The tip of the iceberg: a giant pelvic atypical lipoma presenting as a sciatic hernia

• Main Authors: Stewart Ken J, Smith Graeme HM, Skipworth Richard JE, Anderson David N
• Format: Article
• Language: English
• Published: BMC 2006-06-01
• Series: World Journal of Surgical Oncology
• Online Access: http://www.wjso.com/content/4/1/33

<p>Abstract</p> <p>Background</p> <p>This case report highlights two unusual surgical phenomena: lipoma-like well-differentiated liposarcomas and sciatic hernias. It illustrates the need to be aware that hernias may not always simply contain intra-abdominal viscera.</p> <p>Case presentation</p> <p>A 36 year old woman presented with an expanding, yet reducible, right gluteal mass, indicative of a sciatic hernia. However, magnetic resonance imaging demonstrated a large intra- and extra-pelvic fatty mass traversing the greater sciatic foramen. The tumour was surgically removed through an abdomino-perineal approach. Subsequent pathological examination revealed an atypical lipomatous tumour (synonym: lipoma-like well-differentiated liposarcoma). The patient remains free from recurrence two years following her surgery.</p> <p>Conclusion</p> <p>The presence of a gluteal mass should always suggest the possibility of a sciatic hernia. However, in this case, the hernia consisted of an atypical lipoma spanning the greater sciatic foramen. Although lipoma-like well-differentiated liposarcomas have only a low potential for recurrence, the variable nature of fatty tumours demands that patients require regular clinical and radiological review.</p>