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Open Access Case Report

Pleomorphic lipoma lacking mature fat component in extensive myxoid stroma: a great diagnostic challenge

Xu-Yong Lin12, Yan Wang12, Yang Liu12, Ying Sun3, Yuan Miao12, Yong Zhang12, Juan-Han Yu12 and En-Hua Wang12*

Author affiliations

1 Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, 110001, China

2 Institute of pathology and pathophysiology, China Medical University, Shenyang, 110001, China

3 Department of Outpatient, the First Affiliated Hospital, China Medical University, Shenyang, 110001, China

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Citation and License

Diagnostic Pathology 2012, 7:155  doi:10.1186/1746-1596-7-155

Published: 13 November 2012

Abstract

Pleomorphic lipoma is a relatively uncommon entity, and is considered as a variant of spindle cell lipoma. Histologically, spindle cell lipoma/pleomorphic lipoma consists of varying quantity of mature fat, bland spindle cells and ropey collagen. In addition, pleomorphic lipoma is characterized by multinucleate giant cells, which possess the “floret-like” nuclei and marked pleomorphism. So, in contrast to spindle cell lipoma, pleomorphic lipoma is more easily misdiagnosed as a malignant tumor. Herein, we report a peculiar case of pleomorphic lipoma occurring in axilla with entirely devoid of mature fat in a 71-year-old male. The histopathological findings demonstrated the tumor was made up of bland spindle cells admixed with scattered “floret-like” cells and irregular ropey collagen in an extensive myxoid stroma. Immunostaining showed that the tumor was positive for the Vimentin, Bcl-2 and CD34, and was negative for S-100, desmin, CD68, and α–SMA. Although no fat component was found in the whole section, the tumor was still diagnosed as a pelomprphic lipoma. To our knowledge, this is the third reported case of pelomprphic lipoma which entirely lacked lipomatous component. Because of the existence of atypical multinucleate giant cells and lack of mature fat, this tumor may be easily misdiagnosed nonlipomatous lesions, such as myxoid fibrosarcoma, giant cell fibroblastoma.

So, it is necessary to pay careful attention to the histological spectrum of pleomorphic lipoma, including the tumor with devoid of fat, and it should be kept in mind that pelomprphic lipoma still can be diagnosed even if lacking lipomatous component.

Virtual slides

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1967123180611361 webcite

Keywords:
Pleomorphic lipoma