Difference between revisions of "Adipocytic tumours"

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Adipocytic tumours (view source)

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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.
*[[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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Features:
Features:
*Adipocytes of approximately equal size.
*Adipocytes of approximately equal size.
*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>
*Not vascular.
*Not vascular.
*No nuclear hyperchromasia.
*No nuclear hyperchromasia.


==Lipoma==
Notes:
*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>
**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.
 
==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>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.


==Pleomorphic lipoma==
Images:
===General===
*[http://www.sarcomaimages.com/index.php?v=Lipoblastoma Lipoblastoma (sarcomaimages.com)].
*???


===Microscopic===
==Lipoblastoma like tumor==
Features:
*Multinucleated cells - "floret cells".
**Very ugly looking cells.
*Fibrous septa.


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>
[[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]]


Notes:
*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>


==Hibernoma==
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.
===General===
*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===
==Lipoma==
*Young adults.
{{Main|Lipoma}}


===Gross===
==Pleomorphic lipoma==
*Well-circumscribed.
{{Main|Pleomorphic lipoma}}
*Lobulated and light-brown on sectioning.


===Microscopic===
==Spindle cell lipoma==
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>
{{Main|Spindle cell lipoma}}
*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:
==Hibernoma==
*[http://en.wikipedia.org/wiki/File:Hibernoma1.jpg Hibernoma (WC)].
{{Main|Hibernoma}}


==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''.


===General===
===General===
*''Atypical lipomatous tumour'' is a [[waffle diagnosis]]; it is like [[ASCUS]].
*''Atypical lipomatous tumour'' is a term used to save people with a (curable) peripheral liposarcoma from getting denied life insurance.


===Microscopic===
===Microscopic===
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==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]].


====Subtypes====
===Microscopic===
There are several subtypes:<ref name=Ref_WMSP_601>{{Ref WMSP|601}}</ref>
Features:
*Dedifferentiated liposarcoma.
*Adipose tissue.
*Myxoid liposarcoma.
*Small blood vessels (clustered).
*Mixed-type liposarcoma.
*Pleomorphic liposarcoma.
*Liposarcoma not otherwise specified (NOS).
 
===IHC===
*IHC is of limited value.


*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]]
Michael
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