Case Of Spindle Cell Lipoma Research Articles

PRAME immunohistochemistry in soft tissue tumors and mimics: a study of 350 cases highlighting its imperfect specificity but potentially useful diagnostic applications.

Preferentially expressed antigen in melanoma (PRAME) immunohistochemistry is currently used in pathology for the assessment of melanocytic neoplasms; however, knowledge of its expression patterns in soft tissue tumors is limited. PRAME immunohistochemistry (clone QR005) was assessed on whole tissue sections of 350 soft-tissue tumors and mimics (> 50 histotypes). PRAME immunoreactivity was evaluated as follows: 0 "negative" (0% positive cells); 1+ (1-25% positive cells); 2+ (26-50% positive cells); 3+ (51-75% positive cells), and 4+ "diffuse" (> 75% positive cells). PRAME was expressed in 111 lesions (0 benign, 6 intermediate malignancy, and 105 malignant), including fibrosarcomatous dermatofibrosarcoma protuberans (2/4, 0 diffuse), NTRK-rearranged spindle cell neoplasm (2/4, 0 diffuse), atypical fibroxanthoma (1/7, 0 diffuse), Kaposi sarcoma (1/5, 0 diffuse), myxoid liposarcoma (11/11, 9 diffuse), synovial sarcoma (11/11, 6 diffuse), intimal sarcoma (7/7, 5 diffuse), biphenotypic sinonasal sarcoma (3/3, 1 diffuse), angiosarcoma (10/15, 6 diffuse), malignant peripheral nerve sheath tumor (9/12, 4 diffuse), pleomorphic rhabdomyosarcoma (2/3, 2 diffuse), alveolar rhabdomyosarcoma (2/6, 0 diffuse), embryonal rhabdomyosarcoma (7/7, 4 diffuse), undifferentiated pleomorphic sarcoma (2/12, 1 diffuse), leiomyosarcoma (2/15, 1 diffuse), clear cell sarcoma of soft tissue (1/10, 0 diffuse), low-grade fibromyxoid sarcoma (1/5, 0 diffuse), Ewing sarcoma (2/10, 1 diffuse), CIC-rearranged sarcoma (8/8, 4 diffuse), BCOR-sarcoma (2/5, 1 diffuse), melanoma (20/20, 14 diffuse), and thoracic SMARCA4-deficient undifferentiated tumor (5/5, all diffuse). All tested cases of spindle cell lipoma, dedifferentiated/pleomorphic liposarcoma, dermatofibrosarcoma protuberans, solitary fibrous tumor, inflammatory myofibroblastic tumor, myxoinflammatory fibroblastic sarcoma, nodular fasciitis, myxofibrosarcoma, epithelioid hemangioendothelioma, atypical vascular lesion, hemangioma, lymphangioma, vascular malformation, papillary endothelial hyperplasia, GIST, gastrointestinal clear-cell sarcoma, malignant melanotic nerve sheath tumor, neurofibroma, schwannoma, granular cell tumor, alveolar soft part sarcoma, epithelioid sarcoma, extraskeletal myxoid chondrosarcoma, myoepithelioma, ossifying fibromyxoid tumor, angiomatoid fibrous histiocytoma, PEComa, dermatofibroma, pleomorphic dermal sarcoma, and chordoma were negative. PRAME shows imperfect specificity in soft-tissue pathology but may serve as a diagnostic adjunct in selected differential diagnoses that show contrasting expression patterns.

Case Report: An exceptionally large spindle cell lipoma of the popliteal fossa

Background: Spindle cell lipoma (SCL) is an uncommon subtype of lipomas. It usually occurs in the posterior side of the trunk such as neck, back and shoulders and rarely touches the extremities. Only four cases of SCL of the knee and no cases of SCL of the popliteal fossa have been reported in the literature. We present herein the largest case of SCL of the popliteal fossa and knee to our knowledge. Case presentation: A 75-year-old woman presented with a slow growing swelling of the left knee. Physical examination showed a 12 cm well-limited painless mass of the left popliteal fossa. The mass was pediculated with a central ulceration. MRI scan showed a tumoral mass of the left popliteal fossa with some non-dilated vessels draining to the long saphenous vein. The mass had no evidence of invasion of the underlying tissues. The patient underwent a surgical resection of the mass with postoperative recovery. The histological examination revealed a tumoral proliferation diffusely expressing CD34 without malignancy evidence, and a Ki67 proliferation index <1%. This morphological and immunohistochemical aspect is typical of a SCL. Clinical discussion: SCL is a rare histological variant of lipoma occurring mostly in the posterior side of the upper trunk. SCL of the knee or the popliteal fossa are exceptional. Clinically, it presents as a gradually increasing painless mass with a long evolving history. Histologically, these tumors are made of spindle-shaped cells, rope-like collagen fibers and mature adipocytes surrounded by a fibrous capsule. Immunohistologically, spindle cell lipomas usually show diffuse and strong expression of CD34, and to a lesser degree vimentin. The optimal treatment of SCL is a surgical marginal resection. Conclusions: SCL represents an infrequent subtype, and its atypical presentation should push clinicians to further investigations in order to rule out more worrisome malignancies.

Spindle Cell Lipoma of the Spermatic Cord: A Case Presentation and Literature Review of a Urologic Rarity and Radiologic Mimic of Malignant Liposarcoma

BackgroundSpindle cell lipomas are uncommon variants of typical lipomas, and presentation within the spermatic cord is exceedingly rare. Only three other cases have been reported in medical literature.Case PresentationWe present the fourth case of spindle cell lipoma of the spermatic cord, which in this particular case had imaging findings suggestive of a malignant liposarcoma prompting radical orchiectomy. Histological investigation later concluded that this represented a benign, spindle cell lipoma of the spermatic cord as evidence by positive CD34 staining and microscopic analysis.ConclusionAlthough this particular variant of lipoma is rare, it is the hope that these findings contribute to the continued study of this disease process and can potentially prompt further evaluation prior to radical orchiectomy to limit patient morbidity.

A case of spindle cell lipoma of the tongue

A case of spindle cell lipoma of the tongue

A Case of Spindle Cell Lipoma on Nasal Dorsum of Nose

Spindle cell lipoma is a benign, lipomatous tumor arising most frequently in the subcutaneous on the back of the neck and shoulders in males aged in the third through seventh decade of life. However, we encountered a case of an unusual spindle cell lipoma arising in the subcutaneous and skin layer in the dorsum of nose. A total of two reports of spindle cell lipoma have been found in the nasal and nasal dorsum regions. To our knowledge, this is the first report of spindle cell lipoma in the nasal dorsum.

Spindle cell lipoma of the jejunal mesentery

Abstract 3-year-old girl with diarrhea was found to have an abdominal mass when she visited a hospital. The mass had a smooth margin and clear boundary, with an irregular internal echogenicity, showing patches and streaks. The mass showed low signal intensity on T1-weighted images and high signal intensity on T2-weighted images, and the images were disturbed by the fat component inside the mass. The origin of the tumor was the mesentery. The tumor had a wide base and was contiguous with the small intestine. The tumor, including one side of the mesentery, was resected while the intestinal tract was kept intact. Fibroblast-like spindle cells were arranged in characteristic parallel arrays, with highly variable amounts of mature adipocytes in a background of collagen bundles, myxoid stroma. On immunohistochemical analysis, the spindle cells were strongly positive for CD34 but were negative for S100. Spindle cell lipoma (SCL) is a benign soft tumor, and distinguishing SCLs from liposarcomas is sometimes difficult. SCLs commonly occur in the posterior cervical region and shoulders of old and middle-aged men. Only three cases of SCLs in children have been reported.

Spindle Cell Lipoma of the Buccal Mucosa- A Case Report

Spindle cell lipomas are a distinct variant of lipomas that occur very rarely in the oral cavity. The most common site for occurrence of this entity in the oral cavity is the tongue. The presence of spindle cells in the lesion calls for critical histopathological evaluation of the lesion. Here we present a new case of spindle cell lipoma that occurred on the buccal mucosa of a 45-year-old female patient. We provide an insight to the pathogenesis and the pathology of the entity.

Utility of STAT6 and 13q14 deletion in the classification of the benign spindle cell stromal tumors of the breast

The boundaries of the benign spindle cell stromal tumors of the breast are still confusing. This is the reason why different names are interchangeably used for the same tumor and vice versa the same name for different tumors. Therefore, we studied the immunoexpression of easily available markers, such as CD34, α-smooth muscle actin, and desmin, with the addition of STAT6, as well as the chromosome 13q14 region by fluorescence in situ hybridization analysis in a series of 19 cases of benign spindle cell stromal tumors of the breast. Based on the morphologic and immunohistochemical findings, the following histotypes were identified: (i) tumors (10/19 cases) with the characteristic morphology of myofibroblastoma and stained with vimentin, CD34, desmin, and α-smooth muscle actin; (ii) fibroblastic benign spindle cell tumors (5/19 cases) composed of fibroblast-like cells stained only with vimentin and CD34; (iii) tumors (2/19 cases) with the typical morphologic features of solitary fibrous tumor and stained with vimentin, CD34, and STAT6; (iv) 1 case of spindle cell lipoma stained with vimentin and CD34; and (v) 1 case of fibroma composed of a paucicellular, diffusely hyalinized stroma with expression of vimentin and CD34. Notably most of the tumors, with the exception of solitary fibrous tumor, showed monoallelic deletion of FOXO1. This finding supports that myofibroblastoma, fibroblastic benign spindle cell tumor, spindle cell lipoma, and fibroma of the breast are histogenetically related lesions which belong to the same tumor entity.

Lipoblasts in spindle cell and pleomorphic lipomas: a close scrutiny

The presence and frequency of lipoblasts (LPB) in spindle cell lipomas (SCL) and pleomorphic lipomas (PL) has never been studied in detail on a histologically, immunohistochemically and molecular genetically validated set of tumors. The authors investigated this feature by reviewing 91 cases of SCL and 38 PL. When more than 3 unequivocal LPB were found, the case was regarded as positive for the presence of LPB. All positive cases were then stained with CD34 and retinoblastoma (Rb) protein antibodies and tested by fluorescence in situ hybridization for MDM2 and CDK4 amplifications and the FUS gene rearrangements. The patients with SCL and PL containing LPB were 14 women and 47 men, the rest were of unknown gender. The cases usually presented as superficial, well-circumscribed soft tissue masses and most commonly occurred in the upper back and neck. CD34 was expressed in all cases, while Rb protein was consistently absent in all. Molecular genetic results, when available, were in concordance with the morphological diagnosis of SCL/PL. LPB were found in 37 (41%) cases of SCL and 25 cases of PL (66%). While in many cases they are inconspicuous, in some others they constitute a very prominent component of the tumor. It is important to be aware of this fact in order to avoid misinterpretation as liposarcoma.

Spindle Cell Lipomas Arising at Atypical Locations.

Spindle cell lipomas (SCLs) are benign lipomatous neoplasms that classically arise in the posterior neck, upper back, and shoulders of older male patients. We sought to characterize the occurrence of this entity at nonclassic sites. All cases of SCL arising at atypical sites were retrieved from our archives. Of 439 total cases of SCL, 57 arose at atypical locations in 32 men and 25 women (age range, 27-79 years). The tumor sites included leg (n = 23), buttock/perineum/inguinal (n = 10), forearm (n = 9), finger (n = 9), foot (n = 2), toe (n = 2), hand (n = 1), and flank (n = 1). CD34 was positive staining in all cases tested (52/52), while desmin was negative in most tumors (48/50). Thirty-eight of 38 cases tested exhibited loss of Rb expression. No cases showed CPM/MDM2 amplification (0/48). No local recurrences have been reported (n = 39). SCLs may arise in the trunk, lower extremities, and distal upper extremities. While most SCLs arising in classic sites occur in male patients, there is a relatively equal sex distribution in tumors at atypical sites. Pathologists should be aware that SCLs arise at atypical locations to avoid misclassification as other lipomatous neoplasms, including atypical lipomatous tumor.

Spindle cell lipoma adherent to the digital nerve in the palm.

Dear sir, Spindle cell lipoma, a solitary, slowly growing subcutaneous tumor, mainly in the posterior neck, shoulder girdle, upper back predominantly in men in the fifth to seventh decades. It can arise in other areas of the body. Johnson et al. reported a spindle cell lipoma in the orbital region; Toker et al. reported in the breast; Suster et al. reported in the gastrointestinal tract and Eckert et al. reported in the upper arm. Spindle cell lipomas are typically placed encapsulated in sub cutis, while occasionally they are poorly demarcated and can extend in to the dermis or underlying tissues. No case of spindle cell lipoma in the palm adherent to digital nerve has been reported in the literature. Here, we present a rare case of spindle cell lipoma adherent to the digital nerve in the palm. A 43 years old male patient was admitted to our clinic for further examination of the mass occurring in his right palm 24 months ago and hypoesthesia of radial side of the third finger for 3 months. A physical examination revealed 4 cm × 3 cm subcutaneous mass in the right palmar area. Ultrasonography revealed well circumscribed and low-echo 4 cm × 3 cm mass in the subcutaneous region of the palm. Furthermore, heterogenous signal intensity on all pulse sequences was showed by magnetic resonance imaging. A fine needle biopsy reported a spindle cell lipoma. At exploration, there was a well-circumscribed mass, connected to the digital nerve. (Fig.​(Fig.1a)1a) The multi lobulated 34 mm diameter mass was yellowish-white on its cut surfaces, had a firm texture, and was clearly demarcated from the adjacent tissues by a thin fibrous capsule The patient had no recurrence in 46 months follow-up. Fig. 1 a. Peroperative view of the spindle cell lipoma and the digital nerve b. Spindle cells in non-lipogenic areas are CD34 positive. (CD34; Original magnification X200) Spindle cell lipoma is a benign tumor distinguished by the replacement of mature adipocoyte by collagen forming spindle cells. It is a mixture of short spindle cells, adipocytes, and ropey collagen bundles, sometimes with a myxoid stroma. The differential diagnosis includes dermatofibrosarcoma protuberance, angiomyofibroblastoma, nodular fasciitis and myxoid liposarcoma [1]. Lipoblasts, fat necrosis, and fat with atrophic changes are important to the differential diagnosis of liposarcoma and spindle cell lipoma. There was co-expression of CD34, bcl-2, and vimentin in the spindle cells. (Fig. 1b). Tardio also reported that co-expression of CD34 and bcl-2 was common in atypical adipocytic tumors in a recent study [2]. Spindle cell lipoma is most closely related to pleomorphic lipoma in terms of demographics and presenting location. Cytogenetically, most spindle cell and pleomorphic lipomas show common 16q or 13q abnormalities [3]. Some authors have reported on the intra dermal origin which presents with different clinical or morphological features such as, widespread anatomical distribution, female predilection and an infiltrative pattern. Also, Mounasamy et al. have reported single case of spindle cell lipoma of palm [4]. Definitive diagnosis of spindle cell lipoma is crucial to recognize that this is a benign tumor and avoid misdiagnosing the lesion as a myxoid liposarcoma. The treatment of option for spindle cell lipoma is a complete local excision and its recurrence is extremely rare.

29. Spindle cell uterine lipoma: a case report

Lipomas are benign tumours composed of mature white adipocytes. One of the subtypes, spindle cell lipoma are most commonly found in subcutaneous tissue of shoulder, back and posterior neck and most often occurs in men. Although lipomas are the most common mesenchymal and soft tissue tumours, to date, less than 80 cases of uterine lipomas have been reported in the literature. The only case of spindle cell lipoma in the female genital tract have been in the vulva and cervix.¹ There has been only one case of uterine lipoma reported in Australia in 1946.² To the best of our knowledge, this is the first case of spindle cell uterine lipoma reported. We present a case of an 87 year old female presenting with post menopausal bleeding and large bulky uterus. The uterus showed 70mm yellow intramural mass. Histologically the mass consisted of adipose tissue with variably sized adipocytes with interweaving collagenous fibrous tissue containing pleomorphic spindle cells consistent with features of spindle cell lipoma. Immunohistochemistry for CD34 showed positivity of the spindle cells supporting the diagnosis of spindle cell lipoma.

Spindle cell lipoma of peri-parotid soft tissues. Report of a case and histogenetic considerations

Spindle cell lipoma (SCL) is a rare benign tumor which occurs most commonly in the posterior neck, shoulder and back. We report a rare case of SCL arising in peri-parotid soft tissues in a 66 year-old man. This is an unusual site for such a relatively rare lesion. The histological examination of the lesion showed the typical morphological features of SCL. Only four cases of SCL of the parotid region have been reported to date. Our case emphasizes the possibility that SCL may occur in the peri-parotid soft tissue and awareness of this possibility is crucial for pathologists to avoid confusion with others primary tumors of the parotid gland in which mature adipose tissue may be a metaplastic tumor component.

A rare case of spindle cell lipoma of broad ligament presenting as a pelvic mass.

A rare case of spindle cell lipoma of broad ligament presenting as a pelvic mass.

Dermal Spindle Cell Adenolipoma

Dermal Spindle Cell Adenolipoma

Spindle cell lipoma of the mandibular mucogingival junction: a case report of unusual oral neoplasm

Spindle cell lipoma (SCL) is a benign lipomatous neoplasm typically located in the posterior neck and back of older males. It presents as a well-circumscribed mass in the buccal mucosa, tongue, floor of the mouth or hard palate. There are only two case reports of SCL in the gingiva and alveolar ridge. Here, we report a case of SCL in the mandibular mucogingival junction of a 68-year-old male. Clinical, histopathological and immunohistochemical findings are presented. Although oral SCL is rare, it should be considered in the differential diagnosis of spindle cell neoplasms occurring in the oral cavity.

A Rare Case of Spindle Cell Lipoma of Nose

We present a case report of a 45-year-old lady with history of swelling on right side of the nose since two years. On clinical examination, there was a firm swelling, 3 × 2 cm in size, just above the right nasoalar crease, nontender and mobile. Computed tomography revealed fibrous tissue over anterior surface of the right maxilla and nasal bone with mild sclerosis of the right nasal bone. Excision was done through lateral rhinotomy incision. Histopathological examination of the excised specimen revealed spindle cell lipoma which is very rare. Very few cases have been reported in the literature so far.

Diagnostic Value ofMDM2andDDIT3FluorescenceIn SituHybridization in Liposarcoma Classification: A Single-Institution Experience

BackgroundThe amplification of murine double minutes (MDM2) is the primary feature of well-differentiated liposarcomas (WDLPS) and dedifferentiated liposarcomas (DDLPS), while DDIT3 rearrangement is the main one of myxoid liposarcomas (MLPS). Our aim was to evaluate the added value of MDM2 amplification and DDIT3 rearrangement in making a diagnosis and classifying lipogenic tumors.MethodsEighty-two cases of liposarcoma and 60 lipomas diagnosed between 1995 and 2010 were analysed for MDM2 amplification and DDIT3 rearrangement using a fluorescence in situ hybridization (FISH). The subtypes of liposarcoma were reclassified according to the molecular results, whose results were reviewed with an analysis of the relevant histologic and immunohistochemical findings.ResultsOne case of lipoma (1.67%) was reclassified as a WDLPS. Of the liposarcomas, 13.4% (16/82) were reclassified after the molecular testing. Five cases of MLPS were reclassified as four cases of DDLPS and one case of myxoid lipoma. Two cases of WDLPS were reclassified as one case of spindle cell lipoma and another case of myxofibrosarcoma. Four cases of DDLPS were reclassified as two cases of leiomyosarcoma, one case of angiomyolipoma and another case of fibroinflammatory lesion. Of the six cases of pleomorphic liposarcoma, five were reclassified as DDLPS.ConclusionsIn our series, a critical revision of diagnosis was found at a rate of 3.5% (5/142) after a review of the lipomatous lesions. The uses of molecular testing by MDM2 and DDIT3 FISH were valuable to make an accurate subtyping of liposarcomas as well as to differentiate WDLPS from benign lipomatous tumor.

舌に生じた紡錘細胞脂肪腫の1例

We report a case of spindle cell lipoma （SCL） of the tongue. A 65-year-old man was referred to our department because of a mass arising in the right margin of the tongue. Physical examination revealed 3 elastic soft masses of the right tongue margin, measuring 6mm, 8mm, and 12mm in diameter. Excisional biopsy of the largest mass was performed. The mass was histopathologically diagnosed as SCL, because it consisted of mature adipocytes and CD34 positive-spindle cells. There have been no signs of recurrence or an increase in size of the other 2 masses for 1 year 10 months.

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

The authors describe the first case of spindle cell lipoma of the posterior neck invading the upper cervical spinal canal and the posterior cranial fossa. Spindle cell lipoma is an extremely rare variant of benign lipoma. It usually occurs as a solitary subcutaneous well-circumscribed lesion in the posterior neck or shoulders of adult men. Local aggressiveness is unusual. This 61-year-old man presented with an increased left cerebellar syndrome and headaches. He also had a posterior neck tumefaction, which had been known about for a long time. Computed tomography and MR imaging studies revealed a voluminous mass extending to the upper cervical canal and posterior cranial fossa and eroding the neighboring bones. The lesion was well delimited, and contrast enhancement was intense and heterogeneous. The tumor, which had initially developed under the muscles of the posterior neck, was totally resected. Histological assessment revealed numerous fat cells with spindle cells secreting collagen. The large size of the tumor and the submuscular location, bone erosion, and compression of the CNS were unusual in this rare subtype of benign adipose tumor. Its presentation could simulate a sarcoma.