Difference between revisions of "Adipocytic tumours"

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==Benign==
==Benign==
Benign adipocytic tumours:<ref name=Ref_WMSP_601>{{Ref WMSP|601}}</ref>
Benign adipocytic tumours:<ref name=Ref_WMSP_601>{{Ref WMSP|601}}</ref>
*Lipoma.
*[[Lipoma]].
*Angiolipoma.
*[[Angiolipoma]].
*Myolipoma.
*[[Myolipoma]].
*Pleomorphic lipoma/spindle cell lipoma.
*[[Pleomorphic lipoma]]/[[spindle cell lipoma]].
*Lipomatosis.
*Lipomatosis.
*Lipomatosis of nerve.
*Lipomatosis of nerve.
*Lipoblastoma.
*[[Lipoblastoma]].
*Extrarenal [[angiomyolipoma]].
*Extrarenal [[angiomyolipoma]].
*Extra-adrenal myelolipoma.
*Extra-adrenal [[myelolipoma]].
*Hibernoma.
*[[Hibernoma]].


==Intermediate==
==Intermediate==
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===IHC===
===IHC===
*S100 +ve.
*[[S-100]] +ve.


==Lipoma==
==Lipoblastoma==
===General===
===General===
*Benign.
*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>
*Several variants exist.
**Angiolipoma - one of the (classically) [[painful skin lesions]].


Usual presentation:<ref name=pmid20472310/>
*Painless neck mass.
===Microscopic===
===Microscopic===
Features:
Features:
*Collection of mature adipocytes.
*Nests of cells in the dermis with abundant pale cytoplasm - vaguely resemble adipocytes.
**Variation of size may be seen -- should prompt a search for lipoblasts.<ref name=pmid8548119>{{Cite journal  | last1 = Mentzel | first1 = T. | last2 = Fletcher | first2 = CD. | title = Lipomatous tumours of soft tissues: an update. | journal = Virchows Arch | volume = 427 | issue = 4 | pages = 353-63 | month =  | year = 1995 | doi =  | PMID = 8548119 }}</ref>
**Smaller than mature adipocytes.


Notes:
DDx:
*Microscopically ''not'' definitely distinguishable from mature clump of fat.
*[[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>
**The lesion must be labeled ''lipoma'' to be signed-out as such.


Images:
Images:
*[http://circ.ahajournals.org/content/113/21/e778/F5.expansion.html Lipoma - cardiac (ahajournals.org)].<ref name=pmid16735681>{{Cite journal  | last1 = Friedberg | first1 = MK. | last2 = Chang | first2 = IL. | last3 = Silverman | first3 = NH. | last4 = Ramamoorthy | first4 = C. | last5 = Chan | first5 = FP. | title = Images in cardiovascular medicine. Near sudden death from cardiac lipoma in an adolescent. | journal = Circulation | volume = 113 | issue = 21 | pages = e778-9 | month = May | year = 2006 | doi = 10.1161/CIRCULATIONAHA.105.589630 | PMID = 16735681 | url = http://circ.ahajournals.org/content/113/21/e778.full }}</ref>
*[http://www.sarcomaimages.com/index.php?v=Lipoblastoma Lipoblastoma (sarcomaimages.com)].


====Variants====
==Lipoblastoma like tumor==
=====Angiolipoma=====
Microscopic:
*Numerous blood vessels present.
=====Myolipoma=====
Microscopic:
*Muscle present.


==Pleomorphic lipoma==
[[File: 5 22974716644038 sl 1.png|Lipoblastoma like tumor]]
===General===
[[File: 5 22974716644038 sl 2.png|Lipoblastoma like tumor]]
*Rare.
[[File: 5 22974716644038 sl 3.png|Lipoblastoma like tumor]]
*May mimic a malignancy.<ref name=pmid15510605>{{Cite journal  | last1 = Persichetti | first1 = P. | last2 = Di Lella | first2 = F. | last3 = Marangi | first3 = GF. | last4 = Cagli | first4 = B. | last5 = Simone | first5 = P. | last6 = Tenna | first6 = S. | last7 = Rabitri | first7 = C. | last8 = Cassandro | first8 = R. | last9 = Esposito | first9 = V. | title = Pleomorphic lipoma: a definite histopathological entity. | journal = Anticancer Res | volume = 24 | issue = 5B | pages = 3157-9 | month =  | year =  | doi =  | PMID = 15510605 }}</ref>
[[File: 5 22974716644038 sl 4.png|Lipoblastoma like tumor]]
*Classically shoulder and neck region in adults.<ref>URL: [http://www.webpathology.com/image.asp?n=2&Case=435 http://www.webpathology.com/image.asp?n=2&Case=435]. Accessed on: 3 October 2011.</ref>
*Male > female.<ref name=pmid18181679>{{Cite journal  | last1 = Syed | first1 = S. | last2 = Martin | first2 = AM. | last3 = Haupt | first3 = H. | last4 = Podolski | first4 = V. | last5 = Brooks | first5 = JJ. | title = Frequent detection of androgen receptors in spindle cell lipomas: an explanation for this lesion's male predominance? | journal = Arch Pathol Lab Med | volume = 132 | issue = 1 | pages = 81-3 | month = Jan | year = 2008 | doi = 10.1043/1543-2165(2008)132[81:FDOARI]2.0.CO;2 | PMID = 18181679 }}</ref>


===Microscopic===
Features:
*Multinucleated cells - "floret cells" - '''key feature'''.
**Solid eosinophilic cytoplasm.
**Peripheral nuclei - impart a knobby border to the cells.
*Fibrous septa.


Notes:
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.
*May overlap with ''spindle cell lipoma''.<ref name=spc_stanford>URL: [http://surgpathcriteria.stanford.edu/softfat/spindle_cell_lipoma/ http://surgpathcriteria.stanford.edu/softfat/spindle_cell_lipoma/]. Accessed on: 4 December 2010.</ref>
*Floret cell - may look similar to [[Touton giant cell]]s.


Images:
==Lipoma==
*[http://www.webpathology.com/image.asp?case=435&n=1 Pleomorphic lipoma - low mag. (webpathology.com)].
{{Main|Lipoma}}
*[http://www.webpathology.com/image.asp?n=2&Case=435 Pleomorphic lipoma - high mag. (webpathology.com)].


DDx:
==Pleomorphic lipoma==
*[[Liposarcoma]].
{{Main|Pleomorphic lipoma}}
*Ancient [[neurofibroma]].
*Ancient [[schwannoma]].
 
===IHC===
*AR +ve - ~95% in men, ~85% in women.<ref name=pmid18181679>{{Cite journal  | last1 = Syed | first1 = S. | last2 = Martin | first2 = AM. | last3 = Haupt | first3 = H. | last4 = Podolski | first4 = V. | last5 = Brooks | first5 = JJ. | title = Frequent detection of androgen receptors in spindle cell lipomas: an explanation for this lesion's male predominance? | journal = Arch Pathol Lab Med | volume = 132 | issue = 1 | pages = 81-3 | month = Jan | year = 2008 | doi = 10.1043/1543-2165(2008)132[81:FDOARI]2.0.CO;2 | PMID = 18181679 }}</ref>


==Spindle cell lipoma==
==Spindle cell lipoma==
===General===
{{Main|Spindle cell lipoma}}
*Rare.
*Predominantly men.<ref name=pmid15371618/>
 
===Microscopic===
Features:<ref name=pmid15371618>{{Cite journal  | last1 = Murphey | first1 = MD. | last2 = Carroll | first2 = JF. | last3 = Flemming | first3 = DJ. | last4 = Pope | first4 = TL. | last5 = Gannon | first5 = FH. | last6 = Kransdorf | first6 = MJ. | title = From the archives of the AFIP: benign musculoskeletal lipomatous lesions. | journal = Radiographics | volume = 24 | issue = 5 | pages = 1433-66 | month =  | year =  | doi = 10.1148/rg.245045120 | PMID = 15371618 }}</ref>
*Aligned bland spindled cells adjacent to fat.
*Rope-like collagen bundles - '''key feature'''.
*+/-Myxoid component.
*+/-Staghorn-like vessels.
 
Notes:
*May overlap with ''[[pleomorphic lipoma]]''.<ref name=spc_stanford>URL: [http://surgpathcriteria.stanford.edu/softfat/spindle_cell_lipoma/ http://surgpathcriteria.stanford.edu/softfat/spindle_cell_lipoma/]. Accessed on: 4 December 2010.</ref>
 
Image:
*[http://www.sarcoma.org/pathology_review/round%20cell%20and%20soft%20tissue%20tumors/source/spindle_cell_lipoma3.html Spindle cell lipoma (sarcoma.org)].
 
===IHC===
*CD34 +ve.<ref name=pmid20559119>{{Cite journal  | last1 = Wood | first1 = L. | last2 = Fountaine | first2 = TJ. | last3 = Rosamilia | first3 = L. | last4 = Helm | first4 = KF. | last5 = Clarke | first5 = LE. | title = Cutaneous CD34+ spindle cell neoplasms: Histopathologic features distinguish spindle cell lipoma, solitary fibrous tumor, and dermatofibrosarcoma protuberans. | journal = Am J Dermatopathol | volume = 32 | issue = 8 | pages = 764-8 | month = Dec | year = 2010 | doi = 10.1097/DAD.0b013e3181d0c587 | PMID = 20559119 }}</ref>


==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===
*Young adults.
 
===Gross===
*Well-circumscribed.
*Lobulated and light-brown on sectioning.
 
===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>
*Large polygonal/oval cells:
**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>
***Nucleoli typically prominent.<ref>[http://surgpathcriteria.stanford.edu/softfat/hibernoma/ http://surgpathcriteria.stanford.edu/softfat/hibernoma/]</ref>
**Cytoplasm - multivacuolated, oval, eosinophilic, granular.
 
Image:
*[http://en.wikipedia.org/wiki/File:Hibernoma1.jpg Hibernoma (WC)].


==Atypical lipomatous tumour==
==Atypical lipomatous tumour==
*[[AKA]] ''well-differentiated liposarcoma'', abbreviated ''WDLPS''.
*[[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''.
*Abbreviated ''ALT/WDLPS''.


Line 159: Line 98:


==Liposarcoma==
==Liposarcoma==
{{Main|Liposarcoma}}
==Angiolipoma==
===General===
===General===
*Most common malignant sarcoma in the retroperitoneum.
*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>
*Not all (large) retroperitoneal adipocytic tumours are liposarcomas.
*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>
 
*[[Painful skin lesion]].
Notes:
*Retroperitoneal sarcomas: #1: liposarcoma, #2: [[pleomorphic undifferentiated sarcoma]], #3: leiomyosarcoma, #4: [[MPNST]].
**Extremely rare in retroperitoneum: [[synovial sarcoma]].


===Microscopic===
===Microscopic===
Features:
Features:
*Lipoblasts - '''key feature'''.
*Adipose tissue.
**Large sharply demarcated vacuole.
*Small blood vessels (clustered).
**Nucleus:
***Hyperchromatic (dark staining) nucleus.
***Eccentric location.
***Nuclear indentation.
*Chicken wire-like vascular.
*+/-Myxoid background.
*Cell size variation.


Images:
DDx:
*[http://commons.wikimedia.org/wiki/File:Myxoid_liposarcoma_%2806%29.JPG Myxoid liposarcoma (WC)].
*[[Liposarcoma]].
*[http://commons.wikimedia.org/wiki/File:Myxoid_liposarcoma_%2805%29.JPG Myxoid liposarcoma (WC)].
*[http://www.john-libbey-eurotext.fr/e-docs/00/04/09/14/texte_alt_jleejd00046_gr5.jpg Lipoblasts (john-libbey-eurotext.fr)].
*[http://commons.wikimedia.org/wiki/File:Dedifferentiated_liposarcoma_-_cropped_-_very_high_mag.jpg Dediff. liposarcoma - lipoblasts - very high mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Dedifferentiated_liposarcoma_-_intermed_mag.jpg Dediff. liposarcoma - shows dediff. component - intermed. mag. (WC)].
 
====Subtypes====
There are several subtypes:<ref name=Ref_WMSP_601>{{Ref WMSP|601}}</ref>
*Dedifferentiated liposarcoma.
*Myxoid liposarcoma.
**Round cell liposarcoma - a subtype of myxoid liposarcoma<ref name=pmid8554106>{{Cite journal  | last1 = Smith | first1 = TA. | last2 = Easley | first2 = KA. | last3 = Goldblum | first3 = JR. | title = Myxoid/round cell liposarcoma of the extremities. A clinicopathologic study of 29 cases with particular attention to extent of round cell liposarcoma. | journal = Am J Surg Pathol | volume = 20 | issue = 2 | pages = 171-80 | month = Feb | year = 1996 | doi =  | PMID = 8554106 }}
</ref> that has a worse prognosis;<ref name=pmid21253554>{{Cite journal  | last1 = Conyers | first1 = R. | last2 = Young | first2 = S. | last3 = Thomas | first3 = DM. | title = Liposarcoma: molecular genetics and therapeutics. | journal = Sarcoma | volume = 2011 | issue =  | pages = 483154 | month =  | year = 2011 | doi = 10.1155/2011/483154 | PMID = 21253554 }}</ref> characterized by regions of high cellularity.
*Mixed-type liposarcoma.
*Pleomorphic liposarcoma.
*Liposarcoma not otherwise specified (NOS).
 
=====Myxoid liposarcoma=====
*Has characteristic [[translocations]].
 
Features:
*Chickenwire-type blood vessels.
 
===IHC===
*IHC is of limited value.
 
*S-100 +ve ~1/3 of the time.
*Reticulin ???.


=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.
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