Lipoma vs atypical lipomatous tumour: key differences and diagnostic difficulties

This article provides a detailed comparison between lipomas and atypical lipomatous tumours (ALT), focusing on their clinical presentation, ultrasound features and management strategies.

Soft tissue masses are frequently encountered in clinical practice, with lipomas being the most common benign type. ALTs, although less common, are locally aggressive and pose diagnostic challenges due to their similarity to lipomas in clinical and ultrasound presentation. Ultrasound is a valuable first-line imaging tool, but its operator dependency and limitations in assessing deep or large lesions necessitate careful interpretation.

Lipomas typically appear as soft, painless, mobile masses with variable echogenicity and minimal vascularity. In contrast, ALTs often exceed 5cm, display thick, irregular fibrous septations, heterogeneous echotexture, and may contain non-fatty components or calcifications. MRI is recommended for deeper or suspicious lesions due to its superior tissue characterisation.

Management differs significantly: superficial, painless lipomas <7cm can be handled in primary care, while ALTs require surgical resection with clear margins due to their potential for dedifferentiation. Accurate differentiation is crucial, as misdiagnosis can lead to inappropriate treatment. The article emphasises the importance of recognising key ultrasound features and integrating clinical findings to guide appropriate imaging and referral pathways.

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