Difference between revisions of "Adipocytic tumours"

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==Pleomorphic lipoma==
==Pleomorphic lipoma==
===General===
{{Main|Pleomorphic lipoma}}
*Rare.
*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>
*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>
 
===Gross===
*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>
 
DDx - shoulder lesions:
*[[Elastofibroma]].
*[[Desmoplastic fibroblastoma]].
 
===Microscopic===
Features:
*Multinucleated cells - "floret cells" - '''key feature'''.
**Solid eosinophilic cytoplasm.
**Peripheral nuclei - impart a knobby border to the cells.
*Fibrous septa.
 
Notes:
*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:
*[http://www.webpathology.com/image.asp?case=435&n=1 Pleomorphic lipoma - low mag. (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=2&Case=435 Pleomorphic lipoma - high mag. (webpathology.com)].
 
DDx:
*[[Liposarcoma]].<ref name=pmid6884998>{{Cite journal  | last1 = Azzopardi | first1 = JG. | last2 = Iocco | first2 = J. | last3 = Salm | first3 = R. | title = Pleomorphic lipoma: a tumour simulating liposarcoma. | journal = Histopathology | volume = 7 | issue = 4 | pages = 511-23 | month = Jul | year = 1983 | doi =  | PMID = 6884998 }}</ref>
*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>
*CD34 +ve (26 +ve of 26 cases<ref name=pmid25219904>{{Cite journal  | last1 = Cheah | first1 = A. | last2 = Billings | first2 = S. | last3 = Goldblum | first3 = J. | last4 = Hornick | first4 = J. | last5 = Uddin | first5 = N. | last6 = Rubin | first6 = B. | title = Spindle cell/pleomorphic lipomas of the face: an under-recognized diagnosis. | journal = Histopathology | volume = 66 | issue = 3 | pages = 430-7 | month = Feb | year = 2015 | doi = 10.1111/his.12548 | PMID = 25219904 }}</ref>).
*Desmin -ve (0 +ve of 20 cases<ref name=pmid25219904/>).
*ER -ve/+ve (5 +ve of 21 cases<ref name=pmid25219904/>).


==Spindle cell lipoma==
==Spindle cell lipoma==

Revision as of 22:56, 1 May 2016

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:

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

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.
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