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| ===IHC=== | | ===IHC=== |
| *S100 +ve. | | *[[S-100]] +ve. |
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| ==Lipoblastoma== | | ==Lipoblastoma== |
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| *[http://www.sarcomaimages.com/index.php?v=Lipoblastoma Lipoblastoma (sarcomaimages.com)]. | | *[http://www.sarcomaimages.com/index.php?v=Lipoblastoma Lipoblastoma (sarcomaimages.com)]. |
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| ==Lipoma== | | ==Lipoblastoma like tumor== |
| ===General===
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| *Benign.
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| *Several variants exist.
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| **Angiolipoma - one of the (classically) [[painful skin lesions]].
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| ===Microscopic===
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| Features:
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| *Collection of mature adipocytes.
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| **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>
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| Notes:
| | [[File: 5 22974716644038 sl 1.png|Lipoblastoma like tumor]] |
| *Microscopically ''not'' definitely distinguishable from mature clump of fat.
| | [[File: 5 22974716644038 sl 2.png|Lipoblastoma like tumor]] |
| **The lesion must be labeled ''lipoma'' (by the clinican) to be signed-out as such.
| | [[File: 5 22974716644038 sl 3.png|Lipoblastoma like tumor]] |
| | [[File: 5 22974716644038 sl 4.png|Lipoblastoma like tumor]] |
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| DDx:
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| *[[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.
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| *Benign adipose tissue.
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| Images:
| | 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. |
| *[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>
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| ====Variants==== | | ==Lipoma== |
| =====Angiolipoma=====
| | {{Main|Lipoma}} |
| *A [[painful skin lesions|painful skin lesion]].
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| Microscopic:
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| *Numerous blood vessels present.
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| *+/-Microthrombi.
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| DDx:
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| *[[Liposarcoma]].
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| =====Myolipoma=====
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| Microscopic:
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| *Muscle present.
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| ===Sign out===
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| <pre>
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| SUBCUTANEOUS TISSUE ("LIPOMA"), LEFT AXILLA, EXCISION:
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| - MATURE ADIPOSE TISSUE CONSISTENT WITH LIPOMA.
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| </pre>
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| <pre>
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| LESION ("LIPOMA"), SPERMATIC CORD (LATERALITY NOT SPECIFIED), EXCISION:
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| - MATURE ADIPOSE TISSUE CONSISTENT WITH LIPOMA.
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| </pre>
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| ====Mirco====
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| The sections show mature adipocytes. There is no increase in vascularity. No thick fibrous septa are present.
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| ==Pleomorphic lipoma== | | ==Pleomorphic lipoma== |
| ===General===
| | {{Main|Pleomorphic lipoma}} |
| *Rare.
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| *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>
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| *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>
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| *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>
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| ===Microscopic===
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| Features:
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| *Multinucleated cells - "floret cells" - '''key feature'''.
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| **Solid eosinophilic cytoplasm.
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| **Peripheral nuclei - impart a knobby border to the cells.
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| *Fibrous septa.
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| Notes:
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| *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>
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| *Floret cell - may look similar to [[Touton giant cell]]s.
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| Images:
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| *[http://www.webpathology.com/image.asp?case=435&n=1 Pleomorphic lipoma - low mag. (webpathology.com)].
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| *[http://www.webpathology.com/image.asp?n=2&Case=435 Pleomorphic lipoma - high mag. (webpathology.com)].
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| DDx:
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| *[[Liposarcoma]].
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| *Ancient [[neurofibroma]].
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| *Ancient [[schwannoma]].
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| ===IHC===
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| *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>
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| ==Spindle cell lipoma== | | ==Spindle cell lipoma== |
| ===General===
| | {{Main|Spindle cell lipoma}} |
| *Rare.
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| *Predominantly men.<ref name=pmid15371618/>
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| Note:
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| *Spindle cell lipoma may immunohistochemically and histomorphologically overlap with ''mammary-type myofibroblastoma''<ref name=pmid11474286>{{Cite journal | last1 = McMenamin | first1 = ME. | last2 = Fletcher | first2 = CD. | title = Mammary-type myofibroblastoma of soft tissue: a tumor closely related to spindle cell lipoma. | journal = Am J Surg Pathol | volume = 25 | issue = 8 | pages = 1022-9 | month = Aug | year = 2001 | doi = | PMID = 11474286 }}</ref> - see: ''[[mammary myofibroblastoma]]''.
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| ===Microscopic===
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| 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>
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| *Aligned bland spindled cells adjacent to fat.
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| *Rope-like collagen bundles - '''key feature'''.
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| **May be described as "shreaded wheat".
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| *+/-[[Myxoid]] component.
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| *+/-[[staghorn vessels|Staghorn-like vessels]].
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| Notes:
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| *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>
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| DDx:
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| *[[Neurofibroma]].
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| Image:
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| *[http://www.sarcoma.org/pathology_review/round%20cell%20and%20soft%20tissue%20tumors/source/spindle_cell_lipoma3.html Spindle cell lipoma (sarcoma.org)].
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| ===IHC===
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| *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>
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| *Desmin +ve.
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| *S100 -ve. (???)
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| ==Hibernoma== | | ==Hibernoma== |
| ===General===
| | {{Main|Hibernoma}} |
| *Consists of ''brown fat'' (present in the infants to generate heat).<ref name=Ref_WMSP605>{{Ref WMSP|605}}</ref>
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| *Benign.
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| *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>
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| Epidemiology:
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| *Young adults.
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| ===Gross===
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| *Well-circumscribed.
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| *Lobulated and light-brown on sectioning.
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| ===Microscopic===
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| Features:<ref name=pmid9537018>{{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>
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| *Large polygonal/oval cells:
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| **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>
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| ***Nucleoli typically prominent.<ref>[http://surgpathcriteria.stanford.edu/softfat/hibernoma/ http://surgpathcriteria.stanford.edu/softfat/hibernoma/]</ref>
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| **Cytoplasm - multivacuolated, oval, eosinophilic, granular.
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| *+/-Prominent blood vessels, central.<ref>URL: [http://radiographics.rsna.org/content/24/5/1433.full http://radiographics.rsna.org/content/24/5/1433.full]. Accessed on: 11 February 2013.</ref>
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| DDx:
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| *Reaction to silicone implant.
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| Image:
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| *[http://en.wikipedia.org/wiki/File:Hibernoma1.jpg Hibernoma - high mag. (WC)].
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| *[http://commons.wikimedia.org/wiki/File:Hibernoma3.jpg Hibernoma - low mag. (WC)].
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| ==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''. |
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| ==Liposarcoma== | | ==Liposarcoma== |
| | {{Main|Liposarcoma}} |
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| | ==Angiolipoma== |
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| ===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:
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| *Retroperitoneal sarcomas: #1: liposarcoma, #2: [[pleomorphic undifferentiated sarcoma]], #3: leiomyosarcoma, #4: [[MPNST]].
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| **Extremely rare in retroperitoneum: [[synovial sarcoma]]. | |
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| ===Microscopic=== | | ===Microscopic=== |
| Features: | | Features: |
| *Lipoblasts - '''key feature'''. | | *Adipose tissue. |
| **Large sharply demarcated vacuole. | | *Small blood vessels (clustered). |
| **Nucleus:
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| ***Hyperchromatic (dark staining) nucleus.
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| ***Eccentric location.
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| ***Nuclear indentation.
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| *Chicken wire-like vascular.
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| *+/-[[Myxoid]] background.
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| *Cell size variation.
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| DDx: | | DDx: |
| *[[Angiolipoma]]. | | *[[Liposarcoma]]. |
| *[[Pleomorphic undifferentiated sarcoma]].
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| Images:
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| *[http://commons.wikimedia.org/wiki/File:Myxoid_liposarcoma_%2806%29.JPG Myxoid liposarcoma (WC)].
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| *[http://commons.wikimedia.org/wiki/File:Myxoid_liposarcoma_%2805%29.JPG Myxoid liposarcoma (WC)].
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| *[http://www.john-libbey-eurotext.fr/e-docs/00/04/09/14/texte_alt_jleejd00046_gr5.jpg Lipoblasts (john-libbey-eurotext.fr)].
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| *[http://commons.wikimedia.org/wiki/File:Dedifferentiated_liposarcoma_-_cropped_-_very_high_mag.jpg Dediff. liposarcoma - lipoblasts - very high mag. (WC)].
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| *[http://commons.wikimedia.org/wiki/File:Dedifferentiated_liposarcoma_-_intermed_mag.jpg Dediff. liposarcoma - shows dediff. component - intermed. mag. (WC)].
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| *[http://path.upmc.edu/cases/case302.html Poorly diff. liposarcoma - several images (upmc.edu)].
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| ====Subtypes====
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| There are several subtypes:<ref name=Ref_WMSP_601>{{Ref WMSP|601}}</ref>
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| *Dedifferentiated liposarcoma.
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| *Myxoid liposarcoma.
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| **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 }}
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| </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.
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| *Mixed-type liposarcoma.
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| *Pleomorphic liposarcoma.
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| *Liposarcoma not otherwise specified (NOS).
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| =====Myxoid liposarcoma=====
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| Location:<ref name=pmid22052112>{{Cite journal | last1 = Moreau | first1 = LC. | last2 = Turcotte | first2 = R. | last3 = Ferguson | first3 = P. | last4 = Wunder | first4 = J. | last5 = Clarkson | first5 = P. | last6 = Masri | first6 = B. | last7 = Isler | first7 = M. | last8 = Dion | first8 = N. | last9 = Werier | first9 = J. | title = Myxoid\Round Cell Liposarcoma (MRCLS) Revisited: An Analysis of 418 Primarily Managed Cases. | journal = Ann Surg Oncol | volume = 19 | issue = 4 | pages = 1081-1088 | month = Apr | year = 2012 | doi = 10.1245/s10434-011-2127-z | PMID = 22052112 }}</ref>
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| *90% in lower limb.
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| *81% deep.
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| Microscopic features:
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| *Chickenwire-type blood vessels.
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| *Clear spaces.
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| *Adipocytes - may be rare.
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| Typically has a [[translocations|translocation]]:
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| *t(12;16)(q13;p11) TLS-CHOP.<ref name=pmid7805034>{{Cite journal | last1 = Knight | first1 = JC. | last2 = Renwick | first2 = PJ. | last3 = Dal Cin | first3 = P. | last4 = Van den Berghe | first4 = H. | last5 = Fletcher | first5 = CD. | title = Translocation t(12;16)(q13;p11) in myxoid liposarcoma and round cell liposarcoma: molecular and cytogenetic analysis. | journal = Cancer Res | volume = 55 | issue = 1 | pages = 24-7 | month = Jan | year = 1995 | doi = | PMID = 7805034 }}</ref>
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| *May have the translocation usually seen in [[clear cell sarcoma]]:
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| *t(12;22)(q13;q12) EWS-ATF1.<ref name=pmid21115923>{{Cite journal | last1 = Suzuki | first1 = K. | last2 = Matsui | first2 = Y. | last3 = Endo | first3 = K. | last4 = Kubo | first4 = T. | last5 = Hasegawa | first5 = T. | last6 = Kimura | first6 = T. | last7 = Ohtani | first7 = O. | last8 = Yasui | first8 = N. | title = Myxoid liposarcoma with EWS-CHOP type 1 fusion gene. | journal = Anticancer Res | volume = 30 | issue = 11 | pages = 4679-83 | month = Nov | year = 2010 | doi = | PMID = 21115923 }}</ref>
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| DDx:
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| *[[Low-grade fibromyxoid sarcoma]].
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| Image:
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| *[http://radiographics.rsna.org/content/20/4/1007/F4.expansion.html Myxoid liposarcoma (rsna.org)].
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| =====Dedifferentiated liposarcoma=====
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| *Has an undifferentiated component that, if seen alone, would be diagnosed as [[pleomorphic undifferentiated sarcoma]].
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| *The diagnosis depends on the presence of the differentiated component of the tumour, i.e. the presence of lipoblasts.
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| ===IHC===
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| *IHC is of limited value.
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| *S-100 +ve ~1/3 of the time.
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| *Reticulin ???.
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| =See also= | | =See also= |
| *[[Soft tissue lesions]]. | | *[[Soft tissue lesions]]. |
| *[[Bone]]. | | *[[Bone]]. |
| | *[[Brown fat]]. |
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| =References= | | =References= |
| {{Reflist|2}} | | {{Reflist|2}} |
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| | [[Category:Adipocytic tumours]] |
| [[Category:Soft tissue lesions]] | | [[Category:Soft tissue lesions]] |
