Lipomas are benign tumors composed of mature fat, usually encapsulated. Vast majority of lipomas are small, weighing only a few grams, and grow slowly. Lipoma occur rarely in breast causing diagnostic dilemma. Chondroid lipoma is a rare variant of lipoma which is benign in nature. We present a case of 65 year old female patient presented with lump in right breast, underwent surgical excision and histopathology reported as chondroid lipoma.
Lipoma; Chondroid lipoma; Excision
Chondroid lipoma, a rare benign adipose tissue tumor, may histologically resemble myxoid liposarcoma or extraskeletal myxoid chondrosarcoma, but is genetically distinct. In the current study, an identical reciprocal translocation, t(11;16)(q13;p13) was identified in three chondroid lipomas, a finding consistent with previous isolated reports. A fluorescence in situ hybridization (FISH)-based positional cloning strategy using a series of bacterial artificial chromosome (BAC) probe combinations designed to narrow the 16p13 breakpoint revealed MKL2 as the candidate gene. Subsequent 5′ RACE studies demonstrated C11orf95 as the MKL2 fusion gene partner. MKL/myocardin-like 2 (MKL2) encodes myocardin-related transcription factor B (MRTF-B) in a megakaryoblastic leukemia gene family, and C11orf95 (chromosome 11 open reading frame 95) is a hypothetical protein. Sequencing analysis of RT-PCR generated transcripts from all three chondroid lipomas defined the fusion as occurring between exons 5 and 9 of C11orf95 and MKL2, respectively. Dual-color breakpoint spanning probe sets custom-designed for recognition of the translocation event in interphase cells confirmed the anticipated rearrangements of the C11orf95 and MKL2 loci in all cases. The FISH and RT-PCR assays developed in this study can serve as diagnostic adjuncts for identification of this novel C11orf95-MKL2 fusion oncogene in chondroid lipoma.
Parosteal lipoma is an extremely rare benign tumor composed mainly of mature adipose tissue with a bony component.
PRESENTATION OF CASE
This study reports the case of a 65-year old woman with a big mass on the posteromedial aspect of the right upper arm since 1 year. The swelling was a slow growing, painless, nontender, immobile mass which was not fixed to skin. She had no complaints of painful or restricted movements of the shoulder joint. She had no history of trauma to the upper limb.
MRI revealed a large 13 cm × 5 cm × 8 cm well defined, nonenhancing, lobulated, heterointense, predominantly fat intensity lesion with a small area of chondroid component measuring 2 cm × 1.6 cm in posteromedial aspect of proximal right humerus, seen completely separate from the adjacent muscles.
The patient underwent surgery under general anesthesia. Vertical elliptical incision was taken over the posterior border of the upper arm over the mass. The tumor was below the lower part of deltoid near the upper end of humerus, which formed the roof, and between the long and medial heads of triceps muscles. A part of tumor, measuring 6 cm × 5 cm × 5 cm, was under the long head of triceps displacing it along with radial nerve and vessels medially while the other part, measuring 7 cm × 6 cm × 3 cm, was under the medial head of triceps displacing it laterally. The tumor was excised undocking its periosteal attachment. The specimen weighed 250 g. On histopathology, the lesion was composed of mature lipocytes that had an intimate relationship with the periosteum. No cellular atypia or lipoblasts were seen.
Parosteal lipomas are rare neoplasias with no proven malignant potential. These tumors can be resected without much damage to the adjacent structures, thus preserving the function of the upper limb.
Parosteal lipoma; Lipocytes; Humerus; Periosteum; Triceps
Lipomas are the most common benign soft tissue tumors and appear in any part of the body. They typically consist of mature adipose tissue. Osteolipoma is an extremely rare histologic variant of lipoma that contains mature lamellar bone within the tumor and osteolipoma independent of bone tissue are very rare. We report a case of histologically confirmed osteolipoma independent of bone located in the thigh.
A 47-year-old male presented with a progressively enlarging, painful mass which approximately 10 cm × 8 cm over the anteromedial aspect of his right thigh. Plain films, Computerized Tomography, Magnetic Resonance Imaging and ultrasound guided needle biopsy were performed. Given the benign imaging characteristics and fine needle aspiration, an excisional biopsy was undertaken. The definitive pathologic diagnosis was intramuscular osteolipoma without evidence of malignancy. No recurrence was observed after 18 months follow up.
Although ossifying lipomas are very rare, it is important to keep them in mind when a lesion with adipose tissue in combination with ossification is encountered.
Chondroid syringoma is a rare benign skin adnexal tumor of eccrine/apocrine origin affecting commonly the head and neck region. It is also called as mixed tumor of skin because of the presence of both the epithelial and mesenchymal components. There are very few case reports of chondroid syringoma diagnosed on fine needle aspiration cytology (FNAC). We hereby report a case of giant chondroid syringoma occurring over the lower back in a 50-year-old male, diagnosed initially on cytology and confirmed by histopathology. This case is reported for its unusual size and site of occurrence. We describe the clinical features, cytology, histopathology, immunohistochemistry, and differential diagnosis of giant chondroid syringoma along with review of literature.
Adnexal tumor; chondroid syringoma; fine needle aspiration cytology; immunohistochemistry
Intraosseous lipoma is a very rare lesion, which constitutes not more than 0.1% of bone tumors. The introduction of cross-sectional imaging, especially MRI, seems to have increased the detection rate of these lesions.
The authors presented 6 cases of intraosseous lipomas in bones of the lower extremities. All lesions were detected incidentally and presented radiographically as radiolucent lesions with sclerotic borders and internal trabeculations. One lesion caused bone expansion. CT and MRI identified fatty tissue in all lesions. Cystic degeneration was present in one lesion and dystrophic calcifications in two.
The radiographic appearance of intraosseous lipomas is not characteristic and requires differential diagnostics conducted for a long time. However, CT and MRI allow for a tissue-specific diagnosis. The detection of a predominant fatty component in a lesion confirms its benign character and no further diagnostic work-up is required.
bone tumor; intraosseous lipoma; imaging
Aims. Chondroid lipoma (CL) is a benign tumor that mimics a variety of soft tissue tumors and is characterized by translocation t(11;16). Here, we analyze CL and its histological mimics. Methods. CL (n = 4) was compared to a variety of histological mimics (n = 83) for morphological aspects and immunohistochemical features including cyclinD1(CCND1). Using FISH analysis, CCND1 and FUS were investigated as potential translocation partners. Results. All CLs were strongly positive for CCND1. One of 4 myoepitheliomas, CCND1, was positive. In well-differentiated lipomatous tumors and in chondrosarcomas, CCND1 was frequently expressed, but all myxoid liposarcomas were negative. FISH analysis did not give support for direct involvement of CCND1 and FUS as translocation partners. Conclusions. Chondroid lipoma is extremely rare and has several and more prevalent histological mimics. The differential diagnosis of chondroid lipomas can be unraveled using immunohistochemical and molecular support.
Chondroid syringoma represents the cutaneous counterpart of mixed tumor (pleomorphic adenoma) of salivary glands, therefore it is also termed “mixed tumour of the skin.” It is generally accepted that there are both eccrine and apocrine variants of mixed tumors of skin. Malignant chondroid syringoma is a malignant eccrine neoplasm that is very rarely encountered in radio-pathological and clinical practice. Unlike the benign variety which occurs most often on the head and neck, malignant chondroid syringomas are most often found on the trunk and extremities. The usual presentation is that of an asymptomatic slow-growing mass in the region of head or neck. We present here a case report of histopathologically proven malignant chondroid syringoma of scalp in occipital region, with dural invasion. Malignant chondroid syringomas clinically appear as very large nodules and they metastasize at a very high rate. The treatment of these malignancies is surgical excision.
Chondroid syringoma; pleomorphic adenoma; scalp tumors; skin tumors
Lipoma arborescens (LA) is a rare benign lesion of unknown etiology. It is characterized histologically by villous proliferation of the synovial membrane and diffuse replacement of the subsynovial tissue by mature fat cells. This condition affects the knee joint most commonly. Cases involving other locations including glenohumeral joint, hip, elbow, hand and ankle have been rarely described. Involvement of the subdeltoid bursa has also been reported, but to date no case has described LA with osseous/chondroid differentiation of this bursa. Another significant finding in our case was the coexistence of LA with intermuscular lipoma, SLAP lesion and labral cyst.
Labral cyst; lipoma; lipoma arborescens; osseous/chondroid differentiation; shoulder; SLAP lesion; subdeltoid bursa
The purpose of this report is to present the case of a 54-year-old female patient with a pathologically confirmed diagnosis of soft tissue lipoma. The clinical presentation, pathophysiology, differential diagnosis, and treatment options for lipoma are described.
The patient presented to a chiropractic clinic with painful swelling in the right anterior thigh. Physical examination revealed a palpable mobile mass with minimal tenderness.
Intervention and Outcome
The initial consultation was with the primary care physician, and it resulted in a sonographic examination as the initial imaging modality to rule out deep venous thrombosis. The result of this examination was negative. Following a delay by additional incorrect diagnoses and treatments, a diagnosis of an intermuscular lipoma was established by magnetic resonance imaging and confirmed on biopsy as a soft tissue lipoma. The patient underwent complete excision of the mass.
Lipomas are common benign soft tissue masses and should be considered in the differential diagnosis of a thigh mass. Magnetic resonance imaging with contrast depicts the lipomatous mass as having a characteristic high-intensity fat signal without enhancement. It is important for clinicians to have an increased awareness in recognizing the clinical and imaging manifestations of a soft tissue lipoma to optimize an initial diagnosis and treatment.
Lipoma; Liposarcoma; Soft tissue neoplasm; Chiropractic
Lipoma is a common soft-tissue tumor. There are only very few reported cases of intraosseous lipoma of the jaws in the literature. Intraosseous angiolipomas are even rarer. The exact nature of these lesions is debatable, but it is widely accepted that they represent true benign tumors. These are slow-growing tumor consisting of a mass of mature fat cells. When the vascular component within these tumors is a prominent feature, they are considered to be angiolipomas. The cause of these lesions is uncertain. Clinically, intraosseous lipoma may be asymptomatic, may cause swelling, or may show neurologic signs such as hypesthesia or paresthesia, as was manifested in this case. Radiographically, the lesion usually appears as a well-circumscribed radiolucency. The diagnosis of intraosseous lipoma of the mandible may be a challenge, due to its rarity and clinical similarity with many other radiolucent jaw lesions; therefore, the histopathological examination is always required. Here, we report a case of intraosseous angiolipoma of mandible in a 21-year-old female patient.
Angiolipoma; intraosseous; lipoma; mandible
The purpose of this study was to determine the clinicopathological and immunohistochemical features of lipoma/fibrolipoma with rare occasions as osseous and/or chondroid differentiation in the oral cavity. Two cases of the tumors, who presented with a painless, relatively hard mass on the oral mucosa, were studied. These were consisted of a well-circumscribed
mass of fatty tissue with chondroid and significant fibrous component intermixed with the lobules of fat cells with chondroid and woven bone
component, respectively. Immunohistochemical study revealed that peripheral spindle cells around chondroid tissue stained diffusely for S-100 α & β and Sox-9, though peripheral spindle cells around osteoid tissue only stained for RUNX-2. According to review of the literature, lipoma/fibrolipoma with osseous and/or chondroid differentiation was 18 cases. Also fibrolipoma with osseous and chondroid differentiation is the first to be reported here. These results indicated that the cartilage/bone is produced by differentiation of undifferentiated mesenchymal cells of stroma.
Soft tissue tumors are classified according to their histological resemblance to normal adult tissues and can be grouped into the following categories based on metastatic potential: benign, intermediate (locally aggressive), intermediate (rarely metastasizing) and malignant. Over the past two decades, considerable progress has been made in our understanding of the genetic background of soft tissue tumors. Traditional laboratory techniques, such as cytogenetic analysis and fluorescence in situ hybridization (FISH), can be used for diagnostic purposes in soft tissue pathology practice. Moreover, cytogenetic and molecular studies are often necessary for prognostics and follow-up of soft tissue sarcoma patients. This review provides updated information on the applicability of laboratory genetic testing in the diagnosis of benign and intermediate soft tissue tumors. These tumors include nodular fasciitis, chondroid lipoma, collagenous fibroma (desmoplastic fibroblastoma), giant cell tumor of tendon sheath (GCTTS)/pigmented villonodular synovitis (PVNS), angiofibroma of soft tissue, myxoinflammatory fibroblastic sarcoma (MIFS) and ossifying fibromyxoid tumor (OFMT).
cytogenetics; molecular cytogenetics; soft tissue tumor
The exponential increase in use of computer tomography (CT) and magnetic resonance imaging (MRI) has lead to a significant increase in the detection of asymptomatic adrenal masses. The prevalence of adrenal “incidentalomas” is approximately 4–10%. We present a case of a 55-year-old male with a large right adrenal mass that was followed by serial computer tomography scans and multiple non-diagnostic core biopsies. Due to the large size of the mass and unknown pathology, the patient underwent laparoscopic adrenalectomy. The patient's post-operative course was uneventful. Pathology revealed a very unusual finding, a large adrenal lipoma. Adrenal lipomas are rare, benign, non-functioning tumor like lesions that occur with a relative frequency of only 0–11%. Over the past decade approximately 10 cases have been reported in literature. We review the literature of the current diagnostic and surgical treatment of adrenal lipomas (Pubmed and Cochrane from 1992-current).
Adrenal lipoma; Laparoscopic; Adrenalectomy; Incidentaloma
A mixed tumor is a neoplasm that has microscopic features of both epithelial and mesenchymal differentiation. Such mixed tumors are known as pleomorphic adenomas in the salivary glands, and their cutaneous counterparts are called chondroid syringomas. These tumors commonly occur in the head and neck region of middle-aged men. Hyaline cell–rich chondroid syringoma is a rare benign variant of chondroid syringoma composed of cells with eosinophilic hyaline cytoplasm and plasmacytoid features, the origin of which remains elusive. Although very few cases have been reported in literature, it is important to be aware of this entity so as to avoid misdiagnosis on histopathological examination. In this report we present a case of hyaline cell-rich chondroid syringoma occurring in the finger.
Chondroid syringoma; hyaline cell; mixed tumor
Chondrosarcomas are malignant tumors of cartilage that rarely involve the sinonasal region, and myxoid chondrosarcoma is a rare histologic variant of chondrosarcoma that usually occurs in the soft tissue of extremities. Although several case reports and results of small series of chondrosarcomas in the sinonasal region in children are available, myxoid type chondrosarcoma is extremely rare. We recently experienced a case of low grade myxoid chondrosarcoma involving the sinonasal cavity in a 10-year-old boy, and here we report its radiologic-pathologic findings. In this case, chondroid calcification on CT and septal and marginal enhancement on MRI suggested a chondrosarcoma. Whole body PET-CT demonstrated no definite metastatic lesion and a low peak standardized uptake value primary tumor. However, no definite distinguishing imaging features were observed that distinguished low grade myxoid chondrosarcoma from conventional chondrosarcoma.
Myxoid chondrosarcoma; Sinonasal cavity; Child; Computed tomography (CT); Magnetic resonance (MR); PET-CT
The most common benign tumors of the mesenchyme are the lipomas. Benign fatty tumors can arise in any location in which fat is present. Fibrolipomas are characterised by fat modules. Most patients affected by such tumors are in the fifth or sixth decade of life. When very close to vital structures such as joints, they may cause functional limitations as well as pain. Osseous and chondroid metaplasia can infrequently manifest after chronic persistence. Given the rarity of this condition, a case of a big fibrolipoma of Hoffa's fat pad with osseous and cartilaginous metaplasia is reported. A 44-year-old woman presented with an enlarging soft mass on the right knee in the infrapatellar fat pad. After a thorough preoperative clinical and imaging examination, the mass was removed and sent to laboratory where the diagnosis was put. One year after surgery, both local and general condition of the patient were good and no signs of recurrence were found.
Osteochondrolipoma is an extremely rare histological variant of lipoma with osseous and cartilaginous differentiation. The present study reports an unusual case of an osteochondrolipoma occurring in the left scapular region of a 49-year-old male. The physical examination revealed a 3-cm, hard, non-tender and minimally mobile mass. Plain radiography revealed a faintly ossified soft-tissue mass without evidence of bone erosion. Computed tomography (CT) confirmed the presence of a lesion and the normal appearance of the scapula. Magnetic resonance imaging (MRI) showed a well-circumscribed subcutaneous mass with an almost homogeneous high signal intensity on the T1- and T2-weighted sequences. Contrast-enhanced fat-suppressed T1-weighted sequences demonstrated a faint peripheral and septal enhancement of the mass. A marginal excision of the tumor was performed. Histologically, the tumor was predominantly composed of mature adipocytes mixed with thin trabeculae of mature bone. In addition, small amounts of mature hyaline cartilage and osteoid were identified in the periphery of the lesion. Based on these findings, the tumor was diagnosed as an osteochondrolipoma. The patient demonstrated no evidence of local recurrence within six months of follow-up. Although rare, osteochondrolipoma should be considered as a differential diagnosis of a well-defined, calcified/ossified, subcutaneous mass in the scapular region.
osteochondrolipoma; scapula; magnetic resonance imaging; pathology
A lipoma is a benign tumor which can occur in any part of the body; it is very frequent and can reach a considerable size. Differentiation between lipoma and liposarcoma of low grade malignancy represents an important diagnostic problem, and valuable help in the differential diagnosis is provided by ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), biopsy and/or modern immunohistochemistry. The authors report the case of a 50-year-old man who was referred to their department due to the presence of a large mass growing on the upper thigh of the right leg; over 7 years it had steadily increased in size causing pain and functional impotence. US of the soft tissues and CT scanning were performed. Densitometric values of the mass suggested adipose tissue, which was subsequently confirmed by biopsy.
Lipoma; Ultrasonography; CT
In this article, we present our experience with a case of myxolipoma of the tongue.
Lipoma is a mesenchymal benign tumor occurring with relatively high frequency. However, myxolipoma, one of the histological variant of lipoma characterized by mature adipose tissue and abundant mucoid substances, in the oral cavity is quite rare.
The patient was a 52-year-old man who noticed a painless mass on the left border of tongue about 2 years ago. The lesion was noted at a complete medical checkup, and the patient was admitted to our institution for detailed examination. The mass was a palpable, soft and elastic nodule, 15 mm in diameter, covered with normal mucosa in the left inferior aspect of the tongue. The border of the tumor was well-defined, and computed tomography (CT) revealed a fat density within the mass. On the basis of these finding, the tumor was clinically diagnosed as lipoma and was excised under general anesthesia. Histopathologically, the tumor was a well-defined lobulated mass surrounded by a thin fibrous capsule within the muscle of the tongue. The tumor was diagnosed as myxolipoma because it was consisted of solid proliferation of mature adipocytes replaced by abundant mucoid substances. The post operative course was uneventful, and there was no evidence of recurrence 4 years after surgery.
Myxolipoma; Tongue benign tumor; Lipoma
Patient: Female, 32
Final Diagnosis: Intraosseous lipoma
Symptoms: Swelling of the thigh
Clinical Procedure: Excision of the mass
Intraosseous lipomas happen to be one of rarest benign soft tissue tumors with only a little known about its etiology and pathophysiology. A pubmed search using key word “Intraosseous lipoma”. Came back with 165 results. All the sizes and presentations were reviewed and compared with the case we are presenting. We are reporting a 15×20 cm intraosseous lipoma
32-year-old lady with a large intraosseous lipoma in the proximal thigh. The largest reported in English literature
A intraosseous lesion with this size could still be benign even if its lager than 5 cm. Keeping in mind that with a lesion this size malignancy should always be ruled out.
intraosseous lipoma; bone tumor; benign
A 24-year-old male presented with an inability to walk after a trivial fall. He had pain and mild swelling anterior to the right knee for the past one year. X-ray showed a transverse fracture of patella with a lytic lesion occupying most of the two halves of the patella. Fine needle aspiration cytology (FNAC) of the lytic lesion revealed a few osteoclastic giant cells and occasional osteoblasts against a hemorrhagic background. Patellectomy was performed. Histology revealed trabecular bone admixed with proliferating chondroid tissue at places admixed with myxoid and fibrous tissue with focal areas of calcification suggestive of chondroblastoma. Focal areas showed osteoclastic giant cells with areas of hemorrhage. The purpose is to present a rare tumor occurring at an unusual site which presented as pathological fracture.
Chondroblastoma patella; pathological fracture
Benign mixed tumour of the skin (chondroid syringoma) is an uncommon skin adnexal tumour, usually presenting as a slow growing solitary painless nodule. The morphological appearances are similar to those of a pleomorphic adenoma of the salivary gland. Hair matrix and sebaceous differentiation can be seen in some lesions. Focal ossification is a rare finding. This report presents a case of a similar tumour arising in the cheek of a 43 year old white man, showing extensive ossification. Clinical, radiological, and pathological correlation and diagnosis proved to be difficult preoperatively. Only two cases of a benign mixed tumour with pronounced ossification have been reported so far, both in Japanese patients. This is the first reported case seen in a white man. Awareness of these lesions will avoid potential diagnostic pitfalls.
benign mixed tumour; chondroid syringoma; ossification
Less than 10% of chondrosarcomas occur in children. In addition, as little as 0.5% of low-grade chondrosarcomas arise secondarily from benign chondroid lesions. The presence of focal pain is often used to crudely distinguish a chondrosarcoma (which is usually managed with wide surgical excision), from a benign chondroid lesion (which can be followed by clinical exams and imaging surveillance). Given the difficulty of localizing pain in the pediatric population, initial radiology findings and short-interval follow-up, both imaging and clinical, are critical to accurately differentiate a chondrosarcoma from a benign chondroid lesion. To our knowledge, no case in the literature discusses a chondrosarcoma possibly arising secondarily from an enchondroma in a pediatric patient. We present a clinicopathologic and radiology review of conventional chondrosarcomas. We also attempt to further the understanding of how to manage a chondroid lesion in the pediatric patient with only vague or bilateral complaints of pain.
pediatric chondrosarcoma; chondrosarcoma; bone tumor; pediatric
The myxoid variant of chondrosarcoma is usually seen in soft tissues where it is known as chordoid sarcoma or parachordoma. Rarely, it involves bone and when it does, cranial bones are the preferred location. This tumor is frequently amalgamated with the chondroid variant of chordoma, especially when the lesion occurs in the sphenoid bone/spheno-occipital region, because of their similar clinical presentations, anatomical locations, radiological findings, and mistaken histopathological features. It is essential to distinguish myxoid chondrosarcoma from the chondroid variant of chordoma, because of the different treatment protocol and prognostic importance. We present such a location-based diagnostic dilemma, solved successfully with ancillary immunohistochemistry.
Chondrosarcoma; chordoma; immunohistochemistry; sphenoid bone