Giant lipomas: A 130-year literature review, case series, and introduction of an intuitive management algorithm

Background: Lipomas are the most common benign mesenchymal tumors in adults. On the other hand, giant lipomas, defined as lipomas over >10 cm in length of over 1000 g in weight, are less frequently seen, can be clinically challenging to manage, and require careful attention. While most cases are benign, soft, asymptomatic masses, there is potential for functional limitation, nerve compression syndromes, and sarcomatous changes in such lesions. Methods: A case series is presented and an extensive review of the literature was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) declaration, since the first description of a giant lipoma reported in 1894, with the aim of providing an updated and comprehensive “state-of-the-art” on the management, diagnosis, and treatment of this entity. PubMed, Scopus, and Google Scholar databases were queried for relevant articles using the search terms “Giant lipoma” and “Massive lipoma” from 1894 to 2024. Results: Five consecutive clinical cases were reported. A total of 79 patients were identified from the 65 collected reports. Clinical characteristics of the lesions, surgical details, and patient characteristics are obtained and summarized. Preoperative/postoperative radiological/histological features are reported. Conclusion: Surgical excision remains the gold standard treatment for giant lipomas. According to existing literature, most recommendations are based on expert opinions and there is a paucity of guidelines or universal consensus on a treatment pathway for standardized, multidisciplinary management of such a challenging clinical condition.