Background: Lipomatous lesions are common surgical problems of different classifications and diagnostic spectrum. While small superficial lipomas constitute simple surgical conditions, large and deep lipomas represent a real diagnostic and therapeutic challenge.Methods: We are reporting about a patient who presented with a long history of a slowly growing mass of the right thigh. Although the history was suggestive of a benign lesion, clinical examination of this large ulcerative tumour was suspicious of malignant transformation. Blood and radiology examinations were consistent with a benign lesion. Surgical excision was performed.Results: Histology of the lesion revealed benign lipoma. The patient had an uneventful postoperative course. Conclusion: Advanced presentation of benign lipoma constitutes a challenge. Surgical excision is indicated to relieve the symptoms, to provide tissue diagnosis and to prevent malignant transformation. Introduction Lipoma is a fatty tissue tumor presenting as a painless slowly growing mass which can affect any part of the body rich in adipose tissue. The severity of cases depends on size and site of the mass and on local pressure complications. It varies from patient to patient and even in advanced cases, it is rarely a complex problem.The aim of presenting this case is to highlight the advanced presentation of this lipoma and to confirm that surgical excision is the gold standard of its management. Case report A 59-year-old woman was admitted with a 10 years' history of a painless swelling at the right thigh. The lesion became ulcerative over the past few months with mild pain.She had no significant medical and surgical history. Examination revealed normal vital signs, chest, heart, abdominal and rectal examinations.On local examination, a large mass occupying the posterior aspect of the lower two thirds of the right thigh was confirmed. There was an ulcerative lesion at the posteromedial aspect of the mass. The right popliteal artery was difficult to palpate, but the posterior tibial and dorsalis pedis were normal. There was no neuronal abnormality.Blood tests showed normal blood count, liver function, urea and electrolytes as well as ESR. She had a normal chest and abdominal X-ray. The X-ray of the right thigh showed a soft tissue shadow and normal bone.Surgical excision was performed and the findings were consistent with a giant lipoma. The wound was closed easily as there was redundant skin because of the size of the mass. The weight of the specimen was 3.2kg.The patient had an uneventful recovery and was discharged home with a very good condition. Histology of the specimen reported benign lipoma.
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