Surgical management of a giant interscapular lipoma after a decade of delayed care: a case report

Introduction and importance: Giant lipomas, defined by a diameter exceeding 10 cm or a weight surpassing 1000 g, represent approximately 1% of all lipomas. Although benign, they can cause substantial functional limitation, cosmetic deformity, and psychological distress. Presentation of case: A 55-year-old woman with an unremarkable medical history presented with a progressively enlarging interscapular mass present for over 10 years. The mass measured 38 × 25 × 21 cm and was soft, non-tender, and freely mobile, with skin breakdown at its inferior margin and mild serous discharge. Inflammatory markers were within normal limits. Complete surgical excision was performed under general anesthesia via an elliptical incision incorporating the devitalized skin. The excised specimen weighed 3800 g. Histopathological examination confirmed a benign giant lipoma comprising mature adipocytes in lobules separated by thin fibrous septa, with no atypia, lipoblasts, or evidence of malignant transformation. The postoperative course was uncomplicated; at 6-month follow-up, the wound had healed completely, with no recurrence and marked functional and cosmetic improvement. Clinical discussion: Giant lipomas can lead to cosmetic deformity, psychological distress, and reduced mobility. Pressure-induced skin breakdown may develop at dependent surfaces as lesions increase in size, yet inflammatory markers and histopathological findings may remain benign. Distinguishing giant lipomas from liposarcomas requires formal histopathological evaluation. Conclusion: In this patient, complete surgical excision resulted in symptom resolution without postoperative complications. Histopathological evaluation is mandatory to exclude malignancy.