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LIPOMAM. Rachmat Sulthony

ContentsArticles

Lipoma 1Adipose tissue 6Liposarcoma 14

ReferencesArticle Sources and Contributors 17Image Sources, Licenses and Contributors 18

Article LicensesLicense 19

Lipoma 1

Lipoma

LipomaClassification and external resources

Lipoma on forearm

ICD-10 D17 [1] (ILDS D17.910)

ICD-9 214 [2]

ICD-O: M8850/0 [3]

DiseasesDB 7493 [4]

MedlinePlus 003279 [5]

eMedicine med/2720 [6] derm/242 [7]

MeSH D008067 [8]

A lipoma is a benign tumor composed of adipose tissue. It is the most common form of soft tissue tumor.[9] Lipomasare soft to the touch, usually movable, and are generally painless. Many lipomas are small (under one centimeterdiameter) but can enlarge to sizes greater than six centimeters. Lipomas are commonly found in adults from 40 to 60years of age, but can also be found in children. Some sources claim that malignant transformation can occur,[10]

while others say that this has yet to be convincingly documented.[11]

Types

Lipoma of the breast

There are several subtypes of lipomas:[12]:624–5

• Adenolipomas are lipomas associated with eccrine sweatglands.[13]:627

• Angiolipoleiomyomas are acquired, solitary, asymptomatic acralnodules, characterized histologically by well-circumscribedsubcutaneous tumors composed of smooth muscle cells, bloodvessels, connective tissue, and fat.[12]:627

• Angiolipomas painful subcutaneous nodules having all otherfeatures of a typical lipoma.[12]:624[14]

• Chondroid lipomas are deep-seated, firm, yellow tumors thatcharacteristically occur on the legs of women.[12]:625

Lipoma 2

• Corpus callosum lipoma is a rare congenital brain condition which may or may not present with symptoms.[15]

This occurs in the corpus callosum, also known as the colossal commissure, which is a wide, flat bundle of neuralfibers beneath the cortex in the human brain.

• Hibernomas are lipoma of brown fat.• Intradermal spindle cell lipomas are distinct in that it most commonly affects women, and has a wide

distribution, occurring with relatively equal frequency on the head and neck, trunk, and upper and lowerextremities.[12]:625[14]

• Neural fibrolipomas are overgrowths of fibro-fatty tissue along a nerve trunk, which often leads to nervecompression.[12]:625

• Pleomorphic lipomas, like spindle-cell lipomas, occur for the most part on the backs and necks of elderly men,and are characterized by floret giant cells with overlapping nuclei.[12]:625

• Spindle-cell lipomas are asymptomatic, slow-growing subcutaneous tumors that have a predilection for theposterior back, neck, and shoulders of older men.[12]:625

• Superficial subcutaneous lipomas, the most common type of lipoma, lie just below the surface of the skin.[11]

Most occur on the trunk, thighs and the forearms, although they may be found anywhere in the body where fat islocated.

Prevalence

Lipoma removed from human torso

Approximately one percent of the general population has a lipoma.[11]

These tumors can occur at any age, but are most common in middleage, often appearing in people from 40 to 60 years old.[16] Cutaneouslipomas are rare in children, but these tumors can occur as part of theinherited disease Bannayan-Zonana syndrome.[17][18]

Lipomas are usually relatively small with diameters of about1–3 cm,[19] but in rare cases they can grow over several years into"giant lipomas" that are 10–20 cm across and weigh up to4–5 kg.[20][21]

Causes

The tendency to develop a lipoma is not necessarily hereditaryalthough hereditary conditions, such as familial multiple lipomatosis, may include lipoma development.[22][23]

Genetic studies in mice have shown a correlation between the HMG I-C gene (previously identified as a gene relatedto obesity) and lipoma development. These studies support prior epidemiologic data in humans showing a correlationbetween HMG I-C and mesenchymal tumors.[24]

Cases have been reported where minor injuries are alleged to have triggered the growth of a lipoma, called"post-traumatic lipomas."[25] However, the link between trauma and the development of lipomas is controversial.[26]

Lipoma 3

TreatmentUsually, treatment of a lipoma is not necessary, unless the tumor becomes painful or restricts movement. They areusually removed for cosmetic reasons, if they grow very large, or for histopathology to check that they are not amore dangerous type of tumor such as a liposarcoma.[11] This last point can be important as the actual identity of a"bump" is not known until after it is removed and professionally examined.Lipomas are normally removed by simple excision.[16] The removal can often be done under local anaesthetic, andtake less than 30 minutes.[27] This cures the majority of cases, with about 1–2% of lipomas recurring afterexcision.[28] Liposuction is another option if the lipoma is soft and has a small connective tissue component.Liposuction typically results in less scarring; however, with large lipomas it may fail to remove the entire tumor,which can lead to regrowth.[29]

There are new methods being developed that are supposed to remove the lipomas without scarring. One of them isremoval by the use of injection of compounds that trigger lipolysis, such as steroids or phosphatidylcholine.[16][30]

Resection of an intermuscular lipoma in the elbow region

X-ray of the lipoma. Intraoperative photo. The operating field afterremoval of the lipoma.

Arrow marks the mediannerve which was

compressed by the lipoma.

The resected lipoma(8 cm × 6 cm × 3 cm)

PrognosisLipomas are rarely life-threatening and the common subcutaneous lipomas are not a serious condition. Lipomasgrowing in internal organs can be more dangerous, for example lipomas in the gastrointestinal tract can causebleeding, ulceration and painful obstructions (so-called "malignant by location", despite being a benign growthhistologically).[31][32] Malignant transformation of lipomas into liposarcomas is very rare and most liposarcomas arenot produced from pre-existing benign lesions,[28] although a few cases of malignant transformation have beendescribed for bone and kidney lipomas.[33][34] It is possible these few reported cases were well-differentiatedliposarcomas in which the subtle malignant characteristics were missed when the tumour was first examined.[35]

Deep lipomas have a greater tendency to recur than superficial lipomas, because complete surgical removal of deeplipomas is not always possible.[35][36]

In veterinary medicineLipomas occur in many animals, but are most common in older dogs, particularly older Labrador Retrievers,Doberman Pinschers and Miniature Schnauzers.[37] Overweight female dogs are especially prone to developing thesetumors and most older or overweight dogs have at least one lipoma.[38][39] In dogs, lipomas usually occur in thetrunk or upper limbs.[37] Lipomas are also found less commonly in cattle and horses, and rarely in cats andpigs.[39][40] However, a pedunculated lipoma can cause entrapment and torsion of the intestine in horses, causingnecrosis, colic, and possibly death. The intestine becomes wound around the stalk of the lipoma and loses bloodsupply.[41]

Lipoma 4

Other conditions involving lipomasLipomatosis is a hereditary condition where multiple lipomas are present on the body.Adiposis dolorosa (Dercum disease), is a rare condition involving multiple painful lipomas, swelling, and fatigue. Itis generally seen in obese, post-menopausal women.[42]

Benign symmetric lipomatosis (Madelung disease) is another condition involving lipomatosis. It nearly alwaysappears in middle-aged males after many years of alcoholism, although non-alcoholics and females can also beaffected.

References[1] http:/ / apps. who. int/ classifications/ icd10/ browse/ 2010/ en#/ D17[2] http:/ / www. icd9data. com/ getICD9Code. ashx?icd9=214[3] http:/ / www. progenetix. net/ progenetix/ I88500/[4] http:/ / www. diseasesdatabase. com/ ddb7493. htm[5] http:/ / www. nlm. nih. gov/ medlineplus/ ency/ article/ 003279. htm[6] http:/ / www. emedicine. com/ med/ topic2720. htm[7] http:/ / www. emedicine. com/ derm/ topic242. htm#[8] http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2013/ MB_cgi?field=uid& term=D008067[9] Bancroft LW, Kransdorf MJ, Peterson JJ, O'Connor MI (October 2006). "Benign fatty tumors: classification, clinical course, imaging

appearance, and treatment". Skeletal Radiol. 35 (10): 719–33. doi:10.1007/s00256-006-0189-y. PMID 16927086.[10] 'Obesity Gene' Causes Cancer of Fat Tissue, Schepens Scientists Find (http:/ / www. hms. harvard. edu/ news/ pressreleases/ Schepens/

0400ObesityGene. html) Schepens Eye Research Institute (Harvard Medical School affiliate). April 26, 2000[11] Lipomas (http:/ / www. emedicine. com/ med/ topic2720. htm#) at eMedicine[12] James, William D.; Berger, Timothy G.; Elston, Dirk M. (2005). Andrews' Diseases of the Skin: Clinical Dermatology (10th ed.). London:

Elsevier. ISBN 0-7216-2921-0.[13] James, William D.; Berger, Timothy G.; Elston, Dirk M. (2011). Andrews' Diseases of the Skin: Clinical Dermatology (11th ed.). London:

Elsevier. ISBN 9781437703146.[14] Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. pp. 1838.

ISBN 1-4160-2999-0.[15] Wallace D (December 1976). "Lipoma of the corpus callosum". J Neurol Neurosurg Psychiatry. 39 (12): 1179–85.

doi:10.1136/jnnp.39.12.1179. PMC 492562. PMID 1011028.[16] Salam GA (March 2002). "Lipoma excision" (http:/ / www. aafp. org/ afp/ 20020301/ 901. html). Am Fam Physician 65 (5): 901–4.

PMID 11898962. .[17] Buisson P, Leclair MD, Jacquemont S, et al. (September 2006). "Cutaneous lipoma in children: 5 cases with Bannayan-Riley-Ruvalcaba

syndrome". J. Pediatr. Surg. 41 (9): 1601–3. doi:10.1016/j.jpedsurg.2006.05.013. PMID 16952599.[18] Gujrati M, Thomas C, Zelby A, Jensen E, Lee JM (August 1998). "Bannayan-Zonana syndrome: a rare autosomal dominant syndrome with

multiple lipomas and hemangiomas: a case report and review of literature" (http:/ / linkinghub. elsevier. com/ retrieve/ pii/S0090-3019(98)00039-1). Surg Neurol 50 (2): 164–8. doi:10.1016/S0090-3019(98)00039-1. PMID 9701122. .

[19] Lipoma—topic overview (http:/ / www. webmd. com/ skin-problems-and-treatments/ tc/ lipoma-topic-overview) at webmd.com[20] Hakim E, Kolander Y, Meller Y, Moses M, Sagi A (August 1994). "Gigantic lipomas". Plast. Reconstr. Surg. 94 (2): 369–71.

doi:10.1097/00006534-199408000-00025. PMID 8041830.[21] Terzioglu A, Tuncali D, Yuksel A, Bingul F, Aslan G (March 2004). "Giant lipomas: a series of 12 consecutive cases and a giant

liposarcoma of the thigh". Dermatol Surg 30 (3): 463–7. doi:10.1111/j.1524-4725.2004.30022.x. PMID 15008886.[22] Leffell DJ, Braverman IM (August 1986). "Familial multiple lipomatosis. Report of a case and a review of the literature". J. Am. Acad.

Dermatol. 15 (2 Pt 1): 275–9. doi:10.1016/S0190-9622(86)70166-7. PMID 3745530.[23] Toy BR (October 2003). "Familial multiple lipomatosis" (http:/ / dermatology. cdlib. org/ 94/ NYU/ Jan2002/ 2. html). Dermatol. Online J.

9 (4): 9. PMID 14594582. .[24] Arlotta P, Tai AK, Manfioletti G, Clifford C, Jay G, Ono SJ. (May 2000). "Transgenic mice expressing a truncated form of the high mobility

group I-C protein develop adiposity and an abnormally high prevalence of lipomas". J Biol Chem. 275 (19): 14394–400.doi:10.1074/jbc.M000564200. PMID 10747931.

[25] Signorini M, Campiglio GL (March 1998). "Posttraumatic lipomas: where do they really come from?". Plast. Reconstr. Surg. 101 (3):699–705. doi:10.1097/00006534-199803000-00017. PMID 9500386.

[26] Aust MC, Spies M, Kall S, Jokuszies A, Gohritz A, Vogt P (2007). "Posttraumatic lipoma: fact or fiction?" (http:/ / www. lejacq. com/articleDetail. cfm?pid=SKINmed_6;6:266). Skinmed 6 (6): 266–70. doi:10.1111/j.1540-9740.2007.06361.x. PMID 17975353. .

[27] "Lipoma removal surgery" (http:/ / www. reviewmylife. co. uk/ blog/ 2009/ 08/ 03/ lipoma-and-cyst-removal-surgery/ ). . Retrieved2010-07-26.

Lipoma 5

[28] Dalal KM, Antonescu CR, Singer S (March 2008). "Diagnosis and management of lipomatous tumors". J Surg Oncol 97 (4): 298–313.doi:10.1002/jso.20975. PMID 18286473.

[29] Al-basti HA, El-Khatib HA (2002). "The use of suction-assisted surgical extraction of moderate and large lipomas: long-term follow-up".Aesthetic Plast Surg 26 (2): 114–7. doi:10.1007/s00266-002-1492-1. PMID 12016495.

[30] Bechara FG, Sand M, Sand D, et al. (2006). "Lipolysis of lipomas in patients with familial multiple lipomatosis: anultrasonography-controlled trial". J Cutan Med Surg 10 (4): 155–9. PMID 17234112.

[31] Thompson WM (1 April 2005). "Imaging and findings of lipomas of the gastrointestinal tract" (http:/ / www. ajronline. org/ cgi/pmidlookup?view=long& pmid=15788588). AJR Am J Roentgenol 184 (4): 1163–71. PMID 15788588. .

[32] Taylor AJ, Stewart ET, Dodds WJ (1 December 1990). "Gastrointestinal lipomas: a radiologic and pathologic review" (http:/ / www.ajronline. org/ cgi/ pmidlookup?view=long& pmid=2122666). AJR Am J Roentgenol 155 (6): 1205–10. PMID 2122666. .

[33] Milgram JW (1990). "Malignant transformation in bone lipomas". Skeletal Radiol. 19 (5): 347–52. doi:10.1007/BF00193088.PMID 2165632.

[34] Lowe BA, Brewer J, Houghton DC, Jacobson E, Pitre T (May 1992). "Malignant transformation of angiomyolipoma". J. Urol. 147 (5):1356–8. PMID 1569683.

[35] Goldblum, John R.; Weiss, Sharon W.; Enzinger, Franz M. (2008). Enzinger and Weiss's soft tissue tumors (5th ed.). Mosby Elsevier.ISBN 0-323-04628-2.

[36] Fletcher, C.D.M., Unni, K.K., Mertens, F. (2002). Pathology and Genetics of Tumours of Soft Tissue and Bone. World Health OrganizationClassification of Tumours. 4. Lyon: IARC Press. ISBN 92-832-2413-2.

[37] Adipose Tissue Tumors (http:/ / merckvetmanual. com/ mvm/ index. jsp?cfile=htm/ bc/ 72220. htm) The Merck Veterinary Manual, (9thed.)

[38] Lipomas (http:/ / www. purinaone. com. au/ Article/ articledetails. aspx?id=753) Veterinary & Aquatic Services Department, Purina[39] Lipoma (http:/ / education. vetmed. vt. edu/ curriculum/ vm8304/ lab_companion/ histo-path/ introhistopath/ Lab9/ Lesions/ lipoma. htm)

Virginia Polytechnic Institute and State University[40] Lipomas (Fatty Tumors) (http:/ / vetmedicine. about. com/ cs/ dogdiseasesl/ a/ lipomas. htm) Veterinary Q & A[41] The Merck Veterinary Manual. Merial. 9th Edition. ISBN 0911910506.[42] Lipomas (http:/ / www. emedicine. com/ derm/ topic242. htm#) at eMedicine

External links

Images and video• Illustration (http:/ / pathweb. uchc. edu/ eAtlas/ Bone/ 706. htm) from University of Connecticut Health Center• Esophageal Lipomatosis (http:/ / rad. usuhs. edu/ medpix/ master. php3?mode=slide_sorter& pt_id=11517&

quiz=#top) MedPix Images from Uniformed Services University of the Health Sciences• Lipoma images (http:/ / dermatlas. med. jhmi. edu/ derm/ result. cfm?Diagnosis=-1623404710) from DermAtlas• humpath #2626 (http:/ / www. humpath. com/ spip. php?page=article& id_article=2626)• List of possible treatment options (http:/ / www. lipomaboard. com/ treatments-cures-f3/

here-your-lipoma-treatment-options-far-t284. html)

Adipose tissue 6

Adipose tissue

Adipose tissue is one of the main types of connective tissue.

In biology, adipose tissue(/ˈædɪˌpoʊs/) or body fat or fat depotor just fat is loose connective tissuecomposed of adipocytes. It istechnically composed of roughly only80% fat; fat in its solitary state existsin the liver and muscles. Adiposetissue is derived from lipoblasts. Itsmain role is to store energy in the form of lipids, although it also cushions and insulates the body. Far fromhormonally inert, adipose tissue has in recent years been recognized as a major endocrine organ,[1] as it produceshormones such as leptin, estrogen, resistin, and the cytokine TNFα. Moreover, adipose tissue can affect other organsystems of the body and may lead to disease. Obesity or being overweight in humans and most animals does notdepend on body weight, but on the amount of body fat—to be specific, adipose tissue. The two types of adiposetissue are white adipose tissue (WAT) and brown adipose tissue (BAT). The formation of adipose tissue appears tobe controlled in part by the adipose gene. Adipose tissue was first identified by the Swiss naturalist Conrad Gessnerin 1551.[2]

Anatomical features

In humansIn humans, adipose tissue is located beneath the skin (subcutaneous fat), around internal organs (visceral fat), inbone marrow (yellow bone marrow) and in breast tissue. Adipose tissue is found in specific locations, which arereferred to as adipose depots. Adipose tissue contains several cell types, with the highest percentage of cells beingadipocytes, which contain fat droplets. Other cell types include fibroblasts, macrophages, and endothelial cells.Adipose tissue contains many small blood vessels. In the integumentary system, which includes the skin, itaccumulates in the deepest level, the subcutaneous layer, providing insulation from heat and cold. Around organs, itprovides protective padding. However, its main function is to be a reserve of lipids, which can be burned to meet theenergy needs of the body and to protect us from excess glucose by storing triglycerides produced by the liver fromsugars, although some evidence suggests that most lipids synthesized from carbohydrates occurs in the adipose tissueitself.[3] Adipose depots in different parts of the body have different biochemical profiles. Under normal conditions,it provides feedback for hunger and diet to the brain.

Adipose tissue 7

Mice

The obese mouse on the left has large stores ofadipose tissue. For comparison, a mouse with a

normal amount of adipose tissue is shown on theright.

Mice have eight major adipose depots, four of which are within theabdominal cavity. The paired gonadal depots are attached to the uterusand ovaries in females and the epididymis and testes in males; thepaired retroperitoneal depots are found along the dorsal wall of theabdomen, surrounding the kidney, and, when massive, extend into thepelvis. The mesenteric depot forms a glue-like web that supports theintestines, and the omental depot, which originates near the stomachand spleen, and, when massive, extends into the ventral abdomen. Boththe mesenteric and omental depots incorporate much lymphoid tissueas lymph nodes and milky spots, respectively. The two superficialdepots are the paired inguinal depots, which are found anterior to theupper segment of the hind limbs (underneath the skin) and thesubscapular depots, paired medial mixtures of brown adipose tissue adjacent to regions of white adipose tissue,which are found under the skin between the dorsal crests of the scapulae. The layer of brown adipose tissue in thisdepot is often covered by a "frosting" of white adipose tissue; sometimes these two types of fat (brown and white)are hard to distinguish. The inguinal depots enclose the inguinal group of lymph nodes. Minor depots include thepericardial, which surrounds the heart, and the paired popliteal depots, between the major muscles behind the knees,each containing one large lymph node.[4] Of all the depots in the mouse, the gonadal depots are the largest and themost easily dissected,[5] comprising about 30% of dissectible fat.[6]

ObesityIn a severely obese person, excess adipose tissue hanging downward from the abdomen is referred to as a panniculus(or pannus). A panniculus complicates surgery of the morbidly obese. It may remain as a literal "apron of skin" if aseverely obese person quickly loses large amounts of fat (a common result of gastric bypass surgery). This conditioncannot be effectively corrected through diet and exercise alone, as the panniculus consists of adipocytes and othersupporting cell types shrunken to their minimum volume and diameter. Reconstructive surgery is one method oftreatment.

Abdominal fat

Abdominal fat on a teenage male.

Visceral fat or abdominal fat[7] also known as organ fat orintra-abdominal fat, is located inside the abdominal cavity, packedbetween the organs (stomach, liver, intestines, kidneys, etc.). Visceralfat is different from subcutaneous fat underneath the skin, andintramuscular fat interspersed in skeletal muscles. Fat in the lowerbody, as in thighs and buttocks, is subcutaneous and is not consistentlyspaced tissue, whereas fat in the abdomen is mostly visceral andsemi-fluid.[8] Visceral fat is composed of several adipose depots,including mesenteric, epididymal white adipose tissue (EWAT), andperirenal depots. Visceral fat is considered adipose tissue whereassubcutaneous fat is not considered as such.

An excess of visceral fat is known as central obesity, or "belly fat", inwhich the abdomen protrudes excessively. Excess visceral fat is also linked to type 2 diabetes,[9] insulinresistance,[10] inflammatory diseases,[11] and other obesity-related diseases.[12]

Adipose tissue 8

Female sex hormone causes fat to be stored in the buttocks, thighs, and hips in women.[13][14] Men are more likely tohave fat stored in the belly due to sex hormone differences. When women reach menopause and the estrogenproduced by ovaries declines, fat migrates from their buttocks, hips and thighs to their waists;[15] later fat is stored inthe belly.[16]

High-intensity exercise is one way to effectively reduce total abdominal fat.[17][18] One study suggests at least 10MET-hours per week of aerobic exercise is required for visceral fat reduction.[19]

Epicardial fatEpicardial adipose tissue (EAT) is a particular form of visceral fat deposited around the heart and found to be ametabolically active organ that generates various bioactive molecules, which might significantly affect cardiacfunction.[20] Marked component differences have been observed in comparing EAT with subcutaneous fat,suggesting a depot specific impact of stored fatty acids on adipocyte function and metabolism.[21]

Subcutaneous fat

Subcutaneous fat on an overweight teenage boy'sabdomen.

Most of the remaining nonvisceral fat is found just below the skin in aregion called the hypodermis.[22] This subcutaneous fat is not related tomany of the classic obesity-related pathologies, such as heart disease,cancer, and stroke, and some evidence even suggests it might beprotective.[23] The typically female (or gynecoid) pattern of body fatdistribution around the hips, thighs, and buttocks, is subcutaneous fat,and therefore poses less of a health risk compared to visceral fat.[24]

Like all other fat organs, subcutaneous fat is an active part of theendocrine system, secreting the hormones leptin and resistin.[22]

The relationship between the subcutaneous adipose layer and totalbody fat in a person is often modelled by using regression equations.The most popular of these equations was formed by Durnin andWormersley, who rigorously tested many types of skinfold, and, as aresult, created two formulae to calculate the body density of both men and women. These equations present aninverse correlation between skinfolds and body density – as the sum of skinfolds increases, the body densitydecreases.[25]

Factors such as sex, age, population size or other variables may make the equations invalid and unusable, and, as of2012, Durnin and Wormersley's equations remain only estimates of a person's true level of fatness. New formulaeare still being created.[25]

PhysiologyFree fatty acids are liberated from lipoproteins by lipoprotein lipase (LPL) and enter the adipocyte, where they arereassembled into triglycerides by esterifying it onto glycerol. Human fat tissue contains about 87% lipids.There is a constant flux of FFA(Free Fatty Acids) entering and leaving adipose tissue. The net direction of this fluxis controlled by insulin and leptin - if insulin is elevated there is a net inward flux of FFA and only when insulin islow can FFA leave adipose tissue. Insulin secretion is stimulated by high blood sugar which results from consumingcarbohydrates.In humans, lipolysis (hydrolysis of triglycerides into free fatty acids) is controlled through the balanced control oflipolytic B-adrenergic receptors and a2A-adrenergic receptor-mediated antilipolysis.

Adipose tissue 9

Fat cells have an important physiological role in maintaining triglyceride and free fatty acid levels, as well asdetermining insulin resistance. Abdominal fat has a different metabolic profile—being more prone to induce insulinresistance. This explains to a large degree why central obesity is a marker of impaired glucose tolerance and is anindependent risk factor for cardiovascular disease (even in the absence of diabetes mellitus and hypertension).[26]

Studies of female monkeys at Wake Forest University (2009) discovered individuals suffering from higher stresshave higher levels of visceral fat in their bodies. This suggests a possible cause-and-effect link between the two,wherein stress promotes the accumulation of visceral fat, which in turn causes hormonal and metabolic changes thatcontribute to heart disease and other health problems.[27]

Recent advances in biotechnology have allowed for the harvesting of adult stem cells from adipose tissue, allowingstimulation of tissue regrowth using a patient's own cells. In addition, adipose-derived stem cells from both humanand animals reportedly can be efficiently reprogrammed into induced pluripotent stem cells without the need forfeeder cells.[28] The use of a patient's own cells reduces the chance of tissue rejection and avoids the ethical issuesassociated with the use of human embryonic stem cells.Adipose tissue is the greatest peripheral source of aromatase in both males and females, contributing to theproduction of estradiol.Adipose derived hormones include:•• Adiponectin•• Resistin• Plasminogen activator inhibitor-1 (PAI-1)•• TNFα•• IL-6•• Leptin• Estradiol (E2)Adipose tissues also secrete a type of cytokines (cell-to-cell signalling proteins) called adipokines (adipocytokines),which play a role in obesity-associated complications.

Brown fatA specialised form of adipose tissue in humans, most rodents and small mammals, and some hibernating animals, isbrown fat or brown adipose tissue. It is located mainly around the neck and large blood vessels of the thorax. Thisspecialised tissue can generate heat by "uncoupling" the respiratory chain of oxidative phosphorylation withinmitochondria. The process of uncoupling means, when protons transit down the electrochemical gradient across theinner mitochondrial membrane, the energy from this process is released as heat rather than being used to generateATP. This thermogenic process may be vital in neonates exposed to cold, which then require this thermogenesis tokeep warm, as they are unable to shiver, or take other actions to keep themselves warm.[29]

Attempts to simulate this process pharmacologically have so far been unsuccessful (even lethal[30][31]). Techniquesto manipulate the differentiation of "brown fat" could become a mechanism for weight loss therapy in the future,encouraging the growth of tissue with this specialized metabolism without inducing it in other organs.Until recently, brown adipose tissue was thought to be primarily limited to infants in humans, but new evidence hasnow overturned that belief. Metabolically active tissue with temperature responses similar to brown adipose was firstreported in the neck and trunk of some human adults in 2007,[32] and the presence of brown adipose in human adultswas later verified histologically in the same anatomical regions.[33][34][35]

Adipose tissue 10

GeneticsThe thrifty gene hypothesis (also called the famine hypothesis) states that in some populations the body would bemore efficient at retaining fat in times of plenty, thereby endowing greater resistance to starvation in times of foodscarcity. This hypothesis has been discredited by physical anthropologists, physiologists, and the original proponentof the idea himself.[36]

In 1995, Jeffrey Friedman, in his residency at Rockefeller University, discovered the protein leptin that thegenetically obese mouse lacked.[37] Leptin is produced in the white adipose tissue and signals to the hypothalamus.When leptin levels drop, the body interprets this as loss of energy, and hunger increases. Mice lacking this proteineat until they are four times their normal size.Leptin, however, plays a different role in diet-induced obesity in rodents and humans. Because adipocytes produceleptin, leptin levels are elevated in the obese. However, hunger remains, and, when leptin levels drop due to weightloss, hunger increases. The drop of leptin is better viewed as a starvation signal than the rise of leptin as a satietysignal.[38] However, elevated leptin in obesity is known as leptin resistance. The changes that occur in thehypothalamus to result in leptin resistance in obesity are currently the focus of obesity research.[39]

Gene defects in the leptin gene (ob) are rare in human obesity.[40] As of July, 2010, only 14 individuals from fivefamilies have been identified worldwide who carry a mutated ob gene (one of which was the first ever identifiedcause of genetic obesity in humans) - two families of Pakistani origin living in the UK, one family living in Turkey,one in Egypt, and one in Austria.[41][42][43][44][45] - and two other families have been found that carry a mutated obreceptor.[46][47] Others have been identified as genetically partially deficient in leptin, and, in these individuals,leptin levels on the low end of the normal range can predict obesity.[48]

Several mutations of genes involving the melanocortins (used in brain signaling associated with appetite) and theirreceptors have also been identified as causing obesity in a larger portion of the population than leptin mutations.[49]

In 2007, researchers isolated the adipose gene, which those researchers hypothesize serves to keep animals leanduring times of plenty. In that study, increased adipose gene activity was associated with slimmer animals.[50]

Although its discoverers dubbed this gene the adipose gene, it is not a gene responsible for creating adipose tissue.

Physical propertiesAdipose tissue has a density of ~0.9 g/ml [0.9 kg/L]. Thus, a person with more adipose tissue will float more easilythan a person of the same weight with more muscular tissue, since muscular tissue has a density of 1.06 g/ml[1.06 kg/L].

Body fat meterA body fat meter is a widely available tool used to measure the percentage of fat in the human body. Differentmeters use various methods to determine the body fat to weight ratio. They tend to under-read body fatpercentage.[51]

In contrast with clinical tools, one relatively inexpensive type of body fat meter uses the principle of bioelectricalimpedance analysis (BIA) to determine an individual's body fat percentage. To achieve this, the meter passes a small,harmless, electric current through the body and measures the resistance, then uses information on the person'sweight, height, age, and sex, to calculate an approximate value for the person's body fat percentage. The calculationmeasures the total volume of water in the body (lean tissue and muscle contain a higher percentage of water thanfat), and estimates the percentage of fat based on this information. The result can fluctuate several percentage pointsdepending on what one has eaten and how much water one has consumed prior to the analysis.

Adipose tissue 11

Additional images

Diagrammatic sectional viewof the skin (magnified).

White adipose tissue in paraffin section Electronic instrument of body fat meter

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Further reading• MeSH A10.165.114 (http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2012/ MB_cgi?mode=& term=2&

field=entry#TreeA10. 165. 114)• Stock, M. J.; Cinti, S. (2003). "ADIPOSE TISSUE". Encyclopedia of Food Sciences and Nutrition. pp. 29.

doi:10.1016/B0-12-227055-X/00008-0. ISBN 9780122270550.• Vernon, R. G.; Flint, D. J. (2003). "ADIPOSE TISSUE". Encyclopedia of Food Sciences and Nutrition. pp. 23.

doi:10.1016/B0-12-227055-X/00007-9. ISBN 9780122270550.

Liposarcoma 14

Liposarcoma

LiposarcomaClassification and external resources

Micrograph of myxoid liposarcoma. H&E stain.

ICD-O: M8850/3 [1]

DiseasesDB 31482 [2]

eMedicine derm/856 [3]

MeSH D008080 [4]

Liposarcoma is a malignant tumor[5] that arises in fat cells in deep soft tissue, such as that inside the thigh or in theretroperitoneum.They are typically large bulky tumors which tend to have multiple smaller satellites extending beyond the mainconfines of the tumor.Liposarcomas, like all sarcomas, are rare.[6]

Symptoms

Photo of left leg edema caused by underlyingliposarcoma

Patients usually note a deep seated mass in their soft tissue. Only whenthe tumor is very large do symptoms of pain or functional disturbancesoccur.Retroperitoneal tumors may present themselves with signs of weightloss and emaciation and abdominal pain. These tumors may alsocompress the kidney or ureter leading to kidney failure.

Liposarcoma 15

Diagnosis

CT image showing a lesion that proved to be aliposarcoma.

Micrograph of a myxoid liposarcoma. H&E stain.

Micrograph of a dedifferentiated liposarcoma. Adedifferentiated liposarcoma has a poorly

differentiated component, that is not identifiableas a liposarcoma (left edge of image), and adifferentiated component with lipoblasts and

increased vascularity (right of image).Morphologically benign adipose tissue (center of

image) has few blood vessels. H&E stain.

The diagnosis is established by histologic examination of the tissue, i.e.biopsy or excisional biopsy. Lipoblasts are often present; these arecells with an abundant clear multi-vacuolated cytoplasm and aneccentric darkly staining nucleus that is indented by the vacuoles.

Subtypes

Several subtypes of liposarcoma exist:• Well-differentiated liposarcoma, synonymous with atypical

lipomatous tumor; the former term is used almost exclusively forlesions in the retroperitoneum, while the latter is used for lesionsarising elsewhere.

•• Dedifferentiated liposarcoma, which consists of well-differentiatedliposarcoma adjacent to a more poorly differentiated tumor.

•• Myxoid/round cell liposarcoma.•• Pleomorphic liposarcoma.

Incidence and prevalence

Most frequent in middle-aged and older adults (age 40 and above),liposarcomas are the second most common of all soft-tissue sarcomasfollowing malignant fibrous histiocytomas. Annually 2.5 cases occurper million population.

Prognosis

The prognosis varies depending on the site of origin, the type of cancercell, the tumor size, the depth, and proximity to lymph nodes.Well-differentiated liposarcomas treated with surgery and radiationhave a low recurrence rate (about 10%) and rarely metastasize.[7]

Five-year survival rates vary from 100% to 39% based on histologicalsubtype.[7]

References[1] http:/ / www. progenetix. net/ progenetix/ I88503/[2] http:/ / www. diseasesdatabase. com/ ddb31482. htm[3] http:/ / www. emedicine. com/ derm/ topic856. htm[4] http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2013/ MB_cgi?field=uid& term=D008080[5] Dei Tos AP (August 2000). "Liposarcoma: new entities and evolving concepts" (http:/ / linkinghub. elsevier. com/ retrieve/ pii/

S1092-9134(00)74153-0). Ann Diagn Pathol 4 (4): 252–66. doi:10.1053/adpa.2000.8133. PMID 10982304. .[6] Goldstein-Rice, E (2008). "The Importance of Treatment at a Specialty Center for Sarcomas" (http:/ / sarcomahelp. org/ learning_center/

articles/ sarcoma_centers. html). ESUN. .[7] Gebhardt, M and Buecker, PJ (2004). "Liposarcoma" (http:/ / sarcomahelp. org/ liposarcoma. html). ESUN. .

External links

• humpath #2495 (http:/ / www. humpath. com/ spip. php?page=article& id_article=2495) (Pathology images)

Liposarcoma 16

• Information (http:/ / www. thedoctorsdoctor. com/ diseases/ liposarcoma. htm) from The Doctor's Doctor website• Liposarcoma (http:/ / sarcomahelp. org/ liposarcoma. html?tpm=1_2) by Dr. Gebhardt and Dr. Buecker

Article Sources and Contributors 17

Article Sources and ContributorsLipoma Source: http://en.wikipedia.org/w/index.php?oldid=531143787 Contributors: *Kat*, Aamargulies, Abilash.m, Anthonyhcole, Arcadian, Ashley4455, Auntof6, Barek, Berkay0652,Bloq, Bryan Derksen, Capricorn42, CardinalDan, CarlFeynman, Cattywampus, Chrisfallacaro, CliffC, Crywalt, Dangih, Darvizo, David from Downunder, David spector, Drubarth, Evanh2008,Facts707, Fredsmith2, FreshPineSent, Graham87, HiEv, Horkana, Hu12, IShadowed, Immunize, Indon, Invertzoo, J.delanoy, Jamoaddi, Jen 111 Smith, Jfdwolff, Jim1138, Jmh649, Joyous!,Karthik.yerramilly, Kauczuk, Kenyon, Kjkolb, Kosebamse, Kristine zaballos, Kyng, Legion fi, Leuko, Lipomadr, Mannerssarah, Mark.m.lacey@acm.org, Marshall, Mattopaedia, Mindmatrix,Miseduc8ed, MrOllie, My Core Competency is Competency, NCurse, Neo-Jay, Netha Hussain, Neurospace, Okiefromokla, PamalaLauren, Patho, Peter.C, Prof. Squirrel, RDBrown, RedWolf,Rich Farmbrough, Rjwilmsi, Rod57, RogueNinja, Rollo44, Ruy Pugliesi, Sceptre, Search4Lancer, Siqbal, Sun Creator, Talkhence, Tb303romance, TedBaker88, TimVickers, Unused0026,Veinor, Venmathi, Waggers, WhatamIdoing, Wikipelli, Wouterstomp, Åkebråke, 163 ,55דוד anonymous edits

Adipose tissue Source: http://en.wikipedia.org/w/index.php?oldid=531667108 Contributors: 12345wat, 21655, A Thousand Doors, AThing, Achilles.g, Afromcbenny, Aiken drum, Aitias,Alex.tan, AllGloryToTheHypnotoad, Alteripse, Althepal, American Eagle, Andonic, Andrew Nutter, Andromedabluesphere440, Apparition11, Appraiser, Arcadian, Aspen04, Avenged Eightfold,Aviados, Bdve, Bejnar, Bencherlite, Bevo74, Bmecoli, Bobbyedwards9960, BorisVM, Buftchrstn, Bullenwächter, CHW100, Caltas, Centrx, Chartreuse green, ChemGardener, Chibi.akutenshi,Chris Capoccia, Chrislk02, Clarince63, Cobalt387, Cometstyles, CoolKoon, Courcelles, CredoFromStart, D.c.camero, DINORAWR444, Dah31, Dan Wylie-Sears 2, Danireed, Dash2102,Dcirovic, Dcs002, DeadEyeArrow, Deb, Deflective, DerHexer, Derumi, Devilanna, Dgw, Diberri, Diderot, Dills122, Dirkbb, Dlabtot, DlronW, Dogcow, Dooders1990, Download, Dr.khan,DrSculerati, Drphilharmonic, Drxenocide, EagerToddler39, Ekwity, Eras-mus, Erich gasboy, Ericjs, Esperant, Ewlyahoocom, FF2010, Farosdaughter, Favonian, Florentino floro, Fluffernutter,Frans Fowler, Fæ, Gene Nygaard, Gigemag76, Gillean666, Gioto, Girlwithgreeneyes, Goesgolf20, Gogo Dodo, Grabbuel, Greensburger, Gregorius Pilosus, Gurch, Gymnastjew, Hadal, Hahbie,Hankwang, Hede2000, Holme053, Hotcrocodile, Hydrogen Iodide, II MusLiM HyBRiD II, Idontlikeu123, Immunize, Ivenger, J.delanoy, JSpung, Jack007, JackWasey, Jackdrew123, Jag123,Jahiegel, Janeel j-man, Jeff G., Jennes83, Jfdwolff, Jiekuo, Jmabel, Jmh649, JustAGal, Jwikij, KCtheIron, Kalaiarasy, Kalambaki2, Karandas, Kauczuk, KettyJohnson, Kimiko, Klmd7, Knuckles,Kriis, Kukini, Lenschulwitz, Lijealso, Lincher, Lindsay.Wu, LindsayH, Liquidluck, Lir, LittleHow, LivingByNumbers, Lmbd uk, Loadmaster, Lucidity, Madhero88, Madmedea, Maqsarian,Marek69, Mark Arsten, Mark J Fowler, MarkRose, Markthemenace, Martarius, Martin451, Martinp23, Marysunshine, Maxiboi96, Maximus Rex, Mdabio, Mee Merone, Meewam, MikaelHäggström, Mlf107, Motley Crue Rocks, Mr. Quickling, N5iln, Nalkoff, Nathan Johnson, Nburden, Neddyseagoon, Ninly, Nmg20, Nokmar, Nono64, NotWith, Nutriveg, OctoMocto,Ohnoitsjamie, Ohyahgiveittome, Openseasonflierhole, Osnimf, Oxymoron83, Paddles, ParalysedBeaver, Peter Znamenskiy, Petr-heger, Pfranson, Phoebe, Phynicen, Pinethicket, Pol098, Postdlf,Pperos, Prashanthns, Prolog, Pwqn, Radagast83, Raven4x4x, RedWolf, Renato Caniatti, Reuben, Rezecib, Rich Farmbrough, Rick the shiba, Rjgibb, Rjwilmsi, Roxychik43, Rracecarr, Ruineye,Salsadouche, SchnitzelMannGreek, SchuminWeb, ScottMHoward, Settersr, Sfan00 IMG, Shadowtube567, Shanered06, Sharkford, Sheitan, Skunkboy74, SkyWalker, Smjg, Snowolf, SolarPowered Sheep, Speedyboy, Squarehead94, SteinAlive, Sterlingjones, Stevertigo, Superbb, Sylwia Ufnalska, THEN WHO WAS PHONE?, TakuyaMurata, Tarotcards, Taurrandir, Templatenamespace initialisation script, The Ronin, The Thing That Should Not Be, The Transhumanist, The cattr, The undertow, TheClassic, Thehelpfulone, Thesis4Eva, Thingg, Tiagofandrade,TicketMan, Tide rolls, Timl2k4, Timo Honkasalo, Tracer9999, Track100, Trevinci, True Pagan Warrior, Ulric1313, Uncle Dick, Unschool, Vanessadannenberg, Versageek, Vivio Testarossa,Vmenkov, W4chris, WWCND, WazzaMan, Whoahwhoahemily, Wikiwow, Wildswimmer Pete, William Avery, Wombat888, Woohookitty, Zargulon, Zodon, Zoicon5, Zygfield, 408 ,ברוקוליanonymous edits

Liposarcoma Source: http://en.wikipedia.org/w/index.php?oldid=516320276 Contributors: Altenmann, Anupam, Arcadian, Brim, Dl2000, Emma20001, Graham87, Hu12, Ian Hagemann,Immunize, Kjkolb, Mindmatrix, Mtg300nyc, My Core Competency is Competency, NCurse, Nephron, Nlu, Patho, Pearle, Ph.eyes, Piano non troppo, RJFJR, Rbanzai, Riedl, Rudolf.hellmuth,Snarius, Student7, Unklekrappy, WhatamIdoing, 27 anonymous edits

Image Sources, Licenses and Contributors 18

Image Sources, Licenses and ContributorsFile:Lipoma 02.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Lipoma_02.jpg License: Creative Commons Attribution 3.0 Contributors: Sikander IqbalFile:Lipoma(1).JPG Source: http://en.wikipedia.org/w/index.php?title=File:Lipoma(1).JPG License: Creative Commons Attribution-Sharealike 3.0 Contributors: User:Netha HussainImage:Lipoma.JPG Source: http://en.wikipedia.org/w/index.php?title=File:Lipoma.JPG License: Public Domain Contributors: Ashley4455Image:Lipoma 05.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Lipoma_05.jpg License: Creative Commons Attribution-Sharealike 2.0 Contributors: Sebastian E Valbuena, GregA O'Toole and Eric RoulotImage:Lipoma 03.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Lipoma_03.jpg License: Creative Commons Attribution 2.0 Contributors: Sebastian E Valbuena, Greg A O'Tooleand Eric RoulotImage:Lipoma 04.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Lipoma_04.jpg License: Creative Commons Attribution 2.0 Contributors: Sebastian E Valbuena, Greg A O'Tooleand Eric RoulotImage:Lipoma 06.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Lipoma_06.jpg License: Creative Commons Attribution 2.0 Contributors: Sebastian E Valbuena, Greg A O'Tooleand Eric RoulotImage:Illu connective tissues 1.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Illu_connective_tissues_1.jpg License: Public Domain Contributors: Arcadian, Barbaking,MrBlueSky, 2 anonymous editsFile:Fatmouse.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Fatmouse.jpg License: Public Domain Contributors: Original uploader was Bigplankton at en.wikipedia Laterversions were uploaded by Sunholm at en.wikipedia.File:Overweight teenage male.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Overweight_teenage_male.jpg License: Public Domain Contributors: OctoMoctoFile:Excess abdominal fat.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Excess_abdominal_fat.jpg License: Public Domain Contributors: OctoMoctoImage:Gray940.png Source: http://en.wikipedia.org/w/index.php?title=File:Gray940.png License: Public Domain Contributors: Arcadian, Magnus Manske, OrigamiemenschImage:Yellow adipose tissue in paraffin section - lipids washed out.jpg Source:http://en.wikipedia.org/w/index.php?title=File:Yellow_adipose_tissue_in_paraffin_section_-_lipids_washed_out.jpg License: GNU Free Documentation License Contributors: Jacklee, ReytanImage:Body Fat meter.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Body_Fat_meter.jpg License: Creative Commons Attribution-ShareAlike 3.0 Unported Contributors: 日 陰

猫JogaFile:Myxoid liposarcoma (06).JPG Source: http://en.wikipedia.org/w/index.php?title=File:Myxoid_liposarcoma_(06).JPG License: Creative Commons Attribution-ShareAlike 3.0 Unported Contributors: Alex brollo, KGHImage:edemaliposarcoma.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Edemaliposarcoma.jpg License: Creative Commons Zero Contributors: UnklekrappyImage:Liposarcoma_02.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Liposarcoma_02.jpg License: Creative Commons Attribution-Sharealike 2.0 Contributors: PanoraiaParaskeva, Paraskevas Katsaronis, Eleftherios D Spartalis, Andreas C Lazaris, Hara Gakiopoulou, Panagiotis Mallis and Periklis TomosImage:Myxoid liposarcoma (01).jpg Source: http://en.wikipedia.org/w/index.php?title=File:Myxoid_liposarcoma_(01).jpg License: Creative Commons Attribution-ShareAlike 3.0 Unported Contributors: Alex brollo, KGHImage:Dedifferentiated_liposarcoma_-_intermed_mag.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Dedifferentiated_liposarcoma_-_intermed_mag.jpg License: CreativeCommons Attribution-Sharealike 3.0 Contributors: Nephron

License 19

LicenseCreative Commons Attribution-Share Alike 3.0 Unported//creativecommons.org/licenses/by-sa/3.0/