29 February 2012
By Umesh Isalkar
A 27–year–old woman, suffering from a rare noncancerous tumour of fatty cells — that spread underneath the skin from her left hand finger to one side of the arm and up to the back — was successfully operated upon at the Sassoon general hospital recently. Weighing around 28 kg, the slow–growing tumour started its spread from the middle finger when the patient was eight years old and by the time she turned 18, it had grown into big round, flattened lumps under the skin.
“The woman suffered from rare benign tumour called ‘diffused lipomatosis’. Till date, medical literature has not recorded the infiltrative spread of this kind of tumour into such an enormous size. This is for the first time that a tumourhad grown to an extent of occupying the complete left side of a patient’s hand and up to the left shoulder blade,” said surgeon Kirankumar Jadhav, who carried out the difficult operation at the Sassoon hospital.
The surgery was conducted under the guidance of senior surgeon S S Thakur, head of the surgery department. A team of resident doctors Suveen Jalmatti, Abhijeet Patil, Shreyash Modak and Arvind Ekhande assisted Jadhav in the difficult task. Plastic surgeon Nikhil Panse carried out skin grafting on the operated area after the surgery. The tumour had grown into large, rounded lumps under the skin and the doctors had to cut it off in parts.
“Initially, there was only swelling on the middle finger of my left hand. As I grew older, the swelling started spreading. It spread all along the hand first and then covered the left shoulder. The swelling turned into big lumps of flesh that made me look morbidly obese on one side,” said Pushpa Dandgule, the patient.
The lumps were first removed when Pushpa was 18 years old. “At the time of my marriage, my parents consulted doctors at the Solapur civil hospital who removed the lumps. I got married after that. However,one small lump which was not removed because of its negligible size went on to grow again and by the time I was 27 years old, it grew into large, rounded lumps all over the left hand and back,” she said.
Asked about the difficulties she faced because of the tumour’s extremely huge size, Pushpa said, “My left hand had become totally dysfunctional. I could not sleep on that side, while sleeping on the right side was equally difficult due to the huge weight of the lump. My husband, who is a fruit seller, deserted me due to my condition. Ulcers used to develop due to the stretching of the skin. The ulcers used to bleed and I would go the hospital for dressing everyday. The experience was painful physically and socially.” A mother of three children, Pushpa got herself admitted to the Sassoon hospital two–and–a–half months ago.
“In view of the tumour’s massive spread, we had to remove it in parts. The first surgery was carried out on January 4, during which the lumps on the back, weighing 13 kg and 25 cm in size, were removed. In the second surgery carried out on January 20, the fatty lumps all along the left hand that weighed 15 kg and 40 cm in size were removed. The plastic surgeon carried out skin grafting on the operated area on February 14,” Jadhav said.
Before the surgery, a biopsy test was carried out which showed that the tumour was non–cancerous. Again, when the tumour was completely removed, the doctors sent the surgically removed fleshy parts for histopathology to find out whether there was any cancerous cell which could have managed to escape during the biopsy test and the histopathology report, too, gave a negative report for cancer.
“We are going to report the case in international peer–reviewed medical journal for publication. It is one of the rarest cases of diffused lipomatosis one that needs to be documented,” said Thakur. What are lipomas? L ipomas are the most common subcutaneous soft–tissue tumors of mesenchymal origin. The estimated annual incidence is one per 1,000 persons. Lipomas are generally slow–growing nodules with a firm rubbery consistency. While about 80% of lipomas are less than five cm in diameter, some can reach more than 20 cm and weigh several kgs. They are usually asymptomatic, but can cause pain when they compress nerves. Lipomas tend to occur on the trunk, shoulders, posterior neck, etc.