Patient's Query
Hello doctor,
I have had some lipomas for a long time, all of which were checked and confirmed to be non-vascular. However, in the past three to six months, I have noticed a lot more, maybe around 40 or more in total. Some are like round balls, while others are flat. The round ball ones cause sharp burning when touched. They are located everywhere, with six or seven on both arms, a few on my thighs, and some behind my knees. Most are less than 0.393 inches in size.
I have been dealing with a low-grade fever, ranging up to 98.6 to 99.68 Fahrenheit, for three months now, usually between 10 am and 10 pm, then it stops at night.
The doctor said upon examination that they do not feel like lipomas, but ultrasound results indicate otherwise. What are the chances of this being malignant? I need to know your thoughts and the best approach. All other tests, including CRP (C-reactive protein), ESR (erythrocyte sedimentation rate), and blood tests, came back normal.
Please help.
Thank you.
Hello,
Welcome to icliniq.com.
I understand your concern.
I am a radiologist, and I have reviewed the ultrasound images that you uploaded. Based on my observations: There are multiple well-defined hyperechoic lesions in the subcutaneous plane, just below the skin surface at the scanned areas of interest. One of these in the right arm shows some vascularity. No infiltration is noted in the adjacent structures, and surrounding myofascial planes appear normal. From the appearance of the lesions on the ultrasound images, these seem to be lipomas. Lipomas are very common benign lesions found in the body, usually presenting as multiple growths in areas with fatty tissue. Typically, they require no treatment.
Their malignant counterpart is liposarcoma. In the case of a cancerous lipoma, imaging would typically reveal an ill-defined mass infiltrating adjacent structures, with calcifications, necrosis, and increased internal vascularity. None of these features are observed in your case, except for minimal vascularity in one lump in the right arm.
I would approach this in two ways: either get a repeat ultrasound in five to six months to observe if the lesion in the right arm is increasing in size or developing other malignant features as mentioned above, or proceed with a biopsy. Biopsy would yield quicker results and help alleviate your anxiety sooner. However, it is worth noting that for lipomas in general, a one-year follow-up is typically recommended.
Please let me know if you need further assistance.
Thank you for using icliniq, and have a nice day.
Patient's Query
Thank you for the detailed reply; it is the best one I have received.
However, some are suggesting a biopsy straight away and referring me to a sarcoma clinic, which is making me anxious. Another thing, I have similar type lumps all around, maybe 50 or so. I had a repeat ultrasound from another sonographer today since vascularity was not present before. When they checked the same lumps today, no vascularity was noted in any. Could that have been a mistake? In your opinion, is it better to monitor or proceed with a biopsy? I obviously would prefer not to have a biopsy, but what is your clinical suggestion at this point?
Hello,
Welcome back to icliniq.com.
Thank you for your kind words.
As I mentioned earlier, lipomas are generally avascular (non-vascular). The minimal vascularity seen in one of the lumps on the uploaded images (attachments removed to protect the patient’s identity) was not observed in the ultrasound scan performed later. This could either indicate an error in the earlier scan or that it was missed in the later scan. We cannot be certain about this as ultrasound is a skill-based modality, and therefore, the image quality depends on the expertise and experience of the technician capturing them.
My suggestion would be not to become anxious at this point. Stay positive and schedule a repeat ultrasound in five to six months to monitor for any changes in the size and characteristics of the lumps.
I hope this helps.
Take care.
Patient's Query
Thank you for the reply doctor,
I obtained a second opinion that did not note the vascularity, which is reassuring. However, on the image that shows the vascularity (top left), they suggested that the black circle with a grey center is a lymph node (this is where the red Doppler is). However, if that is the case, this lymph node does not appear normal to me. Is this normal? It has been almost three weeks later, and the lymph node is still visible. Is it normal for it to still appear?
Please advise.
Hello,
Welcome back to icliniq.com.
So, appearance-wise, this lymph node seems normal, with a dark grey cortex (outer region) and a whitish-grey center known as the hilum. Nodes measuring more than 10 to 12 mm across should be further evaluated. I do not see any measurements of this node on the image; therefore, I cannot comment on its size. Minimal vascularity might indicate that it is inflammatory (an enlarged node due to infection or inflammation). They usually regress once the primary focus of the infection is treated. In case they increase in size, then a biopsy is recommended.
I hope this information is helpful to you.
Thank you.
Patient's Query
Thank you for the reply doctor,
When they checked, there was either no vascularity or minimal vascularity, but it was difficult to determine, possibly located to the side of the node. The combined size of the lipoma and lymph node is 9.5 mm, so the lymph node is less than half that size based on the image. My ESR and CRP were negative. Does it not resemble a black ring, which could suggest necrosis, or am I mistaken? Does it appear to be a lymph node to you? It seems to have been there for over a month now, remaining the same size. Does it necessitate a biopsy? Can a lymph node with vascularity be normal, without infection, inflammation, or anything sinister?
I am feeling anxious, so I just need reassurance. Just a note: the skin outside (not seen on ultrasound) is slightly dark, resembling a bruise or vein, although the size is very small, around 6 mm. I am not sure if this is significant.
Please advise.
Hello,
Welcome back to icliniq.com.
It does appear to be a lymph node in the images. No necrosis is visible within it. Mild vascularity can also be observed in normal nodes. Since your blood work, along with ESR (erythrocyte sedimentation rate), is normal, it is less likely to be an inflammatory node. Nothing needs to be done at present. A follow-up ultrasound can be scheduled in a year or so to check for any structural changes. Based on those findings, further management can be decided.
I hope this helps you.
Take care.
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Answered byDr. Ruchi Sharma
Medically reviewed byiCliniq medical review team
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