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Soft Tissue Pathology

Pathology of Spindle Cell Lipoma and Pleomorphic Lipoma     

Dr Sampurna Roy MD                   


Dermatopathology Quiz Case 199

Diagnosis: Pleomorphic Lipoma

Dermatopathology Quiz Case 170

Diagnosis: Spindle Cell Lipoma

Path Quiz Case 2: Case history and images 

Diagnosis: Pleomorphic Lipoma





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.

Gross appearance image:  Image1


 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.

CD34 is extensively positive.


Pseudoangiomatous Spindle Cell Lipoma:

Visit: Vascular Tumours

Histological features of Pleomorphic Lipoma :

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).

There is dense collagen.

Myxoid stroma contains arborizing vessels.

No lipoblasts are present. (Some lipoblast - like cells may be seen)

Mitoses is usually absent.

There is minimal adipocytic nuclear atypia.

Immunohistochemistry reveals CD34, 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 clinico- pathological 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.

Further reading:

Cutaneous CD34+ spindle cell neoplasms: Histopathologic features distinguish spindle cell lipoma, solitary fibrous tumor, and dermatofibrosarcoma protuberans.

Spindle cell lipoma: a rare tumor of the mediastinum.

Spindle cell lipoma.

Spindle cell lipoma of the hypopharynx.

An unusual and spectacular case of spindle cell lipoma of the posterior neck invading the spinal cervical canal and posterior cranial fossa.

Spindle cell lipoma with collagen rosettes.

Spindle cell lipoma of the orbit: a case report of an unusual orbital pathology.

Fine needle aspiration biopsy of intraparotid spindle cell lipoma: a case report.

Spindle cell lipoma showing biphasic pattern--a case report.

Spindle cell lipoma of the floor of the mouth: report of a case.

Intradermal spindle cell/pleomorphic lipoma of the vulva: case report and review of the literature.

Fibrous Spindle Cell Lipoma Report of A New Variant .

Intradermal spindle cell lipoma / pleo- morphic lipoma. A distinct subset. 

Multiple spindle cell lipomas: a report of 7 familial and 11 nonfamilial cases.

Spindle cell and pleomorphic lipoma: an immunohistochemical study and histogenetic analysis. 

Spindle cell lipoma is strongly CD34 positive. An immunohistochemical study.

Pleomorphic lipoma lacking mature fat component in extensive myxoid stroma: a great diagnostic challenge.

Pleomorphic lipoma: a tumour simulating liposarcoma.

Pleomorphic lipoma: A benign tumor simulating liposarcoma. A clinicopathologic analysis of 48 cases. 

Pleomorphic lipoma. Case reports and review of the literature.




Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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