Lipoma and Angiolipoma

Lipoma and Angiolipoma
Key Facts
Terminology
  • Benign neoplasms consisting of mature adipose cells and blood vessels
Clinical Issues
  • Lipomas and angiolipomas form soft palpable circumscribed masses
  • Lesions are benign, and no treatment is necessary
Image Findings
  • Lipomas consist entirely of adipose tissue and are radiolucent with a thin capsule
    • Do not require biopsy
  • Angiolipomas form dense masses
    • Generally require biopsy for definitive diagnosis
Microscopic Pathology
  • Mature adipose tissue without epithelial elements
  • Adipose cells are uniform in size throughout lesion
  • After trauma, may show varying degrees of fibrosis, myxoid change, and calcification
Top Differential Diagnoses
  • Myofibroblastoma/spindle cell lipoma
  • Hamartoma
  • Hibernoma
  • Liposarcoma or angiosarcoma
Reporting Considerations
  • Histologic findings on fine needle aspiration, core needle biopsy, or in fragmented specimens are nonspecific for lipomas
    • Clinical, radiologic, and pathologic correlation is often necessary for diagnosis
Angiolipomas consist of a mixture of small blood vessels and adipose tissue. The borders are well circumscribed image. These lesions may present as a palpable mass or as a mammographic density.
The majority of angiolipomas have small fibrin thrombi image, which are an important diagnostic feature. Unlike dermal angiolipomas that may present with pain, breast lesions are usually asymptomatic.
TERMINOLOGY
Definitions
  • Benign neoplasms consisting of mature adipose cells and blood vessels
CLINICAL ISSUES
Epidemiology
  • Age
    • Most lipomas become clinically apparent in patients 40-60 years old
Presentation
  • Lipomas and angiolipomas form soft palpable circumscribed masses
    • Typically present as slowly growing solitary lesions
  • Also detected at screening mammography
Treatment
  • Surgical approaches
    • Lesions are benign, and no treatment is necessary
    • Palpable masses, or those that are clinically apparent, may be excised for cosmetic reasons or due to patient preference
    • Superficial or subcutaneous lesions are more likely to be clinically apparent and undergo excision
Prognosis
  • Benign lesions without risk of local recurrence
Core Needle Biopsies
  • Histologic features of lipoma on core needle biopsy are nondiagnostic
    • Radiologic correlation is necessary for a final diagnosis
    • Lipomas are rarely biopsied as imaging findings are usually diagnostic
  • Angiolipomas can be diagnosed on core needle biopsies
    • More commonly biopsied than lipomas due to dense appearance that can mimic carcinomas
IMAGE FINDINGS
Mammographic Findings
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Jul 6, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Lipoma and Angiolipoma

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