ANTICANCER RESEARCH 24: 3157-3160 (2004)
Pleomorphic Lipoma: A Definite Histopathological Entity
PAOLO PERSICHETTI1, FILIPPO DI LELLA1, GIOVANNI F. MARANGI1, BARBARA CAGLI1, PIERFRANCO SIMONE1, STEFANIA TENNA1, CARLA RABITTI2, ROBERTO CASSANDRO3, VINCENZO ESPOSITO4,5, ANGELA M. GROEGER5,6,7 and ALFONSO BALDI8
1Department of Plastic and Reconstructive Surgery and 2Department of Pathology, Campus BioMedico University, Rome; 3Institute of Cardio-Thoracic Research, Respiratory Section. V. Monaldi Hospital, Naples; 4Third Division of Infective Diseases, D. Cotugno Hospital, Naples, Italy; 5International Society for the Study of Comparative Oncology (ISSCO), Silver Spring, MD, U.S.A.; 6Division of Vascular Surgery, Cardarelli Hospital, Naples, Italy; 7Department of Cardio-Thoracic Surgery, University of Vienna, Vienna, Austria; 8Department of Biochemistry and Biophysic "F. Cedrangolo", Section of Pathology, Second University of Naples, Italy
Abstract. Pleomorphic lipomas are rare benign tumours mobile, non-tender subcutaneous mass measuring 5 x 3 cm that can resemble a variety of malignant tissue tumour on transversally oriented situated at C7 level. There was no sign of histological examination. We describe a case of pleomorphic cervical adenopathy. Moreover, there was no history of a previous lipoma arising on the posterior aspect of the neck of a 70- trauma at this site. The excisional biopsy specimen was fixed in 10% buffered- year-old man, successfully treated by surgical excision. A formalin and paraffin-embedded. Sections of 5-Ì were stained with review of the literature is presented, summarizing the haematoxylin-eosin, haematoxylin-van Gieson and PAS-haemato- principal clinical and morphological characteristics of this xylin. Other sections were stained with immunohistochemical rare tumor. procedure, using avidin-biotin peroxidase complex (ABC) and antibodies specific for CD34 and S100 (all the reagents were from Lipomas are considered the most common benign soft Dako, Carpinteria, CA, USA). tissue neoplasm of the head and neck (1,2). There are many The patient was treated with surgery and is disease-free at 36 months of follow-up. variants of lipomas, which are differentiated based on the amount and type of mesenchymal elements present. One such variant is pleomorphic lipoma. This is a rare, benign, Results pseudosarcomatous, soft tissue neoplasm, which typically occurs in males (4:1) between the ages of 50 and 70 years Intra-operatively the mass appeared capsulated and well (3,4). Its typical location is in the sub-cutis of the neck and circumscribed. Light microscopic examination revealed a of the shoulder. Currently there are fewer than 150 cases completely excised pleomorphic lipoma based on the reported in the world literature (5). We report on a rare presence of mature fat cells, collagen fibers and "floret-like" case of pleomorphic lipoma. multinucleated giant cells (Figure 1). The immuno- histochemical analysis revealed that more than 80% of Materials and Methods neoplastic cells were positive for CD34 and S-100, while cytokeratin was completely negative (data not shown). A 70-year-old man presented in our Department with a 6-year The light microscopy and immunohistochemical findings history of a mass on the posterior aspect of the neck, gradually were diagnostic for a pleomorphic lipoma. increasing in size. Clinically the lesion appeared as an isolated, Discussion
We describe, here, a rare case of pleomorphic lipoma of the Correspondence to: Dott. Alfonso Baldi, Via G. Orsi 25, 80128 Naples, Italy. Fax: +390815569693, e-mail: [email protected] neck in an adult male (70-year-old). The diagnosis of this rare lesion is difficult and should be considered in every Key Words: Pleomorphic lipoma. growing mass of the head and neck region (5). In our case it
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Figure 1. Section through the tumour showing loosely-textured fibrous stroma containing pleomorphic hyperchromatic cells, chronic inflammatory cells incuding occasional mast cells, and characteristic multinucleated floret-like giant cells with multiple peripherally placed nuclei. Haematoxylin and eosin; original magnification X 40.
was based on the pathological examination of the tissue less than 150 cases of pleomorphic lipoma reported in the sample guided by immunohistological methods and on the literature (5). clinical history of the patient. Fine-needle aspiration has been reported as being Pleomorphic lipoma was first described in the early 80s effective in evaluating subcutaneous lesion especially in the and, in recent years, it has been shown that spindle cell head and neck region (5). However, pleomorphic lipoma lipoma and pleomorphic lipoma are regarded as a single can masquerade as a malignancy on fine-needle aspiration, clinical, histological, immunohistochemical and therefore histological confirmation should be obtained prior cytogenetic entity in the spectrum of benign lipogenic to definitive therapy (6,7). In our experience, we do not neoplasms (1-4). Differential diagnosis between spindle usually perform FNA because of the possibility of false- cell lipoma/pleomorphic lipoma, well-differentiated negative results. We routinely evaluate subcutaneous masses liposarcoma and atypical lipomas relies on clinical and by US. Atypical results or difficult interpretation of US are histopathological examination. Pleomorphic lipoma subsequently evaluated by MRI and eventually by excisional typically arises in the sub-cutis of the neck and the biopsy. In the case presented, we decided to directly shoulder as a progressively enlarging mass. The average perform histological examination of the mass, due to clinical period necessary for diagnosis is 3.3 years. There are still presentation.
3158 Persichetti et al: Pleomorphic Lipoma
Surgical treatment of pleomorphic lipoma involves 2 Krandsorf FM: Benign soft-tissue tumors in a large referral complete surgical excision with clear margins, as simple population: distribution of specific diagnoses by age, sex, and enucleation is inadequate and is associated with a high location. Am J Roentgenol 164: 395-402, 1995. 3 Enzinger FM: Benign lipomatous tumors simulating a recurrence rate. In the case presented, the patient is sarcoma. In: Martin RG, Ayala AG, eds. Management of disease-free at 36 months of follow-up, thus confirming the Primary Bone and Soft Tissue Tumors. Chicago: Year Book reported excellent cure rates for this tumor (8). Publishing, 11-24, 1977. In conclusion, pleomorphic lipoma is a rare benign, 4 Shmookler BM and Enzinger FM: Pleomorphic lipoma: a psueodsarcomatous soft tissue neoplasm typically occurring benign tumor simulating liposarcoma. Cancer 47: 126-133, in the sub-cutis of the neck and shoulder, that can resemble 1981. a variety of malignant soft tissue tumors. Therefore, careful 5 Yencha MW and Hodge JJ: Pleomorphic lipoma: case report and literature review. Dermatol Surg 26: 375-380, 2000. examination of the clinical setting, as well as of the 6 Rigby HS, Wilson YG, Cawthorn SJ and Ibrahim NB: Fine- histopathological characteristics of this kind of tumors is needle aspiration of pleomorphic lipoma: a potential pitfall of essential for a correct diagnosis and to avoid unnecessary cytodiagnosis. Cytopathology 4: 55-58, 1993. and often disfiguring surgery. 7 Dundas KE, Wong MP and Suen KC: Two unusual benign lesions of the neck masquerading as malignancy on fine-needle Acknowledgements aspiration cytology. Diagn Cytopathol 12: 272-279, 1995. 8 Bryant J: Pleomorphic lipoma of the scalp. J Dermatol Surg Oncol 7: 323-325, 1981. This work was supported by FUTURA-Onlus and I.S.S.C.O.
References
1 Enzinger FM and Weiss SW: Soft Tissue Tumors, 3rd ed. St. Received May 18, 2004 Louis: CV Mosby, 351-466: 1995. Accepted August 2, 2004
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