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Archives of Clinical Case Studies and Case Reports
Review Article *Corresponding author
*
Anubha Bajaj, Histopathologist, AB Diagnostics, India
The Adipocerous Versicolour - Pleo Submitted: 10 Jul 2020
Accepted: 14 Jul 2020
morphic Lipoma Published: 18 Jul 2020
Copyright
© 2020 Ashish Sahai
OPEN ACCESS
Anubha Bajaj
Consultant Histopathologist, AB Diagnostics, India
Preface reactivity to D2-40 and focal or non-reactive CD31. The subtype was
Pleomorphic lipoma is cogitated as a contemporary, low grade neoplasm previously denominated as pseudo-vascular, contingent to evaluation
composed of mature adipocytes, bland spindle-shaped cells, atypical cells, in the absence of D2-40.
floret-like, multinucleated giant cells and an encompassing collagenous • Fibrous pleomorphic lipoma which demonstrates abundant fibrous
stroma. The neoplasm depicts a pleomorphic, lipoma-like appearance tissue stroma admixed with bundles of collagen. The subtype may not
with atypical morphological features. Spindle cell lipoma and pleomorphic delineate cogent staining with van Gieson (EVG) stain.
lipoma represent a morphological continuum. Neoplasia with admixed, • Fat free pleomorphic lipoma which may be almost fat free, predom-
concurrent morphological features are common. As an infrequently dis- inantly myxoid and is associated with aforesaid variants. Plexiform
cerned neoplasm, biological behaviour remains uncharted. or curvilinear vasculature with vascular hyalinization is a significant
feature.
• Exceptionally, pleomorphic lipoma appears concurrent to hiberno-
Disease Characteristics ma and is devoid of distinct clinical features. Aforesaid variants of
Pleomorphic lipoma is an exceptional lesion and appears with an estimat-
pleomorphic lipoma may be discerned pertinent to specific location
ed incidence of 0.1% of spindle cell lipoma. The tumefaction commonly
and are intermingled with typical foci of pleomorphic lipoma and
appears in middle aged to elderly individuals between 45 years to 65 years
immune reactive CD34 [2,3].
with a peak incidence within the sixth decade [1].
A male predilection is denominated wherein nearly 90% of subjects in- Histological Elucidation
criminated are males. Characteristically, majority (70%) of tumefaction is Grossly, a nodular or multinodular, partially encapsulated neoplasm is
situated upon dermal or subcutaneous adipose tissue of posterior neck, observed. Tumour perimeter is well defined and tumour infiltration into
upper back or shoulders. Exceptionally, the tumour is discerned within circumscribing soft tissue is absent. However, the exceptional intramuscu-
deep-seated sub-fascial, somatic soft tissues morphologically identical lar or dermal pleomorphic lipoma can depict tumour infiltration. Average
neoplasms situated at sites diverse from aforesaid locales are denominat- tumour magnitude varies from 4 centimetres to 5 centimetres [1].
ed as atypical lipomatous tumour. Common cytogenetic aberrations are
structural rearrangement of chromosome 13q (Rb) or deletion of an entire Macroscopically, a well circumscribed, often encapsulated, greyish/yel-
chromosome 13 although chromosomal deletion 16q and associated vari- low or grey/white, firm neoplasm is denominated. Cut surface is yellow
ations can occur [2]. Exceptionally, the tumour can be familial or multiple. or greyish/ yellow with mucoid foci. On cytology, atypical, enlarged, flo-
Tumour relapse is infrequent and metamorphoses with reoccurrence of ret-like, multinucleated giant cells are admixed with mature adipocytes.
aggressive, dedifferentiated neoplasm or distant metastasis is absent [2]. Cells may demonstrate a malignant countenance [2,3].
The tumefaction is composed of mature adipocytes, bizarre, floret-like
Clinical Elucidation multinucleated giant cells admixed with abundant, dense interstitial col-
Pleomorphic lipoma usually manifests as a superficial, solitary, painless, lagen. Myxoid stroma is imbued with arborizing blood vessels. Lipoblasts
gradually progressive, lobular tumefaction with an average magnitude of are usually absent although few lipoblast - like cells may be present. Min-
5 centimetres. Tumefaction appears as a persistent or enlarging, soft tissue imal nuclear atypia is discerned within the adipocytes although mitosis is
nodule or swelling. Multiple lesions can occur infrequently [1,2]. Akin to exceptional, up to 2 mitosis per 50 high power fields, or absent. Tumour
spindle cell lipoma, pleomorphic lipoma can delineate variants such as necrosis is absent [1,3].
• Vascular pleomorphic lipoma which denominates branching, dilated
or cleft like spaces with papillary tumour projections extending into The neoplasm is comprised of variably quantifiable, 10% to 90% of adult,
circumscribing, cell free spaces. Tumour spaces are layered with en- mature adipose tissue. Infrequently, the neoplasm is devoid of mature ad-
dothelial cells demonstrating a lymphatic phenotype such as immune ipose tissue. Atypical cells can vary from exceptional to frequent. Tumour
Archives of Clinical Case Studies and Case Reports, 2020 Volume 1, Issue 1, P: 1-6cells display enlarged, hyperchromatic nuclei. Nuclei may configure a ing collagen stroma [9]
semi-circular pattern, thereby articulating floret-like giant cells [3,4].
Predominantly circumscribed tumour composed of variable, mature
adipocytes, floret-like, multinucleated giant cells with hyperchromatic,
wreath- like nuclei are admixed with miniature, spheroidal cells with hy-
perchromatic nuclei. The neoplasm is devoid of necrosis or prominent
vascular articulations. Atypical cells appear within adipose tissue or stro-
mal regions of non-adipose tissue [2,4].
The neoplasm is encompassed within abundant bundles of dense, ropey
collagen. Enveloping tumour stroma can be myxoid with entrenched,
thick walled, prominent, arborizing blood vessels. Mast cells can be nu- Figure 2: Pleomorphic lipoma demonstrating mature adipose tissue cells,
merous [1]. As pleomorphic lipoma is composed of mature adipocytes, pleomorphic lipoblasts with hyperchromatic nuclei and enveloping col-
atypical spheroidal, floret-like, multinucleated giant cells admixed within lagenous stroma [10]
a myxoid matrix, proportion of adipocytes and spindle-shaped cells is sig-
nificantly variable. Certain instances of pleomorphic lipoma are fat- poor
with minimal to absent adipocytes. Encompassing myxoid matrix can be
abundant. However, atypical multi-vacuolated lipoblasts, bizarre, pleo-
morphic cells and atypical spindle-shaped cells are absent. Thick, eosin-
ophilic, ropey collagen is a characteristic feature of pleomorphic lipoma.
Also, atypical mitosis is absent in pleomorphic lipoma.
Adipose tissue component is comprised of mature adipocytes with mild
variation of magnitude and contour. Mild to moderate, focal atypia of
adipocytes with dense nuclear chromatin, nuclear enlargement and foci
of bi-nucleation to multi-nucleation, denominated as “anisometric cell li-
poma” or “dysplastic lipoma”, can be observed [2,4].
Figure 3: Pleomorphic lipoma delineating mature adipocytes, pleomor-
Although few, lipoblasts are discerned in around 50% lesions. Lipo- phic, hyperchromatic cells with fascicles of collagen stroma [11]
blasts manifest as miniature, uni-vacuolated, bi-vacuolated or enlarged,
multi-vacuolated cells. Nuclei are hyperchromatic, scalloped with
punched out vacuoles. Zones with pleomorphic, lipoma- like appear-
ance are intermixed with floret-like, multinucleated giant cells, few spin-
dle-shaped cells and an encompassing fibrous to collagenous stroma. Bi-
zarre, hyperchromatic, pleomorphic, multinucleated giant cells are often
admixed with mature adipocytes. Extracellular matrix can be principally
myxoid to predominantly collagenous [3,4].
Pleomorphic lipoma is associated with multitudinous microscopic ap-
pearances and depicts heterogeneous areas within a singular lesion,
contingent to tumour cellularity of diverse denominations of atypical Figure 4: Pleomorphic lipoma exhibiting mature adipocytes, pleomor-
spheroidal or spindle-shaped cells, adipocytes, lipoblasts, pleomorphic phic, hyperchromatic cells with nuclear prominence, red cell extravasa-
multinucleated cells and variable extracellular matrix. Heterologous, met- tion and a collagenous stroma [12]
aplastic differentiation with the emergence of smooth muscle, cartilagi-
nous and osseous elements is infrequent [2,4].
Pleomorphic lipoma frequently depicts a histological concordance with
spindle cell lipoma and demonstrates miniature, spindle-shaped cells
with scanty cytoplasm. On ultra-structural examination, the neoplasm
is comprised of spindle-shaped, non-fat storing mesenchymal cells and
mature adipocytes [3].
Figure 5: Pleomorphic lipoma composed of mature adipose tissue cells
with pleomorphic, hyperchromatic cells, nuclear hyperplasia and a col-
lagenous stroma [13]
Figure 1: Pleomorphic lipoma composed of mature adipocytes, pleomor-
phic, hyperchromatic cells with floret-like giant cells and an encompass-
Archives of Clinical Case Studies and Case Reports, 2020 Volume 1, Issue 1, P: 2-6malignant soft tissue lesions, wherein appropriate clinical and patholog-
ical correlation is critical in demarcation. With atypical cells concurring
in various neoplasia, pleomorphic lipoma can be suitably diagnosed per-
tinent to tumour location.
• Atypical lipomatous tumour is a neoplasm composed of mature ad-
ipose tissue with atypia and emerges in locations excluding dermis
and subcutaneous tissue of posterior neck, upper back or shoulders.
Anatomic distribution appears within limb, limb girdle, hand, foot,
thigh, buttock, forearm, knee, lower leg and upper arm. Infrequently,
head and neck, genital area, trunk, back, larynx, mediastinum, ret-
Figure 6: Pleomorphic lipoma constituted by aggregates of pleomorphic, roperitoneum, trachea and appendix are implicated. Intradermal,
mature adipocytes with hyperchromatic, atypical cells and a circumscribing intra-cavitary or visceral location of the neoplasm is exceptional. In
collagenous stroma [14] contrast to pleomorphic lipoma displaying ropey collagen and sig-
nificant immune reactivity to CD34, atypical lipomatous tumour is
immune reactive to MDM2 and CDK4 [5,6].
• Morphologically identical well differentiated liposarcoma or atypi-
cal lipomatous tumour, especially the sclerosing variant, wherein the
neoplasm is situated within deep-seated soft tissue is denominated.
Well differentiated liposarcoma is a deep-seated neoplasm which
enunciates prominent lipoblasts, dense collagen bundles and variable
quantities of floret-like, multinucleated giant cells. The neoplasm is
primarily immune non-reactive to CD34 although a subset of spin-
dle-shaped cells may be reactive [5].
Figure 7: Pleomorphic lipoma exhibiting mature adipocytes, pleomorphic, • Atypical lipomatous tumour /well differentiated liposarcoma arises
spherical cells with nuclear and cellular hyperplasia and a surrounding in middle aged adults with an identical, broad, anatomic distribu-
collagenous stroma [15] tion of lesions and predilection for extremities. Well differentiated
liposarcoma can emerge within the retroperitoneum, mediastinum
or paratesticular region. Tumefaction is miniature to extensively en-
larged. Grossly, the well circumscribed lesion is associated with irreg-
ular tumour perimeter and infiltrative pattern of tumour progression
[6].
• Atypical lipomatous tumour /well differentiated liposarcoma lacks a
potential for distant metastasis although dedifferentiation into dedif-
ferentiated liposarcoma can arise in nearly 10% subjects. Possibility
of tumour dedifferentiation is maximal within the retroperitoneum.
Even with absence of tumour dedifferentiation, well differentiat-
ed liposarcoma is associated with significant mortality on account
of frequent, localized tumour reoccurrences. Percentage of relapse
is contingent to anatomic localization of the neoplasm and extent
of comprehensive surgical resection. Around 15% reoccurrences
Figure 8: Pleomorphic lipoma composed of atypical, mature adipocytes emerge in lesions of subcutaneous adipose tissue and nearly 30% to
with nuclear hyperplasia and hyperchromasia, red cell extravasation and 50% reappearances occur in neoplasms situated in deep-seated tissue
an enveloping collagenous stroma [16] of extremities or somatic soft tissue of the trunk [4,6].
Immune Histochemical Elucidation • Well differentiated liposarcoma recapitulates fat-rich variant of pleo-
Pleomorphic lipoma is extensively immune reactive to CD34 (100%), B- morphic or atypical spindle-cell lipoma and is almost exclusively
cell lymphoma 2 (Bcl-2 ≈70% to100%), vimentin and CD99 whereas ma- composed of mature adipocytes with aberrant morphological fea-
ture adipose tissue cells are immune reactive to S100 protein. Stromal cell tures such as cellular and nuclear pleomorphism and mild to mod-
react to Factor XIIIa. Tumour cells of pleomorphic lipoma are immune erate atypia. Well differentiated liposarcoma generally comprises of
non-reactive to keratin, CD68, desmin, smooth muscle actin (SMA) and atypical, non lipogenic stromal cell aggregates traversed by fibrous
S100 protein [5]. tissue septa along with the presence of several to absent lipoblasts.
Lipoblasts are not mandatory for categorization of well differentiated
Neoplastic adipocytes are immune reactive to CD34, S100 protein and liposarcoma. Also, pleomorphic lipoblasts are exceptionally delineat-
desmin. Majority (50% to 70%) demonstrate loss of nuclear expression ed in well differentiated liposarcoma [4,5].
of retinoblastoma (Rb) gene and appear immune non-reactive. Amplifi-
cation of mouse double minute 2 (MDM2) homolog or cyclin-dependent • Well differentiated and dedifferentiated liposarcoma characteris-
kinase 4 (CDK4) genes within the adipocytes is focal and minimal [5,6]. tically display supernumerary ring chromosomes or giant marker
chromosomes along with amplification of chromosomal 12q12-15
Differential Diagnosis regions. Aberrant chromosomes delineate amplified sequences of
On account of diverging microscopic appearances, morphological differ- MDM2 and CDK4 genes which can be discerned with array com-
entiation of pleomorphic lipoma is necessitated from several benign and
Archives of Clinical Case Studies and Case Reports, 2020 Volume 1, Issue 1, P: 3-6parative genomic hybridization (aCGH), fluorescent in situ hybrid- • Pleomorphic liposarcoma demonstrates abundant cellular and nucle-
ization (FISH) or multiplex ligation-dependent probe amplification ar pleomorphism, enhanced mitosis and tumour necrosis. Besides,
(MLPA) techniques. Intense nuclear immune reactivity to MDM2 a component of pleomorphic lipoma with floret-like, multinucle-
and CDK4 is denominated. Atypical lipomatous tumour or well ated giant cells is absent. Pleomorphic liposarcoma can depict loss
differentiated liposarcoma denominates an absence of RB1 deletion of expression of nuclear Rb molecule with concurrent loss of RB1
with preservation of Rb expression [1,2]. and flanking genes. However, genetic alterations are complex with
enhanced chromosomal deletions/ gains and multiple structural re-
• Dedifferentiated liposarcoma (DDLS) is discerned in middle aged arrangements. Genetic aberrations of pleomorphic liposarcoma are
or elderly individuals. The neoplasm enunciates a broad anatomic inconsistent and non-specific wherein pathognomonic structural
distribution wherein retroperitoneum is a common site of discern- rearrangements such as reoccurring chromosomal translocation or
ment. Also, extremities, paratesticular region and rarely torso, me- consistently delineated supernumerary ring chromosomes are absent
diastinum, thoracic region and head and neck can be incriminated. [1,2].
Typically, the enlarged, multinodular tumefaction abuts circumscrib-
ing visceral structures. Prognosis is inferior despite radical surgical • Low grade myofibroblastic sarcoma is comprised of fascicles of ill-de-
extermination of the neoplasm with adjuvant radiotherapy. Dediffer- fined, spindle-shaped cells. Tumour perimeter infiltrates into cir-
entiated liposarcoma demonstrates a localized tumour reoccurrence cumscribing soft tissue. Tumour nuclei are pleomorphic and mitotic
in approximately 40% instances and exemplifies a distinct metastatic figures are numerous. The neoplasm is immune reactive to desmin,
potential with distant metastasis in nearly 30% subjects. Mortality en- smooth muscle actin (SMA) or calponin [6,7].
sues due to uncontrollable, localized tumour relapse [1,2].
• Metaplastic spindle cell carcinoma is constituted by sheets of spin-
• Dedifferentiated liposarcoma exhibits diverse morphological appear- dle- shaped cells or a sarcomatoid configuration. The neoplasm is
ances. Majority of neoplasms are extensively cellular, non lipogen- immune reactive to keratin and p63 [6,7].
ic and comprised of spindle-shaped cells with moderate to marked
atypia, configuring loose fascicles with a storiform or pattern-less • Mammary type myofibroblastoma (MMTF) is a benign, well cir-
architecture. Mitotic figures are variable and tumour necrosis is ob- cumscribed, mesenchymal lesion initially described within breast
served [1,2]. parenchyma although is contemplated to denominate an extensive
anatomical distribution. Mammary type myofibroblastoma com-
• The exceptional low grade dedifferentiated liposarcoma enunciates monly appears within the torso, groin, inguinal region and lower
sparse to moderately cellular, fibroblast-like, spindle-shaped cellu- extremities. Middle aged, male subjects are commonly incriminated.
lar proliferation with mild nuclear atypia and minimal mitosis. Low Mammary type myofibroblastoma is composed of proliferation of
grade dedifferentiated liposarcoma depicts an abrupt transition of spindle-shaped cells with a variable, often prominent adipose tissue
well differentiated mature adipocytes into non lipogenic foci of spin- component. Typically, encompassing stroma is collagenous or occa-
dle-shaped cells. Zones of high grade neoplasm with extensive cellu- sionally hyalinised or myxoid. The neoplasm exhibits a median mag-
lar atypia or cellular pleomorphism are intermingled. Pleomorphic nitude of 5.5 centimetres and manifests as preponderantly cellular
lipoblasts are infrequent although are documented in the extremely to pauci-cellular and hyalinised. Spindle-shaped cells configuring the
exceptional dedifferentiated liposarcoma with homologous lipoblas- neoplasm lack atypia, adipocytes demonstrate minimal variation of
tic (pleomorphic liposarcoma-like) differentiation [1,2]. outline and magnitude and lipoblasts are absent. Typically, mammary
type myofibroblastoma is diffusely immune reactive to CD34 (90%)
• Dedifferentiated liposarcoma characteristically displays identical and desmin. Smooth muscle actin (SMA) is manifested in around
aberrations of chromosome 12 as detected in atypical lipomatous 33% instances. The neoplasm depicts chromosomal deletions 13q14
tumour /well differentiated liposarcoma with copy number gains of with deletion of RB1 gene and concordant loss of expression of nu-
MDM2 and CDK4 genes. Dedifferentiated liposarcoma demonstrates clear Rb [1,2].
immune reactivity to MDM2 and CDK4 or genomic amplifications
can be detected with array comparative genomic hybridization • Cellular angiofibroma (CAF) is a benign, fibroblastic, mesenchymal
(aCGH), fluorescent in situ hybridization (FISH) or multiplex liga- neoplasm with an equivalent gender distribution. The neoplasm
tion- dependent probe amplification (MLPA) assay [1,2]. arises within genital or inguinal regions and is uncommon in extra
genital locations such as retroperitoneum, pelvic or lumbar region,
• Pleomorphic liposarcoma is a neoplasm of middle aged and elderly urethra, torso or oral mucosa. Typically well circumscribed, cellular,
individuals. The tumefaction depicts a deep-seated, sub-fascial lo- fibroblastic lesion is constituted by bland, spindle-shaped, occasion-
cation and subcutaneous adipose tissue is rarely incriminated. With ally epithelioid cells denominating a pattern - less configuration.
diverse anatomic distribution, extremities are commonly implicated Around 50% of cellular angiofibromas depict a component of ma-
whereas neoplasms are uncommon within the torso or retroperitone- ture adipocytes of belowimmune reactivity to smooth muscle actin (SMA) and desmin is • Pleomorphic lipoma demonstrates an absence of mouse double min-
discerned in a few instances. Majority (>90%) instances are immune ute 2 (MDM2) homolog and cyclin-dependent kinase 4 (CDK4)
reactive to progesterone receptors (PR) and oestrogen receptors (ER) with fluorescent in situ hybridization (FISH) and polymerase chain
[7,8]. reaction (PCR) [6]. Pleomorphic lipoma demonstrates anomalies of
chromosome 16 with consequent deletions of 16q13-qter along with
• Fat forming solitary fibrous tumour (SFT) is an exceptional variant frequent deletions within chromosome 13q. Pleomorphic lipoma
of solitary fibrous tumour with a variable, preponderant adipose demonstrates a polysomy of chromosome 12 in an estimated 89%
tissue component. The neoplasm commonly arises in middle aged instances [6].
adults. Fat forming solitary fibrous tumour arises in deep-seated soft
tissues of lower extremities and retroperitoneum wherein sites such • Molecular assay with fluorescent in situ hybridization (FISH) and
as orbit, pleura, perineum, spinal cord and mediastinum are uncom- multiplex ligation- dependent probe amplification (MLPA) displays
monly incriminated. Majority of neoplasms demonstrate an indolent a significant subset with genetic deletions /losses of chromosome
clinical course although the biological behaviour is unpredictable. 13q14, deletion of tumour suppressor gene RB1 and adjacent genes
Malignant tumefaction delineates features such as cellular and nu- RCTBTB2, DLEU1, ITM2B. The neoplasm also depicts a consistent
clear atypia, enhanced cellularity, elevated mitotic activity ≥ 4/10high absence of MDM2 or CDK4 genomic amplification. In addition,
power fields, tumour necrosis and invasive pattern of evolution. Con- chromosome 7 monosomy is documented [6,7].
temporary risk stratification models can precisely predict prognostic
outcomes. Fat forming solitary fibrous tumour is composed of bland Therapeutic Options
spindle-shaped cells, a pattern-less tumour architecture and an en- Conservative surgical excision of the neoplasm is generally curative. As a
compassing, attenuated, variably collagenous stroma with a variable clinically indolent lesion of mature adipocytes, majority of pleomorphic li-
admixture of minimal to absent mature adipocytes [1,2]. pomas are accompanied by an excellent prognosis where a comprehensive
surgical excision is undertaken. Incompletely excised tumefaction demon-
• Typically, solitary fibrous tumour depicts several branching, stag- strate a localized tumour reoccurrence. In contrast to classical atypical
horn - like vascular articulations. Lipoblasts are absent whereas lipomatous tumour, well differentiated liposarcoma and dedifferentiated
spindle-shaped cells and adipocytes are devoid of cellular and nu- liposarcoma, possible tumour dedifferentiation and/or distant metasta-
clear atypia. Solitary fibrous tumour, including the fat forming vari- sis is minimal to absent in pleomorphic lipoma. Thus, aggressive surgical
ant, comprehensively demonstrates a sensitive and specific immune eradication of the tumour is nonessential [8].
marker nuclear signal transducer and activator of transcription
6(STAT6) enunciated due to presence of NAB2-STAT6 fusion gene. Table: Differential Diagnosis of Pleomorphic Lipoma [1,2]
The neoplasm is immune reactive to nuclear CD34, CD99 and B- cell
Pleomorphic Lipoma Fat Necrosis Pleomorphic Hya-
lymphoma 2 (Bcl2). Also, deletion of RB1 gene with concordant nu-
linising Angiectatic
clear loss of expression of Rb is absent [1,2].
Tumour
• Diffuse neurofibroma is commonly located within the dermis and Scattered large eccen- Small central nuclei
subcutaneous adipose tissue of head and neck region of young can- tric nuclei
didates. Although diffuse neurofibroma is contemplated as a benign Prominent foam cell Foam cells fill spaces
lesion, tumour reoccurrence can occur in incompletely resected neo- population absent of dead adipocytes
plasms. Malignant metamorphoses is exceptional [7].
Ropey collagen Ropey collagen absent Ropey collagen absent
• Diffuse neurofibroma is comprised of monomorphic proliferation of No intracytoplasmic Intracytoplasmic
spindle-shaped cells with wavy nuclei and floret-like, multinucleated hemosiderin hemosiderin present
giant cells. Adipose tissue component is minimal as differentiation Aggregates of large Aggregates of vessels
into mature adipose tissue cells is exceptional although peripheral vessels absent with hyalinised walls
entrapment of abutting adipose tissue can occur. Degenerative atypia and fibrin
with focal articulation of atypical, hyperchromatic cells can ensue.
Restricted to back Various locations Various locations
Enunciation of hyperplastic nerve bundles and Meissnerian corpus-
of neck, upper back,
cles can indicate diffuse neurofibroma. The neoplasm is immune re-
shoulders
active to S100 protein, SOX10 and fingerprint- like CD34. Enuncia-
tion of Rb is preserved with an absence of deletion of RB1 gene [7,8].
References
1. Lecoutere E, Creytens D (2020) Atypical spindle cell/ pleomorphic
• Lipomatous haemangipericytoma exhibits a typical staghorn vascu-
lipomatous tumour. Histol Histopathol 18: 18210.
lar pattern.
2. Anderson WJ, Jo VY (2019) Pleomorphic lipoma – updates and cur-
rent differential diagnosis. Semin Diagn Pathol 36: 122-128.
• Myxoid liposarcoma is composed of lipoblasts and pleomorphic
3. Bahadir B, Behzatoglu K, Ezgi Hacıhasanoğlu, Sevim Baykal Koca,
spindle-shaped cells with a prominent, plexiform vascular pattern.
Buket Bambul, et al. (2018) Atypical spindle cell/ pleomorphic lipo-
Dense bundles of collagen are usually absent. The neoplasm is im-
matous tumour- a clinicopathologic, immunohistochemical and mo-
mune non reactive to CD34 [7,8].
lecular study of 20 cases. Pathol Int 68: 550-556.
• Schwannoma is a neoplasm of diverse morphology, absent or min-
4. Creytens D, Mentzel T, Liesbeth Ferdinande, Evelyne Lecoutere, Joost
imal adipose tissue component and is intensely immune reactive to
van Gorp, et al. (2017) Atypical pleomorphic lipomatous tumour- a
S100 [8].
clinicopathologic, immunohistochemical and molecular study of 21
cases emphasizing its relationship to atypical spindle cell lipomatous
• Investigative Assay
tumour and suggesting a morphological spectrum (atypical spindle
Archives of Clinical Case Studies and Case Reports, 2020 Volume 1, Issue 1, P: 5-6cell/ pleomorphic lipomatous tumour. Am J Surg Pathol 41: 1443-
1455.
5. Creytens D (2020) What’s new in adipocytic neoplasia. Virchows
Arch 476: 29-39.
6. Van Treeck BJ, Fritchie KJ (2019) Updates in spindle cell/ pleomor-
phic lipomas. Semin Diagn Pathol 36: 105-111.
7. McCarthy AJ, Chetty R (2018) Tumours composed of fat are no lon-
ger a simple diagnosis-overview of fatty tumours with a spindle cell
component. J Clin Pathol 71: 483-492.
8. Chen BJ, Marino- Enreiquez A, Christopher DM Fletcher, Jason L
Hornick (2012) Loss of retinoblastoma protein expression in spindle
cell/ pleomorphic lipomas and cytogenetically related tumours- an
immunohistochemical study with diagnostic implications. Am J Surg
Pathol 36: 1119-1128.
9. Image 1 Courtesy: Webpathology.com
10. Image 2 Courtesy: Basic medical key
11. Image 3 Courtesy: Pathology outlines
12. Image 4 Courtesy: Dermnet NZ
13. Image 5 Courtesy: You tube.com
14. Image 6 Courtesy: Science direct
15. Image 7 Courtesy: Twitter
16. Image 8 Courtesy: Wiley online library
Cite
* this article: Anubha Bajaj (2020) The Adipocerous Versicolour - Pleomorphic Lipoma. Archives of Clinical Case Studies and Case Reports 1:
1-6.
*Copyright: ©2020 Anubha Bajaj. This is an open-access article
distributed under the terms of the Creative Commons Attribution License,
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