomas (−). The quantity of fibrin thrombi was much higher in painful angiolipomas (++) than in painless angiolipomas (−/+). Extended subcutaneous lipectomy is a reliable method for treating severe forms of painful angiolipomatosis. Advantages of the technique are a reduced number of operations, pain relief, and a lower rate of recurrence at the operated sites. The only obvious signs in painful angiolipomas (which rarely appear in painless benign lipomatous tumors) are vascularity and thrombi formation in the vessels located close to the capsule. This pain could be related to ischemia. Treatment options should include special prophylaxis against thrombus formation. European Journal of Plastic Surgery Springer Journals

Painful angiolipomatosis: evaluation of the extended subcutaneous lipectomy and the immunohistochemical and histological analysis compared to other benign lipomatous tumors

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