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The tip of the iceberg: lipomatous tumours presenting as abdominal or pelvic wall hernias
Liposarcomas are the most common soft tissue sarcoma. They occur mainly in the thigh or retroperitoneum. Due to their size, lipomatous tumours can herniate either through the abdominal wall or in the groin. The part of the tumour that herniates represents only the ‘tip of the iceberg’, as the main p...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611857/ https://www.ncbi.nlm.nih.gov/pubmed/31278606 http://dx.doi.org/10.1186/s13244-019-0739-1 |
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author | van Langevelde, Kirsten Azzopardi, Christine Kiernan, Gareth Gibbons, Max Orosz, Zsolt Teh, James |
author_facet | van Langevelde, Kirsten Azzopardi, Christine Kiernan, Gareth Gibbons, Max Orosz, Zsolt Teh, James |
author_sort | van Langevelde, Kirsten |
collection | PubMed |
description | Liposarcomas are the most common soft tissue sarcoma. They occur mainly in the thigh or retroperitoneum. Due to their size, lipomatous tumours can herniate either through the abdominal wall or in the groin. The part of the tumour that herniates represents only the ‘tip of the iceberg’, as the main part of the tumour is not detectable clinically and is often underestimated. Due to their deep location, lipomatous tumours are often large at the time of presentation and therefore their surgical management can be challenging. Furthermore, due to their delayed presentation, there is a higher risk of de-differentiation. In this pictorial review, we discuss different presentations of herniating lipomatous tumours according to the location of the abdominal wall defects. We aim to cover a wide spectrum of hernia defects including inguinal, ventral, lumbar, sciatic and ischiorectal hernias. We also present cases of tumours within the psoas compartment ‘herniating’ from the pelvis into the thigh. In case of a palpable lump, the first diagnostic step is to perform an ultrasound. If the herniating tissue is not fully accessible with ultrasound, additional cross-sectional imaging by CT or MRI is warranted. In this article, CT and MRI findings in lipomatous tumours are addressed and the use of contrast enhanced sequences in MRI is discussed. Patients’ outcome depends not only on adequate diagnosis but also on the correct route of tissue sampling for histology and oncological resection to prevent local recurrence and loss of function. Therefore, referral to a specialised sarcoma treatment centre is key and needs to be done before biopsy. |
format | Online Article Text |
id | pubmed-6611857 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-66118572019-07-11 The tip of the iceberg: lipomatous tumours presenting as abdominal or pelvic wall hernias van Langevelde, Kirsten Azzopardi, Christine Kiernan, Gareth Gibbons, Max Orosz, Zsolt Teh, James Insights Imaging Educational Review Liposarcomas are the most common soft tissue sarcoma. They occur mainly in the thigh or retroperitoneum. Due to their size, lipomatous tumours can herniate either through the abdominal wall or in the groin. The part of the tumour that herniates represents only the ‘tip of the iceberg’, as the main part of the tumour is not detectable clinically and is often underestimated. Due to their deep location, lipomatous tumours are often large at the time of presentation and therefore their surgical management can be challenging. Furthermore, due to their delayed presentation, there is a higher risk of de-differentiation. In this pictorial review, we discuss different presentations of herniating lipomatous tumours according to the location of the abdominal wall defects. We aim to cover a wide spectrum of hernia defects including inguinal, ventral, lumbar, sciatic and ischiorectal hernias. We also present cases of tumours within the psoas compartment ‘herniating’ from the pelvis into the thigh. In case of a palpable lump, the first diagnostic step is to perform an ultrasound. If the herniating tissue is not fully accessible with ultrasound, additional cross-sectional imaging by CT or MRI is warranted. In this article, CT and MRI findings in lipomatous tumours are addressed and the use of contrast enhanced sequences in MRI is discussed. Patients’ outcome depends not only on adequate diagnosis but also on the correct route of tissue sampling for histology and oncological resection to prevent local recurrence and loss of function. Therefore, referral to a specialised sarcoma treatment centre is key and needs to be done before biopsy. Springer Berlin Heidelberg 2019-07-05 /pmc/articles/PMC6611857/ /pubmed/31278606 http://dx.doi.org/10.1186/s13244-019-0739-1 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Educational Review van Langevelde, Kirsten Azzopardi, Christine Kiernan, Gareth Gibbons, Max Orosz, Zsolt Teh, James The tip of the iceberg: lipomatous tumours presenting as abdominal or pelvic wall hernias |
title | The tip of the iceberg: lipomatous tumours presenting as abdominal or pelvic wall hernias |
title_full | The tip of the iceberg: lipomatous tumours presenting as abdominal or pelvic wall hernias |
title_fullStr | The tip of the iceberg: lipomatous tumours presenting as abdominal or pelvic wall hernias |
title_full_unstemmed | The tip of the iceberg: lipomatous tumours presenting as abdominal or pelvic wall hernias |
title_short | The tip of the iceberg: lipomatous tumours presenting as abdominal or pelvic wall hernias |
title_sort | tip of the iceberg: lipomatous tumours presenting as abdominal or pelvic wall hernias |
topic | Educational Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611857/ https://www.ncbi.nlm.nih.gov/pubmed/31278606 http://dx.doi.org/10.1186/s13244-019-0739-1 |
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