Lipoma arborescens: Case review of a rare synovial lipomatosis

Abstract

Lipoma Arborescens is a rare, chronic, gradually progressive intra-articular lesion of benign nature. It is seen in most commonly in the knee but can also be seen in shoulder, elbow and wrist joints. It is characterized by villous proliferation of Synovium and replacement of Sub synovial tissue by mature adipocytes. We report a 20 years old male patient. We elaborate clinical features, role of investigations, differential diagnosis and treatment options available. Case report: We present you a 20 years old male patient diagnosed with lipoma arborescens of knee joint. The MRI report of right knee showed synovium which appeared markedly thickened and showed post-contrast enhancement with fat containing non-enhancing frond-like synovial masses outlined by concurrent joint effusion. These frond like masses were found predominantly in suprapatellar pouch. This patient underwent open synovectomy which showed multiple grey yellow papillary like excrescences seen arising from underlying flat piece of synovium. Approximately 80 cc of lobulated globules were removed and was sent to histopathological examination which confirmed synovial lipomatosis (Hoffa’s disease) associated with chronic lymphoplasmocytic synovitis. On 3 months follow up the patient had complete symptomatic relief.