Spindle Cell Lipoma Research Articles

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.

Oral Fibrolipoma Arising from Maxillary Alveolus: A Rare Case Entity

Lipoma is a non malignant tumour of adipocytes. Lipomas are most commonly seen during 4th to 6th decades of life. About 20% lipomas are seen in head and neck region of which only 1% to 4% have been reported in oral cavity. Most common site of occurance in oral cavity is buccal mucosa and tongue (50%). Various histological variants of lipoma have been identified, which include fibrolipoma, angiolipoma, infiltrating (intramuscular) lipoma, pleomorphic lipoma, osteolipoma, sialolipoma, chondrolipoma, myxolipoma and spindle cell lipoma. Fibrolipoma is a rare histological variant and occurrence on alveolus is even rare. Thus, reporting a case of Fibrolipoma of size 2×2 cm arising from maxillary alveolus in a 42-year-old female patient with a long standing history of 4 years

Oral Fibrolipoma: A Rare Histological Subtype

Lipomas are soft tissue tumors who originate from adipose tissue. Histologically, subtypes ends are defined. These are fibrolipoma, angiolipoma, myxoid lipomas, spindle cell lipoma, pleomorphic lipoma and intramuscular lipoma. When a large proportion of connective tissue is present, the term fibrolipoma is used. Fibrolipoma subtype of the oral cavity is rare. The tumor has been reported to be more frequent in the buccal mucosa. This case report describes the treatment of an asymptomatic fibrolipoma lesion in the right buccal mucosa by local excision. Since asymptomatic lesions usually can only be detected in intraoral examination, physicians should be careful during clinical examinations and have information about rare histological subtype.

Nevus Lipomatosus Cutaneous Superficialis with Spindle Cell Lipoma-like Areas: A Case Report

Nevus Lipomatosus Cutaneous Superficialis (NLCS) is a rare occurring cutaneous hamartoma with presence of mature adipocytes in dermis.Though first reported in 1921 by Haffman and Zurhelle, fewer cases have been documented in literature since then. Authors hereby report a case of nevus lipomatosus cutaneous superficialis in an unusual age of 55-year-old male with multiple painless ill defined sessile nodules of 1.5 to 3 cm on lower back. Surgical excision was performed and histopathology revealed characteristic features as that of NLCS along with intervening areas of spindle cell lipoma. Coexistence of other lesion along with NLCS, both clinically or on histopathology is further an infrequent occurrence. No such case has been reported in literature so far.

İğsi Hücreli Lipomların Cerrahi Tedavisi Sonrası Klinik Sonuçlar

Aim: Spindle cell lipoma is a rare tumor. Although located subcutaneously, they are localized in the posterior neck, shoulder, and lumbar regions. It can radiologically mimic liposarcoma. It is important to differentiate spindle cell lipoma from atypical lipomatous tumors. In this study, we aimed to present our studies on our patients with spindle cell lipoma with histopathological and clinical findings and give brief information about the differential diagnosis of this rare lipomatous lesion. Material and Methods: A total of 29 patients (27 male, 2 female) who underwent surgical treatment for spindle cell lipoma between January 2015 and December 2020 were included in this retrospective study. All patients were presented with mass lesions, and preoperative biopsy was performed in cases with low-fat content mass lesions. Results: The mean age of the patients was 57.0±14.6 (range, 25-79) years and the mean follow-up period was 25.0±8.6 (range, 6-47) months. No additional disease was detected in the patients. Marginal resection was preferred in 5 (17.2%) patients with lesions close to neurovascular structures. Wide resection was performed in the other 24 (82.8%) patients. CD34 was positive in all lesions. In one patient, CDK4 was positive, and the diagnosis was made as atypical spindle cell lipoma. At the last follow-up, there was no complication and recurrence in any of the cases. Conclusion: Spindle cell lipomas should be regarded in the differential diagnosis of lipomatous tumors. Local excision with negative margins may prevent a recurrence. Correct histopathologic differentiation from liposarcoma is of paramount importance for appropriate treatment.

Histological and Ultrastructural Description of Benign Adipocytic Tumors in Farmed Striped Sea Bream (Lythognathus mormyrus).

Simple SummaryMesenchymal neoplasms of the skin are common tumors in domestic animals and often reported in fish pathology. Among them, lipomas are frequently observed, but the definition of their different histological features and their classification in fish are still in their primordial stages. In the present work, the authors describe different type of lipomas found in a wild stock of striped seabream and outline their key differential microscopical features. Two new types of lipoma never observed in fish pathology, defined as spindle cell lipoma and atypical spindle cell-like lipoma, are reported.Cutaneous neoplasms affecting wild striped bream (Lythognathus mormyrus) have been recorded after their introduction in a marine aquaculture farm in the Adriatic Sea. The tumors were evident on 24% of the reared fish, showing single or multiple nodules, with a diameter ranging between 0.5–4.0 cm. Histologically, all the neoplastic lesions were located in the stratum spongiosum of the dermis and were surrounded by a thin capsule of connective tissue. The tumors were predominantly composed of adipocytes grouped and surrounded by a thin net of fibroblasts and collagen fibers. In some lipomas a mixture of adipocytes and uniform spindle cells were also observed. Fibroblasts and collagen fibers, or spindle cells, showing few mitotic figures were mainly observed in other nodules. Three of the tumors showed bands of cells with elongated nuclei. Five neoplasms differed from the classic spindle cell lipoma due to the presence of scattered giant cells. These cells presented acidophilic abundant cytoplasm with multiple hyperchromatic nuclei showing a concentric “floret-like” arrangement. The tumors were further characterized by ultrastructural observations that allowed ruling out the presence of virus-like particles within the lesions. Histological features of the masses lead to the identification of four prevalent patterns of neoplasms: lipoma, fibrolipoma, spindle cell lipoma (SCL), and atypical spindle cell-like lipoma (ASCL). The different neoplasms could arise from the transformation of mesenchymal cells of dermal origin. To the author’s knowledge, this is the first report describing key differential histological and ultrastructural features of these neoplasms in striped sea bream.

Pleomorphic lipoma: A rare entity

Pleomorphic lipoma is a rare neoplasm that is considered as a variant of spindle cell lipoma. It predominantly occurs in the dermis or subcutis of the posterior neck, upper back, and shoulders. Pleomorphic lipoma may clinically present as a slow-growing and well-circumscribed subcutaneous mass. Though it is a benign tumour it may contain atypical cells for which it may mimick sarcoma or other malignant soft tissue tumours. So histopathological diagnosis is vital for preventing unnecessary surgery. Here we report a case of a pleomorphic lipoma on upper back in a 55yr old patient.

Fat-Free Spindle Cell Lipoma of the Scalp: Lipoma Without a Lipogenic Component.

Spindle cell lipoma (SCL) is a rare, benign subcutaneous neoplasm that typically occurs on the upper trunk or neck of middle-aged men. The diagnosis of SCL is often straightforward due to its characteristic clinical presentation and classic histologic features of admixed mature adipocytes and CD-34 positive bland spindle cells. However, the diagnosis can be elusive when low-fat and free-fat patterns occur. Due to the lack of lipogenic content and morphologic overlap, this rare tumor is often mistaken for other benign and malignant soft tissue tumors. The authors present the case of a middle-aged man with a fat-free SCL of the temporal scalp. To our knowledge, this is the first reported case in the literature ofa fat-free SCL involving the temporal scalp. With careful attention to the clinical context, histologic features, immunohistochemical profile, and cytogenetic abnormalities, the proper diagnosis of SCL without a lipogenic component can be achieved.

Spindle Cell Lipoma Revisited: Common and Unusual Magnetic Resonance Imaging Findings in 54 Patients With New Observations.

The aims of the study were to study demographic data of patients with spindle cell lipoma and describe a spectrum of magnetic resonance imaging features of the tumor.

The incidence and relevance of non-fatty components in trunk and extremity lipomatous soft tissue masses.

To determine the incidence and diagnostic relevance of non-fatty 'solid appearing' components within lipomatous tumours of the trunk and extremity. Retrospective review of patients referred to a specialist musculoskeletal oncology service over a 12-month period with a lipomatous trunk or extremity soft tissue tumour. The presence and morphology (solitary/multifocal; homogeneous/heterogeneous; well-defined/poorly defined) of non-fatty components was recorded based on MRI and compared with the final histological diagnosis. 213 patients with 217 lipomatous tumours were included, 119 (55.9%) males and 94 (44.1%) females with mean age of 54.6 years (range 7-93 years). Seventy-seven (35.5%) lesions arose superficial to the fascia and 139 (64.1%) deep, while a single case involved both compartments. Mean maximal tumour dimension was 94.9 mm (range 12-288 mm). Non-fatty 'solid appearing' components were identified in 28 (12.9%) cases, of which eight were solitary and 20 were multifocal, six had homogeneous SI and 22 had heterogeneous SI, and eight had well-defined margins, while 20 had poorly defined margins. Histological diagnosis was available in 20 of the tumours containing non-fatty components, 16 of which were benign, two intermediate grade and two malignant (a dedifferentiated liposarcoma and a myxoid liposarcoma). The commonest diagnosis was spindle cell lipoma, which accounted for 10 of 20 (50%) cases with confirmed histology. Non-fatty components are identified in ~13% of trunk and extremity lipomatous tumours. The majority of such lesions are benign lipoma variants, most commonly spindle cell lipoma. Solid non-fatty components are identified in approximately 13% of lipomatous tumours referred to a specialist sarcoma service. Despite the concern that these may represent dedifferentiated liposarcomas, high-grade tumours were seen in only two cases, the commonest diagnosis being a spindle cell lipoma.

54. Genome-wide copy number abnormalities in lipomatous neoplasms detected with chromosomal microarray: Is gain of MDM2 necessary for 12q amplification characterization and prognostication?

Lipomatous neoplasms (LN) are a heterogeneous group of adipocytic tumors, including benign lipomas, low-grade atypical lipomatous tumors (ALT), and high-grade liposarcomas [sub-grouped into de-differentiated liposarcomas (DDLS) evolved from ALT and pleomorphic liposarcomas]. Using histological (H&E) approaches, ALT are often difficult to distinguish from benign lipomas, while DDLS are challenging to differentiate from other high-grade sarcomas. Given this diagnostic challenge, molecular signatures can aid in the characterization/prognostication of these tumors and have shown MDM2 and/or CDK4 amplification in ALT and DDLS tumors, with MDM2 being recognized as the likely “driver” gene, based on fluorescence in situ hybridization (FISH) studies. We describe an atypical lipomatous tumor having features of spindle cell lipoma. A genome-wide copy number microarray (MA) assessment showed amplification on 3q (6-10 copies; 4 contiguous regions) and 12q (6-11 copies; 7 contiguous regions), with the 12q amplification regions being juxtaposed to, but not encompassing, the MDM2 gene. A FISH test for this specimen, using a commercial probe, yielded an “MDM2” positive result (albeit with smaller signals). This “discrepant” finding is not unexpected since the 209 kb FISH probe encompasses loci other than MDM2, including the CPM gene (which is amplified in the MA). To our knowledge, this is the first documented case of 12q amplification in a LN that does not encompass the MDM2 gene. Moreover, in our experience (n= 44 tumors), 100% of the 12q (MDM2/CPM) amplified LN have shown additional imbalances using MA methods [including, but not limited to, amplifications of 1q (60%); CDK4 and/or HMGA2 (58%), & HMGA2 (25%)]. In summary, our data underscore the advantages of using MA to evaluate LN. Moreover, this rare tumor having 12q15 amplification that does not encompass the MDM2 gene may provide new insight as to the role of MDM2 (versus possibly CPM) as a “driver” for ALT/DDLS tumor formation/progression.

Wilms' Tumor 1 (WT1): A Novel Immunomarker of Dermatofibrosarcoma Protuberans-An Immunohistochemical Study on a Series of 114 Cases of Bland-Looking Mesenchymal Spindle Cell Lesions of the Dermis/Subcutaneous Tissues.

Simple SummaryDermatofibrosarcoma protuberans (DFSP) is a superficial fibroblastic spindle cell sarcoma with a high rate of local recurrence (20% to 50%) but with a low metastatic potential. DFSP is characterized by COL1A1-PDGFB gene fusion and diffuse immunohistochemical expression of CD34. This immunomarker is especially useful in distinguishing DFSP from its morphological mimickers, especially when pathologists are faced with small biopsies. Apart from CD34, there are no additional diagnostic immunomarkers for DFSP, and thus, there is the need to identify more sensitive and specific markers for this sarcoma. Recently, Wilms’ tumor 1 (WT1) has been shown to be diffusely expressed in the cytoplasm of several benign and malignant mesenchymal spindle cell lesions. Based on this background, the aim of this study is to evaluate the immunohistochemical expression of WT1 protein in a series of bland-looking spindle cell lesions of the dermis/subcutis, emphasizing its potential diagnostic role in identifying DFSP among its morphological mimickers.Purpose: to investigate the immunohistochemical expression and distribution of Wilms’ tumor 1 (WT1) (transcription factor produced by the tumor suppressor gene of the same name) in a series of 114 cases of bland-looking mesenchymal spindle cell lesions of the dermis/subcutaneous tissues to establish whether this immunomarker is differentially expressed in dermatofibrosarcoma protuberans (DFSP) versus its potential morphological mimickers. Methods: This retrospective multi-centric immunohistochemical study included 57 DFSP cases, 15 dermatofibromas, 5 deep fibrous histiocytomas, 8 neurofibromas, 5 spindle cell lipomas, 8 dermal scars, 6 nodular fasciitis, 5 cutaneous leiomyomas and 5 solitary fibrous tumors. Among the 57 DFSP cases, 11 were recurrent lesions; 2 non-recurrent cases exhibited an additional “fibrosarcomatous” overgrowth and 1 recurrent and 2 primary tumors contained a minority of “giant cell fibroblastoma” components. Results: Most DFSP (95% of cases) exhibited cytoplasmic staining for WT1; 11/11 residual/recurrent tumors showed diffuse and strong WT1 cytoplasmic immunoreactivity; apart from neurofibromas, WT1 expression was lacking in all the other cases studied. Conclusions: The cytoplasmic expression of WT1 may be exploitable as a complementary diagnostic immunomarker to CD34 in confirming the diagnosis of DFSP and to better evaluate the residual/recurrent tumor component.

A report of a patient presenting with three metachronous 13q14LOH mesenchymal tumours: spindle cell lipoma, cellular angiofibroma and mammary myofibroblastoma

Spindle cell lipoma, cellular angiofibroma and mammary myofibroblastoma are mesenchymal tumours that have overlapping morphological and immunophenotypic features. Aberrations in chromosome 13q14 have been identified as a recurrent feature. We report a unique case of a 69-year-old woman who metachronously developed all three tumours. She developed a peri-urethral and a recurrent peri-vaginal cellular angiofibroma at age 54 and 57, respectively, a spindle cell lipoma at age 62 and a mammary myofibroblastoma at age 69. Dual-colour interphase fluorescent in situ hybridisation (FISH) revealed losses of RB1 and FOXO1 (13q14LOH [loss of heterozygosity]) within neoplastic cells. There was also loss of retinoblastoma (Rb) protein expression. To our knowledge, this is the first report of these three tumours arising in the same patient. The genetic link between these tumours supports the hypothesis that they may arise from the same progenitor cells. However, further research is required to elucidate the precise pathogenetic link.

A Giant Spindle Cell Lipoma of the Parotid-Masseter Lodge (A Case Report)

Background: The spindle cell lipoma is a rare benign tumor that originated from subcutaneous adipose tissue. It is a slow growing lesion and may become voluminous causing the patient an aesthetic disfigure. The diagnosis is made by the histological examination combined with immunohistochemical analysis. Radiological features present a variety of description because of the proportions difference of spindle cell lipoma components, but imaging is useful to determine the mass extents. The treatment of this kind of benign tumors is surgery which must be completed without need for other therapy. Aim: This case report highlights the exceptional location of spindle cell lipoma in the soft tissues of the parotid-masseter lodge, which may raise differential diagnosis problems with a primary parotid gland tumor. Case Presentation: A 58-year-old man, with no medical history, was presenting a swelling of the parotid region, growing progressively for 6 years, without other associated sign. The patient benefited from a careful physical examination. A computed tomography and magnetic resonance imaging were carried out. Clinical and radiological findings were suggesting a benign tumor occupying the left parotid-masseter lodge. The patient went through a surgical excision of the tumor. Histological and immunohistochemical features revealed a classic shape of spindle cell lipoma. After one year of follow-up, we notice a good recovery without local recurrence. Conclusion: Surgeons and pathologists have to keep in mind the possible development of spindle cell lipoma in any subcutaneous site even if unusual one.

Angiomyofibroblastoma of the Lower Genital Tract of Women: Report of Two Cases

Superficial angiomyofibroblastoma of the lower genital tract of women is a very rare, benign neoplasm that most commonly arises in the vulvo-vaginal area. Our first case is a 45-year-old woman who presented with menometrorrhagia. On gynecological examination, a pedinculated polipoid mass 2.5 cm in size was found on the cervix. The second case is a 40-year-old woman presented with a nodular mass 5 cm in size on the vulva. She admitted to hospital with itching and cosmetic problems. Histologic examination revealed bland spindled and epithelioid cells arranged around blood vessels. Tumor cells have immunoreactivity for desmin, vimentin, estrogen and progesterone receptors but staining for cytokeratin was negative. In the lipomatous variant, the cells are dispersed into the adipose tissue. Differential diagnosis of lipomatous angiomyofibroblastoma includes; spindle cell lipoma, angiomyolipoma, and cellular angiofibroma. We will discuss the differential diagnosis of these cases with immunohistochemical and morphological findings.

A case of huge spindle cell lipoma in the floor of the mouth

紡錘形細胞脂肪腫は脂肪腫の一型であり，成熟した脂肪組織に紡錘形細胞の混在，および膠原線維の増殖を伴うのが特徴である。紡錘形細胞脂肪腫の口腔領域での発生は比較的稀である。われわれは69歳女性の口底に発生した紡錘形細胞脂肪腫の1例を経験したので報告する。患者は口底の腫脹の精査依頼で当科を紹介来院した。T1，T2強調像にて舌下隙に30×25×27mmの境界明瞭な高信号を示す腫瘤を認めた。全身麻酔下に口底腫瘍摘出術を行ったところ，摘出物の病理組織学的診断は紡錘形細胞脂肪腫であった。術後3年が経過するが再発は認めていない。

A case of spindle cell lipoma of the tongue

A case of spindle cell lipoma of the tongue

Telocytes/CD34+ Stromal Cells in Pathologically Affected White Adipose Tissue

We studied telocytes/CD34+ stromal cells (TCs/CD34+SCs) in pathologically affected white adipose tissue after briefly examining them in normal fat. To this aim, we reviewed pathological processes, including original contributions, in which TCs/CD34+SCs are conserved, increased, and lost, or acquire a specific arrangement. The pathologic processes in which TCs/CD34+SCs are studied in adipose tissue include inflammation and repair through granulation tissue, iatrogenic insulin-amyloid type amyloidosis, non-adipose tissue components (nerve fascicles and fibres in neuromas and hyperplastic neurogenic processes) and tumours (signet ring carcinoma with Krukenberg tumour and colon carcinoma) growing in adipose tissue, adipose tissue tumours (spindle cell lipoma, dendritic fibromyxolipoma, pleomorphic lipoma, infiltrating angiolipoma of skeletal muscle and elastofibrolipoma), lipomatous hypertrophy of the interatrial septum, nevus lipomatosus cutaneous superficialis of Hoffman–Zurhelle and irradiated adipose tissue of the perirectal and thymic regions. Two highly interesting issues emerged: (1) whether the loss of CD34 expression in TCs/CD34+SCs is by changes in marker expression or the disappearance of these cells (the findings suggest the first possibility) and (2) whether in some invasive and metastatic malignant tumours, TCs/CD34+SCs that completely surround neoplastic cells act as nurse and/or isolating cells. Further studies are required on adipose tissue TCs/CD34+SCs, mainly in lipomatosis and obesity.

Dendritic fibromyxolipoma: A case report.

Dendritic fibromyxolipoma (DFML) is a rare variant of spindle cell lipoma. It is characterized by extensive myxoid change and the presence of stellate cells with dendritic processes. The present study reports three cases of DFML that arose from the limbs and thoracic cavity. Pathologically, the tumor was composed of mature adipocytes admixing with patch spindle cells in a myxoid stroma. The cell atypia was not apparent and mitotic figures were rare. Immunohistochemistry revealed that the spindle cells were strongly positive for CD34. The three patients demonstrated no significant issues during a two-year's follow-up without evidence of recurrence and metastasis. The current study additionally reviewed all reported DFML cases in the PubMed database and Chinese journals.

Cutaneous side effects in a cohort of patients with chronic myeloid leukemia treated with tyrosine kinase inhibitors: General description and further characterization, correlation with photoexposition and study of hypopigmentation as treatment's prognostic factor.

Cutaneous adverse effects (AE) related to tyrosine-kinase inhibitor (TKI) drugs have been mainly described as case reports. We have characterized their appearance and correlation with patient's photoexposition habits and, further, with treatment response, in 61 patients with chronic myelogenous leukemia (CML) treated with TKI drugs. We have found hypopigmentation in 49.2% of the cases and a statistically significant association with interferon (IFN) intake. Eyelid edema's frequency was 45.4%. Mean photo-exposure was 1.95 h/day and only 8.3% of the patients used sunscreen daily. 44.3% of the patients reported a lighter skin color with the treatment and a statistically significant relationship with conjunctival hemorrhage was also found. Concordance between patients and dermatologist was moderate (kappa index 0.41). We found xerosis (21.3%), eczematous eruptions (21.3%), melasma (4.9%) and other isolated skin problems (ie, granulomatous panniculitis) in up to 16.4% of cases. Appearance of hypopigmented macules is associated to vascular conjunctival fragility and these patients need a slightly longer time to reach a complete molecular response, but without additional changes in survival or relapse frequency. We have stablished a specific dermatologic diagnosis in all the cases and we have not found the previously published as maculopapular rashes. Hypopigmentation, the more frequent AE, was not perceived as a relevant side effect. Photosensitivity, in our cases, was not reported, although imatinib-treated patients avoided sun-exposure. In addition, we identified some nonpreviously described dermatologic conditions in patients taking TKI drugs, like granulomatous panniculitis tufted folliculitis or oral spindle cell lipoma.