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Shaker N, Blankenship H, Shaker N, Alhalaseh Y, Niu S, Mansoor I, Shakra RA, Sangueza OP. Pseudoangiomatous Spindle Cell Lipoma: A Rare and Distinct Pattern of Lipomatous Tumors. Int J Surg Pathol 2024; 32:1046-1050. [PMID: 37908107 DOI: 10.1177/10668969231211337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Pseudoangiomatous spindle cell lipoma is a rare pattern within the spindle cell lipoma spectrum that exhibits a remarkable histological pattern characterized by its resemblance to vascular lesions, creating a pseudoangiomatous appearance. Approximately 20 to 30 reports have been described in the literature. In this context, we present an intriguing report of pseudoangiomatous spindle cell lipoma showcasing a unique low-fat pseudo angiomatous pattern in a 61-year-old male patient presented with a 6-cm subcutaneous mass on his right arm, which was thoroughly investigated and subsequently excised. Microscopic examination revealed bland spindle cells infiltrates within a fibromyxoid stroma. Notably, the tumor exhibited distinctive branching and dilated vascular-like spaces that formed pseudopapillary (villiform) projections. Interestingly, the tumor displayed certain regions featuring mature adipose tissue components, alongside hyalinized blood vessels. No necrosis, atypical spindle cells, increased mitotic activity, or pleomorphic lipoblasts were observed. The immunohistochemical evaluation demonstrated diffuse positive staining for CD34 and negative staining for STAT6. This report of a low-fat pattern of pseudoangiomatous spindle cell lipoma underscores the importance of recognizing and characterizing rare entity subtype for accurate diagnosis and appropriate management. This report contributes to the expanding understanding of the diverse presentations of pseudo angiomatous spindle cell lipomas and underscores the significance of comprehensive histopathological assessment.
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Affiliation(s)
- Nada Shaker
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Heath Blankenship
- Departments of Dermatology and Pathology, School of Medicine, Wake Forest University, Winston Salem, NC, USA
| | - Nuha Shaker
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yazan Alhalaseh
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Shuo Niu
- Departments of Dermatology and Pathology, School of Medicine, Wake Forest University, Winston Salem, NC, USA
| | - Ibrahim Mansoor
- Department of Pathology, International Medical Center Hospital, Al-Ruwais, Jeddah, Saudi Arabia
| | - Rafat Abu Shakra
- Department of Pathology, International Medical Center Hospital, Al-Ruwais, Jeddah, Saudi Arabia
| | - Omar P Sangueza
- Departments of Dermatology and Pathology, School of Medicine, Wake Forest University, Winston Salem, NC, USA
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2
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Thorpe B, Lage P, Beiras C, Bargas-Osorio K, Canseco F. Giant pleomorphic lipoma in patient with multiple osteochondromatosis. J Surg Case Rep 2024; 2024:rjae353. [PMID: 38817778 PMCID: PMC11137670 DOI: 10.1093/jscr/rjae353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024] Open
Abstract
Pleomorphic lipomas are infrequent soft tissue tumours with pseudosarcomatous behaviour. Their polymorphism provides them certain characteristics that may resemble malignancy, which may mislead the initial diagnosis. The presented case report is a 45-year-old man with a giant growing tumour on the left cervicoscapular region initially categorised as a liposarcoma by magnetic resonance with a final confirmed diagnosis of pleomorphic lipoma after the surgical resection and the examination of the pathologist. The patient presented important functional restriction of the upper left extremity, which decreased after surgical resection, improving the quality of life.
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Affiliation(s)
- Benjamin Thorpe
- General Surgery Department, Hospital Clinico Universitario de Santiago de Compostela, Rua Choupana s/n, Santiago de Compostela 15706, Spain
| | - Paloma Lage
- Plastic Surgery Department, Hospital Clinico Universitario de Santiago de Compostela, Rua Choupana s/n, Santiago de Compostela 15706, Spain
| | - Carolina Beiras
- General Surgery Department, Hospital Clinico Universitario de Santiago de Compostela, Rua Choupana s/n, Santiago de Compostela 15706, Spain
| | - Kelly Bargas-Osorio
- Pathology Department, Hospital Clinico Universitario de Santigao de Compostela, Rua Choupana s/n, Santiago de Compostela 15706, Spain
| | - Francisco Canseco
- Plastic Surgery Department, Hospital Clinico Universitario de Santiago de Compostela, Rua Choupana s/n, Santiago de Compostela 15706, Spain
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3
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Ahuja S, Madan NK, Khan AA, Zaheer S. Pleomorphic Lipoma of the Parotid Gland: A Potential Cytological Pitfall. Indian J Otolaryngol Head Neck Surg 2024; 76:2066-2070. [PMID: 38566631 PMCID: PMC10982250 DOI: 10.1007/s12070-023-04400-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 04/04/2024] Open
Abstract
Pleomorphic lipoma is an uncommon benign adipocytic tumor that arises from the subcutis. It has no risk of recurrence, metastasis or malignant transformation. The cytological findings of pleomorphic lipoma are often overdiagnosed as suspicious of malignancy owing to the pleomorphic morphology of the floret giant cells. We present a rare case of pleomorphic lipoma of the parotid gland which was misdiagnosed as a malignant tumor on fine needle aspiration cytology. Histopathological examination and positive expression for CD34 helped to arrive at the final diagnosis. Awareness about this rare entity will prevent overdiagnosis as a malignant tumor and unnecessary radical resections for this benign tumor.
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Affiliation(s)
- Sana Ahuja
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Neha Kawatra Madan
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Adil Aziz Khan
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sufian Zaheer
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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4
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Montaser Kouhsari L, LeBoit PE, McCalmont TH, Hinds B, North JP. Histopathologic and Genetic Findings in Atypical Spindle Cell/Pleomorphic Lipomatous Tumors and Atypical Pleomorphic Fibromas. J Cutan Pathol 2022; 49:623-631. [PMID: 35332938 DOI: 10.1111/cup.14230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 02/15/2022] [Accepted: 03/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Spindle cell lipomas, pleomorphic lipomas (SCL/PLs) and pleomorphic fibromas (PF) are tumors with loss of retinoblastoma (RB). The latest World Health Organization classification includes a category of atypical spindle cell/pleomorphic lipomatous tumors (ASPLT) that encompasses tumors in this spectrum that show atypical histopathologic features. We have observed PFs that show similar atypical features. METHODS Cases of SCL/PL and PF with atypical features were collected from tissue archives between 2010-2019. Genetic alterations were investigated using array comparative genomic hybridization (aCGH). RESULT Of 15 cases found, most tumors were dermal-based with fibrocytic or fibroadipocytic appearance and occasional lipoblasts. All cases had a high proliferation index with atypical mitotic figures in 71% of cases. Chromosome 13q loss was present in all cases with CGH data. Additional recurrent chromosomal losses included 17p, 16q, 17q, 20p, 4, and 10. No recurrence was found in limited follow up. CONCLUSIONS ASPLTs are characterized by loss of RB, prominent nuclear pleomorphism, mitotic activity including atypical mitotic figures, and genomic instability with multiple chromosomal aberrations. A similar group of tumors with these histopathologic features lacks lipomatous differentiation, and we propose the diagnosis of atypical PF as a fibromatous variant of ASPLT. Limited clinical follow up appears benign.
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Affiliation(s)
- Laleh Montaser Kouhsari
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Philip E LeBoit
- Departments of Pathology and Dermatology, University of California San Francisco, San Francisco, California, United States
| | - Timothy H McCalmont
- Departments of Pathology and Dermatology, University of California San Francisco, San Francisco, California, United States
| | - Brian Hinds
- Department of Dermatology, University of California San Diego, San Diego, California, United States
| | - Jeffrey P North
- Departments of Pathology and Dermatology, University of California San Francisco, San Francisco, California, United States
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5
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Hammer PM, Kunder CA, Howitt BE, Charville GW. Well-differentiated lipomatous neoplasms with p53 alterations: a clinicopathological and molecular study of eight cases with features of atypical pleomorphic lipomatous tumour. Histopathology 2022; 80:656-664. [PMID: 34725851 PMCID: PMC8860877 DOI: 10.1111/his.14593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 10/28/2021] [Accepted: 10/31/2021] [Indexed: 11/29/2022]
Abstract
AIMS Well-differentiated lipomatous neoplasms encompass a broad spectrum of benign and malignant tumours, many of which are characterised by recurrent genetic abnormalities. Although a key regulator of p53 signalling, MDM2, is characteristically amplified in well-differentiated liposarcoma, recurrent abnormalities of p53 itself have not been reported in well-differentiated adipocytic neoplasms. Here, we present a series of well-differentiated lipomatous tumours characterised by p53 alterations and histological features in keeping with atypical pleomorphic lipomatous tumour (APLT). METHODS AND RESULTS We reviewed the morphological, immunohistochemical and molecular genetic features of eight lipomatous tumours with p53 alterations. Four tumours arose in the thigh, and one case each arose in the shoulder, calf, upper back, and subclavicular regions; six tumours were deep/subfascial and two were subcutaneous. Relevant clinical history included two patients with Li-Fraumeni syndrome. Morphologically, all cases showed well-differentiated adipocytes with prominent nuclear pleomorphism, limited mitotic activity, and no tumour cell necrosis. All cases were negative for MDM2 overexpression and amplification as determined with immunohistochemistry and fluorescence in-situ hybridisation, respectively. Immunohistochemically, p16 was diffusely overexpressed in all cases; seven tumours (88%) showed abnormal loss of Rb and p53. TP53 mutation or deletion was identified in four of six tumours evaluated with exon-targeted hybrid capture-based massively parallel sequencing; RB1 mutation or deletion was present in five of six cases. CONCLUSIONS We present a series of eight well-differentiated lipomatous neoplasms characterised by p53 alterations in addition to Rb loss and histological features of APLT. These findings suggest that impaired p53 signalling may contribute to the pathogenesis of APLT in a subset of cases.
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Affiliation(s)
- Phoebe M Hammer
- Department of Pathology Stanford University School of Medicine Stanford CA USA
| | - Christian A Kunder
- Department of Pathology Stanford University School of Medicine Stanford CA USA
| | - Brooke E Howitt
- Department of Pathology Stanford University School of Medicine Stanford CA USA
| | - Gregory W Charville
- Department of Pathology Stanford University School of Medicine Stanford CA USA
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6
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Thway K. What’s new in adipocytic neoplasia? Histopathology 2021; 80:76-97. [DOI: 10.1111/his.14548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Khin Thway
- Sarcoma Unit Royal Marsden Hospital London UK
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7
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Nautiyal H, Egiz A, Farajzadeh S, Fazail AH, Nautiyal S. Epithelioid Variant of Pleomorphic Liposarcoma: A Rare Challenging Diagnosis Causing Severe Medial Thigh Pain. Cureus 2021; 13:e19531. [PMID: 34934551 PMCID: PMC8668048 DOI: 10.7759/cureus.19531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2021] [Indexed: 11/05/2022] Open
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Anderson WJ, Fletcher CDM, Jo VY. Atypical Pleomorphic Lipomatous Tumor: Expanding Our Current Understanding in a Clinicopathologic Analysis of 64 Cases. Am J Surg Pathol 2021; 45:1282-1292. [PMID: 33782225 DOI: 10.1097/pas.0000000000001706] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Atypical pleomorphic lipomatous tumor (APLT) is a recently recognized adipocytic neoplasm that lies on a spectrum with atypical spindle cell lipomatous tumor (ASCLT). APLT/ASCLT are included together in the fifth edition World Health Organization Classification of Soft Tissue and Bone Tumours; however limited data on APLT have emerged since its first description in 2017. This study aims to further define the clinicopathologic features of APLT in a large series of 64 cases. Histologic features and ancillary studies were reviewed, and clinical and follow-up data were obtained from referring institutions. Immunohistochemistry for MDM2, CDK4, CD34, Rb, S100, and desmin was performed in cases with available material. Patients were 24 females and 40 males, and the median age was 61 years (range, 20 to 89 y). Tumors arose in upper limb (33%), lower limb (31%), trunk (23%), head and neck (8%), breast (3%), and inguinal region (2%), with a median size of 5.4 cm (range, 1.5 to 14.5 cm). Tumor depth was mostly subcutaneous or deep/subfascial. Microscopically, APLTs were variably composed of atypical spindle and pleomorphic cells, adipocytes, and lipoblasts, often showing infiltrative growth, myxoid or collagenous stroma, and multinucleate floret cells. Mitoses were infrequent and necrosis was consistently absent. By immunohistochemistry, tumors expressed CD34 (63%), S100 (19%), and desmin (28%). APLT showed frequent loss of Rb (79%; 46/58). Rare cases showed staining for MDM2 (2%) or CDK4 (12%); however, fluorescence in situ hybridization was negative for MDM2 amplification in all cases tested (0/22). Follow-up in 28 patients (median duration: 21 mo) revealed a single patient with local recurrence (4%); no patient developed metastatic disease. Despite its frequently infiltrative growth, nuclear pleomorphism, and hypercellularity which can mimic sarcoma, APLT behaves in an indolent manner and should be distinguished from its more aggressive mimics, including atypical lipomatous tumor/well-differentiated liposarcoma and pleomorphic liposarcoma. Immunohistochemistry for CD34, S100, desmin, and Rb (demonstrating loss), as well as exclusion of MDM2 amplification, can support the diagnosis.
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Affiliation(s)
- William J Anderson
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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9
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The Rapidly Expanding Group of RB1-Deleted Soft Tissue Tumors: An Updated Review. Diagnostics (Basel) 2021; 11:diagnostics11030430. [PMID: 33802620 PMCID: PMC8000249 DOI: 10.3390/diagnostics11030430] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/21/2021] [Accepted: 02/26/2021] [Indexed: 11/17/2022] Open
Abstract
The classification of soft tissue tumors has evolved considerably in the last decade, largely due to advances in understanding the pathogenetic basis of many of these, sometimes rare, tumors. Deletion of Retinoblastoma 1 (RB1), a well-known tumor suppressor gene, has been implicated in the tumorigenesis of a particular group of soft tissue neoplasms. This group of so-called “RB1-deleted soft tissue tumors” has been rapidly expanding in recent years, currently consisting of spindle cell/pleomorphic lipoma, atypical spindle cell/pleomorphic lipomatous tumor, pleomorphic liposarcoma, myofibroblastoma, cellular angiofibroma, and acral fibromyxoma. Most of these neoplasms, except pleomorphic liposarcoma, are considered benign entities and are mainly described in the older adult population. This article will review the currently known morphological, immunohistochemical, and molecular features of this heterogeneous group of mesenchymal tumors with an emphasis on differential diagnosis.
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10
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Berg SH, Massoud CM, Jackson-Cook C, Boikos SA, Smith SC, Mochel MC. A Reappraisal of Superficial Pleomorphic Liposarcoma. Am J Clin Pathol 2020; 154:353-361. [PMID: 32525520 DOI: 10.1093/ajcp/aqaa045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Superficial pleomorphic liposarcoma (PL) has a favorable prognosis compared to deeply seated PL. Given developments in the classification of lipomatous neoplasms, we reappraised a series of cases. METHODS Retrospective clinicopathologic evaluation and genome-wide single-nucleotide polymorphism (SNP) microarray studies were performed for cases previously designated superficial PL. RESULTS Four cases were identified (age, 48-70 years). Two were dermally confined, whereas two were superficial subcutaneous; no recurrences or metastases were reported. Tumors demonstrated pleomorphic spindled morphology with variable cellularity. Multivacuolated atypical lipoblasts were focal in 3 and abundant in 1. Dermal tumors demonstrated atypical cells within sclerotic collagen. Genome-wide SNP microarray studies revealed consistent gains and losses, including losses at the 13q14.2 locus encompassing RB1 and DLEU2 and deletion/disruption of the TP53 locus. Although subcutaneous examples showed genomic changes similar to deep PL, the dermal examples showed fewer genetic alterations, including changes reported in the spectrum of atypical spindle cell/pleomorphic lipomatous tumors (ASPLT). All lacked MDM2 amplification. CONCLUSIONS Careful integration of histologic and genetic features may improve classification of lipomatous neoplasms with atypia, allowing reclassification of some superficial PL as ASPLT.
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Affiliation(s)
| | | | - Colleen Jackson-Cook
- Department of Pathology, Virginia Commonwealth University Health System, Richmond
- Department of Human and Molecular Genetics, Virginia Commonwealth University Health System, Richmond
| | - Sosipatros Alexander Boikos
- Department of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University Health System, Richmond
| | | | - Mark Cameron Mochel
- Department of Pathology, Virginia Commonwealth University Health System, Richmond
- Department of Dermatology, Virginia Commonwealth University Health System, Richmond
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McCarthy AJ, Carroll P, Vajpeyi R, Darling G, Chetty R. Well-Differentiated Liposarcoma (Atypical Lipomatous Tumor) Presenting as an Esophageal Polyp. J Gastrointest Cancer 2020; 50:589-595. [PMID: 29349606 DOI: 10.1007/s12029-018-0052-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Aoife J McCarthy
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto General Hospital, 200 Elizabeth Street, 11th Floor, Eaton Wing, Toronto, Ontario, M5G 2C4, Canada. .,University of Toronto, Toronto, Canada.
| | - Paul Carroll
- University of Toronto, Toronto, Canada.,Surgery and Critical Care Program, Departments of Thoracic Surgery and Surgical Oncology, University Health Network and University of Toronto, Toronto, Canada
| | - Rajkumar Vajpeyi
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto General Hospital, 200 Elizabeth Street, 11th Floor, Eaton Wing, Toronto, Ontario, M5G 2C4, Canada.,University of Toronto, Toronto, Canada
| | - Gail Darling
- University of Toronto, Toronto, Canada.,Surgery and Critical Care Program, Departments of Thoracic Surgery and Surgical Oncology, University Health Network and University of Toronto, Toronto, Canada
| | - Runjan Chetty
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto General Hospital, 200 Elizabeth Street, 11th Floor, Eaton Wing, Toronto, Ontario, M5G 2C4, Canada.,University of Toronto, Toronto, Canada
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12
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Spindle Cell Predominant Trichodiscoma or Spindle Cell Lipoma With Adnexal Induction? A Study of 25 Cases, Revealing a Subset of Cases With RB1 Heterozygous Deletion in the Spindle Cell Stroma. Am J Dermatopathol 2020; 41:637-643. [PMID: 30908293 DOI: 10.1097/dad.0000000000001358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In our routine and consultative pathology practices, we have noticed that a relatively high proportion of spindle cell predominant trichodiscomas demonstrate a remarkable stromal admixture of adipose tissue, which along with spindle cells, prominent collagen bundles and myxoid change closely resembles spindle cell lipoma (SCL). To clarify their possible relationship to SCL, 25 cases of trichodiscoma and fibrofolliculoma with stromal "lipomatous metaplasia" were collected and examined using immunohistochemical stains [CD34 and retinoblastoma-1 (RB1) protein] and fluorescence in situ hybridization (RB1 deletion). The patients ranged in age from 35 to 81 years (median 64 years). The male to female ratio was almost equal (14:11). All tumors with a known location were situated on the face with a special predilection for the nose. All cases were sporadic, with all patients having a single lesion and showing no clinical features of Birt-Hogg-Dubé syndrome. No case with available follow-up presented with a recurrence or an otherwise aggressive clinical course. Spindle cell stroma was immunohistochemically positive for CD34 in 16 of 20 cases, and 18 of 19 cases showed loss of RB1 staining in lesional spindle cells. Fluorescence in situ hybridization analysis detected RB1 gene heterozygous deletion in 6 of 20 cases. We conclude that despite the SCL-like appearance of the investigated cases, the majority of them supposedly represent genuine spindle cell predominant trichodiscomas with adipose tissue admixture. However, there was a subset of histopathologically indistinguishable cases with proved RB1 deletion, which likely represent SCL with trichodiscoma/fibrofolliculoma-like epithelial/adnexal induction rather than spindle cell predominant variant of trichodiscoma.
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13
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Jelinek JS, Wu A, Wallace M, Kumar D, Henshaw RM, Murphey MJ, Van Horn A, Aboulafia AJ. Imaging of spindle cell lipoma. Clin Radiol 2020; 75:396.e15-396.e21. [PMID: 31932047 DOI: 10.1016/j.crad.2019.11.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/26/2019] [Indexed: 11/28/2022]
Abstract
AIM To review the evaluation, diagnosis, and treatment of spindle cell lipoma (SCL) with emphasis on the location of these tumours and the spectrum of magnetic resonance imaging (MRI) and computed tomography (CT) appearances. MATERIALS AND METHODS The MRI and CT findings of 27 histopathologically proven SCLs were evaluated retrospectively. Imaging features evaluated included margins, percentage visible fat, MRI signal characteristics, oedema, and contrast enhancement patterns. RESULTS Patient ages ranged from 18 to 80 years with an average age of 56.5 years. Men were affected twice as frequently as women (M=18, F=9). SCLs ranged in size from 2 to 10 cm, with an average greatest dimension of 5.5 cm. Five lesions (19%) contained no visible fat on CT or MRI, and the leading differential diagnosis of high-grade soft-tissue sarcoma diagnosis was suggested by referring surgeons. Five lesions (19%) had <50% fatty areas, nine lesions (52%) demonstrated >50% but <90% fat at MRI or CT. Only three of 25 lesions (12%) had an appearance of a typical lipoma on unenhanced MRI sequences. All SCLs that were imaged with contrast medium (n = 18) demonstrated some degree of enhancement, with eight (44%) showing marked enhancement, four (22%) showing moderate, and six (33%) minimal enhancement. CONCLUSION SCLs have considerably variable imaging appearances and may have minimal or no visible fat at MRI or CT. Imaging features may make it difficult to distinguish this benign tumour from a potentially higher-grade malignant tumour.
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Affiliation(s)
- J S Jelinek
- Department of Radiology, MedStar Washington Hospital Center, 110 Irving Street, NW, Washington DC, 20010, USA.
| | - A Wu
- Department of Internal Medicine, MedStar Franklin Square Medical Center, 9000 Franklin Square Drive, Baltimore, MD, 21237, USA
| | - M Wallace
- Department of Orthopedic Oncology, MedStar Franklin Square Medical Center, 9000 Franklin Square Drive, Baltimore, MD, 21237, USA
| | - D Kumar
- Department of Radiology, MedStar Washington Hospital Center, 110 Irving Street, NW, Washington DC, 20010, USA
| | - R M Henshaw
- Department of Orthopedic Oncology, MedStar Franklin Square Medical Center, 9000 Franklin Square Drive, Baltimore, MD, 21237, USA
| | - M J Murphey
- American Institute for Radiologic Pathology, 1100 Wayne Avenue, Silver Spring, MD, 20910, USA
| | - A Van Horn
- Department of Orthopedic Oncology, MedStar Franklin Square Medical Center, 9000 Franklin Square Drive, Baltimore, MD, 21237, USA
| | - A J Aboulafia
- Department of Orthopedic Oncology, MedStar Franklin Square Medical Center, 9000 Franklin Square Drive, Baltimore, MD, 21237, USA
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Update on Lipomatous Tumors with Emphasis on Emerging Entities, Unusual Anatomic Sites, and Variant Histologic Patterns. Surg Pathol Clin 2019; 12:21-33. [PMID: 30709444 DOI: 10.1016/j.path.2018.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This article reviews the histologic patterns of spindle cell/pleomorphic lipoma, well-differentiated liposarcoma, and dedifferentiated liposarcoma in the context of both usual and atypical anatomic presentation. The utility of molecular and immunohistochemical diagnostic modalities to distinguish these entities is described. In addition, more recently described and controversial entities, including atypical spindle cell lipomatous tumor and anisometric cell lipoma, are discussed.
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15
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Abstract
Spindle cell/pleomorphic lipomas are benign lipomatous neoplasms that show loss of RB1 and classically harbor components of mature adipose tissue, bland spindled cells and ropy collagen. This review highlights the clinicopathologic features and morphologic spectrum of spindle cell/pleomorphic lipoma, discusses an updated differential diagnosis, and provides a practical diagnostic strategy for spindle cell/pleomorphic lipomas with atypical clinical presentations.
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Affiliation(s)
- Benjamin J Van Treeck
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
| | - Karen J Fritchie
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
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16
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Burkes JN, Campos L, Williams FC, Kim RY. Laryngeal Spindle Cell/Pleomorphic Lipoma: A Case Report. An In-Depth Review of the Adipocytic Tumors. J Oral Maxillofac Surg 2019; 77:1401-1410. [PMID: 30826392 DOI: 10.1016/j.joms.2019.01.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 02/06/2023]
Abstract
Spindle cell and pleomorphic lipomas (SC/PLs) are a rare form of lipomatous tumors. They typically occur as a slow-growing localized mass in the subcutaneous fatty tissue of the posterior neck, back, and shoulders. This benign variant represents less than 1.5% of all lipomas and is relatively uncommon in the head and neck area. A manifestation in the larynx is even rarer. Unlike other anatomic locations, laryngeal lipomas can pose life-threatening symptoms secondary to acute obstruction of the upper aerodigestive tract. This report presents a case of a large SC/PL of the larynx associated with hoarseness, dysphagia, globus sensation, and neck fullness. The tumor was successfully removed through an anterior transcervical approach with infrahyoid myotomy. The authors review the literature concerning head and neck adipocytic tumors with spindle cells and discuss the difficulties in distinguishing SC/PLs from liposarcomas. To the best of the authors' knowledge, this is the first case to be reported in the oral and maxillofacial surgery literature.
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Affiliation(s)
- Jason N Burkes
- Former Fellow, Head and Neck Oncologic and Microvascular Reconstructive Surgery, John Peter Smith Hospital, Fort Worth, TX; Associate Program Director, National Capital Consortium Oral Maxillofacial Surgery Residency Program, Walter Reed National Military Medical Center, Bethesda, MD
| | - Luisa Campos
- Resident, Department of Oral and Maxillofacial Surgery, Texas A&M College of Dentistry, Baylor University Medical Center, Dallas, TX
| | - Fayette C Williams
- Director of Maxillofacial Oncology and Reconstructive Surgery, John Peter Smith Hospital, Fort Worth, TX
| | - Roderick Y Kim
- Assistant Fellowship Director, Head and Neck Oncologic and Microvascular Reconstructive Surgery, John Peter Smith Hospital, Fort Worth, TX.
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Goh GH, Putti TC, Ngo R, Agaimy A, Petersson F. Primary Pleomorphic Lipoma of the Parotid Gland with Prominent Myxoid Change: Report of a Rare Case Mimicking Carcinoma Ex Pleomorphic Adenoma on Fine Needle Aspiration Cytology. Head Neck Pathol 2019; 14:246-249. [PMID: 30610525 PMCID: PMC7021853 DOI: 10.1007/s12105-018-00998-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 12/29/2018] [Indexed: 11/25/2022]
Abstract
We present a case of a primary 2.5 cm pleomorphic lipoma of the right parotid gland with prominent myxoid change which on FNA displayed features that mimicked a carcinoma or sarcoma ex pleomorphic adenoma. The patient was a 79 year old man with no oncological history or tumor elsewhere. On immunohistochemistry the neoplastic cells strongly expressed CD34. There was no expression of retinoblastoma protein, smooth muscle actin, S100-protein or cytokeratins (AE1/3 and CAM5.2). The Ki-67 proliferation index was low (< 2%). Fluorescence in situ hybridization was negative for MDM2 gene amplification.
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Affiliation(s)
- Giap Hean Goh
- Department of Pathology, National University Hospital, Singapore, Singapore
| | | | - Raymond Ngo
- Department of Otolaryngology - Head and Neck Surgery (ENT), National University Hospital, Singapore, Singapore
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Friedrich Alexander University (FAU), Erlangen, Germany
| | - Fredrik Petersson
- Department of Pathology, National University Hospital, Singapore, Singapore.
- Department of Pathology, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
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Lipoblastoma-like tumor of the vulva: a clinicopathologic, immunohistochemical, fluorescence in situ hybridization and genomic copy number profiling study of seven cases. Mod Pathol 2018; 31:1862-1868. [PMID: 29976943 DOI: 10.1038/s41379-018-0102-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/28/2018] [Accepted: 05/28/2018] [Indexed: 11/09/2022]
Abstract
Lipoblastoma-like tumor of the vulva was first described as a benign mesenchymal neoplasm of adipocytic differentiation having features of lipoblastoma, myxoid liposarcoma, and spindle cell lipoma. Prior studies of lipoblastoma-like tumor have evaluated PLAG1, HMGA2, and RB1 immunohistochemistry and DDIT3 rearrangement status, with results supporting its distinction from lipoblastoma and myxoid liposarcoma. However, absent RB1 expression was reported in a majority of tested cases, suggesting that lipoblastoma-like tumor may have underlying 13q alterations and be related to RB1-deleted soft tissue tumors. To further understand the molecular genetics of lipoblastoma-like tumor, we examined 7 cases by RB1 immunohistochemistry, DDIT3 and PLAG1 break apart FISH probes, RB1 enumeration FISH probe, and genomic copy number analysis by microarray. Patient age ranged from 21 to 56 years (median 35 years). Clinical follow up was available for 5 patients (71%) ranging 3-264 months (median 74 months). Microscopically, lipoblastoma-like tumor formed large lobules separated by thin and/or thick bands of fibrous tissue and had a prominent network of thin-walled vessels. Each tumor was predominantly composed of spindle cells and lipoblasts with variable quantities of mature adipocytes. RB1 immunohistochemistry exhibited a heterogeneous or "mosaic" pattern of weak and negative nuclear expression in all seven cases. DDIT3 and PLAG1 FISH were negative in each case. No evidence of RB1 regional gain or loss was identified by FISH. Genomic copy number analysis by chromosomal microarray showed a normal diploid profile in six tumors (86%). One tumor had copy number abnormalities consisting of an 11.9 megabase deletion from 1p13.3 to 1p11.2 and monosomy 14. Although lipoblastoma-like tumor has features of lipoblastoma, myxoid liposarcoma, and spindle cell lipoma, it is genetically different from these tumors. Furthermore, lipoblastoma-like tumor does not appear to have structural abnormalities of 13q resulting in deletion of RB1.
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20
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Babaoğlu B, Ercin ME, Kösemehmetoğlu K. Atypical mitoses are present in otherwise classical pleomorphic lipomas. Hum Pathol 2018; 81:299-300. [DOI: 10.1016/j.humpath.2018.04.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/20/2018] [Indexed: 10/28/2022]
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Michal M, Kazakov DV, Michalova K, Michal M. Atypical multivacuolated lipoblasts and atypical mitoses are not compatible with the diagnosis of spindle cell/pleomorphic lipoma—reply. Hum Pathol 2018; 74:189. [DOI: 10.1016/j.humpath.2017.11.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
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Creytens D, Mentzel T, Ferdinande L, van Gorp J, Van Dorpe J, Flucke U. Atypical multivacuolated lipoblasts and atypical mitoses are not compatible with the diagnosis of spindle cell/pleomorphic lipoma. Hum Pathol 2018; 74:188-189. [DOI: 10.1016/j.humpath.2017.11.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/24/2017] [Indexed: 11/30/2022]
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McCarthy AJ, Chetty R. Tumours composed of fat are no longer a simple diagnosis: an overview of fatty tumours with a spindle cell component. J Clin Pathol 2018; 71:483-492. [PMID: 29358476 DOI: 10.1136/jclinpath-2017-204975] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 12/24/2017] [Indexed: 12/16/2022]
Abstract
This is a review of the morphological spectrum of fatty tumours containing a component of spindle cells, highlighting the immunohistochemical and cytogenetic workup that is now mandatory for accurate diagnosis, with the goal of providing a practical approach for practising surgical pathologists. There have been significant advances in recent years in classifying and understanding the pathogenesis of fatty tumours with spindle cells, based on the correlation of histological, immunohistochemical and cytogenetic/molecular findings. In spite of this, morphological diagnosis and accurate classification of fatty tumours with spindle cells can be challenging to diagnostic pathologists. A group of three lesions: spindle cell lipoma, mammary-type myofibroblastoma and cellular angiofibroma share morphological features and are united by retinoblastoma protein (pRb) loss. Closely allied to these lesions, especially spindle cell lipoma is the newly designated atypical spindle cell lipomatous tumour, which shares morphological, immunohistochemical and cytogenetic features with the trio of tumours lacking nuclear pRb. All of these lesions lack MDM2 and CDK4 amplification as well and separation is based on clinical features, principally location. Atypical lipomatous tumour or well-differentiated liposarcoma shows retention of pRb but overexpression and amplification of MDM2. Fatty tumours with spindle cells need to be extensively sampled, with careful attention paid to cellular atypia and location, and they need to have immunohistochemical workup with pRb, MDM2, desmin, CD34 and p16. In addition, cytogenetic analysis for MDM2 and CDK4 amplification has become crucial for the proper identification of these lesions.
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Affiliation(s)
- Aoife J McCarthy
- Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada
| | - Runjan Chetty
- Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada
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Michal M, Babaoglu B, Kazakov DV, Michal, Kosemehmetoglu K. Atypical mitoses in pleomorphic lipomas. Hum Pathol 2017; 70:143. [DOI: 10.1016/j.humpath.2017.06.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/21/2017] [Indexed: 11/16/2022]
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Anisometric cell lipoma: Insight from a case series and review of the literature on adipocytic neoplasms in survivors of retinoblastoma suggest a role for RB1 loss and possible relationship to fat-predominant (“fat-only”) spindle cell lipoma. Ann Diagn Pathol 2017; 29:52-56. [DOI: 10.1016/j.anndiagpath.2017.04.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 04/10/2017] [Indexed: 11/21/2022]
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