Lipomatous tumors.

Beecher, Abraham C. W., 184[4]-November 7, 1893.

Journal : Photographic review of medicine & surgery ; vol. 2., no. 3.

Philadelphia : J. B. Lippincott & Co., 1871-72.

Description : pp. 24-26, [1] pl. ; ill.: 1 photo. ; 24 cm.

Photograph : mounted albumen.

Subject : Lipomatosis.

Notes :

M. P., aged 45, is a native of Germany, and a brewer by occupation. He has always enjoyed good health, with the exception of his present trouble, for which he entered the Philadelphia Hospital during the service of Dr. Wm. H. Pancoast. His present condition did not appear until after adult life, when he became addicted to the use of large quantities of beer; he then began to grow around the trunk, which continued until then began to grow around the trunk, which continued until his body reached its present form and magnitude. There has been but slight increase within the last few years.

His neck is naturally short, and, as it participates in the growth, seems almost obliterated. The shoulders and arms are very much enlarged, though the elbows and forearms are of natural size. The chest and abdominal walls are very full and protuberant, while the mammary glands are large and pendent. The umbilicus is depressed about an inch and a quarter. At the lower portion of the abdomen, over the mons veneris, is a remarkable growth of the same nature as the others, large and pendent, covering entirely the genitalia and simulating at first sight an enormous double hernia.

The posterior view, which is presented, is as remarkable as the anterior. The neck, shoulders, and arms are in the same condition as the front, the parts being symmetrical. Between the shoulders, on the lower cervical and upper dorsal regions, is a tumor about half the size of the one in the pubic region.

From the middle of the back, running obliquely outward on each side one-fourth of the circumference of the trunk, the tissues are thrown into large folds, running parallel with each other from the axillae to the iliac crests.

The lower extremities are entirely free.

The growths wherever they appear are soft, as in persons who are naturally and uniformly fat. They are pendent where in folds or protruding from the general level.

They occasion but slight discomfort, neither is the deformity very apparent when the subject is dressed, as he is a short man.

The condition here presented seems to belong to the class of lipomatous growths, and is interesting from its rare manifestation, symmetrical development, and the extent of surface which it covers.

Lipomata may develop subcutaneously in any portion of the body, but particularly in the parts where the largest quantities of fat are usually found.

Sir B. Brodie, in his Lectures on Pathology and Surgery, says, "These tumors are situated under the integuments in some part where there is naturally adipose structure. You do not find them begin to exist where there is no adeps. But wherever natural adipose structure exists there these unnatural growths of adipose substance may take place."

Most writers consider that lipomata are of precisely the same structure as the adipose tissue, making no difference between them and obesity ; in either there is of necessity an hypertrophy or increased quantity of the connective tissue.

Paget says, " It is difficult sometimes to say where the normal structure ceases and the abnormal begins."

Billroth, in his Surgical Pathology, says, " The disposition to obesity is not considered morbid, but rather that of hypernutrition of parts ; more frequent after twenty years, rare in infancy, attacking phlegmatic persons in preference." The same author adds, "The anatomical composition of lipoma is simple, consisting of adipose tissue which is divided into lobes by connective tissue."

Rindfleisch, in his Pathological Histology, says, " For me obesity is fatty infiltration of the existing connective tissue; the lipoma the fatty infiltration of a new formation, which grows from its own centres."

Thus, then, by comparing the opinions of prominent authors, we arrive at the conclusion that but little difference exists between these fatty formations, except as to manifestation.

In the circumscribed forms, surgical interference is the only tangible treatment, but where they extend over large surfaces it is not to be considered. In the present case no treatment was urged.

As an illustration of the extent to which the adipose tissue may become enlarged we have the famous case of Daniel Lambert, who lived in England, and weighed over seven hundred pounds; and in Professor Gross's Pathological Anatomy is recorded a case of a man weighing six hundred and eighteen pounds, who was on exhibition in Philadelphia in 1827, the fat being confined to the abdomen and lower extremities.

Two cases resembling the one under consideration are reported by Professor Verneuil, of Paris, in the " Revue Photographique des H˘pitaux de Paris" for 1869.

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