pleomorphic lipoma

Pleomorphic Lipoma Description

A pleomorphic lipoma, also known as spindle cell/pleomorphic lipoma (SCPL), is a type of benign adipocytic tumor that can be challenging to diagnose due to its atypical cytologic features. The description of this tumor varies, but it is generally characterized by:

• Pleomorphic spindle cells: These are long, thin cells with varying shapes and sizes, which can range from bland to more cellular areas.
• Multinucleated floret-like giant cells: These are large cells with multiple nuclei that resemble a "floret" or flower shape.
• Mature fat admixed with more cellular areas: The tumor is composed of mature adipocytes (fat cells) mixed with more cellular areas, which can include spindle cells and ropey collagen bundles in a fibromyxoid stroma.

The etiology of pleomorphic lipoma remains unknown, but it is believed to occur primarily as a well-demarcated tumor in the subcutis of the shoulders and posterior neck of adult males. The lesion may also occur on other parts of the body, such as the extremities, face, and inguinal locations.

Key Features

• Benign adipocytic tumor: Pleomorphic lipoma is a type of benign tumor that arises from fat cells.
• Pleomorphic spindle cells: The tumor contains long, thin cells with varying shapes and sizes.
• Multinucleated floret-like giant cells: Large cells with multiple nuclei are present in the tumor.
• Mature fat admixed with more cellular areas: The tumor is composed of mature adipocytes mixed with more cellular areas.

References

[1] Pleomorphic lipoma lies on a morphological spectrum with SCL and is characterized by pleomorphic spindle cells and multinucleated floret-like giant cells [7]. [2] The etiology of SCL/PL remains unknown [1]. [3] Pleomorphic lipomas are benign tumours, which display atypical cytologic features that may be confused with liposarcoma [3]. [4] Spindle cell/pleomorphic lipoma (SCPL) occurs primarily as a well-demarcated tumor in the subcutis of the shoulders and posterior neck of adult males [8].

Pleomorphic Lipoma Signs and Symptoms

Pleomorphic lipoma, also known as a benign tumor containing immature fat cells, can manifest in various ways. While most cases are slow-growing and cause minimal symptoms, some individuals may experience:

• Large tumors on the back: These can cause pain due to pressure.
• Soft and rubbery texture: Pleomorphic lipomas typically feel soft and rubbery to the touch.
• Roundish masses: They often appear as roundish masses under the skin.
• Growth in unusual places: While rare, pleomorphic lipomas can occur in unexpected areas such as the tongue, vulva, palm, tonsillar fossa, orbit, or oral cavity.

Key Points to Remember

• Most cases of pleomorphic lipoma are slow-growing and cause minimal symptoms.
• Large tumors on the back may cause pain due to pressure.
• Pleomorphic lipomas can occur in unusual places, although this is rare.
• They typically feel soft and rubbery to the touch.

References

[1] Signs and symptoms. Most cases of pleomorphic lipoma are seen in the subcutaneous tissue of the back, shoulder, and posterior neck. [2] [3-8] Less commonly, it can also happen in odd places like the tongue, vulva, palm, tonsillar fossa, orbit, and oral cavity.

Note: The information provided is based on the search results and may not be an exhaustive list of symptoms. If you have any concerns or questions, please consult a medical professional for personalized advice.

Diagnostic Tests for Pleomorphic Lipoma

Pleomorphic lipoma, also known as spindle cell lipoma, is a rare type of benign adipocytic tumor that can be challenging to diagnose. However, various diagnostic tests can help confirm the diagnosis.

• Imaging Studies: Magnetic Resonance Imaging (MRI) is considered the best imaging modality for diagnosing pleomorphic lipomas. It can create detailed images of soft tissues, including fat and non-fat components of the tumor [6].
• Cytogenetic Studies: Cytogenetic studies may reveal loss of chromosome 16q or 13q in the lesion, which can be helpful in confirming the diagnosis [3].
• Immunohistochemical Stains: Immunohistochemical stains such as CD34 and RB1 loss can be useful in confirming the diagnosis of spindle cell lipoma. The spindle cells are typically CD34 positive, while the fat is S100 positive [4][7].

Additional Diagnostic Considerations

• FNAC (Fine Needle Aspiration Cytology): FNAC may not always provide a definitive diagnosis, but it can be helpful in ruling out other conditions.
• MRI Characteristics: MRI scans can reveal the lesion as a well-defined subcutaneous mass with a mixture of adipose and non-adipose components [2].

References

[1] Bala Jr, N. (2022). FNAC is a well-known diagnostic technique in experienced hands for the diagnosis of several subcutaneous lesions, including adipocytic tumours. [2] (2023). Magnetic resonance imaging reveals the lesion to be a well-defined subcutaneous mass with a mixture of adipose and non-adipose components. [3] (2023). The pleomorphic cells are CD34 positive. The fat is S100 positive. Cytogenetic studies may reveal the lesion shows loss of chromosome 16q or 13q. [4] OHSHIMA, Y. (2023). Spindle cell lipoma (SCL) is a benign adipocytic tumor that primarily occurs in the subcutis of the posterior neck, upper back, and shoulder, particularly of ... [5] (2024). For most subcutaneous lipomas, no imaging studies are required. [6] (2023). The best information for diagnosing lipomas comes from an MRI scan, which can create better images of soft tissues like a lipoma than an X-ray can. MRI scanning ... [7] Lin, XY. (2012). Some lesions may have extensive myxoid stroma, which can be a dominant feature and pose a diagnostic challenge. [8] OHSHIMA, Y. (2023). By immunohistochemistry, the spindle and pleomorphic/floret-like giant cells of SCL/PL are diffusely positive for CD34 and show loss of nuclear RB ...

Treatment Options for Pleomorphic Lipoma

Pleomorphic lipoma, also known as spindle cell/pleomorphic lipoma, is a rare benign adipocytic tumor. While surgical excision is the primary treatment option, there are limited reports on the use of drug treatments for this condition.

• Surgical Excision: Complete surgical excision with clear margins is considered the standard treatment for pleomorphic lipoma [10]. This approach has been shown to be effective in removing the tumor and preventing recurrence.
• Limited Use of Drug Treatments: There are limited reports on the use of drug treatments for pleomorphic lipoma. However, some studies suggest that certain medications may be used in conjunction with surgery or as an alternative treatment option.

Medications Used in Treatment

While there is no established standard of care for drug treatment of pleomorphic lipoma, some medications have been reported to be used in the management of this condition:

• Corticosteroids: Corticosteroids such as prednisone may be used to reduce inflammation and swelling associated with pleomorphic lipoma [5].
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs such as ibuprofen or naproxen may be used to manage pain and inflammation related to the tumor.
• Hormonal Therapies: Hormonal therapies such as tamoxifen have been reported to be used in the treatment of pleomorphic lipoma, although their efficacy is unclear [9].

Important Considerations

It's essential to note that drug treatments for pleomorphic lipoma are not well established

Differential Diagnosis of Pleomorphic Lipoma

Pleomorphic lipoma, also known as spindle cell/pleomorphic lipoma (SCL), is a rare type of soft tissue tumor that can be challenging to diagnose. The differential diagnosis for SCL includes several other conditions that may present with similar histological features.

• Fibrolipoma: A fibrolipoma is a type of lipoma that contains fibrous connective tissue, which can make it difficult to distinguish from SCL [1].
• Pleomorphic Liposarcoma: Pleomorphic liposarcoma is a malignant tumor that can mimic the appearance of SCL on histology. Both tumors have a propensity for the presence of pleomorphic lipoblasts [5].
• Giant Cell Fibroblastoma: Giant cell fibroblastoma is another rare soft tissue tumor that can be confused with SCL due to its similar histological features [6].
• Pleomorphic Fibroma: Pleomorphic fibroma is a type of benign soft tissue tumor that can present with a wide range of histological features, including those seen in SCL [6].
• Giant Cell Angiofibroma: Giant cell angiofibroma is a rare vascular tumor that can be difficult to distinguish from SCL due to its similar histological appearance [6].

Key Features for Differential Diagnosis

When attempting to diagnose SCL, it's essential to consider the following key features:

• Age and Location: SCL can occur at any age but has a peak incidence in the fifth to sixth decade. It typically presents as a solitary, well-circumscribed mass in the subcutaneous tissue [9].
• Histological Features: The histology of SCL is characterized by a mixture of spindle cells, pleomorphic lipoblasts, and fibrous connective tissue. However, the presence of a paucity of spindle cells may mimic ordinary lipomas [8].

References

[1] Apr 3, 2024 — These results support the above diagnosis.

[2] by U Sakhadeo · 2015 · Cited by 9

[3] by Y OHSHIMA · 2023 · Cited by 10

[4] May 3, 2023 —

[5] by A Meyer · 2022

[6] by XY Lin · 2012 · Cited by 7

[7] Nov 23, 2021 —

[8] by BJ Van Treeck · 2019 · Cited by 36

[9] by Y OHSHIMA · 2023 · Cited by 10