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Author Notes:

Keith A. Delman, MD, 1365C Clifton Road, NE, Building C, 2nd Floor, Atlanta, GA 30322, Phone: 404-778-3303, Fax: 404-778-4255; kdelman@emory.edu

Ms Baxter has disclosed past receipt of an NIH TL1 training grant; this is not related to the current work.

Dr Weiss has disclosed receipt of royalties from textbook publication; this is not related to the current work.


Research Funding:

Dr Fisher is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Surgery
  • BONE
  • WALL

The General Surgeon's Quandary: Atypical Lipomatous Tumor vs Lipoma, Who Needs a Surgical Oncologist?


Journal Title:

Journal of The American College of Surgeons


Volume 217, Number 5


, Pages 881-888

Type of Work:

Article | Post-print: After Peer Review


Background: Differentiating large lipomas from atypical lipomatous tumors (ALT) is challenging, and preoperative management guidelines are not well defined. The diagnostic ambiguity leads many surgeons to refer all patients with large lipomatous masses to an oncologic specialist, perhaps unnecessarily. Study Design: In this retrospective cohort study of patients with nonretroperitoneal lipomatous tumors, preoperative characteristics discernible without invasive diagnostic procedures were evaluated for diagnostic predictive value. Results: We identified 319 patients (256 with lipomas, 63 with ALTs) treated between 1994 and 2012. Patients with ALTs were older (60.5 vs 53.5 years, p < 0.0001), had larger tumors (16.0 vs 8.3 cm, p < 0.0001), had tumors more often located on an extremity (88.9% vs 60.5% torso, p < 0.0001), and more frequently had a history of previous operations at the same site, exclusive of excision leading to diagnosis and referral (20.6% vs 5.9%, p = 0.001). Local recurrence was observed in 2 patients with lipomas (0.8%) vs 14 with ALTs (22.6%, p < 0.0001). No patients with ALTs developed distant metastases or disease-specific mortality, with a median follow-up of 27.4 months (range 0 to 164.6 months). On multivariate analysis, age ≥55 years, tumor size ≥10 cm, extremity location, and history of previous resections were predictors for diagnosis of ALT (p < 0.05). Conclusions: Characteristics of lipomatous masses associated with a diagnosis of ALT include patient age ≥55 years, tumor size ≥10 cm, previous resection, and extremity location (vs torso). These easily identifiable traits may guide surgical management or referral to a specialist.

Copyright information:

© 2013 by the American College of Surgeons.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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