Introduction: Lipoma is a benign tumor of adipose tissue, most often located in the subcutaneous tissue or deep soft tissues. It is usually solitary, slow-growing, and asymptomatic. Giant lipomas (≥10 cm or ≥1 kg) are rare and may cause compression of blood vessels and nerves, restricted mobility, and cosmetic deformity. Genetic predisposition is associated with mutations in genes such as High Mobility Group AT-hook 2 (HMGA2) and Domain-Containing Preferred Translocation Partner in Lipoma (LPP). Diagnosis is based on clinical examination and imaging, including ultrasonography, CT, and, in diagnostically equivocal cases, MRI. Suspicious cases are confirmed by histology to rule out malignant tumors.
Clinical presentation: Patient O., 65 years old, was admitted to the surgical department with a giant lipoma of the right thigh, present for over 15 years and associated with discomfort, a feeling of heaviness, and cramps. On examination, a mass measuring 40 × 35 cm was detected, of soft-elastic consistency, painless, mobile, with no skin changes. Diagnostic work-up included ultrasonography (US), computed tomography (CT), and biopsy, confirming a benign lipoma. Planned surgical excision was performed under spinal anesthesia; the lipoma was completely removed. The excised mass measured 50 × 35 cm and weighed 5700 g. The surgery was uneventful, with a blood loss of 100 ml. The postoperative period was smooth; drains were removed on postoperative days 4-5, and sutures were removed on days 9-10. The patient was discharged in satisfactory condition, with complete wound healing and a recommendation for follow-up with a surgeon.
Discussion: Giant lipomas are rare but can cause compression of blood vessels and nerves, restricted mobility, and cosmetic discomfort. Their size and atypical course may mimic malignant tumors, necessitating thorough preoperative evaluation using MRI, histology, and, if necessary, genetic testing by fluorescence in situ hybridization (FISH) for MDM2 (Mouse Double Minute 2) gene amplification. The primary and safest treatment remains radical surgical excision with preservation of anatomical structures. Small or cosmetically significant lipomas may be treated with less invasive methods, but giant forms require full surgical intervention to restore function and improve the patient's quality of life.
Conclusion: Giant thigh lipomas require a comprehensive and carefully planned approach, including thorough diagnostic assessment and radical surgical intervention. Effective treatment results in sustained improvement of the patient's physical and psycho-emotional condition, reduction of pain, and restoration of quality of life, as reflected by a marked improvement in SF-36 and EQ-5D scores during long-term follow-up.