Difference between revisions of "Adipocytic tumours"

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(→‎Lipoma: +fat)
(→‎Lipoma: split-out)
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==Lipoma==
==Lipoma==
===General===
{{Main|Lipoma}}
*Benign.
*Several variants exist.
**Angiolipoma - one of the (classically) [[painful skin lesions]].
 
===Microscopic===
Features:
*Collection of mature 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>
 
Notes:
*Microscopically ''not'' definitely distinguishable from mature clump of fat.
**The lesion must be labeled ''lipoma'' (by the clinican) to be signed-out as such.
 
DDx:
*[[Liposarcoma]] - increased number of blood vessels,<ref name=pmid11685482>{{Cite journal  | last1 = Yang | first1 = YJ. | last2 = Damron | first2 = TA. | last3 = Cohen | first3 = H. | last4 = Hojnowski | first4 = L. | title = Distinction of well-differentiated liposarcoma from lipoma in two patients with multiple well-differentiated fatty masses. | journal = Skeletal Radiol | volume = 30 | issue = 10 | pages = 584-9 | month = Oct | year = 2001 | doi = 10.1007/s002560100395 | PMID = 11685482 }}</ref> esp. chickenwire-like vessels, fibrous septae.
*Benign adipose tissue.
 
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>
 
====Variants====
=====Angiolipoma=====
*A [[painful skin lesions|painful skin lesion]].
 
Microscopic:
*Numerous blood vessels present.
*+/-Microthrombi.
 
DDx:
*[[Liposarcoma]].
=====Myolipoma=====
General:
*May mimic a sarcoma radiologically.<ref>URL: [http://www.webmedcentral.com/article_view/1878 http://www.webmedcentral.com/article_view/1878]. Accessed on: 14 March 2013.</ref>
*Extremely rare.<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 | url = http://radiographics.rsna.org/content/24/5/1433.long }}</ref>
*Usually large ~ 16 cm.<ref name=pmid1703396>{{Cite journal  | last1 = Meis | first1 = JM. | last2 = Enzinger | first2 = FM. | title = Myolipoma of soft tissue. | journal = Am J Surg Pathol | volume = 15 | issue = 2 | pages = 121-5 | month = Feb | year = 1991 | doi =  | PMID = 1703396 }}</ref>
 
Microscopic:<ref name=pmid15371618/>
*Mature adipose tissue.
*Benign smooth muscle - usually ~ 2x amount of fat.
 
Note:
*If skeletal muscle is present consider ''intramuscular lipoma''.<ref> URL: [http://surgpathcriteria.stanford.edu/softfat/lipoma/intramuscular_lipoma.html http://surgpathcriteria.stanford.edu/softfat/lipoma/intramuscular_lipoma.html]. Accessed on: 14 March 2013.</ref>
 
IHC:<ref name=pmid15371618/>
*Actin +ve.
*Desmin +ve.
 
Images:
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168809/figure/F1/ Myolipoma (nih.gov)].<ref name=pmid21927569>{{Cite journal  | last1 = Lee | first1 = YS. | last2 = Park | first2 = SE. | last3 = Lee | first3 = JU. | last4 = Choi | first4 = ES. | title = MRI of a subcutaneous myolipoma in the ankle: a case report. | journal = Korean J Radiol | volume = 12 | issue = 5 | pages = 641-5 | month =  | year =  | doi = 10.3348/kjr.2011.12.5.641 | PMID = 21927569 | PMC = 3168809 }}</ref>
*[http://www.webpathology.com/image.asp?case=431&n=1 Myolipoma (webpathology.com)].
 
====Images====
<gallery>
Image:Yellow_adipose_tissue_in_paraffin_section_-_lipids_washed_out.jpg | Mature fat. (WC)
</gallery>
===Sign out===
<pre>
SUBCUTANEOUS TISSUE ("LIPOMA"), LEFT AXILLA, EXCISION:
- MATURE ADIPOSE TISSUE CONSISTENT WITH LIPOMA.
</pre>
 
<pre>
LESION ("LIPOMA"), SPERMATIC CORD (LATERALITY NOT SPECIFIED), EXCISION:
- MATURE ADIPOSE TISSUE CONSISTENT WITH LIPOMA.
</pre>
 
====Colonic lipoma (clinically suspected)====
<pre>
B. SIGMOID COLON AT 55 CM, BIOPSY:
- COLORECTAL-TYPE MUCOSA WITHIN NORMAL LIMITS WITH A SMALL AMOUNT OF SUBMUCOSAL
  ADIPOSE TISSUE; COMPATIBLE WITH CLINICAL IMPRESSION OF LIPOMA.
</pre>
 
====Mirco====
The sections show mature adipocytes.  There is no increase in vascularity.  No thick fibrous septa are present.


==Pleomorphic lipoma==
==Pleomorphic lipoma==

Revision as of 01:40, 31 October 2013

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

  • S100 +ve.

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

General

  • Rare.
  • May mimic a malignancy.[6]
  • Male > female.[7]

Gross

  • Classically shoulder and neck region in adults.[8]

DDx - shoulder lesions:

Microscopic

Features:

  • Multinucleated cells - "floret cells" - key feature.
    • Solid eosinophilic cytoplasm.
    • Peripheral nuclei - impart a knobby border to the cells.
  • Fibrous septa.

Notes:

Images:

DDx:

IHC

  • AR +ve - ~95% in men, ~85% in women.[7]

Spindle cell lipoma

General

  • Rare.
  • Predominantly men.[10]

Note:

  • Spindle cell lipoma may immunohistochemically and histomorphologically overlap with mammary-type myofibroblastoma[11] - see: mammary myofibroblastoma.

Microscopic

Features:[10]

  • Aligned bland spindled cells adjacent to fat.
  • Rope-like collagen bundles - key feature.
    • May be described as "shreaded wheat".
  • +/-Myxoid component.
  • +/-Staghorn-like vessels.

Notes:

DDx:

Image

www:

IHC

  • CD34 +ve.[13]
  • Desmin +ve.
  • S100 -ve. (???)

Hibernoma

Main article: Hibernoma

Atypical lipomatous tumour

  • AKA well-differentiated liposarcoma, abbreviated WDLPS.
  • 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:[14]

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

Liposarcoma

General

  • Most common malignant sarcoma in the retroperitoneum.
  • Not all (large) retroperitoneal adipocytic tumours are liposarcomas.

Notes:

Microscopic

Features:

  • Lipoblasts - key feature.
    • Large sharply demarcated vacuole.
    • Nucleus:
      • Hyperchromatic (dark staining) nucleus.
      • Eccentric location.
      • Nuclear indentation.
  • Chicken wire-like vascular.
  • +/-Myxoid background.
  • Cell size variation.

DDx:

Images:

Subtypes

Main subtypes:[1]

  • Dedifferentiated liposarcoma.
  • Myxoid liposarcoma.
    • Round cell liposarcoma - a subtype of myxoid liposarcoma[15] that has a worse prognosis;[16] characterized by regions of high cellularity.
  • Mixed-type liposarcoma.
  • Pleomorphic liposarcoma.
  • Liposarcoma not otherwise specified (NOS).

Additional reported type:

  • Spindle cell liposarcoma.[12]
Myxoid liposarcoma
  • AKA myxoid/round cell liposarcoma.
  • AKA round cell liposarcoma.
Gross

Location:[17]

  • 90% in lower limb.
  • 81% deep.
Microscopic

Features:

  • Chickenwire-type blood vessels.
  • Clear spaces.
  • Adipocytes - may be rare.

DDx:

Images:

Molecular

Typically has a translocation:

Dedifferentiated liposarcoma
  • Has an undifferentiated component that, if seen alone, would be diagnosed as pleomorphic undifferentiated sarcoma.
  • The diagnosis depends on the presence of the differentiated component of the tumour, i.e. the presence of lipoblasts.

IHC

  • IHC is of limited value.
  • S-100 +ve ~1/3 of the time.
  • Reticulin ???.

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 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. ↑ Persichetti, P.; Di Lella, F.; Marangi, GF.; Cagli, B.; Simone, P.; Tenna, S.; Rabitri, C.; Cassandro, R. et al. "Pleomorphic lipoma: a definite histopathological entity.". Anticancer Res 24 (5B): 3157-9. PMID 15510605.
  7. ↑ 7.0 7.1 Syed, S.; Martin, AM.; Haupt, H.; Podolski, V.; Brooks, JJ. (Jan 2008). "Frequent detection of androgen receptors in spindle cell lipomas: an explanation for this lesion's male predominance?". Arch Pathol Lab Med 132 (1): 81-3. doi:10.1043/1543-2165(2008)132[81:FDOARI]2.0.CO;2. PMID 18181679.
  8. ↑ URL: http://www.webpathology.com/image.asp?n=2&Case=435. Accessed on: 3 October 2011.
  9. ↑ 9.0 9.1 URL: http://surgpathcriteria.stanford.edu/softfat/spindle_cell_lipoma/. Accessed on: 4 December 2010.
  10. ↑ 10.0 10.1 Murphey, MD.; Carroll, JF.; Flemming, DJ.; Pope, TL.; Gannon, FH.; Kransdorf, MJ.. "From the archives of the AFIP: benign musculoskeletal lipomatous lesions.". Radiographics 24 (5): 1433-66. doi:10.1148/rg.245045120. PMID 15371618.
  11. ↑ McMenamin, ME.; Fletcher, CD. (Aug 2001). "Mammary-type myofibroblastoma of soft tissue: a tumor closely related to spindle cell lipoma.". Am J Surg Pathol 25 (8): 1022-9. PMID 11474286.
  12. ↑ 12.0 12.1 Dei Tos, AP.; Mentzel, T.; Newman, PL.; Fletcher, CD. (Sep 1994). "Spindle cell liposarcoma, a hitherto unrecognized variant of liposarcoma. Analysis of six cases.". Am J Surg Pathol 18 (9): 913-21. PMID 8067512.
  13. ↑ Wood, L.; Fountaine, TJ.; Rosamilia, L.; Helm, KF.; Clarke, LE. (Dec 2010). "Cutaneous CD34+ spindle cell neoplasms: Histopathologic features distinguish spindle cell lipoma, solitary fibrous tumor, and dermatofibrosarcoma protuberans.". Am J Dermatopathol 32 (8): 764-8. doi:10.1097/DAD.0b013e3181d0c587. PMID 20559119.
  14. ↑ 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.
  15. ↑ Smith, TA.; Easley, KA.; Goldblum, JR. (Feb 1996). "Myxoid/round cell liposarcoma of the extremities. A clinicopathologic study of 29 cases with particular attention to extent of round cell liposarcoma.". Am J Surg Pathol 20 (2): 171-80. PMID 8554106.
  16. ↑ Conyers, R.; Young, S.; Thomas, DM. (2011). "Liposarcoma: molecular genetics and therapeutics.". Sarcoma 2011: 483154. doi:10.1155/2011/483154. PMID 21253554.
  17. ↑ Moreau, LC.; Turcotte, R.; Ferguson, P.; Wunder, J.; Clarkson, P.; Masri, B.; Isler, M.; Dion, N. et al. (Apr 2012). "Myxoid\Round Cell Liposarcoma (MRCLS) Revisited: An Analysis of 418 Primarily Managed Cases.". Ann Surg Oncol 19 (4): 1081-1088. doi:10.1245/s10434-011-2127-z. PMID 22052112.
  18. ↑ Knight, JC.; Renwick, PJ.; Dal Cin, P.; Van den Berghe, H.; Fletcher, CD. (Jan 1995). "Translocation t(12;16)(q13;p11) in myxoid liposarcoma and round cell liposarcoma: molecular and cytogenetic analysis.". Cancer Res 55 (1): 24-7. PMID 7805034.
  19. ↑ Suzuki, K.; Matsui, Y.; Endo, K.; Kubo, T.; Hasegawa, T.; Kimura, T.; Ohtani, O.; Yasui, N. (Nov 2010). "Myxoid liposarcoma with EWS-CHOP type 1 fusion gene.". Anticancer Res 30 (11): 4679-83. PMID 21115923.
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