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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]]. |
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| ==Intermediate== | | ==Intermediate== |
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| ===IHC=== | | ===IHC=== |
| *S100 +ve. | | *[[S-100]] +ve. |
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| ==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.
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| **Angiolipoma - one of the (classically) [[painful skin lesions]].
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| | 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. |
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| 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.
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| 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)]. |
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| ==Pleomorphic lipoma== | | ==Lipoblastoma like tumor== |
| ===General===
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| *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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| ===Microscopic===
| | [[File: 5 22974716644038 sl 1.png|Lipoblastoma like tumor]] |
| Features:
| | [[File: 5 22974716644038 sl 2.png|Lipoblastoma like tumor]] |
| *Multinucleated cells - "floret cells".
| | [[File: 5 22974716644038 sl 3.png|Lipoblastoma like tumor]] |
| **Very ugly looking cells.
| | [[File: 5 22974716644038 sl 4.png|Lipoblastoma like tumor]] |
| *Fibrous septa.
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| Image: [http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970321-7&figureId=fig9 Floret cells in a pleomorphic lipoma (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>
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| 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>
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| ==Spindle cell lipoma== | | ==Lipoma== |
| ===General===
| | {{Main|Lipoma}} |
| *Rare.
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| *Predominantly men.<ref name=pmid15371618/>
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| ===Microscopic=== | | ==Pleomorphic lipoma== |
| 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>
| | {{Main|Pleomorphic lipoma}} |
| *Aligned bland spindled cells adjacent to fat.
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| *Rope-like collagen bundles.
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| *+/-Myxoid component.
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| *+/-Staghorn-like vessels.
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| Notes:
| | ==Spindle cell lipoma== |
| *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>
| | {{Main|Spindle cell lipoma}} |
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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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| ==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>{{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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| Image:
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| *[http://en.wikipedia.org/wiki/File:Hibernoma1.jpg Hibernoma (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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| 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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| ====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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| ===IHC===
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| *IHC is of limited value.
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| *S-100 +ve ~1/3 of the time.
| | DDx: |
| *Reticulin ???. | | *[[Liposarcoma]]. |
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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]] |