Rare fatty tumour near heart could be left as is

Dear Dr. Roach: My husband has been diagnosed with a lipoma that is located between his heart and esophagus. It is approximately 10 centimetres by 15 cm in size. The surgeon said he has never seen one in this location in all of his 50 years of practice. It is not currently a health issue and has not changed in size in the past 18 months. When the doctor described the extensive surgery that would be needed to remove the lipoma, I asked if it could be removed with liposuction, as this is the procedure apparently used for removing lipomas that are close to the surface. He and another surgeon looked at the CAT scan together and said that they didn’t know.

My question to you is, Do you know if this is a possibility? They said that if they used liposuction, they may not get it all. What difference would that make as long as it was smaller, with no chance of pushing into the heart or esophagus? My husband is 70 years old and in fairly good health otherwise.

P.M.

A lipoma, a benign fatty tumour, is very rarely found in the mediastinum (that's the anatomic name for the part of the chest cavity that includes the heart and esophagus).

The question I have is why are they considering removing it?

It is certainly a large size, but if it isn't causing problems, I’m not sure why they would want to intervene. I reviewed the literature on lipomas, and they are removed only when they are already compressing an important structure, such as the heart or a large blood vessel, or when the diagnosis isn’t clear. Given that it is stable in size, I would be reluctant to recommend a very invasive surgery.

I could not find anything on using liposuction.

All cases in the literature I found used a standard open surgical technique, and one study noted this was the only way of removing the entire tumour. Dear Dr. Roach: Results from a recent yearly checkup showed an abnormal micro-albumin-to-urine-creatinine ratio.

My level last year was 0.5, and now it is 6.5. I am concerned about the spike in results and wonder if this is something about which I should be concerned. I am 81, healthy and take metformin and lisinopril. My A1C level was 6.0 per cent. The computerized report offered no recommendations, but I worry that I need some followup.

D.D.

The microalbumin-to-urine-creatinine ratio is a screening test for large amounts of protein developing in the urine (proteinuria). It is used mostly in people with diabetes (which I assume you have or are at high risk for, given that you are treated with metformin and the fact that your doctor checks your A1C). Albumin is the major protein found in urine in people with kidney disease.

A ratio of 6.5 is still very low. Normal is considered less than 30. Between 30 and 300, people are considered to have “moderately increased albuminuria.” (This is considered the preferred term now, over “microalbuminuria.”) A level over 300 is now called “severely increased albuminuria,” and people with this are at high risk for developing progressive kidney disease.

Most kidney and diabetes specialists recommend an ACE inhibitor, like the lisinopril you are taking, to prevent kidney damage in the first place.

Even though you had a large increase, your level is normal, you are on appropriate medication, your diabetes is under control, and I do not think you need to worry about this result.