We describe the case of a 90 year old patient with a giant gluteal lipoma having evolved over more than 20 years. The patient was well aware of this slow-growing painless mass on his right hip but refused any treatment. He was addressed to the surgical consultation by his family doctor for lameness and unbalanced walking. (figure 1A, B).
A CT scan was performed. However, the lesion was so large that it could not be scanned entirely (figure 2).
After discussing the pros and cons of an intervention with the patient and his family, the decision was taken to remove the mass surgically. The patient was installed in a dorsal decubitus position (figure 3A). The operation resulted in the removal of a 30×60 cm 20 kg lipoma (figure 3B).
Outcome and follow-up
The pathology report confirmed that the tumour was benign. Skin was preserved in order to allow a functional reconstruction of the gluteal region. Wound management was simple, and follow-up was unremarkable. Additionally, the patient received intensive physiotherapy for walk recovery and after 5 weeks he could achieve completely independent walking.
Credits: Dr Alexis Litchinko, BMJ