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Suspected liposarcoma of the hip by magnetic resonance imaging 3 years after large-volume fat grafting for buttock augmentation.

This is the case of an otherwise healthy 30-year-old woman who presented to the office with a presumed diagnosis of liposarcoma in the superior gluteal area near the left hip. She had first presented to her primary care doctor several weeks before with a complaint of 2 “bumps” on her hip, which she noticed after a minor trauma. A lipoma was suspected, and the patient was referred to a dermatologist, who recommended magnetic resonance imaging (MRI) after feeling 2 firm, round, mobile, 4-cm nodules in the soft tissues between the left gluteal muscle and the skin. The radiologist suspected that these may represent a malignant process, possibly liposarcoma. He stated that the T2 images showed what appeared to be encased viable fat, and the T1 images showed intervening stromal elements suggesting the possibility of a malignancy.

The patient was then referred for diagnosis and treatment. It was at this point that the patient revealed a surgical history of cosmetic liposuction and buttock augmentation with large-volume fat injection done at another hospital 3 years earlier. Physical examination confirmed the presence of firm, nontender nodules as described above. With this additional history, it was more likely that these masses represented a nonmalignant process such as fat necrosis, but with such a potentially serious diagnosis, an oncologic surgeon was brought on the team. Due to the nature of these firm masses and review of the patient’s MRI, an excisional biopsy was recommended, and the patient was asked whether plastic surgery should be available for reconstruction …