A case of intermuscular lipoma located between the external abdominal oblique and internal abdominal oblique muscles in a fourteen- year -old dog is described. Presenting signs, radiographic findings, surgical treatments and the follow-up treatment are discussed

Abdul Rahman, Sheikh Omar

Ching, T. S.

Hii, K. L.

Thilagar, S.

Toe, I

Universiti Putra Malaysia Institutional Repository

J. ~t. Malaysia (2005) 17(2): 25 - 27BENIGN INTERMUSCULAR LIPOMA IN A BITCHS.ThiIagarl, I.Toel, K.L HiP, A.R. Sheikh Omar! and T.S.ChinglJFaculty of Veterinary Medicine, Universiti Putra Malaysia,43400 UPM Serdang Selangor, Malaysia.2Private Practice, Johor BaruSUMMARYA case of intermuscular lipoma located between the external abdominal oblique and internal abdominal obliquemuscles in a fourteen- year -old dog is described. Presenting signs, radiographic findings, surgical treatments and thefollow-up treatment are discussed.Keywords: Benign, lipoma, intermuscular, bitchINTRODUCTIONTumors arising from adipose tissues are classified as ei-ther benign (Lipoma, Angiolipoma) or malignant (Liposa-rcoma). Lipoma is a common benign tumor of well-dif-ferentiated adipocytes seen in most domestic animalsparticularly common in the dog (Aiello, 1998). Predomi-nantly subcutaneous, they occur most commonly in thetrunk, gluteal region and proximal limbs (Goldschmidtand Hendrick, 2002). They generally grow slowly andare well circumscribed (Ogilvie and Moore ,1995). Th-ompson et. al. (1999) reported cases of intermuscularlipoma in the thigh region in dogs. This report describesa case of intermuscular lipoma located between the ab-dominal muscles in a dog.CASE HISTORYA 14-year-old spayed female Spitz, weighing 14 kg waspresented to the University Veterinary Hospital, UniversitiPutra Malaysia with a history of a slow growing massat the left side of the cranial lower abdominal region,observed over one year.PHYSICAL EXAMINATION FINIDNGS:Upon physical examination, temperature, pulse and res-piratory rate of the dog were found to be within normalrange. Vaccination and deworming status were up-to-date.The dog was in good body condition. A large size(15x20cm), non-painful, finn mass was located at theleft lower lateral abdominal wall. It was sessile, soft onpalpation and no free movement of skin over the masscould be observed as in subcutaneous lipoma cases, butan abnormal swelling was noticed from the overlyingmuscle. Palpation of the mass did not reveal any definiteinformation with regard to its exact anatomical location.The differential diagnosis at that point was space occu-pying lesion, possibly neoplasm, could be benignlma-lignant such as lipoma, fibrolipoma, angiolipoma andmast cell tumor.DIAGNOSIS:A lateral radiographic view of the abdomen revealed thepresence of a soft tissue mass at the left lower lateralabdominal wall extending from the 11 th rib to caudalabdomen, (Figure O. The ventro-dorsal radiographicview of the abdomen showed a clear and well demar-cated opaque mass in the same region but its exact loca-tion could not be clearly identified. No significant changeswere observed from the hematological examination.Complete blood cell count and blood chemistry werenormal.SURGICAL PROCEDURE:Exploratory surgery was performed on the next day. Thedog was premedicated with atropine sulphate*(0.05mg!kg. sIc) and acepromazine*(O.lmg/kg, s/c)and inducedwith 2.5% solution of thiopentone sodium* (12.5 mg!kg,) intravenously. This was maintained with 2 %Halothane*(*Troy laboratories PTY) and oxygen (0.9 Uminute) delivered via a T-piece circuit using a cuffed 8.5endotracheal tube. The dog was positioned in dorsalrecumbency and a cranial mid ventral4 cm skin incisionwas made lcm caudal to the xyphoid process. A furtherincision was made on the linea alba. Upon examinationof the abdominal cavity, the transverse abdominusand the peritoneum were intact. The midline ventrallaparotomy muscle and subcutaneous tissue was closedimmediately by using 2-0 vicryl (Johnson&Johnson Intl)and 2-0 ethilon (Johnson & Johnson Intl) for skin.The dog was repositioned on right lateral recum-bency and a 12 cm cranio-caudal skin incision was madeover the mass on the left lateral abdominal wall. Thisexposed the external abdominal oblique. The musclewas bulgy. An incision was made on the muscle. A soft,26 S.Thilagar, I.Toe, K.L.Hii, A.R.Sheikh Omar and T.S.ChingFig.l. Lateral radiograph of the thorax and cranial abdomen showing dense mass caudal to rib cage (arrow)Fig.2. Incison on the external abdominal oblique muscle showing soft lobulated mass (Lipoma) white in colourFig.3. Mass showing its attachments to the 12th rib and adjoining fascia and underlying internalabdominal oblique muscleBENIGN INTERMUSCULAR LIPOMA IN A BITCHwhite, mass (14x 8 cm) was located between the exter-nal and internal abdominal oblique muscle (Figure 2).No attachments of the mass with underlying muscle wasobserved. However, the mass was loosely attached withthe parietal surface of the 12 th rib and available subcuta-neous fascia near to the rib. (Fig ure 3). The mass wasslowly excised and removed from its location and sepa-rated from the underlying tissues. There was no erosionof the rib and invasion was observed either on the pari-etal surface of the rib or into the abdominal muscle layer.The external abdominal oblique was closed routinelyusing 2-0 vicryl® (Johnson & Johnson Inti) and the skinwas closed using 2-0 ethilon (Johnson & Johnson Inti).Amoxicillin-LA (Norbrook Lab. Ltd) was given subcu-taneously as post-operative antibiotics at a dose rate of20mglkg body weight and continued per os another 5days. Intravenous fluid therapy with 850 ml of 0.9%sodium chloride (Braun Melsungen , AG) was infused 1tablet (bid) of Campain (Camden industries (M) Sdn.Bhd) for 5 days and administered per os from the secondpost operative day anti inflammatory medications.Histopathological examination revealed typical fattyadipose tissue with no evidence of inflammatory reac-tion. The cells were round to polygonal without muchstroma thus confirmed the mass as a lipoma. The doghad an uneventful recovery by the 5th postoperative day.There was no reoccurrence and or further growth duringthe 6-month post operative follow-up of the dog.DISCUSSIONFree movement of the skin over the subcutaneous lipoma(Moulton, 1990) was not observed in this case, as themass was located between the abdominal muscles. In-ter-muscular lipoma that arises between muscles givesan impression of a muscle swelling with a large firm fluc-tuant mass and enlarged by expansion (Thompson et al.,1999). No involvement of invasion into the adjacentmuscle or fascia could be seen either histologically ormorphologically in this case, which is similar to the find-ings of previous reports. Generally, all types of lipomas(Lipoma, Angiolipoma) occur in adult dogs and the inci-dence increases with age. It is more common in obesefemale animals than in males (Moulton, 1990; Thomp-27son et al., 1999).1t is true of this case. Thompson et al.,(1999) described cases of lipoma located between thesemitendinosus and semimembranosus muscles of thighregion, whereas in this case the lipoma was located be-tween the abdominal muscles. No reoccurrence of growthwas noticed during follow-up. Surgical excision offersgood prognosis and is curative for lipomas (Ogilvie andMoore, 1995; Thompson et al., 1999). Lipoma usuallyoriginates from the adipocytes of subcutaneous tissue,fascia and occasionally from the periosteum. In this case,attachment was seen at the cranial border of the masswith parietal surface of the 12 th rib and its surroundingfascia, giving a new view with regard to location of in-termuscular lipoma in dogs. It is top be noted that loca-tion of intermuscular lipoma at the anterior abdominalwall has been recorded in human patients (Fletcher andMartin-Bates, 1988).REFERENCESAiello, S.E. (1998). Merck Veterinary Manual. Merck& Co. Inc., pp. Whitehouse Station, New Jersey :702-770.Fletcher,C.D., Martin-Bates, E. (1988). Intramuscularand intermuscular lipoma: neglected diagnosis. His-topathology 12(3):275-281.Goldschmidt, M.H and Hendrick, M.J. (2002). Tumorsof the skin and soft tissues in tumors in domesticanimals, Meuten, D.J. (Ed.). 14th ed. Iowa StatePress, Iowa. pp. 96-97.Moulton, J.E. (1990). Tumors in Domestic Animals. 3'"ed. Berkeley: University of California, pp. 31-33.Ogilvie, GK. and Moore, A.S. (1995). Managing theveterinary cancer patient. In: Vet Learning systems,Trenton, New Jersey., pp. 486-487.Thompson, MJ., Withrow, S.J., Dernell, W.S.and Pow-ers, B.E. (1999). Intermuscular lipoma of the thighregion in dogs in 11 cases. J. Amer. Vet. Hosp. Asso-ciation 35:165-167.

Benign intermuscular lipoma in a bitch

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Benign intermuscular lipoma in a bitch

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