Giant disfiguring occipital lipoma: successful surgical management of a late-presenting case in a resource-limited setting in Somalia

Background: Giant lipomas – defined as lipomas exceeding 10 cm – are rare and clinically significant because they can mimic malignant soft tissue tumors such as liposarcomas. Diagnostic uncertainty, particularly when these lesions arise in unusual locations, underscores the importance of comprehensive evaluation and timely management. Case Presentation: We report the case of a 60-year-old woman who presented with a giant occipital lipoma that had been slowly enlarging for over 20 years, with marked progression in the preceding 5 years. The mass caused significant morbidity, including cosmetic disfigurement, chronic headaches, sleep disturbances, and psychosocial distress. Imaging with ultrasound and computed tomography confirmed a large, well-encapsulated fatty mass without intracranial extension, and fine-needle aspiration cytology established a diagnosis of benign lipoma. The patient underwent successful surgical excision under general anesthesia. The tumor was removed in its entirety, and her postoperative course was uneventful, with marked improvement in quality of life. Discussion: This case highlights the challenges of managing giant lipomas in resource-limited settings, where delays in surgical intervention can allow benign conditions to grow to massive, disfiguring sizes. Timely diagnosis and surgery are essential to prevent morbidity, improve outcomes, and restore quality of life. Conclusion: Giant lipomas, though rare, should be considered in the differential diagnosis of large soft tissue tumors of the head and neck. This case illustrates the importance of early recognition, thorough evaluation, and prompt surgical management, even in low-resource settings such as Somalia, to prevent complications and improve patient well-being.