Search

Spindle cell lipomas are a rare type of lipoma usually presenting in middle-aged to older men, often located on the posterior neck or shoulder; presentation on the foot is exceptionally uncommon. We report a 24-year-old man with spindle cell lipomas on the hallux of his left foot. He experienced an uneventful recovery after excision of the mass. We discuss clinical, radiologic, and histopathologic features of spindle cell lipomas and we review the differential diagnosis at this anatomic site.

Abstract Background Spindle cell lipoma is a benign adipocytic tumour, commonly occuring in the subcutis of posterior neck, upper back and shoulder, particularly in middle aged males. It is often composed of relatively equal ratio of fat and spindle cells, yet either component may predominate. Because of its variable ratio, a spindle cell lipoma may mimic liposarcoma radiologically. This article aimed to describe the MRI characteristics that assist in diagnosing spindle cell lipoma. Case presentation: A 45-year-old female presented with a gradually progressive neck swelling along the posterior aspect over a period of 2 years. Physical examination revealed a firm, mobile, non-tender mass in the left suboccipital region. Radiographic imaging showed a well-defined heterogeneous, minimally enhancing soft tissue swelling with areas of macroscopic fat and multiple macrocalcifications in the left suboccipital region extending to the left parapharyngeal space, showing loss of fat plane with adjacent muscles. Differential diagnoses of soft tissue neoplasms such as atypical lipoma and low-grade liposarcoma were considered. Surgical excision confirmed a myxoid variant of spindle cell lipoma upon histopathological examination. Conclusion Spindle cell lipomas, commonly found in the posterior neck, have varied imaging features that are not distinctive. Despite their non-specific nature, radiologists should recognize these features, as the tumor can be treated effectively with simple excision. When encountering a well-defined, complex fatty mass in the subcutaneous tissue of the posterior neck, consider a diagnostic possibility of spindle cell lipoma.

A jejunal intussusception as a presentation of retroperitoneal liposarcoma (RLPS) is a rare occurrence. The majority of RLPS are presented as an abdominal mass, however, having a jejunal obstruction is an interesting case. The aim is to describe the management of jejunal intussusception secondary to atypical lipomatous tumours with concurrent RLPS. A 61-year-old lady presented with a sudden onset of intestinal obstruction with 1 month of constitutional symptoms and an enlarging right lumbar mass. Computed tomography showed a small bowel intussusception with diffuse peritoneal and retroperitoneal lipomatosis. Emergency exploratory laparotomy, segmental bowel resection, and partial excision of intraperitoneal mesenteric lipoma were performed. A stage En-bloc resection of the RLPS and right nephrectomy was done later. However, she refused for subsequent surgery. A complete resection is the gold standard in managing RLPS. In this report, the management is rendered not to the standard as the patient first presented with intestinal obstruction requiring emergency reduction with a piecemeal resection. A stage surgery was required to determine a promising prognosis, but the patient refused such surgery. A small bowel intussusception in adults is rare but is mostly caused by a tumor or neoplasm. Early recognition of the complexity of the case should be preempted and referred to the tertiary team for further definitive surgery. Patient exhaustion from the subsequent surgery might hamper the only management available for the case.

Atypical lipomatous tumor, also known as well-differentiated liposarcoma, is rare in the head and neck region. The primary and most effective option in the treatment of this malignancy with a good prognosis is excision with clean surgical margins. Therefore, it is important to distinguish this malignancy from lesions that require more aggressive treatment. In this article, we present the case of an atypical lipomatous tumor originating from the nasopharynx and almost completely obstructing the oropharynx in a 38-year-old male patient with chronic lymphocytic leukemia. To the best of our knowledge, this is the first report in the literature of an atypical lipomatous tumor case originating from the nasopharynx.

Atypical lipomatous tumor, also known as well-differentiated liposarcoma, is rare in the head and neck region. The primary and most effective option in the treatment of this malignancy with a good prognosis is excision with clean surgical margins. Therefore, it is important to distinguish this malignancy from lesions that require more aggressive treatment. In this article, we present the case of an atypical lipomatous tumor originating from the nasopharynx and almost completely obstructing the oropharynx in a 38-year-old male patient with chronic lymphocytic leukemia. To the best of our knowledge, this is the first report in the literature of an atypical lipomatous tumor case originating from the nasopharynx. [ABSTRACT FROM AUTHOR]

Abstract Background Intestinal obstruction is a common surgical emergency that is presented to the hospital with various aetiologies. Among all, mesenteric lipoma is one of the uncommon extraluminal causes of intestinal obstruction. In such conditions, bowel volvulus, compression or even adhesion are the underlying pathologies. Case presentation We report a 69-year-old gentleman who presented with a triad of intestinal obstruction which required exploratory laparotomy. Preoperative computed tomography revealed multiple coalescing lobulated hypoattenuating lesions encircling part of a small bowel forming transitional zone. These lesions are comparatively more hypoattenuating in comparison with the surrounding mesenteric fat. Intraoperatively, a giant ileal mesenteric lipoma was identified causing compression and folding to the adjacent small bowel, leading to proximal bowel dilatation. Excision of the lipoma with a few mesenteric lymphadenectomy was done, revealing a benign mesenteric lipoma and reactive lymph nodes. Despite ileus, he made a good postoperative recovery and was discharged well. Conclusions Patients with recurrent abdominal pain must have a thorough endoscopic and imaging assessment. Besides common or malignant aetiology, rarities should be considered and actively sought. Mesenteric lipoma is a relatively indolent tumour for which early detection can alter clinical presentation.

Copyright of Journal of Ankara University Faculty of Medicine / Ankara Üniversitesi Tip Fakültesi Mecmuasi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Intestinal obstruction is a common surgical emergency that is presented to the hospital with various aetiologies. Among all, mesenteric lipoma is one of the uncommon extraluminal causes of intestinal obstruction. In such conditions, bowel volvulus, compression or even adhesion are the underlying pathologies. Case presentation: We report a 69-year-old gentleman who presented with a triad of intestinal obstruction which required exploratory laparotomy. Preoperative computed tomography revealed multiple coalescing lobulated hypoattenuating lesions encircling part of a small bowel forming transitional zone. These lesions are comparatively more hypoattenuating in comparison with the surrounding mesenteric fat. Intraoperatively, a giant ileal mesenteric lipoma was identified causing compression and folding to the adjacent small bowel, leading to proximal bowel dilatation. Excision of the lipoma with a few mesenteric lymphadenectomy was done, revealing a benign mesenteric lipoma and reactive lymph nodes. Despite ileus, he made a good postoperative recovery and was discharged well. Conclusions: Patients with recurrent abdominal pain must have a thorough endoscopic and imaging assessment. Besides common or malignant aetiology, rarities should be considered and actively sought. Mesenteric lipoma is a relatively indolent tumour for which early detection can alter clinical presentation. [ABSTRACT FROM AUTHOR]

Abstract Background Among primary cardiac tumors, atypical lipoma is very rare. In particular, cases with lipomas in both the pericardium and the atria are even rare. Case presentation We report the case of a 49-year-old male patient presented to our department because of chest pain. Echocardiography revealed two large masses in both the pericardium and the right atrium. Then the tumors were completely resected and the histopathological examination revealed atypical lipoma. The patient recovered well without any complication and discharged from hospital. Conclusions We report a very rare case of a huge atypical lipomas located on the pericardium and right atrium. These tumors were easily detected by echocardiography and final diagnosed after surgical resection and pathological examination.

Abstract Background Atypical lipomatous tumours (ALT) are common adipocytic tumours. Due to their large size and deep-seated location, wide resection might result in severe functional deficits. The question which margins should be aimed is hence discussed controversially. Methods Forty consecutive patients underwent limb-sparing resections. Margins were defined as R0 (wide resection), R1 (marginal resection) or R2 if tumour was left. All patients were followed for evidence of local recurrence or remote metastases. Overall and recurrence-free survival was calculated. Results The mean age at the time of surgery was 61.9 years. The mean tumour diameter was 17 cm with no patient having metastatic disease. In 8 cases a wide (R0) resection, in 31 cases a marginal (R1) and in one patient a R2-resection was performed. The median follow-up time was 40 months. Four patients died due to causes that were not tumour-related. 3 (7.5%) patients (all R1) developed local recurrences. Two of our 3 recurrences in this series occurred in 6 already recurring cases. We observed no dedifferentiation of tumours and no metastatic disease. Conclusions ALT represents a comparatively common diagnosis in large deep-seated lesions of the extremities, especially in patients over 60 years. Marginal resection shows an acceptable rate of local recurrence. The risk of dedifferentiation as proven also in a metaanalysis of the English literature of the last 30 years is close to 1%, metastatic disease is exceedingly rare.

Background: Among primary cardiac tumors, atypical lipoma is very rare. In particular, cases with lipomas in both the pericardium and the atria are even rare.Case Presentation: We report the case of a 49-year-old male patient presented to our department because of chest pain. Echocardiography revealed two large masses in both the pericardium and the right atrium. Then the tumors were completely resected and the histopathological examination revealed atypical lipoma. The patient recovered well without any complication and discharged from hospital.Conclusions: We report a very rare case of a huge atypical lipomas located on the pericardium and right atrium. These tumors were easily detected by echocardiography and final diagnosed after surgical resection and pathological examination. [ABSTRACT FROM AUTHOR]

A 24-year-old woman presented with a 5-month history of a left flank mass that was painful on palpation. Magnetic resonance imaging revealed a 10.0 × 6.0 × 2.5 cm mass consistent with lipoma. A fatty lobulated mass was excised and subjected to H&E staining and immunohistochemical analyses. The specimen consisted of mature univacuolated adipocytic cells, with intermixed multivacuolated eosinophilic granular cells. No atypia or hyperchromasia was identified. Most of the cells were S100 positive and Ki-67 immunonegative. A diagnosis of a lipoma-like hibernoma was rendered. Hibernomas are rare benign lipomatous tumors that show differentiation toward brown fat. The lipoma-like hibernoma subtype is rare and can be misdiagnosed as atypical lipoma or well-differentiated liposarcoma. Here we describe an example of this rare tumor.

Lipomas are the most frequent soft tissue tumors. Osteolipomas are a rare variant that can be difficult to diagnose. We report the case of a 66-year-old man consulting with a tumor of 2 years development in the right paravertebral cervical region. Neurologically, the patient had no sign of myelopathy or neurological focality. Magnetic resonance imaging showed a mass with a lipid component and calcifications inside within the right paravertebral musculature with a possible origin in the right C3 posterior root. A computed tomography scan and guided biopsy were performed, revealing hematic material and small bone spicules with no apparent neoplastic element. The tumor was totally removed, including the right C3 posterior branch, and was confirmed to be an osteolipoma on biopsy. The patient remains asymptomatic at 6-month follow-up. The osteolipoma is a benign tumor of soft tissue, characterized by lipoma areas with mature bone tissue differentiation, and even with hematopoietic marrow.

A 24-year-old woman presented with a 5-month history of a left flank mass that was painful on palpation. Magnetic resonance imaging revealed a 10.0 × 6.0 × 2.5 cm mass consistent with lipoma. A fatty lobulated mass was excised and subjected to H&E staining and immunohistochemical analyses. The specimen consisted of mature univacuolated adipocytic cells, with intermixed multivacuolated eosinophilic granular cells. No atypia or hyperchromasia was identified. Most of the cells were S100 positive and Ki-67 immunonegative. A diagnosis of a lipoma-like hibernoma was rendered. Hibernomas are rare benign lipomatous tumors that show differentiation toward brown fat. The lipoma-like hibernoma subtype is rare and can be misdiagnosed as atypical lipoma or well-differentiated liposarcoma. Here we describe an example of this rare tumor. [ABSTRACT FROM AUTHOR]

Lipomas are the most frequent soft tissue tumors. Osteolipomas are a rare variant that can be difficult to diagnose. We report the case of a 66-year-old man consulting with a tumor of 2 years development in the right paravertebral cervical region. Neurologically, the patient had no sign of myelopathy or neurological focality. Magnetic resonance imaging showed a mass with a lipid component and calcifications inside within the right paravertebral musculature with a possible origin in the right C3 posterior root. A computed tomography scan and guided biopsy were performed, revealing hematic material and small bone spicules with no apparent neoplastic element. The tumor was totally removed, including the right C3 posterior branch, and was confirmed to be an osteolipoma on biopsy. The patient remains asymptomatic at 6-month follow-up. The osteolipoma is a benign tumor of soft tissue, characterized by lipoma areas with mature bone tissue differentiation, and even with hematopoietic marrow. [ABSTRACT FROM AUTHOR]

The authors of this case report are describing a rare tumor (well-differentiated liposarcoma ═ WDLS) in the orofacial region of a 93-year-old man. At the same time they are presenting a brief review about malignant adipose tissue tumors.

While MRI is recognized to be the gold standard examination to diagnose giant lipomas and exclude liposarcomas, there is insufficient knowledge about how to clarify the degree of malignancy of intermediate lesions. We report here the case of a digital giant lipoma, where MRI showed a benign polylobulated lipomatous tumor, but that presented nuclear atypia on conventional histological examination suggestive for an atypical lipoma or well-differentiated liposarcoma. To exclude such a lipomatous tumor necessitating a more aggressive surgical excision, complementary cytogenetics with fluorescence in situ hybridization study for MDM2 and CDK4 genes was required. A literature review of the diagnostic approach for lipomatous tumors of the extremities, including MR images, histological examination, and new cytogenetic techniques, is performed. Level of Evidence: Level V, diagnostic study. [ABSTRACT FROM AUTHOR]

Atypical Lipomatous Tumor/Well Differentiated Liposarcoma (ALT/WDLS) is a soft tissue sarcoma of intermediate malignant behavior, most frequently affecting the retroperitoneum and lower extremities. Oral liposarcomas are very rare neoplasms, the most common histological subtype being ALT/WDLS. In this study, three additional cases of ALT/WDLS located on the tongue (2 cases) and the lower lip (1 case), respectively, are described. Analysis of the salient clinicopathologic features of 63 oral ALT/WDLS cases previously reported in the English language literature, as well as of the 3 cases presented in this study, indicates that the indolent biologic behavior of this tumor justifies its designation as a locally spreading malignant neoplasm, affording a rather conservative surgical approach. [ABSTRACT FROM AUTHOR]

Controversy exists with regard to the nomenclature, treatment and outcome of a group of well-differentiated lipomatous tumours sometimes labelled as atypical lipomas. The purpose of the present paper is to attempt to clarify these controversies by reporting our experience with this lesion. The clinical features and follow up of 61 patients with the diagnosis of deep atypical lipoma and a minimum two-year follow up were examined. All patients were treated by marginal excision alone. A local recurrence was seen in five patients (8%). Three recurred once and two recurred twice. No patient had a metastasis or died as a result of the tumour. No lesion dedifferentiated. We believe the term atypical lipoma is appropriate for these tumours, as they appear not to have any metastatic potential, merely a propensity to recur locally. The chance of dedifferentiation is small and radiotherapy may play a role in its causation. We suggest that a simple marginal resection (shelling-out) is adequate treatment for these lesions. Radiotherapy should not be used. [ABSTRACT FROM AUTHOR]

We document an uncommon variant of pulmonary hamartoma (PH), discovered in the left upper lobe of a 60-year-old man after an episode of pneumothorax, a unique clinical presentation for such an occurrence. The tumour showed a prominent leaf-like pattern and was mainly composed of mature fat with adipocytes of different size and scattered throughout lipoblasts and floret-like cells. A lobectomy was performed and more than 7 years after surgery the patient''s course is still uneventful. This case represents an exceedingly rare example of an histologically malignant change in PH and bears a close clinicopathologic resemblance to atypical lipomatous tumours of soft tissues. [Copyright &y& Elsevier]

We investigated the diagnostic significance of supernumerary ring chromosomes in low-grade soft-tissue neoplasms. Chromosome slides were prepared from 123 samples of soft-tissue tumours using the standard trypsin-Giemsa banding technique. Supernumerary ring chromosomes were found in 6 cases of soft tissue tumours: 5 cases of atypical lipomatous tumour (ALT) and 1 case of dermatofibrosarcoma protuberans (DFSP). By chromosome painting with fluorescence in situ hybridization (FISH), the ring chromosome in 1 ALT was painted over its entire length with the chromosome 12 probe. Nuclear blebs and micronuclei, which were observed in each case of ALT, also contained chromosome 12 material; and these structures may represent a topological distribution of ring or giant marker chromosomes in the interphase nuclei. Our findings suggest that supernumerary ring chromosomes are characteristic of some low-grade soft tissue neoplasms including ALT and DFSP. [ABSTRACT FROM AUTHOR]

This review summarizes the clinicopathological features of recently characterized variants of lipomatous tumours of soft tissue, attempts to deal with some difficult conceptual issues relating to adipocytic neoplasms and aims to provide an update on cytogenetic aspects of fatty tumours. Myolipoma is a rare benign neoplasm, occurring most frequently in adults in the deep soft tissue of the abdomen or retroperitoneum, and is composed of irregularly admixed mature adipose and smooth muscle tissues. Chondroid lipoma represents an unusual benign lesion occurring mainly in adult females subcutaneously or in deep soft tissue; it is easily mistaken for myxoid liposarcoma or extraskeletal myxoid chondrosarcoma. Spindle-cell liposarcoma is a variant of well-differentiated liposarcoma quite commonly found in subcutaneous tissue of the shoulder region and upper limbs and is composed of relatively bland-appearing spindle cells mixed with a well-differentiated liposarcomatous component. Recently there has been considerable debate about classification of lipomatous tumours. The term atypical lipoma was proposed for a group of well-differentiated non-metastasizing liposarcomas arising in surgically amenable soft tissues and for deep-seated atypical adipocytic neoplasms that show variation in adipocytic size and atypical stromal cells but lack lipoblasts. However, these neoplasms recur repeatedly and may dedifferentiate and thereby acquire metastatic potential. We use the diagnosis atypical lipoma with caution and propose to use the terms well-differentiated liposarcoma and atypical lipoma interchangeably. The relationship between myxoid and round-cell liposarcoma, which constitutes the morphological spectrum of a single entity, has been clarified but there remain considerable problems in defining likely clinical behaviour. The recent advances in cytogenetic characterization and classification of lipomatous tumours, which is already proving to be of diagnostic importance, are reviewed, and the genetic importance of the distinct chromosomal translocation in myxoid/round cell liposarcoma is briefly discussed. [ABSTRACT FROM AUTHOR]

Mutations of the tumor suppressor gene p53 have been identified in a wide variety of human tumors, including soft tissue sarcomas. Most missense mutations of p53 increase the half-life of the protein resulting in its accumulation in the nucleus. Immunohistochemical staining with a monoclonal antibody PAB1801 (Oncogene Science, Uniondale, NY) detects the intranuclear accumulation of p53 protein in formalin-fixed tissue, and, thus, indicates the presence of missense mutations within the p53 gene. We compared p53 immunoreactivity in paraffin sections of low-grade sarcomas that progressed to high-grade lesions with low-grade sarcomas that had not progressed to high-grade lesions to determine if (1) histologic progression is associated with increasing incidence of p53 missense mutations, and (2) p53 missense mutations within low-grade areas are predictive of which lesions undergo histologic progression. To examine these questions we studied well-differentiated liposarcoma with and without dedifferentiation and dermatofibrosarcoma protuberans with and without areas of fibrosarcoma. Nuclear p53 immunoreactivity was detected in 48% (12/25) of well-differentiated liposarcoma with dedifferentiation compared to only 6% (1/17) of well-differentiated liposarcoma alone. p53 nuclear immunoreactivity was also detected in 25% (4/16) of dermatofibrosarcoma protuberans with fibrosarcoma, and in 0% (0/24) of dermatofibrosarcoma protuberans lacking fibrosarcoma. In cases of well-differentiated liposarcoma with dedifferentiation and dermatofibrosarcoma protuberans with fibrosarcoma displaying immunoreactivity. the staining occurred almost exclusively in the high-grade areas and very infrequently in the low-grade regions as well. We conclude that histologic progression of well-differentiated liposarcoma and dermatofibrosarcoma protuberans is associated with increased nuclear p53 immunoreactivity. Since p53 immunoreactivity occurs infrequently in the low-grade areas of those sarcomas that had transformed to higher grade lesions, it does not appear to be a useful predictor of tumor progression in low-grade lesions. [ABSTRACT FROM AUTHOR]

Introduction: Atypical lipomatous tumors or well-differentiated liposarcomas (ALT/WDLS) are low-grade soft tissue tumors that are commonly located on the trunk and extremities. There is no consensus on the best surgical approach for ALT/WDLS., Methods: A systematic literature review of PubMed, Medline, Embase, Scopus, and google scholar was performed. All published studies on trunk or extremities ALT/WDLS with reported outcome data were considered and independently screened for inclusion by at least two of the authors., Results: A total of eighteen studies comprising 793 patients with ALT/WDLS were included. 580 patients underwent marginal excision, with local recurrence observed in 69 (11.9%). 213 patients underwent wide excision with local recurrence in 7(3.3%). Recurrent tumors were successfully re-resected with marginal or wide excision. Dedifferentiation was confirmed in 9 patients (1.1%), and a distant pulmonary metastasis in 1 patient (0.1%)., Discussion: Marginal excision of truncal or extremities ALT/WDLS results in a slightly higher local recurrence rate. However, recurrences are almost always amenable to re-resection. The findings support the use of marginal excision for truncal or extremities ALT/WDLS., Competing Interests: Declaration of competing interest There is no conflict of interest to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose To report a case series of atypical lipomas of the hand and forearm and review the literature to define the clinical presentation, surgical approach, and postoperative complications including recurrence. Methods All cases of atypical lipomas of the hand and forearm treated by the author between 1994 and 2010 were retrospectively reviewed. The charts were reviewed for age, gender, tumor site, symptoms, preoperative studies, tumor size, type of surgical excision, and postoperative complications including recurrence. Results Nine cases were identified. All patients were middle-aged adults with a mean age of 55 years (range, 40–65 years). There were 5 women and 4 men. All patients presented with a single, painless, enlarging mass in either the palm or the volar forearm. Magnetic resonance imaging showed the tumors to be hyperintense on T1- and hypointense on T2-weighted images. All patients had marginal excision of the tumor. Histologically, 5 tumors were conventional, and 4 tumors were cellular atypical lipomas. The mean follow-up was 10 years (range, 6–16 years). There was no evidence of recurrence by clinical examination at final follow-up. Conclusions The results of the current series and a review of the literature suggest that atypical lipomas of the hand and forearm may have a more benign behavior than atypical lipomas of other anatomical sites. Type of study/level of evidence Therapeutic IV. [ABSTRACT FROM AUTHOR]

Our case is a male patient aged 52 years. The presence of a giant lipoma, arising from mediastinal fatty tissue, weighing 3.9 kg with a maximum diameter of 32 cm, with smooth edges and a capsule, and filling the left hemithorax, and thus causing atelectasia of the left lung, is discussed together with the literature. No case of such a large intrathoracic lipoma has been reported in the literature. [ABSTRACT FROM AUTHOR]

Spindle cell lipoma, a rare variant of lipoma, is a benign tumor found in the posterior neck and shoulder. A 24-year-old man with a close family history of malignant lymphoma had presented with a large, firm, nodular mass found in the right supraclavicular area. Excision of the deeply located mass revealed a pale yellow, rubbery nodule which grossly resembled an enlarged lymph node, with a variant of lymphoma as a primary suspect. However, pathological studies revealed the lesion to be a spindle cell lipoma. Although atypical in location, spindle cell lipoma should always be kept in differential diagnosis of a newly-noted soft tissue mass, as this entity may be easily cured by simple excision., Competing Interests: No potential conflict of interest relevant to this article was reported.

Hibernoma is a very rare, benign soft fatty tumor that derived from remnants of fetal brown tissue. The following case of hibernoma break out occurred from a patient who had received surgical resection of neurilemmoma. There has never been a case that reported about hibernoma accompanied by neurilemmoma. It is anticipated that this experience would be helpful to other physicians who are interested in this rare type of tumor.