lipomas are benign , encapsulated tumours of mesenchymal origin , arising from the adipose tissue .
superficial , simple lipomas can grow for many years without causing any functional problems , and they rarely reach very large dimensions .
the surgical excision of giant occipitocervical lipomas is necessary for aesthetic concerns , pain and limitation of neck motion , especially in the recumbent position .
a 52-year - old male patient was admitted to our clinic due to swelling at the back of his head .
the history revealed that the swelling had been present for 10 years ; it had grown gradually from the size of a small hazelnut . during the patient 's general physical examination , a large , mobile mass of 10  10 cm was found , localized in the left occipitocervical region .
the patient magnetic resonance imaging ( mri ) revealed a mass of 10  10 cm in the left occipitocervical region that had adhered to the adjacent bone structure , causing a thickening of the scalp ; however , there was no bone defect or destruction .
the patient was operated on , and the subcutaneous mass was totally excised [ figure 1 ] . during the pathological examination the excised soft tissue mass was classified as a lipoma .
( a ) axial and ( b ) sagittal t2-weighted mr imaging shows the large lipoma ; ( c ) the lipoma in the occipitocervical region ; ( d ) the resected lipoma ; ( e ) picture of the completely resected lipoma a 56-year - old male patient was admitted to our clinic due to a swelling at the back of the head .
the physical examination revealed a giant , painful mass covering the entire left occipital region .
an mri showed a 11  10 cm mass , with a smooth , lobulated contour , and subcutaneous localization in the occipital region extending halfway down the neck , hyperintense on the t1-t2-weighted sequences with a thin septal contrast enhancement after contrast administration , which was adherent to the surrounding muscle tissue and bone .
the pathological examination of the mass revealed a tumour covered with a thin , fibrous , connective tissue capsule that consisted of thin vascular structures formed by mature adipocytes of large vacuolated cytoplasm .
( a ) axial and ( b ) sagittal t2-weighted mr imaging shows the giant lipoma ; ( c ) the lipoma in the occipital region ; ( d ) the capsule of the lipoma after skin incision ; ( e ) the resected lipoma peeled off from the surrounding tissue and removed together with the capsule ; ( f ) picture of the completely resected lipoma after anaesthesia and intubation , the patient was placed in a prone position . following this ,
the capsule of the mass was reached via an elliptical skin incision about half the size of the mass . with careful dissection of the subcutaneous tissues surrounding the capsule ,
the skin was primarily closed . to prevent the accumulation of blood in the potential space and enhance early adhesion ,
a 52-year - old male patient was admitted to our clinic due to swelling at the back of his head .
the history revealed that the swelling had been present for 10 years ; it had grown gradually from the size of a small hazelnut . during the patient 's general physical examination , a large , mobile mass of 10  10 cm was found , localized in the left occipitocervical region .
the patient magnetic resonance imaging ( mri ) revealed a mass of 10  10 cm in the left occipitocervical region that had adhered to the adjacent bone structure , causing a thickening of the scalp ; however , there was no bone defect or destruction .
the patient was operated on , and the subcutaneous mass was totally excised [ figure 1 ] . during the pathological examination the excised soft tissue mass was classified as a lipoma .
( a ) axial and ( b ) sagittal t2-weighted mr imaging shows the large lipoma ; ( c ) the lipoma in the occipitocervical region ; ( d ) the resected lipoma ; ( e ) picture of the completely resected lipoma
a 56-year - old male patient was admitted to our clinic due to a swelling at the back of the head .
the physical examination revealed a giant , painful mass covering the entire left occipital region .
an mri showed a 11  10 cm mass , with a smooth , lobulated contour , and subcutaneous localization in the occipital region extending halfway down the neck , hyperintense on the t1-t2-weighted sequences with a thin septal contrast enhancement after contrast administration , which was adherent to the surrounding muscle tissue and bone .
the pathological examination of the mass revealed a tumour covered with a thin , fibrous , connective tissue capsule that consisted of thin vascular structures formed by mature adipocytes of large vacuolated cytoplasm .
( a ) axial and ( b ) sagittal t2-weighted mr imaging shows the giant lipoma ; ( c ) the lipoma in the occipital region ; ( d ) the capsule of the lipoma after skin incision ; ( e ) the resected lipoma peeled off from the surrounding tissue and removed together with the capsule ; ( f ) picture of the completely resected lipoma
after anaesthesia and intubation , the patient was placed in a prone position . following this ,
the capsule of the mass was reached via an elliptical skin incision about half the size of the mass . with careful dissection of the subcutaneous tissues surrounding the capsule ,
the skin was primarily closed . to prevent the accumulation of blood in the potential space and enhance early adhesion ,
lipoma is a benign tumour of mesenchymal origin that is rarely seen in the head and neck region .
although the recurrence rate is not high , resection may be difficult due to the large size and adherence to the surrounding tissues . especially in our second case ,
resection was difficult due to the hard capsule , which was adherent to the occipital bone .
lipomas are usually asymptomatic , but they can cause pain when they are large and press on the nerves .
the two patients in our study were admitted to the hospital due to pain and cosmetic concerns .
lipomas tend to locate in the trunk , shoulders , posterior neck , and axilla .
approximately 80% are in the form of a single lesion , and they are generally seen in women . on the other hand ,
in addition to a physical examination , radiological assessment is necessary for the evaluation of the nature of the lipoma and surgical planning .
connection with the surrounding tissues and bone can be evaluated by computed tomography ( ct ) and magnetic resonance imaging ( mri ) . in the case of suspicious
certain positions of the body and/or some daily physical activities may be restricted due to the size of the tumour .
lipomas that are large , painful , and cause cosmetic problems should be operated on following good preoperative planning .
 lipomas are capsulated benign tumours that are commonly found in all body parts . 
 a lipoma is a well - defined mesenchymal tumour that arises from the adipose tissue . 
 although giant lipomas are rare in the head and neck regions , when they are located here , they are most commonly found in the subcutaneous posterior neck area . 
 recurrence as well as invasion is very rare after total surgical excision . in this article 
 , we present two rare cases of giant lipomas in the posterior occipitocervical region , which is an exceptional location . 
INTRODUCTION
CASE REPORTS
Case 1
Case 2
Surgery
DISCUSSION