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     Path Case 2: Diagnosis- Pleomorphic Lipoma

               Spindle Cell Lipoma ;
Pleomorphic lipoma

          Dr Sampurna Roy MD

 

  Path Quiz Case 2: Case history and images -

December  2009

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Lipoma and variants

Lipoblastoma

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Spindle cell/pleomorphic lipoma

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Spindle cell lipoma and pleomorphic lipoma occur in adults and are more common in males.  
These are  located on the  back of the neck, upper back or shoulders.
These tumours usually present as a solitary, painless, slow growing, lobular mass with an average diameter of 5 cms.  Rarely multiple lesions may develop. Cut surface has a yellow or grayish - yellow  colour. Sometimes mucoid areas are present.

Histological features of Spindle cell lipoma:
This is a well circumscribed lesion usually confined to the subcutis.
Some lesions are confined to the dermis (intradermal spindle cell lipoma).
The tumour consists of an admixture of adipocytes and spindle cells.
Spindle cells are arranged in short fascicles.
The spindle cells are small and elongated and contain bland, uniform nuclei and pale eosinophilic cytoplasm.
In areas nuclear palisading is present.
The stroma is characterized by the presence of eosinophilic collagen fibres.
Numerous mast cells are present. There is no increase in mitoses.
Some cases show prominent myxoid changes.
The adipocytes are mature.
No lipoblasts are seen.
In 'pseudoangiomatous variant' , irregular branching vascular channel together with villiform connective tissue projections are present.
Pseudoangiomatous spindle cell lipoma with "true" angiomatous features.Virchows Arch. 2005 Oct;447(4):781-3. Epub 2005 Oct 19.

Histological features of Pleomorphic lipoma :  

Image Link1 ; Image Link2 ; Image Link3 ; Image Link4 .

This is a well circumscribed tumour which is usually superficial in location.
The tumour consists of mature adipocytes, abundant  interstitial collagen, together with bizarre, often multinucleated cells (floret giant cells). Some lipoblast like cells are also present. Mitoses is usually absent. There is minimal adipocytic nuclear atypia.

In spindle cell lipoma immunohistochemistry reveals CD34 , vimentin and XIIIa positive stromal cells.

Spindle cell lipoma and pleomorphic lipoma share common karyotypic abnormalities  -  Rearrangements of 13q and 16q.

Differential diagnosis of spindle cell lipoma and pleomorphic lipoma:

Differential diagnosis of spindle cell lipoma - Schwannoma and neurofibroma (Adipocytes absent, S100 protein positive ).
In
well differentiated liposarcoma (atypical lipoma)-sclerosing variant careful clinicopathological correlation is important . Unlike pleomorphic lipoma these are usually located in deeper tissue .There is variation in size of adipocytes together with other atypical features. Scattered lipoblasts are also present. 
Differential diagnosis of pleomorphic lipoma also includes
pleomorphic liposarcoma.

IMAGE LINKS (Spindle cell lipoma):   1  ; 2345 (ESCOP) 

IMAGE  LINKS:(Spindle cell lipoma): Click1 ; 2 ; 3 ; 4 ; 5 ; 6 (ESCOP)

                         

Abstract:

Spindle cell lipoma showing biphasic pattern--a case report.Ups J Med Sci. 2005;110(2):173-8.

Spindle cell lipoma of the floor of the mouth: report of a case.Auris Nasus Larynx. 2005 Jun;32(2):205-7. Epub 2005 Mar 23.

Primary purely intradermal pleomorphic liposarcoma. J Cutan Pathol 2003 Sept;30(8); 516-20

Intradermal spindle cell/pleomorphic lipoma of the vulva: case report and review of the literature. J Cutan Pathol 2002;29:59

Fibrous Spindle Cell Lipoma Report of A New Variant .Am J Dermatopathology 2001; 23:112-115

Intradermal spindle cell lipoma / pleo- morphic lipoma. A distinct subset. Am J Dermatopathol 2000 ; 22: 496- 502

Multiple spindle cell lipomas: a report of 7 familial and 11 nonfamilial cases. Am J Surg Pathol. 1998 Jan;22(1):40-8

Spindle cell and pleomorphic lipoma: an immunohistochemical study and histogenetic analysis. J Pathol. 1989 Jul;158(3):219-22

Spindle cell lipoma. Cancer 1975; 36: 1852-1859

Spindle cell lipoma-a pseudoangiomatous variant.Histopathology 1994;24: 562-569

Dermal spindle cell lipoma: plexiform and nodular variants. Histopathology. 1995 Dec; 27(6):533-40

Spindle cell lipoma of the skin. Am J Dermatopathol 1995; 17: 529-533

Spindle cell lipoma is strongly CD34 positive. An immunohistochemical study. J Cutan Pathol 1996;23:546-550

Pleomorphic lipoma: a tumour simulating liposarcoma. Histopathology 1983 Jul; 7(4): 511-23

Pleomorphic lipoma: A benign tumor simulating liposarcoma. A clinicopathologic analysis of 48 cases. Cancer 1981; 47: 126

Pleomorphic lipoma. Case reports and review of the literature.J Dermatol Surg Oncol 1992 Mar;18(3):197-202

                   

 

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