Difference between revisions of "Adipocytic tumours"

From Libre Pathology
Jump to navigation Jump to search
(→‎Lipoma: angiolipoma)
 
(96 intermediate revisions by 2 users not shown)
Line 1: Line 1:
'''Adipocytic tumours''' fall into the grouping ''[[soft tissue lesions]]'' and includes things that are very common (e.g. lipoma) and everything from benign to malignant.   
'''Adipocytic tumours''' fall into the grouping ''[[soft tissue lesions]]'' and includes things that are very common (e.g. lipoma) and everything from benign to malignant.   


==Lipoma==
=Overview=
===General===
This grouping includes a number of tumours, which can be divided based on their behaviour into ''benign'', ''intermediate'' and ''malignant''.
*Benign.
 
*Several variants exist.
==Benign==
**Angiolipoma - one of the (classically) [[painful skin lesions]].
Benign adipocytic tumours:<ref name=Ref_WMSP_601>{{Ref WMSP|601}}</ref>
*[[Lipoma]].
*[[Angiolipoma]].
*[[Myolipoma]].
*[[Pleomorphic lipoma]]/[[spindle cell lipoma]].
*Lipomatosis.
*Lipomatosis of nerve.
*[[Lipoblastoma]].
*Extrarenal [[angiomyolipoma]].
*Extra-adrenal [[myelolipoma]].
*[[Hibernoma]].
 
==Intermediate==
Intermediate adipocytic tumours:<ref name=Ref_WMSP_601>{{Ref WMSP|601}}</ref>
*Atypical lipomatous tumour.
 
==Malignant==
Malignant adipocytic tumours:<ref name=Ref_WMSP_601>{{Ref WMSP|601}}</ref>
*Dedifferentiated liposarcoma.
*Myxoid liposarcoma.
*Pleomorphic liposarcoma.
*Mixed-type liposarcoma.
*Liposarcoma NOS.


=Detail section=
==Normal mature fat==
===Microscopic===
===Microscopic===
Features:
Features:
*Collection of mature adipocytes.
*Adipocytes of approximately equal size.
**Variation of size may be seen -- should prompt a search for lipoblasts.<ref name=pmid8548119>PMID 8548119.</ref>
*Not vascular.
*No nuclear hyperchromasia.


Notes:
Notes:
*Microscopically ''not'' definitely distinguishable from mature clump of fat.
*May have nuclear pseudoinclusions (Lockhern cell).<ref>URL: [http://journals.lww.com/amjdermatopathology/Citation/2004/12000/Original_Observation_to_Rediscovery__Nuclear.9.aspx http://journals.lww.com/amjdermatopathology/Citation/2004/12000/Original_Observation_to_Rediscovery__Nuclear.9.aspx]. Accessed on: 18 April 2011.</ref>
**The lesion must be labeled ''lipoma'' to be signed-out as such.
**There is some suggestion this is not benign.<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970574-5 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970574-5]. Accessed on: 18 April 2011.</ref>
 
===IHC===
*[[S-100]] +ve.


==Pleomorphic lipoma==
==Lipoblastoma==
===General===
===General===
*???
*Rare paediatric tumour.<ref name=pmid20472310>{{Cite journal  | last1 = Pham | first1 = NS. | last2 = Poirier | first2 = B. | last3 = Fuller | first3 = SC. | last4 = Dublin | first4 = AB. | last5 = Tollefson | first5 = TT. | title = Pediatric lipoblastoma in the head and neck: a systematic review of 48 reported cases. | journal = Int J Pediatr Otorhinolaryngol | volume = 74 | issue = 7 | pages = 723-8 | month = Jul | year = 2010 | doi = 10.1016/j.ijporl.2010.04.010 | PMID = 20472310 }}</ref>


Usual presentation:<ref name=pmid20472310/>
*Painless neck mass.
===Microscopic===
===Microscopic===
Features:
Features:
*Multinucleated cells - "floret cells".
*Nests of cells in the dermis with abundant pale cytoplasm - vaguely resemble adipocytes.
**Very ugly looking cells.
**Smaller than mature adipocytes.
*Fibrous septa.
 
DDx:
*[[Myxoid liposarcoma]].<ref name=pmid21212605>{{Cite journal  | last1 = Nagano | first1 = A. | last2 = Ohno | first2 = T. | last3 = Nishimoto | first3 = Y. | last4 = Hirose | first4 = Y. | last5 = Miyake | first5 = S. | last6 = Shimizu | first6 = K. | title = Lipoblastoma mimicking myxoid liposarcoma: a clinical report and literature review. | journal = Tohoku J Exp Med | volume = 223 | issue = 1 | pages = 75-8 | month =  | year = 2011 | doi =  | PMID = 21212605 }}</ref>
 
Images:
*[http://www.sarcomaimages.com/index.php?v=Lipoblastoma Lipoblastoma (sarcomaimages.com)].
 
==Lipoblastoma like tumor==
 
[[File: 5 22974716644038 sl 1.png|Lipoblastoma like tumor]]
[[File: 5 22974716644038 sl 2.png|Lipoblastoma like tumor]]
[[File: 5 22974716644038 sl 3.png|Lipoblastoma like tumor]]
[[File: 5 22974716644038 sl 4.png|Lipoblastoma like tumor]]
 
 
Lipoblastoma like tumor in 26 yo woman, tumor of pelvis. A. Lobulated appearance at low power. B. Cytologically bland lipoblasts with a myxoid stroma. C. Numerous thin-walled branching blood vessels. D. Loose collagenous stroma. The morphologic features, combined with molecular findings of negative DDI T3 gene rearrangement and lack of MDM2 amplification permit the diagnosis.
 
==Lipoma==
{{Main|Lipoma}}


Image: [http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970321-7&figureId=fig9 Floret cells in a pleomorphic lipooma (pathconsultddx.com)].<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970321-7 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970321-7]. Accessed on: 4 December 2010.</ref>
==Pleomorphic lipoma==
{{Main|Pleomorphic lipoma}}


Notes:
==Spindle cell lipoma==
*May overlap with ''spindle cell lipoma''.<ref>URL: [http://surgpathcriteria.stanford.edu/softfat/spindle_cell_lipoma/ http://surgpathcriteria.stanford.edu/softfat/spindle_cell_lipoma/]. Accessed on: 4 December 2010.</ref>
{{Main|Spindle cell lipoma}}


==Hibernoma==
==Hibernoma==
===General===
{{Main|Hibernoma}}
*Consists of ''brown fat'' (present in the infants to generate heat).<ref name=Ref_WMSP605>{{Ref WMSP|605}}</ref>
*Benign.
*Usually asymptomatic.<ref name=pmid19131775>{{cite journal |author=Ahmed SA, Schuller I |title=Pediatric hibernoma: a case review |journal=J. Pediatr. Hematol. Oncol. |volume=30 |issue=12 |pages=900–1 |year=2008 |month=December |pmid=19131775 |doi=10.1097/MPH.0b013e318184e6dd |url=}}</ref>


===Epidemiology===
==Atypical lipomatous tumour==
*Young adults.
*[[AKA]] ''well-differentiated liposarcoma'', abbreviated ''WDLPS''.<ref name=pmid24659226>{{Cite journal  | last1 = Creytens | first1 = D. | last2 = van Gorp | first2 = J. | last3 = Savola | first3 = S. | last4 = Ferdinande | first4 = L. | last5 = Mentzel | first5 = T. | last6 = Libbrecht | first6 = L. | title = Atypical spindle cell lipoma: a clinicopathologic, immunohistochemical, and molecular study emphasizing its relationship to classical spindle cell lipoma. | journal = Virchows Arch | volume = 465 | issue = 1 | pages = 97-108 | month = Jul | year = 2014 | doi = 10.1007/s00428-014-1568-8 | PMID = 24659226 }}</ref>
*Abbreviated ''ALT/WDLPS''.


===Gross===
===General===
*Well-circumscribed.
*''Atypical lipomatous tumour'' is a term used to save people with a (curable) peripheral liposarcoma from getting denied life insurance.
*Lobulated and light-brown on sectioning.


===Microscopic===
===Microscopic===
Features:<ref>{{cite journal |author=Chen DY, Wang CM, Chan HL |title=Hibernoma. Case report and literature review |journal=Dermatol Surg |volume=24 |issue=3 |pages=393–5 |year=1998 |month=March |pmid=9537018 |doi= |url=}}</ref>
Features:<ref>{{Ref WMSP|605}}</ref>
*Large polygonal/oval cells:
*Large adipocytes.
**Nucleus - central & small.<ref>[http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)70271-6 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)70271-6]</ref>
*Atypical lipoblasts - focal, scattered:
***Nucleoli typically prominent.<ref>[http://surgpathcriteria.stanford.edu/softfat/hibernoma/ http://surgpathcriteria.stanford.edu/softfat/hibernoma/]</ref>
**Nuclear hyperchromasia.
**Cytoplasm - multivacuolated, oval, eosinophilic, granular.
**+/-Multinucleated.
 
Image:
*[http://en.wikipedia.org/wiki/File:Hibernoma1.jpg Hibernoma (WC)].


==Liposarcoma==
==Liposarcoma==
*Most common malignant sarcoma in the retroperitoneum.
{{Main|Liposarcoma}}


===Microscopy===
==Angiolipoma==
Features:
*Lipoblasts:
**Large sharply demarcated vacuole.
**Nucleus:
***Hyperchromatic (dark staining) nucleus.
***Eccentric location.
***Nuclear indentation.


Images:
===General===
*[http://commons.wikimedia.org/wiki/File:Myxoid_liposarcoma_%2806%29.JPG Myxoid liposarcoma (WC)].
*May be syndromic - typically [[autosomal recessive]].<ref name=pmid25671454>{{cite journal |authors=Garib G, Siegal GP, Andea AA |title=Autosomal-dominant familial angiolipomatosis |journal=Cutis |volume=95 |issue=1 |pages=E26–9 |date=January 2015 |pmid=25671454 |doi= |url=}}</ref>
*[http://commons.wikimedia.org/wiki/File:Myxoid_liposarcoma_%2805%29.JPG Myxoid liposarcoma (WC)].
*Can be seen in the context of [[Birt–Hogg–Dubé syndrome]].<ref name=pmid8734663>{{cite journal |authors=Chung JY, Ramos-Caro FA, Beers B, Ford MJ, Flowers F |title=Multiple lipomas, angiolipomas, and parathyroid adenomas in a patient with Birt-Hogg-Dube syndrome |journal=Int J Dermatol |volume=35 |issue=5 |pages=365–7 |date=May 1996 |pmid=8734663 |doi=10.1111/j.1365-4362.1996.tb03642.x |url=}}</ref>
*[http://www.john-libbey-eurotext.fr/e-docs/00/04/09/14/texte_alt_jleejd00046_gr5.jpg Lipoblasts (john-libbey-eurotext.fr)].
*[[Painful skin lesion]].


===IHC===
===Microscopic===
*IHC is of limited value.
Features:
*Adipose tissue.
*Small blood vessels (clustered).


*S-100 +ve ~1/3 of the time.
DDx:
*Reticulin ???.
*[[Liposarcoma]].


==See also==
=See also=
*[[Soft tissue lesions]].
*[[Soft tissue lesions]].
*[[Bone]].
*[[Bone]].
*[[Brown fat]].


==References==
=References=
{{Reflist|2}}
{{Reflist|2}}


[[Category:Adipocytic tumours]]
[[Category:Soft tissue lesions]]
[[Category:Soft tissue lesions]]

Latest revision as of 15:51, 22 April 2024

Adipocytic tumours fall into the grouping soft tissue lesions and includes things that are very common (e.g. lipoma) and everything from benign to malignant.

Overview

This grouping includes a number of tumours, which can be divided based on their behaviour into benign, intermediate and malignant.

Benign

Benign adipocytic tumours:[1]

Intermediate

Intermediate adipocytic tumours:[1]

  • Atypical lipomatous tumour.

Malignant

Malignant adipocytic tumours:[1]

  • Dedifferentiated liposarcoma.
  • Myxoid liposarcoma.
  • Pleomorphic liposarcoma.
  • Mixed-type liposarcoma.
  • Liposarcoma NOS.

Detail section

Normal mature fat

Microscopic

Features:

  • Adipocytes of approximately equal size.
  • Not vascular.
  • No nuclear hyperchromasia.

Notes:

  • May have nuclear pseudoinclusions (Lockhern cell).[2]
    • There is some suggestion this is not benign.[3]

IHC

Lipoblastoma

General

  • Rare paediatric tumour.[4]

Usual presentation:[4]

  • Painless neck mass.

Microscopic

Features:

  • Nests of cells in the dermis with abundant pale cytoplasm - vaguely resemble adipocytes.
    • Smaller than mature adipocytes.

DDx:

Images:

Lipoblastoma like tumor

Lipoblastoma like tumor Lipoblastoma like tumor Lipoblastoma like tumor Lipoblastoma like tumor


Lipoblastoma like tumor in 26 yo woman, tumor of pelvis. A. Lobulated appearance at low power. B. Cytologically bland lipoblasts with a myxoid stroma. C. Numerous thin-walled branching blood vessels. D. Loose collagenous stroma. The morphologic features, combined with molecular findings of negative DDI T3 gene rearrangement and lack of MDM2 amplification permit the diagnosis.

Lipoma

Main article: Lipoma

Pleomorphic lipoma

Main article: Pleomorphic lipoma

Spindle cell lipoma

Main article: Spindle cell lipoma

Hibernoma

Main article: Hibernoma

Atypical lipomatous tumour

  • AKA well-differentiated liposarcoma, abbreviated WDLPS.[6]
  • Abbreviated ALT/WDLPS.

General

  • Atypical lipomatous tumour is a term used to save people with a (curable) peripheral liposarcoma from getting denied life insurance.

Microscopic

Features:[7]

  • Large adipocytes.
  • Atypical lipoblasts - focal, scattered:
    • Nuclear hyperchromasia.
    • +/-Multinucleated.

Liposarcoma

Main article: Liposarcoma

Angiolipoma

General

Microscopic

Features:

  • Adipose tissue.
  • Small blood vessels (clustered).

DDx:

See also

References

  1. ↑ 1.0 1.1 1.2 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 601. ISBN 978-0781765275.
  2. ↑ URL: http://journals.lww.com/amjdermatopathology/Citation/2004/12000/Original_Observation_to_Rediscovery__Nuclear.9.aspx. Accessed on: 18 April 2011.
  3. ↑ URL: http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970574-5. Accessed on: 18 April 2011.
  4. ↑ 4.0 4.1 Pham, NS.; Poirier, B.; Fuller, SC.; Dublin, AB.; Tollefson, TT. (Jul 2010). "Pediatric lipoblastoma in the head and neck: a systematic review of 48 reported cases.". Int J Pediatr Otorhinolaryngol 74 (7): 723-8. doi:10.1016/j.ijporl.2010.04.010. PMID 20472310.
  5. ↑ Nagano, A.; Ohno, T.; Nishimoto, Y.; Hirose, Y.; Miyake, S.; Shimizu, K. (2011). "Lipoblastoma mimicking myxoid liposarcoma: a clinical report and literature review.". Tohoku J Exp Med 223 (1): 75-8. PMID 21212605.
  6. ↑ Creytens, D.; van Gorp, J.; Savola, S.; Ferdinande, L.; Mentzel, T.; Libbrecht, L. (Jul 2014). "Atypical spindle cell lipoma: a clinicopathologic, immunohistochemical, and molecular study emphasizing its relationship to classical spindle cell lipoma.". Virchows Arch 465 (1): 97-108. doi:10.1007/s00428-014-1568-8. PMID 24659226.
  7. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 605. ISBN 978-0781765275.
  8. ↑ Garib G, Siegal GP, Andea AA (January 2015). "Autosomal-dominant familial angiolipomatosis". Cutis 95 (1): E26–9. PMID 25671454.
  9. ↑ Chung JY, Ramos-Caro FA, Beers B, Ford MJ, Flowers F (May 1996). "Multiple lipomas, angiolipomas, and parathyroid adenomas in a patient with Birt-Hogg-Dube syndrome". Int J Dermatol 35 (5): 365–7. doi:10.1111/j.1365-4362.1996.tb03642.x. PMID 8734663.
Retrieved from "https://librepathology.org/w/index.php?title=Adipocytic_tumours&oldid=52902"