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Kim, Kim, Kim, Ki, Lee, and Park: Radiologic Findings of Intraosseous Lipoma of Long Bones
Musculoskeletal Radiology
Original Article

Journal of the Korean Society of Radiology 2016; 75(4): 313-321.

Published online: 29 September 2016

DOI: https://doi.org/10.3348/jksr.2016.75.4.313

Radiologic Findings of Intraosseous Lipoma of Long Bones

Ju Won Kim, MD1, Sin Joong Kim, MD2, Go Eun Kim, MD2, So Yeon Ki, MD1, Seung Jin Lee, MD3, Jin Gyoon Park, MD2, 4

1Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea.

2Department of Radiology, Chonnam National University Hospital, Gwangju, Korea.

3Department of Radiology, Chonnam National University Bitgoeul Hospital, Gwangju, Korea.

4Department of Radiology, Chonnam National University Medical School, Gwangju, Korea.

Corresponding author: Jin Gyoon Park, MD. Department of Radiology, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea. Tel. 82-62-220-5746, Fax. 82-62-226-4380, parkjg@jnu.ac.kr

Received 16 February 2016       Revised 29 March 2016       Accepted 6 June 2016

Copyright © 2016 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate radiologic findings of intraosseous lipoma on plain radiograph and magnetic resonance imaging (MRI).

Materials and Methods

Twenty-seven radiologically or pathologically confirmed intraosseous lipomas of long bones were included in the study. The size, involved bone and site, bone destruction pattern, border, internal calcification, bony expansion, cortical disruption and endosteal erosion were retrospectively analyzed on plain radiograph. The cases were classified into three stages based on calcification and cystic change. Eccentricity, margin, signal intensity of internal fatty portion, and presence of enhancement were analyzed.

Results

Twelve tumors were located in femur and 8 in humerus. Proximal metaphysis was the most common involved site, with 14 cases. All tumors had geographic bone destruction, with sclerotic rim in 18 cases on plain radiograph. Internal calcification was seen in 18 cases and bony expansion in 6 cases. Twenty-three cases had cystic change in MRI. Eleven cases had eccentric location. The margins were well-defined in 11 cases. High signal intensity of fatty portion on fat-sat T2-weighted image was present in 17 cases. Contrast enhancement was seen in 17 cases.

Conclusion

Knowledge of plain radiographic and MRI findings of intraosseous lipoma of long bones is valuable to the tumor diagnosis differentiation from other bone lesions.

Keywords: MRI, Radiography, Bone Neoplasms, Lipoma

Figures and Tables

Fig. 1

A 55-year-old woman with an intraosseous lipoma (MRI stage 3) in proximal epiphysis of right humerus.

A. Anteroposterior radiograph reveals about a 1.8 cm osteolytic lesion (arrow) with well-defined sclerotic rim.
B. Coronal T1-weighted MR image shows peripheral fat signal intensity (arrowhead) and central low signal intensity, with well-defined smooth peripheral border.
C. Fat-saturated T2-weighted MR image shows peripheral fat suppression (arrowhead) and central cystic change with high signal intensity.
D. Contrast enhanced T1-weighted MR image shows rim enhancement of central cystic change.
jksr-75-313-g001
Fig. 2

A 59-year-old woman with an intraosseous lipoma (MRI stage 3) in proximal metaphysis of right femur.

A. Anteroposterior radiograph shows a poorly defined geographic lesion in intertrochanteric portion of the right femur with reticular calcification.
B. On coronal T1-weighted MR image, high signal intensity (arrowheads) in peripheral portion of the lesion demonstrate fat component of the lesion, corresponding to low signal intensity in fat-saturated T2-weighted MR image.
C. Cystic change in the center of the lesion shows high signal intensity on coronal fat-saturated T2-weighted MR image.
D. Contrast enhanced fat-saturated T1-weighted MR image shows subtle rim enhancement of cystic change.
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Fig. 3

A 57-year-old man with an intraosseous lipoma (MRI stage 3) in distal metaphysis of right tibia.

A. Anteroposterior radiograph shows an expansive osteolytic lesion with well-defined border, sclerotic rim, and internal ring calcifications.
B. Coronal T1-weighted MR image shows well-defined mass with peripheral high signal intensity and central cystic changes (arrowheads).
C. Coronal fat-saturated T2-weighted MR image shows cystic changes (arrowheads) with high signal intensity. Marginal low signal intensity reveals internal round calcification.
D. Contrast enhanced fat-saturated T1-weighted MR image shows subtle rim enhancement of cystic changes. Curettage and bone cement insertion was conducted to prevent expected osteoarthritis and pathologic fracture. Lesion was confirmed histopathologically.
jksr-75-313-g003
Fig. 4

A 48-year-old man with an intraosseous lipoma (MRI stage 3) in proximal diaphysis of right humerus.

A. Anteroposterior radiograph shows an osteolytic lesion with sclerotic rim.
B. Small fatty portion of intraosseous lipoma (arrowhead) and adjacent bone marrow have similar high signal intensity in T1-weighted MR image. Thin low signal intensity rims demarcate intraosseous lipoma and internal cystic change.
C. It is difficult to differentiate peripheral fatty portion (arrowhead) of intraosseous lipoma with adjacent fatty bone marrow in fat-saturated T2-weighted MR image. This case demonstrates that intraosseous lipoma containing small fat and extensive cystic change can be misdiagnosed as other cystic bone lesion.
jksr-75-313-g004
Table 1

Age Distribution of Intraosseous Lipomas in Long Bones

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Age (Years) No. of Patients
20–29 3
30–39 4
40–49 7
50–59 7
60–69 4
70–79 1
80–89 1
Total 27
Table 2

Involved Bones and Sites of Intraosseous Lipomas in Long Bones

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Bone Site
Prox E Prox M D Dist M Dist E Total
Femur 1 9 1 0 1 12
Humerus 3 3 1 1 0 8
Tibia 0 1 1 1 1 4
Fibula 0 1 1 1 0 3
Total 4 14 4 3 2 27

D = diaphysis, Dist E = distal epiphysis, Dist M = distal metaphysis, Prox E = proximal epiphysis, Prox M = proximal metaphysis

Table 3

Size of Intraosseous Lipomas in Long Bones

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Size (cm) No. of Patients
1.5–3.0 7
3.1–6.0 12
6.1–9.0 4
9.1–12.0 3
12.1–15.0 1
Total 27
Table 4

Radiographic Findings of Intraosseous Lipomas in Long Bones (n = 27)

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Radiographic Findings No. of Patients (%)
Bone destruction pattern & Border
 Geographic (I) 27 (100)
  Well-defined border with sclerotic rim (Ia) 18 (67)
  Well-defined border without sclerotic rim (Ib) 2 (7)
  Ill-defined border (Ic) 7 (26)
 Moth-eaten (II) 0
 Infiltrative (III) 0
Internal calcification
 Negative 9 (33)
 Positive 18 (67)
  Reticular 5
  Amorphous 5
  Dot 4
  Ring 4
Distribution of internal calcification
 Central 5 (28)
 Peripheral 9 (50)
 Diffuse 4 (22)
Bony expansion
 Negative 21 (78)
 Positive 6 (22)
Cortical disruption
 Negative 26 (96)
 Positive 1 (4)
Endosteal erosion
 Negative 26 (96)
 Positive 1 (4)
Table 5

MRI Findings of Intraosseous Lipomas in Long Bones (n = 27)

jksr-75-313-i005
MRI Findings No. of Patients (%)
MRI stage
 Stage 1 4 (15)
 Stage 2 0
 Stage 3 23 (85)
Location at transverse plane
 Concentric 16 (59)
 Eccentric 11 (41)
Calcification
 Negative 10 (37)
 Positive 17 (63)
Cystic change
 Negative 4 (15)
 Positive 23 (85)
  1 (no. of cyst) 16
  2 5
  ≥ 3 2
Margin on T1WI
 Distinct 11 (41)
  Smooth 9
  Lobular 2
 Indistinct 16 (59)
Edematous change of fat component on T2WI
 Negative 10 (37)
 Positive 17 (63)

T1WI = T1-weighted image, T2WI = T2-weighted image

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