BACKGROUND: A subcutaneous lipoma is a benign tumor comprised of mature adipocytes. Clinically it presents as a soft, freely moveable, doughy mass that is typically painless and slow growing. Lipomas containing fat necrosis and corresponding palpable nodular elements are rare and suggest an alternative diagnosis. Lipomas in the vulvar region are rare and giant vulvar lipomas with palpable fat necrosis are unreported.

CASE REPORT: A 25-year-old patient presented with a 4-year history of an enlarging right vulvar mass with multiple small (<1 cm) firm nodules within the tumor. A pelvic MRI (magnetic resonance imaging) did not visualize the nodules but histopathologic examination revealed a benign lipoma containing fat necrosis and discrete areas of calcium deposition.

CONCLUSIONS: Fat necrosis can occur in vulvar lipomas and present with intratumor nodularity. MRI imaging, clinical findings and histology may be discordant.

Keywords: Fat Necrosis, Lipoma, Vulvar Diseases, Diagnosis, Differential, Magnetic Resonance Imaging