Diagnosis and treatment of upper eyelid lipoma
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Lipomas are soft, benign tumours, and usually present with slow growth. Histologically, they are characterized by fat lobules among fibrous septa. Lipomas are occur most commonly within the subcutaneous tissue of the back, neck, and limbs.1 Nevertheless, all areas can be affected by this kind of lesion. Herein, presents a case of a lipoma of the upper eyelid.

A 76-year-old otherwise healthy woman presented with a 4-year history of slow, progressive right upper eyelid swelling. She did not experience pain or other symptomatology, but only slight discomfort and increasing size of the mass over the previous 14 days. No proptosis or resistance to retropulsion was evident. On ophthalmologic examination a soft, non-ulcerated, and not well-circumscribed mass was evident. The pupils were isochoric and there was not relative pupil afferent defect. An ultrasonography examination was carried out. A hyperechoic noncapsulated mass was detected. The mass was located between the superior orbital margin and the orbicularis oculi muscle. The lesion measured 27 × 4 × 4.4 mm.

The decision was made to pursue surgical excision with biopsy. The surgery proceeded as follows, local anesthetic with 2% xylocaine with epinephrine was administered 20 minutes before surgical excision in order to facilitate hydro-dissection and to control bleeding. An upper lid skin incision was made and an irregular lobular mass under the muscular layer in the pre-septal plane was exposed. The tissue colour was lighter than the periorbital fat. The lesion showed irregular margins, but it did not seem to infiltrate the orbicularis oculi muscle macroscopically. The irregular lobules were carefully excised with a Colorado® Micro-Dissection needle at 3 W coagulation in order to minimize muscle and skin damage and to control bleeding. The tumour was removed and sent for pathologic examination. The histologic section showed mature adipocytes organized in lobules divided by fibrous septa. The cells showed slight pleomorphism, but no atypia or mitotic features. No capsule and no orbicularis oculi muscle infiltration were observed. No functional deficits were detected during the post-operative period. No complications were reported after a two months’ follow up.

Source: https://www.sciencedirect.com/science/article/pii/S2451993620301894?dgcid=rss_sd_all
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