Spindle Cell and Pleomorphic Lipoma



Spindle Cell and Pleomorphic Lipoma


Amitabh Srivastava, MD










Spindle cell and pleomorphic lipomas are well-circumscribed tumors with a pale yellow, homogeneous appearance that lacks the lobular configuration seen in typical lipomas.






Spindle cell lipomas show mature adipocytes admixed with a bland spindle cell proliferation in a dense collagenous stroma.


TERMINOLOGY


Abbreviations



  • Spindle cell lipoma (SCL)/pleomorphic lipoma (PL)


Definitions



  • Benign adipocytic tumor with variable admixture of spindle cells, ropey collagen, and multinucleated tumor giant cells


CLINICAL ISSUES


Epidemiology



  • Age



    • Typically in older age group (> 50 years)


  • Gender



    • Predominantly in men; < 10% in women


Site



  • Shoulder and posterior neck most common sites of involvement


  • Other sites



    • Upper arm


    • Face


    • Oral cavity


  • Lower extremity involvement is rare


Presentation



  • Painless mass



    • Dermal or subcutaneous nodule


    • Often present for long duration


    • Rarely multiple or familial


Treatment



  • Conservative surgical excision is adequate


Prognosis



  • Benign behavior


  • Local recurrence is rare


MACROSCOPIC FEATURES


Gross Appearance



  • Well-circumscribed tumor


  • Yellow-gray white appearance


  • Firm consistency


  • Some cases may show myxoid appearance


MICROSCOPIC PATHOLOGY


Histologic Features



  • Spindle cell lipoma is composed of variable admixture of 3 components



    • Mature adipocytes


    • Bland spindle cell proliferation


    • Myxoid stroma with ropey collagen and mast cells


  • Pleomorphic lipoma is part of same spectrum



    • In addition to above features, also shows multinucleated tumor giant cells with peripherally arranged nuclei (“floret cells”)


    • Lipoblasts may be present in pleomorphic lipoma


Cytologic Features



  • Bland nuclei in spindle cell lipoma


  • Hyperchromatic nuclei in multinucleated tumor giant cells in pleomorphic lipoma


Variants

Jul 8, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Spindle Cell and Pleomorphic Lipoma

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