Medicine 2017: Swellings

Lipoma

Benign tumor from adipose tissue
Commonest benign tumor
Can be single or multiple(lipomatosis), usually encapsulated, slowly growing, soft swelling
Usually painless.
Types
Painful lipomas are called neurolipomas . Dercum’s disease is tender deposition of fat especially on the trunk also known as adiposis dolorosa. It is basically neurolipomatosis.
Fibrolipoma
Nevolipoma

Sites :

Clinical features

Usually localized , nontender semifluctuant mobile mass with edges slipping between palpating fingers
It is free from overlying skin
Differential diagnoses
Neurofibroma
Sebaceous cyst
Dermoid
Lymph node enlargement

Complications

Treatment

Excision

Sebaceous cyst

Retention cyst due to blockage of the duct of sebaceous gland
Contains yellowish white cheesy material
Common sites face , scalp and scrotum (not seen in palms and soles)
Clinical features
Painless swelling which is smooth, soft, nontender, freely mobile but adherent to skin over the summit, fluctuant, nontransilluminant and punctum over the summit (70%)
It moulds on finger indentation

Dermoid

Types :

1.Sequestration dermoid

Cysts generally develops in line of embryonic fusion. So may be seen anywhere in midline, outer angle of dermoid, behind pinna or root of nose
Clinical features- painless swelling in the line of embryonic fusion, soft, smooth, fluctuant and nontransillumintating with free skin

2. Implantational dermoid

Due to minor pricks or trauma, epidermis gets buried into deeper subcutaneous tissue which causes reaction and cyst formation.
Common in fingers , toes and feet
Clinical features – swelling is painless , soft , tensely cystic nontransilluminating often adherent to skin

TREATMENT : Excision

Ganglion

Cystic swelling containing clear gel formed by degeneration of synovial tissue.
Occur in relation to tendon sheath or joint capsule
Common sites: dorsum of wrist, flexor aspect of wrist
Clinical features
Well localized smooth, soft , cystic, nontender, transilluminant and mobile but mobility restricted when tendon is contracted against resistance

Treatment
excision but high recurrence rate

Bursa

Bursa is a sac like cavity containing fluid within which prevents friction between tendon and bone

Minor injuries and pressure lead to bursitis which will present as swelling and pain

Treatment excision if necessary

Neurofibroma

Tumor arising from connective tissue of the nerve.
Can be single or multiple
Types :
Nodular neurofibroma – single, smooth, firm, often tender swelling which moves perpendicular to direction of nerve but not in the direction of nerve
Plexiform neurofibroma – commonly occurs in the direction of Vth cranial nerve in skin of face . It attains enormous size with thickening of skin which hangs downwards.
Generalised neurofibromatosis (von Recklinghausen’s disease) – it is inherited as autosomal dominant disease. Multiple neurofibromas associated with pigmented spots in skin (café au lait spots) . Associated with MEN type IIb

Complications

Treatment : excision for symptomatic , cosmetically problematic or malignant changes

Callosity and corn

Callosity

raised thickened patch of hyperkeratosis common in areas which undergoes excessive wear and tear.
Histologically there is increased thickening of epidermis particularly the stratum corneum and granular layer

Corn

Circumscribed horny thickening cone-like in shape with its apex pointing inwards and base at surface.
Occurs at the site of friction and often disappears spontaneously when causing factor is removed
Histologically composed of keratin masses with intact basal layer
Often caused by ill-fitting and tight shoes chiefly affecting feet and toes.

Wart

Medicine 2017