LIPOMA

M. Rachmat Sulthony

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Contents
Articles
Lipoma 1
Adipose tissue 6
Liposarcoma 14

References
Article Sources and Contributors 17
Image Sources, Licenses and Contributors 18

Article Licenses
License 19
Lipoma 1

Lipoma
Lipoma
Classification and external resources

Lipoma on forearm

ICD-10 [1]
D17 (ILDS D17.910)

ICD-9 [2]
214

ICD-O: [3]
M8850/0

DiseasesDB [4]
7493

MedlinePlus [5]
003279

eMedicine [6] [7]

med/2720 derm/242

MeSH [8]
D008067

A lipoma is a benign tumor composed of adipose tissue. It is the most common form of soft tissue tumor.[9] Lipomas
are soft to the touch, usually movable, and are generally painless. Many lipomas are small (under one centimeter
diameter) but can enlarge to sizes greater than six centimeters. Lipomas are commonly found in adults from 40 to 60
years of age, but can also be found in children. Some sources claim that malignant transformation can occur,[10]
while others say that this has yet to be convincingly documented.[11]

Types
There are several subtypes of lipomas:[12]:624–5
• Adenolipomas are lipomas associated with eccrine sweat
glands.[13]:627
• Angiolipoleiomyomas are acquired, solitary, asymptomatic acral
nodules, characterized histologically by well-circumscribed
subcutaneous tumors composed of smooth muscle cells, blood
vessels, connective tissue, and fat.[12]:627
• Angiolipomas painful subcutaneous nodules having all other
Lipoma of the breast features of a typical lipoma.[12]:624[14]
• Chondroid lipomas are deep-seated, firm, yellow tumors that
characteristically occur on the legs of women.[12]:625
Lipoma 2

• Corpus callosum lipoma is a rare congenital brain condition which may or may not present with symptoms.[15]
This occurs in the corpus callosum, also known as the colossal commissure, which is a wide, flat bundle of neural
fibers beneath the cortex in the human brain.
• Hibernomas are lipoma of brown fat.
• Intradermal spindle cell lipomas are distinct in that it most commonly affects women, and has a wide
distribution, occurring with relatively equal frequency on the head and neck, trunk, and upper and lower
extremities.[12]:625[14]
• Neural fibrolipomas are overgrowths of fibro-fatty tissue along a nerve trunk, which often leads to nerve
compression.[12]:625
• Pleomorphic lipomas, like spindle-cell lipomas, occur for the most part on the backs and necks of elderly men,
and are characterized by floret giant cells with overlapping nuclei.[12]:625
• Spindle-cell lipomas are asymptomatic, slow-growing subcutaneous tumors that have a predilection for the
posterior back, neck, and shoulders of older men.[12]:625
• Superficial subcutaneous lipomas, the most common type of lipoma, lie just below the surface of the skin.[11]
Most occur on the trunk, thighs and the forearms, although they may be found anywhere in the body where fat is
located.

Prevalence
Approximately one percent of the general population has a lipoma.[11]
These tumors can occur at any age, but are most common in middle
age, often appearing in people from 40 to 60 years old.[16] Cutaneous
lipomas are rare in children, but these tumors can occur as part of the
inherited disease Bannayan-Zonana syndrome.[17][18]
Lipomas are usually relatively small with diameters of about
1–3 cm,[19] but in rare cases they can grow over several years into
"giant lipomas" that are 10–20 cm across and weigh up to
4–5 kg.[20][21]

Causes
Lipoma removed from human torso
The tendency to develop a lipoma is not necessarily hereditary
although hereditary conditions, such as familial multiple lipomatosis, may include lipoma development.[22][23]
Genetic studies in mice have shown a correlation between the HMG I-C gene (previously identified as a gene related
to obesity) and lipoma development. These studies support prior epidemiologic data in humans showing a correlation
between HMG I-C and mesenchymal tumors.[24]
Cases have been reported where minor injuries are alleged to have triggered the growth of a lipoma, called
"post-traumatic lipomas."[25] However, the link between trauma and the development of lipomas is controversial.[26]
Lipoma 3

Treatment
Usually, treatment of a lipoma is not necessary, unless the tumor becomes painful or restricts movement. They are
usually removed for cosmetic reasons, if they grow very large, or for histopathology to check that they are not a
more dangerous type of tumor such as a liposarcoma.[11] This last point can be important as the actual identity of a
"bump" is not known until after it is removed and professionally examined.
Lipomas are normally removed by simple excision.[16] The removal can often be done under local anaesthetic, and
take less than 30 minutes.[27] This cures the majority of cases, with about 1–2% of lipomas recurring after
excision.[28] Liposuction is another option if the lipoma is soft and has a small connective tissue component.
Liposuction typically results in less scarring; however, with large lipomas it may fail to remove the entire tumor,
which can lead to regrowth.[29]
There are new methods being developed that are supposed to remove the lipomas without scarring. One of them is
removal by the use of injection of compounds that trigger lipolysis, such as steroids or phosphatidylcholine.[16][30]

Resection of an intermuscular lipoma in the elbow region

X-ray of the lipoma.
Intraoperative photo. The operating field after The resected lipoma
removal of the lipoma. (8 cm × 6 cm × 3 cm)
Arrow marks the median
nerve which was
compressed by the lipoma.

Prognosis
Lipomas are rarely life-threatening and the common subcutaneous lipomas are not a serious condition. Lipomas
growing in internal organs can be more dangerous, for example lipomas in the gastrointestinal tract can cause
bleeding, ulceration and painful obstructions (so-called "malignant by location", despite being a benign growth
histologically).[31][32] Malignant transformation of lipomas into liposarcomas is very rare and most liposarcomas are
not produced from pre-existing benign lesions,[28] although a few cases of malignant transformation have been
described for bone and kidney lipomas.[33][34] It is possible these few reported cases were well-differentiated
liposarcomas in which the subtle malignant characteristics were missed when the tumour was first examined.[35]
Deep lipomas have a greater tendency to recur than superficial lipomas, because complete surgical removal of deep
lipomas is not always possible.[35][36]

In veterinary medicine
Lipomas occur in many animals, but are most common in older dogs, particularly older Labrador Retrievers,
Doberman Pinschers and Miniature Schnauzers.[37] Overweight female dogs are especially prone to developing these
tumors and most older or overweight dogs have at least one lipoma.[38][39] In dogs, lipomas usually occur in the
trunk or upper limbs.[37] Lipomas are also found less commonly in cattle and horses, and rarely in cats and
pigs.[39][40] However, a pedunculated lipoma can cause entrapment and torsion of the intestine in horses, causing
necrosis, colic, and possibly death. The intestine becomes wound around the stalk of the lipoma and loses blood
supply.[41]
Lipoma 4

Other conditions involving lipomas

Lipomatosis is a hereditary condition where multiple lipomas are present on the body.
Adiposis dolorosa (Dercum disease), is a rare condition involving multiple painful lipomas, swelling, and fatigue. It
is generally seen in obese, post-menopausal women.[42]
Benign symmetric lipomatosis (Madelung disease) is another condition involving lipomatosis. It nearly always
appears in middle-aged males after many years of alcoholism, although non-alcoholics and females can also be
affected.

References
[1] http:/ / apps. who. int/ classifications/ icd10/ browse/ 2010/ en#/ D17
[2] http:/ / www. icd9data. com/ getICD9Code. ashx?icd9=214
[3] http:/ / www. progenetix. net/ progenetix/ I88500/
[4] http:/ / www. diseasesdatabase. com/ ddb7493. htm
[5] http:/ / www. nlm. nih. gov/ medlineplus/ ency/ article/ 003279. htm
[6] http:/ / www. emedicine. com/ med/ topic2720. htm
[7] http:/ / www. emedicine. com/ derm/ topic242. htm#
[8] http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2013/ MB_cgi?field=uid& term=D008067
[9] Bancroft LW, Kransdorf MJ, Peterson JJ, O'Connor MI (October 2006). "Benign fatty tumors: classification, clinical course, imaging
appearance, and treatment". Skeletal Radiol. 35 (10): 719–33. doi:10.1007/s00256-006-0189-y. PMID 16927086.
[10] 'Obesity Gene' Causes Cancer of Fat Tissue, Schepens Scientists Find (http:/ / www. hms. harvard. edu/ news/ pressreleases/ Schepens/
0400ObesityGene. html) Schepens Eye Research Institute (Harvard Medical School affiliate). April 26, 2000
[11] Lipomas (http:/ / www. emedicine. com/ med/ topic2720. htm#) at eMedicine
[12] James, William D.; Berger, Timothy G.; Elston, Dirk M. (2005). Andrews' Diseases of the Skin: Clinical Dermatology (10th ed.). London:
Elsevier. ISBN 0-7216-2921-0.
[13] James, William D.; Berger, Timothy G.; Elston, Dirk M. (2011). Andrews' Diseases of the Skin: Clinical Dermatology (11th ed.). London:
Elsevier. ISBN 9781437703146.
[14] Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. pp. 1838.
ISBN 1-4160-2999-0.
[15] Wallace D (December 1976). "Lipoma of the corpus callosum". J Neurol Neurosurg Psychiatry. 39 (12): 1179–85.
doi:10.1136/jnnp.39.12.1179. PMC 492562. PMID 1011028.
[16] Salam GA (March 2002). "Lipoma excision" (http:/ / www. aafp. org/ afp/ 20020301/ 901. html). Am Fam Physician 65 (5): 901–4.
PMID 11898962. .
[17] Buisson P, Leclair MD, Jacquemont S, et al. (September 2006). "Cutaneous lipoma in children: 5 cases with Bannayan-Riley-Ruvalcaba
syndrome". J. Pediatr. Surg. 41 (9): 1601–3. doi:10.1016/j.jpedsurg.2006.05.013. PMID 16952599.
[18] Gujrati M, Thomas C, Zelby A, Jensen E, Lee JM (August 1998). "Bannayan-Zonana syndrome: a rare autosomal dominant syndrome with
multiple lipomas and hemangiomas: a case report and review of literature" (http:/ / linkinghub. elsevier. com/ retrieve/ pii/
S0090-3019(98)00039-1). Surg Neurol 50 (2): 164–8. doi:10.1016/S0090-3019(98)00039-1. PMID 9701122. .
[19] Lipoma—topic overview (http:/ / www. webmd. com/ skin-problems-and-treatments/ tc/ lipoma-topic-overview) at webmd.com
[20] Hakim E, Kolander Y, Meller Y, Moses M, Sagi A (August 1994). "Gigantic lipomas". Plast. Reconstr. Surg. 94 (2): 369–71.
doi:10.1097/00006534-199408000-00025. PMID 8041830.
[21] Terzioglu A, Tuncali D, Yuksel A, Bingul F, Aslan G (March 2004). "Giant lipomas: a series of 12 consecutive cases and a giant
liposarcoma of the thigh". Dermatol Surg 30 (3): 463–7. doi:10.1111/j.1524-4725.2004.30022.x. PMID 15008886.
[22] Leffell DJ, Braverman IM (August 1986). "Familial multiple lipomatosis. Report of a case and a review of the literature". J. Am. Acad.
Dermatol. 15 (2 Pt 1): 275–9. doi:10.1016/S0190-9622(86)70166-7. PMID 3745530.
[23] Toy BR (October 2003). "Familial multiple lipomatosis" (http:/ / dermatology. cdlib. org/ 94/ NYU/ Jan2002/ 2. html). Dermatol. Online J.
9 (4): 9. PMID 14594582. .
[24] Arlotta P, Tai AK, Manfioletti G, Clifford C, Jay G, Ono SJ. (May 2000). "Transgenic mice expressing a truncated form of the high mobility
group I-C protein develop adiposity and an abnormally high prevalence of lipomas". J Biol Chem. 275 (19): 14394–400.
doi:10.1074/jbc.M000564200. PMID 10747931.
[25] Signorini M, Campiglio GL (March 1998). "Posttraumatic lipomas: where do they really come from?". Plast. Reconstr. Surg. 101 (3):
699–705. doi:10.1097/00006534-199803000-00017. PMID 9500386.
[26] Aust MC, Spies M, Kall S, Jokuszies A, Gohritz A, Vogt P (2007). "Posttraumatic lipoma: fact or fiction?" (http:/ / www. lejacq. com/
articleDetail. cfm?pid=SKINmed_6;6:266). Skinmed 6 (6): 266–70. doi:10.1111/j.1540-9740.2007.06361.x. PMID 17975353. .
[27] "Lipoma removal surgery" (http:/ / www. reviewmylife. co. uk/ blog/ 2009/ 08/ 03/ lipoma-and-cyst-removal-surgery/ ). . Retrieved
2010-07-26.
Lipoma 5

[28] Dalal KM, Antonescu CR, Singer S (March 2008). "Diagnosis and management of lipomatous tumors". J Surg Oncol 97 (4): 298–313.
doi:10.1002/jso.20975. PMID 18286473.
[29] Al-basti HA, El-Khatib HA (2002). "The use of suction-assisted surgical extraction of moderate and large lipomas: long-term follow-up".
Aesthetic Plast Surg 26 (2): 114–7. doi:10.1007/s00266-002-1492-1. PMID 12016495.
[30] Bechara FG, Sand M, Sand D, et al. (2006). "Lipolysis of lipomas in patients with familial multiple lipomatosis: an
ultrasonography-controlled trial". J Cutan Med Surg 10 (4): 155–9. PMID 17234112.
[31] Thompson WM (1 April 2005). "Imaging and findings of lipomas of the gastrointestinal tract" (http:/ / www. ajronline. org/ cgi/
pmidlookup?view=long& pmid=15788588). AJR Am J Roentgenol 184 (4): 1163–71. PMID 15788588. .
[32] Taylor AJ, Stewart ET, Dodds WJ (1 December 1990). "Gastrointestinal lipomas: a radiologic and pathologic review" (http:/ / www.
ajronline. org/ cgi/ pmidlookup?view=long& pmid=2122666). AJR Am J Roentgenol 155 (6): 1205–10. PMID 2122666. .
[33] Milgram JW (1990). "Malignant transformation in bone lipomas". Skeletal Radiol. 19 (5): 347–52. doi:10.1007/BF00193088.
PMID 2165632.
[34] Lowe BA, Brewer J, Houghton DC, Jacobson E, Pitre T (May 1992). "Malignant transformation of angiomyolipoma". J. Urol. 147 (5):
1356–8. PMID 1569683.
[35] Goldblum, John R.; Weiss, Sharon W.; Enzinger, Franz M. (2008). Enzinger and Weiss's soft tissue tumors (5th ed.). Mosby Elsevier.
ISBN 0-323-04628-2.
[36] Fletcher, C.D.M., Unni, K.K., Mertens, F. (2002). Pathology and Genetics of Tumours of Soft Tissue and Bone. World Health Organization
Classification of Tumours. 4. Lyon: IARC Press. ISBN 92-832-2413-2.
[37] Adipose Tissue Tumors (http:/ / merckvetmanual. com/ mvm/ index. jsp?cfile=htm/ bc/ 72220. htm) The Merck Veterinary Manual, (9th
ed.)
[38] Lipomas (http:/ / www. purinaone. com. au/ Article/ articledetails. aspx?id=753) Veterinary & Aquatic Services Department, Purina
[39] Lipoma (http:/ / education. vetmed. vt. edu/ curriculum/ vm8304/ lab_companion/ histo-path/ introhistopath/ Lab9/ Lesions/ lipoma. htm)
Virginia Polytechnic Institute and State University
[40] Lipomas (Fatty Tumors) (http:/ / vetmedicine. about. com/ cs/ dogdiseasesl/ a/ lipomas. htm) Veterinary Q & A
[41] The Merck Veterinary Manual. Merial. 9th Edition. ISBN 0911910506.
[42] Lipomas (http:/ / www. emedicine. com/ derm/ topic242. htm#) at eMedicine

External links

Images and video

• Illustration (http://pathweb.uchc.edu/eAtlas/Bone/706.htm) from University of Connecticut Health Center
• Esophageal Lipomatosis (http://rad.usuhs.edu/medpix/master.php3?mode=slide_sorter&pt_id=11517&
quiz=#top) MedPix Images from Uniformed Services University of the Health Sciences
• Lipoma images (http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=-1623404710) from DermAtlas
• humpath #2626 (http://www.humpath.com/spip.php?page=article&id_article=2626)
• List of possible treatment options (http://www.lipomaboard.com/treatments-cures-f3/
here-your-lipoma-treatment-options-far-t284.html)
Adipose tissue 6

Adipose tissue
In biology, adipose tissue
(/ˈædɪˌpoʊs/) or body fat or fat depot
or just fat is loose connective tissue
composed of adipocytes. It is
technically composed of roughly only
80% fat; fat in its solitary state exists
Adipose tissue is one of the main types of connective tissue.
in the liver and muscles. Adipose
tissue is derived from lipoblasts. Its
main role is to store energy in the form of lipids, although it also cushions and insulates the body. Far from
hormonally inert, adipose tissue has in recent years been recognized as a major endocrine organ,[1] as it produces
hormones such as leptin, estrogen, resistin, and the cytokine TNFα. Moreover, adipose tissue can affect other organ
systems of the body and may lead to disease. Obesity or being overweight in humans and most animals does not
depend on body weight, but on the amount of body fat—to be specific, adipose tissue. The two types of adipose
tissue are white adipose tissue (WAT) and brown adipose tissue (BAT). The formation of adipose tissue appears to
be controlled in part by the adipose gene. Adipose tissue was first identified by the Swiss naturalist Conrad Gessner
in 1551.[2]

Anatomical features

In humans
In humans, adipose tissue is located beneath the skin (subcutaneous fat), around internal organs (visceral fat), in
bone marrow (yellow bone marrow) and in breast tissue. Adipose tissue is found in specific locations, which are
referred to as adipose depots. Adipose tissue contains several cell types, with the highest percentage of cells being
adipocytes, which contain fat droplets. Other cell types include fibroblasts, macrophages, and endothelial cells.
Adipose tissue contains many small blood vessels. In the integumentary system, which includes the skin, it
accumulates in the deepest level, the subcutaneous layer, providing insulation from heat and cold. Around organs, it
provides protective padding. However, its main function is to be a reserve of lipids, which can be burned to meet the
energy needs of the body and to protect us from excess glucose by storing triglycerides produced by the liver from
sugars, although some evidence suggests that most lipids synthesized from carbohydrates occurs in the adipose tissue
itself.[3] Adipose depots in different parts of the body have different biochemical profiles. Under normal conditions,
it provides feedback for hunger and diet to the brain.
Adipose tissue 7

Mice
Mice have eight major adipose depots, four of which are within the
abdominal cavity. The paired gonadal depots are attached to the uterus
and ovaries in females and the epididymis and testes in males; the
paired retroperitoneal depots are found along the dorsal wall of the
abdomen, surrounding the kidney, and, when massive, extend into the
pelvis. The mesenteric depot forms a glue-like web that supports the
intestines, and the omental depot, which originates near the stomach
and spleen, and, when massive, extends into the ventral abdomen. Both
the mesenteric and omental depots incorporate much lymphoid tissue The obese mouse on the left has large stores of
adipose tissue. For comparison, a mouse with a
as lymph nodes and milky spots, respectively. The two superficial
normal amount of adipose tissue is shown on the
depots are the paired inguinal depots, which are found anterior to the right.
upper segment of the hind limbs (underneath the skin) and the
subscapular depots, paired medial mixtures of brown adipose tissue adjacent to regions of white adipose tissue,
which are found under the skin between the dorsal crests of the scapulae. The layer of brown adipose tissue in this
depot is often covered by a "frosting" of white adipose tissue; sometimes these two types of fat (brown and white)
are hard to distinguish. The inguinal depots enclose the inguinal group of lymph nodes. Minor depots include the
pericardial, which surrounds the heart, and the paired popliteal depots, between the major muscles behind the knees,
each containing one large lymph node.[4] Of all the depots in the mouse, the gonadal depots are the largest and the
most easily dissected,[5] comprising about 30% of dissectible fat.[6]

Obesity
In a severely obese person, excess adipose tissue hanging downward from the abdomen is referred to as a panniculus
(or pannus). A panniculus complicates surgery of the morbidly obese. It may remain as a literal "apron of skin" if a
severely obese person quickly loses large amounts of fat (a common result of gastric bypass surgery). This condition
cannot be effectively corrected through diet and exercise alone, as the panniculus consists of adipocytes and other
supporting cell types shrunken to their minimum volume and diameter. Reconstructive surgery is one method of
treatment.

Abdominal fat
Visceral fat or abdominal fat[7] also known as organ fat or
intra-abdominal fat, is located inside the abdominal cavity, packed
between the organs (stomach, liver, intestines, kidneys, etc.). Visceral
fat is different from subcutaneous fat underneath the skin, and
intramuscular fat interspersed in skeletal muscles. Fat in the lower
body, as in thighs and buttocks, is subcutaneous and is not consistently
spaced tissue, whereas fat in the abdomen is mostly visceral and
semi-fluid.[8] Visceral fat is composed of several adipose depots,
including mesenteric, epididymal white adipose tissue (EWAT), and
perirenal depots. Visceral fat is considered adipose tissue whereas
subcutaneous fat is not considered as such.
Abdominal fat on a teenage male.
An excess of visceral fat is known as central obesity, or "belly fat", in
which the abdomen protrudes excessively. Excess visceral fat is also linked to type 2 diabetes,[9] insulin
resistance,[10] inflammatory diseases,[11] and other obesity-related diseases.[12]
Adipose tissue 8

Female sex hormone causes fat to be stored in the buttocks, thighs, and hips in women.[13][14] Men are more likely to
have fat stored in the belly due to sex hormone differences. When women reach menopause and the estrogen
produced by ovaries declines, fat migrates from their buttocks, hips and thighs to their waists;[15] later fat is stored in
the belly.[16]
High-intensity exercise is one way to effectively reduce total abdominal fat.[17][18] One study suggests at least 10
MET-hours per week of aerobic exercise is required for visceral fat reduction.[19]

Epicardial fat
Epicardial adipose tissue (EAT) is a particular form of visceral fat deposited around the heart and found to be a
metabolically active organ that generates various bioactive molecules, which might significantly affect cardiac
function.[20] Marked component differences have been observed in comparing EAT with subcutaneous fat,
suggesting a depot specific impact of stored fatty acids on adipocyte function and metabolism.[21]

Subcutaneous fat
Most of the remaining nonvisceral fat is found just below the skin in a
region called the hypodermis.[22] This subcutaneous fat is not related to
many of the classic obesity-related pathologies, such as heart disease,
cancer, and stroke, and some evidence even suggests it might be
protective.[23] The typically female (or gynecoid) pattern of body fat
distribution around the hips, thighs, and buttocks, is subcutaneous fat,
and therefore poses less of a health risk compared to visceral fat.[24]

Like all other fat organs, subcutaneous fat is an active part of the
endocrine system, secreting the hormones leptin and resistin.[22]
The relationship between the subcutaneous adipose layer and total
body fat in a person is often modelled by using regression equations. Subcutaneous fat on an overweight teenage boy's
abdomen.
The most popular of these equations was formed by Durnin and
Wormersley, who rigorously tested many types of skinfold, and, as a
result, created two formulae to calculate the body density of both men and women. These equations present an
inverse correlation between skinfolds and body density – as the sum of skinfolds increases, the body density
decreases.[25]

Factors such as sex, age, population size or other variables may make the equations invalid and unusable, and, as of
2012, Durnin and Wormersley's equations remain only estimates of a person's true level of fatness. New formulae
are still being created.[25]

Physiology
Free fatty acids are liberated from lipoproteins by lipoprotein lipase (LPL) and enter the adipocyte, where they are
reassembled into triglycerides by esterifying it onto glycerol. Human fat tissue contains about 87% lipids.
There is a constant flux of FFA(Free Fatty Acids) entering and leaving adipose tissue. The net direction of this flux
is controlled by insulin and leptin - if insulin is elevated there is a net inward flux of FFA and only when insulin is
low can FFA leave adipose tissue. Insulin secretion is stimulated by high blood sugar which results from consuming
carbohydrates.
In humans, lipolysis (hydrolysis of triglycerides into free fatty acids) is controlled through the balanced control of
lipolytic B-adrenergic receptors and a2A-adrenergic receptor-mediated antilipolysis.
Adipose tissue 9

Fat cells have an important physiological role in maintaining triglyceride and free fatty acid levels, as well as
determining insulin resistance. Abdominal fat has a different metabolic profile—being more prone to induce insulin
resistance. This explains to a large degree why central obesity is a marker of impaired glucose tolerance and is an
independent risk factor for cardiovascular disease (even in the absence of diabetes mellitus and hypertension).[26]
Studies of female monkeys at Wake Forest University (2009) discovered individuals suffering from higher stress
have higher levels of visceral fat in their bodies. This suggests a possible cause-and-effect link between the two,
wherein stress promotes the accumulation of visceral fat, which in turn causes hormonal and metabolic changes that
contribute to heart disease and other health problems.[27]
Recent advances in biotechnology have allowed for the harvesting of adult stem cells from adipose tissue, allowing
stimulation of tissue regrowth using a patient's own cells. In addition, adipose-derived stem cells from both human
and animals reportedly can be efficiently reprogrammed into induced pluripotent stem cells without the need for
feeder cells.[28] The use of a patient's own cells reduces the chance of tissue rejection and avoids the ethical issues
associated with the use of human embryonic stem cells.
Adipose tissue is the greatest peripheral source of aromatase in both males and females, contributing to the
production of estradiol.
Adipose derived hormones include:
• Adiponectin
• Resistin
• Plasminogen activator inhibitor-1 (PAI-1)
• TNFα
• IL-6
• Leptin
• Estradiol (E2)
Adipose tissues also secrete a type of cytokines (cell-to-cell signalling proteins) called adipokines (adipocytokines),
which play a role in obesity-associated complications.

Brown fat
A specialised form of adipose tissue in humans, most rodents and small mammals, and some hibernating animals, is
brown fat or brown adipose tissue. It is located mainly around the neck and large blood vessels of the thorax. This
specialised tissue can generate heat by "uncoupling" the respiratory chain of oxidative phosphorylation within
mitochondria. The process of uncoupling means, when protons transit down the electrochemical gradient across the
inner mitochondrial membrane, the energy from this process is released as heat rather than being used to generate
ATP. This thermogenic process may be vital in neonates exposed to cold, which then require this thermogenesis to
keep warm, as they are unable to shiver, or take other actions to keep themselves warm.[29]
Attempts to simulate this process pharmacologically have so far been unsuccessful (even lethal[30][31]). Techniques
to manipulate the differentiation of "brown fat" could become a mechanism for weight loss therapy in the future,
encouraging the growth of tissue with this specialized metabolism without inducing it in other organs.
Until recently, brown adipose tissue was thought to be primarily limited to infants in humans, but new evidence has
now overturned that belief. Metabolically active tissue with temperature responses similar to brown adipose was first
reported in the neck and trunk of some human adults in 2007,[32] and the presence of brown adipose in human adults
was later verified histologically in the same anatomical regions.[33][34][35]
Adipose tissue 10

Genetics
The thrifty gene hypothesis (also called the famine hypothesis) states that in some populations the body would be
more efficient at retaining fat in times of plenty, thereby endowing greater resistance to starvation in times of food
scarcity. This hypothesis has been discredited by physical anthropologists, physiologists, and the original proponent
of the idea himself.[36]
In 1995, Jeffrey Friedman, in his residency at Rockefeller University, discovered the protein leptin that the
genetically obese mouse lacked.[37] Leptin is produced in the white adipose tissue and signals to the hypothalamus.
When leptin levels drop, the body interprets this as loss of energy, and hunger increases. Mice lacking this protein
eat until they are four times their normal size.
Leptin, however, plays a different role in diet-induced obesity in rodents and humans. Because adipocytes produce
leptin, leptin levels are elevated in the obese. However, hunger remains, and, when leptin levels drop due to weight
loss, hunger increases. The drop of leptin is better viewed as a starvation signal than the rise of leptin as a satiety
signal.[38] However, elevated leptin in obesity is known as leptin resistance. The changes that occur in the
hypothalamus to result in leptin resistance in obesity are currently the focus of obesity research.[39]
Gene defects in the leptin gene (ob) are rare in human obesity.[40] As of July, 2010, only 14 individuals from five
families have been identified worldwide who carry a mutated ob gene (one of which was the first ever identified
cause of genetic obesity in humans) - two families of Pakistani origin living in the UK, one family living in Turkey,
one in Egypt, and one in Austria.[41][42][43][44][45] - and two other families have been found that carry a mutated ob
receptor.[46][47] Others have been identified as genetically partially deficient in leptin, and, in these individuals,
leptin levels on the low end of the normal range can predict obesity.[48]
Several mutations of genes involving the melanocortins (used in brain signaling associated with appetite) and their
receptors have also been identified as causing obesity in a larger portion of the population than leptin mutations.[49]
In 2007, researchers isolated the adipose gene, which those researchers hypothesize serves to keep animals lean
during times of plenty. In that study, increased adipose gene activity was associated with slimmer animals.[50]
Although its discoverers dubbed this gene the adipose gene, it is not a gene responsible for creating adipose tissue.

Physical properties
Adipose tissue has a density of ~0.9 g/ml [0.9 kg/L]. Thus, a person with more adipose tissue will float more easily
than a person of the same weight with more muscular tissue, since muscular tissue has a density of 1.06 g/ml
[1.06 kg/L].

Body fat meter

A body fat meter is a widely available tool used to measure the percentage of fat in the human body. Different
meters use various methods to determine the body fat to weight ratio. They tend to under-read body fat
percentage.[51]
In contrast with clinical tools, one relatively inexpensive type of body fat meter uses the principle of bioelectrical
impedance analysis (BIA) to determine an individual's body fat percentage. To achieve this, the meter passes a small,
harmless, electric current through the body and measures the resistance, then uses information on the person's
weight, height, age, and sex, to calculate an approximate value for the person's body fat percentage. The calculation
measures the total volume of water in the body (lean tissue and muscle contain a higher percentage of water than
fat), and estimates the percentage of fat based on this information. The result can fluctuate several percentage points
depending on what one has eaten and how much water one has consumed prior to the analysis.
Adipose tissue 11

Additional images

Diagrammatic sectional view White adipose tissue in paraffin section Electronic instrument of body fat meter
of the skin (magnified).

References
[1] Kershaw EE, Flier JS (2004). "Adipose tissue as an endocrine organ". J. Clin. Endocrinol. Metab. 89 (6): 2548–56.
doi:10.1210/jc.2004-0395. PMID 15181022.
[2] Cannon, B; Nedergaard, J (2008). "Developmental biology: Neither fat nor flesh". Nature 454 (7207): 947–8. doi:10.1038/454947a.
PMID 18719573.
[3] (http:/ / www. ncbi. nlm. nih. gov/ pubmed/ 9174472\),Hepatic and whole-body fat synthesis in humans during carbohydrate overfeeding.
[4] Pond, Caroline M. (1998). The Fats of Life. Cambridge University Press. ISBN 0-521-63577-2.
[5] Cinti, S (July 2005). "The adipose organ". Prostaglandins, leukotrienes, and essential fatty acids (Elsevier Science) 73 (952–3278): 9–15.
doi:10.1016/j.plefa.2005.04.010. PMID 15936182.
[6] Bachmanov, Alexander; D. R. Reed, M. G. Tordoff, R. A. Price (March 2001). "Nutrient preference and diet-induced adiposity in
C57BL/6ByJ and 129P3/J mice". Physiology & Behavior 72 (31–9384): 603–613. doi:10.1016/S0031-9384(01)00412-7. PMC 3341942.
PMID 11282146.
[7] Fat on the Inside: Looking Thin is Not Enough (http:/ / lowfatcooking. about. com/ od/ healthandfitness/ a/ bodyfat. htm), By Fiona Haynes,
About.com
[8] Abdominal fat and what to do about it (https:/ / www. health. harvard. edu/ fhg/ updates/ Abdominal-fat-and-what-to-do-about-it. shtml),
President & Fellows of Harvard College
[9] Montague, CT; O'Rahilly, S (2000). "The perils of portliness: Causes and consequences of visceral adiposity". Diabetes 49 (6): 883–8.
doi:10.2337/diabetes.49.6.883. PMID 10866038.
[10] Kern, PA; Ranganathan, S; Li, C; Wood, L; Ranganathan, G (2001). "Adipose tissue tumor necrosis factor and interleukin-6 expression in
human obesity and insulin resistance". American journal of physiology. Endocrinology and metabolism 280 (5): E745–51. PMID 11287357.
[11] Marette, A (2003). "Molecular mechanisms of inflammation in obesity-linked insulin resistance". International journal of obesity and
related metabolic disorders : journal of the International Association for the Study of Obesity 27 Suppl 3: S46–8. doi:10.1038/sj.ijo.0802500.
PMID 14704744.
[12] Mokdad, AH; Ford, ES; Bowman, BA; Dietz, WH; Vinicor, F; Bales, VS; Marks, JS (2003). "Prevalence of obesity, diabetes, and
obesity-related health risk factors, 2001". JAMA: the Journal of the American Medical Association 289 (1): 76–9. doi:10.1001/jama.289.1.76.
PMID 12503980.
[13] Estrogen causes fat to be stored around the pelvic region, hips, butt and thighs (pelvic region) (http:/ / www. annecollins. com/ obesity/
reduce-abdominal-fat. htm)
[14] Waistline Worries: Turning Apples Back Into Pears (http:/ / www. healthywomen. org/ columns/ drpeekescolumn/ dbcolumn/
waistlineworriesturningapplesbackintopears)
[15] Researchers think that the lack of estrogen at menopause plays a role in driving our fat northward (http:/ / health. yahoo. com/ topic/
nutrition/ overview/ article/ womens-health/ 26287)
[16] Abdominal fat and what to do about it (http:/ / www. health. harvard. edu/ newsweek/ Abdominal-fat-and-what-to-do-about-it. htm)
[17] Irving; Davis, C.; Brock, D.; Weltman, J.; Swift, D.; Barrett, E.; Gaesser, G.; Weltman, A. (2008). "Effect of exercise training intensity on
abdominal visceral fat and body composition". Medicine and science in sports and exercise 40 (11): 1863–1872.
doi:10.1249/MSS.0b013e3181801d40. PMC 2730190. PMID 18845966.
[18] Coker; Williams, R.; Kortebein, P.; Sullivan, D.; Evans, W. (2009). "Influence of Exercise Intensity on Abdominal Fat and Adiponectin in
Elderly Adults". Metabolic syndrome and related disorders 7 (4): 363–368. doi:10.1089/met.2008.0060. PMC 3135883. PMID 19196080.
[19] Ohkawara, K.; Tanaka, S.; Miyachi, M.; Ishikawa-takata, K.; Tabata, I. (2007). "A dose-response relation between aerobic exercise and
visceral fat reduction: systematic review of clinical trials". International journal of obesity (2005) 31 (12): 1786–1797.
doi:10.1038/sj.ijo.0803683. PMID 17637702.
Adipose tissue 12

[20] Mazurek T, Zhang L, Zalewski A, et al. (November 2003). "Human epicardial adipose tissue is a source of inflammatory mediators".
Circulation 108 (20): 2460–6. doi:10.1161/01.CIR.0000099542.57313.C5. PMID 14581396.
[21] Pezeshkian M, Noori M, Najjarpour-Jabbari H, et al. (April 2009). "Fatty acid composition of epicardial and subcutaneous human adipose
tissue". Metab Syndr Relat Disord 7 (2): 125–31. PMID 19422139.
[22] E Marieb and K Hoehn. Anatomy and Physiology, 3rd Edition. Benjamin Cummings 2008. ISBN 0-8053-0094-5
[23] Porter SA, Massaro JM, Hoffmann U, Vasan RS, O'Donnel CJ, Fox CS. Abdominal subcutaneous adipose tissue: a protective fat depot?
Diabetes Care. 2009 Jun;32(6):1068-75. Epub 2009 Feb 24
[24] Mayo Clinic staff. Belly fat in women: How to keep it off. MayoClinic.com. URL http:/ / www. mayoclinic. com/ health/ belly-fat/
WO00128/ METHOD=print. Access date July 2, 2010
[25] Brodie, D.; Moscrip, V.; Hutcheon, R. (1998). "Body Composition Measurement: A Review of Hydrodensitometry, Anthropometry, and
Impedance Methods". Nutrition 14 (3): 296–310. doi:10.1016/S0899-9007(97)00474-7. PMID 9583375.
[26] Dhaliwal SS, Welborn TA. (May 2009) "Central obesity and multivariable cardiovascular risk as assessed by the Framingham prediction
scores" Am J Cardiol. (American Journal of Cardiology) 103(10): pp. 1403-1407
[27] Alice Park (2009-08-08). "Fat-Bellied Monkeys Suggest Why Stress Sucks" (http:/ / www. time. com/ time/ health/ article/
0,8599,1915237,00. html). Time. . Retrieved 2009-08-08.
[28] Sugii, S; Kida, Y; Kawamura, T; Suzuki, J; Vassena, R; Yin, YQ; Lutz, MK; Berggren, WT et al. (2010). "Human and mouse
adipose-derived cells support feeder-independent induction of pluripotent stem cells". Proceedings of the National Academy of Sciences of the
United States of America 107 (8): 3558–63. doi:10.1073/pnas.0910172106. PMC 2840462. PMID 20133714.
[29] Himms-Hagen, J (1990). "Brown adipose tissue thermogenesis: Interdisciplinary studies". FASEB journal : official publication of the
Federation of American Societies for Experimental Biology 4 (11): 2890–8. PMID 2199286.
[30] McFee, RB; Caraccio, TR; McGuigan, MA; Reynolds, SA; Bellanger, P (2004). "Dying to be thin: A dinitrophenol related fatality".
Veterinary and human toxicology 46 (5): 251–4. PMID 15487646.
[31] Miranda, EJ; McIntyre, IM; Parker, DR; Gary, RD; Logan, BK (2006). "Two deaths attributed to the use of 2,4-dinitrophenol". Journal of
analytical toxicology 30 (3): 219–22. PMID 16803658.
[32] Nedergaard, J.; Bengtsson, T.; Cannon, B. (2007). "Unexpected evidence for active brown adipose tissue in adult humans". AJP:
Endocrinology and Metabolism 293 (2): E444. doi:10.1152/ajpendo.00691.2006. PMID 17473055.
[33] Virtanen, KA; Lidell, ME; Orava, J; Heglind, M; Westergren, R; Niemi, T; Taittonen, M; Laine, J et al. (2009). "Functional brown adipose
tissue in healthy adults". The New England Journal of Medicine 360 (15): 1518–25. doi:10.1056/NEJMoa0808949. PMID 19357407.
[34] Van Marken Lichtenbelt, WD; Vanhommerig, JW; Smulders, NM; Drossaerts, JM; Kemerink, GJ; Bouvy, ND; Schrauwen, P; Teule, GJ
(2009). "Cold-activated brown adipose tissue in healthy men". The New England Journal of Medicine 360 (15): 1500–8.
doi:10.1056/NEJMoa0808718. PMID 19357405.
[35] Cypess, AM; Lehman, S; Williams, G; Tal, I; Rodman, D; Goldfine, AB; Kuo, FC; Palmer, EL et al. (2009). "Identification and importance
of brown adipose tissue in adult humans". The New England Journal of Medicine 360 (15): 1509–17. doi:10.1056/NEJMoa0810780.
PMC 2859951. PMID 19357406.
[36] Speakerman, John R. (2007). "Genetics of Obesity: Five Fundamental Problems with the Famine Hypothesis". Adipose Tissue and
Adipokines in Health and Disease.
[37] Pelleymounter, MA; Cullen, MJ; Baker, MB; Hecht, R; Winters, D; Boone, T; Collins, F (1995). "Effects of the obese gene product on body
weight regulation in ob/ob mice". Science 269 (5223): 540–3. doi:10.1126/science.7624776. PMID 7624776.
[38] Smith; Ravussin (2006). "Role of the Adipocyte in Metabolism and Endocrine Function". Endocrinology.
[39] Morris, DL; Rui, L (2009). "Recent advances in understanding leptin signaling and leptin resistance". American journal of physiology.
Endocrinology and metabolism 297 (6): E1247–59. doi:10.1152/ajpendo.00274.2009. PMC 2793049. PMID 19724019.
[40] Carlsson, B; Lindell, K; Gabrielsson, B; Karlsson, C; Bjarnason, R; Westphal, O; Karlsson, U; Sjöström, L et al. (1997). "Obese (ob) gene
defects are rare in human obesity". Obesity research 5 (1): 30–5. PMID 9061713.
[41] Montague CT, Farooqi IS, Whitehead JP, Soos MA, Rau H, Wareham NJ, Sewter CP, Digby JE, Mohammed SN, Hurst JA, Cheetham CH,
Earley AR, Barnett AH, Prins JB, O'Rahilly S. Congenital leptin deficiency is associated with severe early-onset obesity in humans. Nature.
1997 Jun 26;387(6636):903-8.
[42] Strobel A, Issad T, Camoin L, Ozata M, Strosberg AD. A leptin missense mutation associated with hypogonadism and morbid obesity. Nat
Genet. 1998 Mar;18(3):213-5.
[43] Gibson WT, Farooqi IS, Moreau M, DePaoli AM, Lawrence E, O'Rahilly S, Trussell RA. Congenital leptin deficiency due to homozygosity
for the Delta133G mutation: report of another case and evaluation of response to four years of leptin therapy. J Clin Endocrinol Metab. 2004
Oct;89(10):4821-6.
[44] Mazen I, El-Gammal M, Abdel-Hamid M, Amr K. A novel homozygous missense mutation of the leptin gene (N103K) in an obese Egyptian
patient. Mol Genet Metab. 2009 Aug;97(4):305-8. Epub 2009 Apr 9.
[45] Fischer-Posovszky P, von Schnurbein J, Moepps B, Lahr G, Strauss G, Barth TF, Kassubek J, Mühleder H, Möller P, Debatin KM,
Gierschik P, Wabitsch M. A new missense mutation in the leptin gene causes mild obesity and hypogonadism without affecting T cell
responsiveness. J Clin Endocrinol Metab. 2010 Jun;95(6):2836-40. Epub 2010 Apr 9.
[46] Clément K, Vaisse C, Lahlou N, Cabrol S, Pelloux V, Cassuto D, Gourmelen M, Dina C, Chambaz J, Lacorte JM, Basdevant A, Bougnères
P, Lebouc Y, Froguel P, Guy-Grand B. A mutation in the human leptin receptor gene causes obesity and pituitary dysfunction. Nature. 1998
Mar 26;392(6674):398-401.
Adipose tissue 13

[47] Pankov YA. Adipose tissue as an endocrine organ regulating growth, puberty, and other physiological functions. Biochemistry (Mosc). 1999
Jun;64(6):601-9.
[48] Farooqi IS, Keogh JM, Kamath S, Jones S, Gibson WT, Trussell R, Jebb SA, Lip GY, O'Rahilly S. Partial leptin deficiency and human
adiposity. Nature. 2001 Nov 1;414(6859):34-5.
[49] Farooqi IS, O'Rahilly S. Mutations in ligands and receptors of the leptin-melanocortin pathway that lead to obesity. Nat Clin Pract
Endocrinol Metab. 2008 Oct;4(10):569-77. Epub 2008 Sep 9.
[50] Suh, JM; Zeve, D; McKay, R; Seo, J; Salo, Z; Li, R; Wang, M; Graff, JM (2007). "Adipose is a conserved dosage-sensitive antiobesity
gene". Cell metabolism 6 (3): 195–207. doi:10.1016/j.cmet.2007.08.001. PMC 2587167. PMID 17767906.
[51] "Body fat scales review and compare" (http:/ / www. choice. com. au/ Reviews-and-Tests/ Food-and-Health/ Diet-and-exercise/
Weight-loss/ Body-fat-scales-review-and-compare. aspx). 10 January 2010. Archived (http:/ / web. archive. org/ web/ 20100117183041/ http:/
/ www. choice. com. au/ Reviews-and-Tests/ Food-and-Health/ Diet-and-exercise/ Weight-loss/ Body-fat-scales-review-and-compare. aspx)
from the original on 17 January 2010. . Retrieved 11 January 2010.

Further reading
• MeSH A10.165.114 (http://www.nlm.nih.gov/cgi/mesh/2012/MB_cgi?mode=&term={{{2}}}&
field=entry#TreeA10.165.114)
• Stock, M. J.; Cinti, S. (2003). "ADIPOSE TISSUE". Encyclopedia of Food Sciences and Nutrition. pp. 29.
doi:10.1016/B0-12-227055-X/00008-0. ISBN 9780122270550.
• Vernon, R. G.; Flint, D. J. (2003). "ADIPOSE TISSUE". Encyclopedia of Food Sciences and Nutrition. pp. 23.
doi:10.1016/B0-12-227055-X/00007-9. ISBN 9780122270550.
Liposarcoma 14

Liposarcoma
Liposarcoma
Classification and external resources

Micrograph of myxoid liposarcoma. H&E stain.

ICD-O: [1]
M8850/3

DiseasesDB [2]
31482

eMedicine [3]
derm/856

MeSH [4]
D008080

Liposarcoma is a malignant tumor[5] that arises in fat cells in deep soft tissue, such as that inside the thigh or in the
retroperitoneum.
They are typically large bulky tumors which tend to have multiple smaller satellites extending beyond the main
confines of the tumor.
Liposarcomas, like all sarcomas, are rare.[6]

Symptoms
Patients usually note a deep seated mass in their soft tissue. Only when
the tumor is very large do symptoms of pain or functional disturbances
occur.
Retroperitoneal tumors may present themselves with signs of weight
loss and emaciation and abdominal pain. These tumors may also
compress the kidney or ureter leading to kidney failure.

Photo of left leg edema caused by underlying

liposarcoma
Liposarcoma 15

Diagnosis
The diagnosis is established by histologic examination of the tissue, i.e.
biopsy or excisional biopsy. Lipoblasts are often present; these are
cells with an abundant clear multi-vacuolated cytoplasm and an
eccentric darkly staining nucleus that is indented by the vacuoles.

Subtypes
Several subtypes of liposarcoma exist: CT image showing a lesion that proved to be a
• Well-differentiated liposarcoma, synonymous with atypical liposarcoma.

lipomatous tumor; the former term is used almost exclusively for

lesions in the retroperitoneum, while the latter is used for lesions
arising elsewhere.
• Dedifferentiated liposarcoma, which consists of well-differentiated
liposarcoma adjacent to a more poorly differentiated tumor.
• Myxoid/round cell liposarcoma.
• Pleomorphic liposarcoma.

Incidence and prevalence

Most frequent in middle-aged and older adults (age 40 and above), Micrograph of a myxoid liposarcoma. H&E stain.
liposarcomas are the second most common of all soft-tissue sarcomas
following malignant fibrous histiocytomas. Annually 2.5 cases occur
per million population.

Prognosis
The prognosis varies depending on the site of origin, the type of cancer
cell, the tumor size, the depth, and proximity to lymph nodes.
Well-differentiated liposarcomas treated with surgery and radiation
have a low recurrence rate (about 10%) and rarely metastasize.[7]
Micrograph of a dedifferentiated liposarcoma. A
Five-year survival rates vary from 100% to 39% based on histological dedifferentiated liposarcoma has a poorly
subtype.[7] differentiated component, that is not identifiable
as a liposarcoma (left edge of image), and a
differentiated component with lipoblasts and
References increased vascularity (right of image).
Morphologically benign adipose tissue (center of
[1] http:/ / www. progenetix. net/ progenetix/ I88503/
image) has few blood vessels. H&E stain.
[2] http:/ / www. diseasesdatabase. com/ ddb31482. htm
[3] http:/ / www. emedicine. com/ derm/ topic856. htm
[4] http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2013/ MB_cgi?field=uid& term=D008080
[5] Dei Tos AP (August 2000). "Liposarcoma: new entities and evolving concepts" (http:/ / linkinghub. elsevier. com/ retrieve/ pii/
S1092-9134(00)74153-0). Ann Diagn Pathol 4 (4): 252–66. doi:10.1053/adpa.2000.8133. PMID 10982304. .
[6] Goldstein-Rice, E (2008). "The Importance of Treatment at a Specialty Center for Sarcomas" (http:/ / sarcomahelp. org/ learning_center/
articles/ sarcoma_centers. html). ESUN. .
[7] Gebhardt, M and Buecker, PJ (2004). "Liposarcoma" (http:/ / sarcomahelp. org/ liposarcoma. html). ESUN. .

External links
• humpath #2495 (http://www.humpath.com/spip.php?page=article&id_article=2495) (Pathology images)
Liposarcoma 16

• Information (http://www.thedoctorsdoctor.com/diseases/liposarcoma.htm) from The Doctor's Doctor website

• Liposarcoma (http://sarcomahelp.org/liposarcoma.html?tpm=1_2) by Dr. Gebhardt and Dr. Buecker
Article Sources and Contributors 17

Article Sources and Contributors

Lipoma  Source: http://en.wikipedia.org/w/index.php?oldid=531143787  Contributors: *Kat*, Aamargulies, Abilash.m, Anthonyhcole, Arcadian, Ashley4455, Auntof6, Barek, Berkay0652,
Bloq, Bryan Derksen, Capricorn42, CardinalDan, CarlFeynman, Cattywampus, Chrisfallacaro, CliffC, Crywalt, Dangih, Darvizo, David from Downunder, David spector, Drubarth, Evanh2008,
Facts707, Fredsmith2, FreshPineSent, Graham87, HiEv, Horkana, Hu12, IShadowed, Immunize, Indon, Invertzoo, J.delanoy, Jamoaddi, Jen 111 Smith, Jfdwolff, Jim1138, Jmh649, Joyous!,
Karthik.yerramilly, Kauczuk, Kenyon, Kjkolb, Kosebamse, Kristine zaballos, Kyng, Legion fi, Leuko, Lipomadr, Mannerssarah, Mark.m.lacey@acm.org, Marshall, Mattopaedia, Mindmatrix,
Miseduc8ed, MrOllie, My Core Competency is Competency, NCurse, Neo-Jay, Netha Hussain, Neurospace, Okiefromokla, PamalaLauren, Patho, Peter.C, Prof. Squirrel, RDBrown, RedWolf,
Rich Farmbrough, Rjwilmsi, Rod57, RogueNinja, Rollo44, Ruy Pugliesi, Sceptre, Search4Lancer, Siqbal, Sun Creator, Talkhence, Tb303romance, TedBaker88, TimVickers, Unused0026,
Veinor, Venmathi, Waggers, WhatamIdoing, Wikipelli, Wouterstomp, Åkebråke, 163 ,55‫ דוד‬anonymous edits

Adipose tissue  Source: http://en.wikipedia.org/w/index.php?oldid=531667108  Contributors: 12345wat, 21655, A Thousand Doors, AThing, Achilles.g, Afromcbenny, Aiken drum, Aitias,
Alex.tan, AllGloryToTheHypnotoad, Alteripse, Althepal, American Eagle, Andonic, Andrew Nutter, Andromedabluesphere440, Apparition11, Appraiser, Arcadian, Aspen04, Avenged Eightfold,
Aviados, Bdve, Bejnar, Bencherlite, Bevo74, Bmecoli, Bobbyedwards9960, BorisVM, Buftchrstn, Bullenwächter, CHW100, Caltas, Centrx, Chartreuse green, ChemGardener, Chibi.akutenshi,
Chris Capoccia, Chrislk02, Clarince63, Cobalt387, Cometstyles, CoolKoon, Courcelles, CredoFromStart, D.c.camero, DINORAWR444, Dah31, Dan Wylie-Sears 2, Danireed, Dash2102,
Dcirovic, Dcs002, DeadEyeArrow, Deb, Deflective, DerHexer, Derumi, Devilanna, Dgw, Diberri, Diderot, Dills122, Dirkbb, Dlabtot, DlronW, Dogcow, Dooders1990, Download, Dr.khan,
DrSculerati, Drphilharmonic, Drxenocide, EagerToddler39, Ekwity, Eras-mus, Erich gasboy, Ericjs, Esperant, Ewlyahoocom, FF2010, Farosdaughter, Favonian, Florentino floro, Fluffernutter,
Frans Fowler, Fæ, Gene Nygaard, Gigemag76, Gillean666, Gioto, Girlwithgreeneyes, Goesgolf20, Gogo Dodo, Grabbuel, Greensburger, Gregorius Pilosus, Gurch, Gymnastjew, Hadal, Hahbie,
Hankwang, Hede2000, Holme053, Hotcrocodile, Hydrogen Iodide, II MusLiM HyBRiD II, Idontlikeu123, Immunize, Ivenger, J.delanoy, JSpung, Jack007, JackWasey, Jackdrew123, Jag123,
Jahiegel, Janeel j-man, Jeff G., Jennes83, Jfdwolff, Jiekuo, Jmabel, Jmh649, JustAGal, Jwikij, KCtheIron, Kalaiarasy, Kalambaki2, Karandas, Kauczuk, KettyJohnson, Kimiko, Klmd7, Knuckles,
Kriis, Kukini, Lenschulwitz, Lijealso, Lincher, Lindsay.Wu, LindsayH, Liquidluck, Lir, LittleHow, LivingByNumbers, Lmbd uk, Loadmaster, Lucidity, Madhero88, Madmedea, Maqsarian,
Marek69, Mark Arsten, Mark J Fowler, MarkRose, Markthemenace, Martarius, Martin451, Martinp23, Marysunshine, Maxiboi96, Maximus Rex, Mdabio, Mee Merone, Meewam, Mikael
Häggström, Mlf107, Motley Crue Rocks, Mr. Quickling, N5iln, Nalkoff, Nathan Johnson, Nburden, Neddyseagoon, Ninly, Nmg20, Nokmar, Nono64, NotWith, Nutriveg, OctoMocto,
Ohnoitsjamie, Ohyahgiveittome, Openseasonflierhole, Osnimf, Oxymoron83, Paddles, ParalysedBeaver, Peter Znamenskiy, Petr-heger, Pfranson, Phoebe, Phynicen, Pinethicket, Pol098, Postdlf,
Pperos, Prashanthns, Prolog, Pwqn, Radagast83, Raven4x4x, RedWolf, Renato Caniatti, Reuben, Rezecib, Rich Farmbrough, Rick the shiba, Rjgibb, Rjwilmsi, Roxychik43, Rracecarr, Ruineye,
Salsadouche, SchnitzelMannGreek, SchuminWeb, ScottMHoward, Settersr, Sfan00 IMG, Shadowtube567, Shanered06, Sharkford, Sheitan, Skunkboy74, SkyWalker, Smjg, Snowolf, Solar
Powered Sheep, Speedyboy, Squarehead94, SteinAlive, Sterlingjones, Stevertigo, Superbb, Sylwia Ufnalska, THEN WHO WAS PHONE?, TakuyaMurata, Tarotcards, Taurrandir, Template
namespace initialisation script, The Ronin, The Thing That Should Not Be, The Transhumanist, The cattr, The undertow, TheClassic, Thehelpfulone, Thesis4Eva, Thingg, Tiagofandrade,
TicketMan, Tide rolls, Timl2k4, Timo Honkasalo, Tracer9999, Track100, Trevinci, True Pagan Warrior, Ulric1313, Uncle Dick, Unschool, Vanessadannenberg, Versageek, Vivio Testarossa,
Vmenkov, W4chris, WWCND, WazzaMan, Whoahwhoahemily, Wikiwow, Wildswimmer Pete, William Avery, Wombat888, Woohookitty, Zargulon, Zodon, Zoicon5, Zygfield, 408 ,‫ברוקולי‬
anonymous edits

Liposarcoma  Source: http://en.wikipedia.org/w/index.php?oldid=516320276  Contributors: Altenmann, Anupam, Arcadian, Brim, Dl2000, Emma20001, Graham87, Hu12, Ian Hagemann,
Immunize, Kjkolb, Mindmatrix, Mtg300nyc, My Core Competency is Competency, NCurse, Nephron, Nlu, Patho, Pearle, Ph.eyes, Piano non troppo, RJFJR, Rbanzai, Riedl, Rudolf.hellmuth,
Snarius, Student7, Unklekrappy, WhatamIdoing, 27 anonymous edits
Image Sources, Licenses and Contributors 18

Image Sources, Licenses and Contributors

File:Lipoma 02.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Lipoma_02.jpg  License: Creative Commons Attribution 3.0  Contributors: Sikander Iqbal
File:Lipoma(1).JPG  Source: http://en.wikipedia.org/w/index.php?title=File:Lipoma(1).JPG  License: Creative Commons Attribution-Sharealike 3.0  Contributors: User:Netha Hussain
Image:Lipoma.JPG  Source: http://en.wikipedia.org/w/index.php?title=File:Lipoma.JPG  License: Public Domain  Contributors: Ashley4455
Image:Lipoma 05.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Lipoma_05.jpg  License: Creative Commons Attribution-Sharealike 2.0  Contributors: Sebastian E Valbuena, Greg
A O'Toole and Eric Roulot
Image:Lipoma 03.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Lipoma_03.jpg  License: Creative Commons Attribution 2.0  Contributors: Sebastian E Valbuena, Greg A O'Toole
and Eric Roulot
Image:Lipoma 04.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Lipoma_04.jpg  License: Creative Commons Attribution 2.0  Contributors: Sebastian E Valbuena, Greg A O'Toole
and Eric Roulot
Image:Lipoma 06.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Lipoma_06.jpg  License: Creative Commons Attribution 2.0  Contributors: Sebastian E Valbuena, Greg A O'Toole
and Eric Roulot
Image:Illu connective tissues 1.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Illu_connective_tissues_1.jpg  License: Public Domain  Contributors: Arcadian, Barbaking,
MrBlueSky, 2 anonymous edits
File:Fatmouse.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Fatmouse.jpg  License: Public Domain  Contributors: Original uploader was Bigplankton at en.wikipedia Later
versions were uploaded by Sunholm at en.wikipedia.
File:Overweight teenage male.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Overweight_teenage_male.jpg  License: Public Domain  Contributors: OctoMocto
File:Excess abdominal fat.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Excess_abdominal_fat.jpg  License: Public Domain  Contributors: OctoMocto
Image:Gray940.png  Source: http://en.wikipedia.org/w/index.php?title=File:Gray940.png  License: Public Domain  Contributors: Arcadian, Magnus Manske, Origamiemensch
Image:Yellow adipose tissue in paraffin section - lipids washed out.jpg  Source:
http://en.wikipedia.org/w/index.php?title=File:Yellow_adipose_tissue_in_paraffin_section_-_lipids_washed_out.jpg  License: GNU Free Documentation License  Contributors: Jacklee, Reytan
Image:Body Fat meter.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Body_Fat_meter.jpg  License: Creative Commons Attribution-ShareAlike 3.0 Unported  Contributors: 日 陰
猫Joga
File:Myxoid liposarcoma (06).JPG  Source: http://en.wikipedia.org/w/index.php?title=File:Myxoid_liposarcoma_(06).JPG  License: Creative Commons Attribution-ShareAlike 3.0 Unported
 Contributors: Alex brollo, KGH
Image:edemaliposarcoma.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Edemaliposarcoma.jpg  License: Creative Commons Zero  Contributors: Unklekrappy
Image:Liposarcoma_02.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Liposarcoma_02.jpg  License: Creative Commons Attribution-Sharealike 2.0  Contributors: Panoraia
Paraskeva, Paraskevas Katsaronis, Eleftherios D Spartalis, Andreas C Lazaris, Hara Gakiopoulou, Panagiotis Mallis and Periklis Tomos
Image:Myxoid liposarcoma (01).jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Myxoid_liposarcoma_(01).jpg  License: Creative Commons Attribution-ShareAlike 3.0 Unported
 Contributors: Alex brollo, KGH
Image:Dedifferentiated_liposarcoma_-_intermed_mag.jpg  Source: http://en.wikipedia.org/w/index.php?title=File:Dedifferentiated_liposarcoma_-_intermed_mag.jpg  License: Creative
Commons Attribution-Sharealike 3.0  Contributors: Nephron
License 19

License
Creative Commons Attribution-Share Alike 3.0 Unported
//creativecommons.org/licenses/by-sa/3.0/