Multiple Fibrolipomas of the skin

Introduction

Skin tags are a common findings in a dermatologic practice. As they seem to be of little consequence and are easily removed, they have received little attention in the dermatologic literature.[1] They are usually single or multiple less than 5mm in length. When they are above 1 cm in diameter they are usually solitary, But multiple much large lesions are very rare.[2] We herein report such a rare case.

Case Report

A 25 year old male presented with multiple sessile tumours on his right leg of 6 moths duration. These lesions were asymptomatic and gradually increased in size and number and continued to grow. On examination there were numerous brown, soft, broad based nodules in the distal portion of right leg [Figure]. These lesions were mostly found on posterior and lateral surface of the legs and were situated on muscular parts. They were nontender and partly compressible; the buttonhole sign (neurofibromata) was absent. Their size ranged from 1 to 2 cms in diameter. There were no evidence or history of trauma or inflammation. A typical lesion was excised for histologic examination.

Microscopic examination of the excised skin lesion showed loosely arranged collagen and a central core of mature fat covered by a epidermis. A strand of loosely woven connective tissue extended to the base of the lesion and was continuous with collagen between the papillary and reticular dermis of the normal skin. A histological diagnosis of fibrolipoma was made. The entire lesion was removed and skin grafting was done.

Discussion

Skin tags are common cutaneous lesions and are of three clinical types: 1) multiple small furrowed papules, especially on the neck and in the axilla, approximately 1 to 2 mm in width and height; 2) single or multiple filiform lesions in varying locations, approximately 2 mm in width and 5 mm in height; and (3) solitary large bag-like protuberances, usually on the lower trunk, about 1 cm in diameter. These larger lesions are occasionally multiple[1] and are commonly seen on the lower trunk.[2] But in the present case these multiple lesion was found in the lower leg. Because of diverse microscopic findings in these clinically similar lesions, there has been a problem with nomenclature. These are also called as soft fibromas, papillomas, acrochordon, fibroepithelial polyps and others. The papules or nodules may have predominance of epidermis and little connective tissue, thus fibroma would be an inappropriate term for many of them. Not all lesions are nipple like or papillomatous. Not all lesions are in the form of an extended string as implied by the term acrochordon. The term tag is noncommital, merely meaning "appendage". and thus might serve better for the entire spectrum of these lesions.[1] Histologically these lesions show fibrous and / fat cells. So they can be called as fibroepithelial polyp or lipofibroma (fibrolipoma) depending on the presence or absence and amount of fat.

Microscopically, the larger, bag-like lesions (fibroepithelial polyps, fibrolipoma) usually have a stroma composed of loosely arranged collagen and a central core of mature adipose tissue. They show surface flattened epidermis.[2] In some instances the dermis is quite thin, so that the fat cells compose a significant portions of the tumour which may then be regarded as lipofibroma.