Giant frontoparietal scalp lipoma presenting as a massive cranial swelling: clinicoradiological, cytological and histopathological correlation

Abstract

Lipomas are the most common benign mesenchymal tumors composed of mature adipocytes. While frequently encountered in the trunk and extremities, giant lipomas of the scalp are rare owing to limited subcutaneous tissue and cosmetic concerns prompting early treatment. A 59-year-old male presented with a gradually progressive swelling over the left frontoparietal scalp for 14 years in OPD of Department of General Surgery of Saraswathi Institute of Medical Sciences, Hapur, U.P., India. Examination revealed a painless, well-circumscribed, soft-to-firm swelling measuring approximately 11×8 cm with normal overlying skin. Ultrasonography demonstrated a well-defined heterogeneous hyperechoic lesion measuring 11.1×8.6 cm in the subcutaneous plane without internal vascularity, suggestive of lipoma. Fine-needle aspiration cytology showed mature adipocytes without atypia, favoring a lipomatous lesion. The patient underwent complete surgical excision under appropriate anesthesia. Intraoperatively, a large encapsulated adipocytic mass was identified and excised en bloc. Histopathological examination confirmed lipoma. Postoperative recovery was uneventful. Giant scalp lipomas are uncommon and may attain considerable size before presentation. Imaging, cytology, and histopathology are useful for diagnosis. Complete surgical excision remains curative with excellent cosmetic and functional outcomes.