A 40-year-old woman presents with a slowly growing, painless mass of the posterior thigh. MRI shows a well-defined lesion with signal characteristics of fat on T1 and T2. There is no septation or nodular enhancement. The most appropriate initial management is:

• A Observation and repeat MRI in 6 months ✓
• B Core needle biopsy followed by wide excision
• C Marginal excision at the time of initial presentation
• D Amputation of the lower limb

Explanation

A soft tissue mass with pure fat signal (homogeneous T1 and T2 hyperintensity), no thick septae, no nodular enhancement, and no lipoblasts strongly suggests a benign lipoma. Small, superficial lipomas can be observed; deep lipomas >5 cm in the thigh warrant further evaluation. The described features are fully benign — no biopsy is needed immediately, and annual imaging surveillance is appropriate for asymptomatic lesions. Core biopsy is reserved for lesions with concerning features (thick septa, enhancement, heterogeneity) suggesting liposarcoma.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.