UNUSUAL SITES FOR LIPOMATA, By Surgeon-Capt. D. M.
MOIIl, h.a.,
m.b.
Lipoma at the ankle.? Although it is well known that liporaata may occur in the areolar tissue of any part of the body, yet they are uncommon on the extremities, and I have seen no case recorded as occurring at the ankle. Lipomata are usually homasoplastic, and this case forms no exception to the rule, because the origin of the lipoma?pedicle in the pad of adipose and areolar tissu between the tendo achillis and back of the tibia seems to indicate that this mass of' fat was the matrix in which the tumour started. In this case, like in many others, 110 exciting cause (e.g., pressure or irritation) could The position of the tumour over the be traced. line of- the posterior tibial artery, its almost fluctuating consistence, the tense ulcerated and painful condition of the skin, and the surrounding venous plexus, all combined to obscure the diagnosis in the first instance. Regarding the differential diagnosis of lipomata, I see two methods worth noting mentioned in the Lancet. One method is based 011 the fact that fat freezes very rapidly. In vol. II, p. 845, of the Lancet for 1876, a reference is made to Mr. Bryant's proposal to distinguish lipoma from cold abscess In vol. I, and doubtful tumours, by freezing. Mason the of F. Lancet for Mr. alludes 1878, p.78 to the application of ether or ice for diagnostic purposes. He says :?(t If the growth is felt to become harder, the presumption is that the tumour is fatty." The other method is based on the lobulated nature of the tumour and the relation of the lobules to the skin. In vol. II, p. 412 of the Lancet for 1872, the following occurs :?" Dr. Leon Labbe laid stress 011 an easy and practical means of making out lipoma. It consists in squeezing and gently raising the skin around the tumour. It follows that the surface, which was before quite: smooth and
WILLIAMS KALA-AZAR IN AN INSANE.
July 1892.1
becomes slightly red, whilst the interstices between the lobules are marked out by white lines. The appearance thus afforded is quite characteristic of lipoma."
equal,
Ankle. Lipoma at the Ankle.
Basanta,
was found to extend backwards and to spring distinct connective tissue from a pedicle | in the pad of adipose and areolar tissue between j the tibia and the tendo achillis. The tumour | weighed six ounces. | Case No.2?Lipoma at the inner canthus of the the 11th December 1891, a youno|1 eye-lids.?Oil Mahomedan woman, about 18 years of ao-e, game I to the Municipal Hospital, Chittagong, with | a small lipoma at the inner canthus of her right | eye. A portion of the tumour, about the size i of a cherry, was removed through an incision i made in the conjunctiva of the lower lid. The i tumour was found to spring by a pedicle from As the removal of the rest the fat of the orbit. of the tumour through the conjunctival incision involved some risk of wounding the canaliculi and the lachrymal sac, a curved incision was made on the side of the nose, and the remaining portion of the tumour?a piece about the size of a hazel-nut?was removed through this second incision. Both wounds healed by first intention. Fatty tumours are not common on the face'; but Mr. F. Mason, in the Lancet, vol. I, p. 78, for 1878, mentions a case with lipoma under the eye-brow, another case with lipoma in the temporal region, and a third in the substance of the cheek.
aitat. 45. setat.
Case No. 1.?Basanta,male Buddhist,cultivator, cetat 45, was admitted into the Chittagong Municipal Hospital on the 19th October 1891, was operated on next day, and was discharged cured on the 10th November 1891. Previous history.?The growth of the tumour had been slow, gradual,and uniform for over six No years, and almost painless until recently. history of injury nor irritation. Present appearance.?There is a large pearshaped tumour which extends from more than 1 inch below the tip of the internal malleolus of the right tibia vertically upwards for 5^ inches; the greatest breadth, 5^ inches, is in its circumference of the inferior portion-; the tumour and the ankle is 11? inches. It lies chiefly on the tibia, but also partly on the astragalus and os calcis, and on the space between these bones aud the tendo achillis. The skin over the tumour is tense, but adherent only in (he centre of the lower aud larger portion where the skin has given way, owing to the tension, Numerous enlarged aud an ulcer has formed. and tortuous veins course over the tumour, which feels soft, doughy and almost fluctuatwith any indication of lobulation.
ing, scarcely Operation.?An incision
been made, the tumour
5 inches
was
long having
dissected
out.
It
207
j
;
MOIIl, h.a.,
m.b.
Lipoma at the ankle.? Although it is well known that liporaata may occur in the areolar tissue of any part of the body, yet they are uncommon on the extremities, and I have seen no case recorded as occurring at the ankle. Lipomata are usually homasoplastic, and this case forms no exception to the rule, because the origin of the lipoma?pedicle in the pad of adipose and areolar tissu between the tendo achillis and back of the tibia seems to indicate that this mass of' fat was the matrix in which the tumour started. In this case, like in many others, 110 exciting cause (e.g., pressure or irritation) could The position of the tumour over the be traced. line of- the posterior tibial artery, its almost fluctuating consistence, the tense ulcerated and painful condition of the skin, and the surrounding venous plexus, all combined to obscure the diagnosis in the first instance. Regarding the differential diagnosis of lipomata, I see two methods worth noting mentioned in the Lancet. One method is based 011 the fact that fat freezes very rapidly. In vol. II, p. 845, of the Lancet for 1876, a reference is made to Mr. Bryant's proposal to distinguish lipoma from cold abscess In vol. I, and doubtful tumours, by freezing. Mason the of F. Lancet for Mr. alludes 1878, p.78 to the application of ether or ice for diagnostic purposes. He says :?(t If the growth is felt to become harder, the presumption is that the tumour is fatty." The other method is based on the lobulated nature of the tumour and the relation of the lobules to the skin. In vol. II, p. 412 of the Lancet for 1872, the following occurs :?" Dr. Leon Labbe laid stress 011 an easy and practical means of making out lipoma. It consists in squeezing and gently raising the skin around the tumour. It follows that the surface, which was before quite: smooth and
WILLIAMS KALA-AZAR IN AN INSANE.
July 1892.1
becomes slightly red, whilst the interstices between the lobules are marked out by white lines. The appearance thus afforded is quite characteristic of lipoma."
equal,
Ankle. Lipoma at the Ankle.
Basanta,
was found to extend backwards and to spring distinct connective tissue from a pedicle | in the pad of adipose and areolar tissue between j the tibia and the tendo achillis. The tumour | weighed six ounces. | Case No.2?Lipoma at the inner canthus of the the 11th December 1891, a youno|1 eye-lids.?Oil Mahomedan woman, about 18 years of ao-e, game I to the Municipal Hospital, Chittagong, with | a small lipoma at the inner canthus of her right | eye. A portion of the tumour, about the size i of a cherry, was removed through an incision i made in the conjunctiva of the lower lid. The i tumour was found to spring by a pedicle from As the removal of the rest the fat of the orbit. of the tumour through the conjunctival incision involved some risk of wounding the canaliculi and the lachrymal sac, a curved incision was made on the side of the nose, and the remaining portion of the tumour?a piece about the size of a hazel-nut?was removed through this second incision. Both wounds healed by first intention. Fatty tumours are not common on the face'; but Mr. F. Mason, in the Lancet, vol. I, p. 78, for 1878, mentions a case with lipoma under the eye-brow, another case with lipoma in the temporal region, and a third in the substance of the cheek.
aitat. 45. setat.
Case No. 1.?Basanta,male Buddhist,cultivator, cetat 45, was admitted into the Chittagong Municipal Hospital on the 19th October 1891, was operated on next day, and was discharged cured on the 10th November 1891. Previous history.?The growth of the tumour had been slow, gradual,and uniform for over six No years, and almost painless until recently. history of injury nor irritation. Present appearance.?There is a large pearshaped tumour which extends from more than 1 inch below the tip of the internal malleolus of the right tibia vertically upwards for 5^ inches; the greatest breadth, 5^ inches, is in its circumference of the inferior portion-; the tumour and the ankle is 11? inches. It lies chiefly on the tibia, but also partly on the astragalus and os calcis, and on the space between these bones aud the tendo achillis. The skin over the tumour is tense, but adherent only in (he centre of the lower aud larger portion where the skin has given way, owing to the tension, Numerous enlarged aud an ulcer has formed. and tortuous veins course over the tumour, which feels soft, doughy and almost fluctuatwith any indication of lobulation.
ing, scarcely Operation.?An incision
been made, the tumour
5 inches
was
long having
dissected
out.
It
207
j
;
