e in size in the course of
years. The operation consists in dividing the skin and capsule over the
tumour and shelling it out. Care must be taken that none of the outlying
lobules are left behind. If the overlying skin is damaged or closely
adherent, it should be removed along with the tumour.

[Illustration: FIG. 46.--Pedunculated Lipoma of Buttock of forty years'
duration in a woman aet. 68.]

_Multiple subcutaneous lipomas_ are frequently symmetrical, and in a
certain group of cases, met with chiefly in women, pain is a prominent
symptom, hence the term _adiposis dolorosa_ (Dercum). These multiple
tumours show little or no tendency to increase in size, and the pain
which attends their development does not persist.

In the neck, axilla, and pubes a diffuse overgrowth of the subcutaneous
fat is sometimes met with, forming symmetrical tumour-like masses, known
as _diffuse lipoma_. As this is not, strictly speaking, a tumour, the
term _diffuse lipomatosis_ is to be preferred. A similar condition was
described by Jonathan Hutchinson as being met with in the domestic
animals. If causing disfigurement, the mass of fat may be removed by
operation.

[Illustration: FIG. 47.--Diffuse Lipomatosis of Neck.]

_Lipoma in other Situations._--The _periosteal lipoma_ is usually
congenital, and is most often met with in the hand; it forms a
projecting lobulated tumour, which, when situated in the palm, resembles
an angioma or a lymphangioma. The _subserous lipoma_ arises from the
extra-peritoneal fat in the posterior abdominal wall, in which case it
tends to grow forwards between the layers of the mesentery and to give
rise to an abdominal tumour; or it may grow from the extra-peritoneal
fat in the anterior abdominal wall and protrude from one of the hernial
openings or through an abnormal opening in the parietes, constituting a
_fatty hernia_. A _subsynovial lipoma_ grows from the fat surrounding
the synovial membrane of a joint, and projects into its interior, giving
rise to the symptoms of loose body. Lipomas are also met with growing
from the adipose connective tissue _between or in the substance of
muscles_, and, when situated beneath the deep fascia, such as the fascia
lata of the thigh, the characteristic signs are obscured and a
differential diagnosis is difficult. It may be differentiated from a
cold abscess by puncture with an exploring needle.

[Illustration: FIG. 48.--Zanthoma of Hands in a girl aet. 14, showing
mult