Introduction:
“An 88 y/o man with a mass in the Neck”
California Tumor Tissue Registry’s
Case of the Month
CTTR COTM Vol 9:4
January, 2007
An 88-year-old man complaining of a mass in the right side of his neck was found to have a well-circumscribed, 5.0 x 4.5 x 3.5 cm fatty tumor mostly involving subcutaneous tissues. It also had denser, white “fibrous” areas.
Microscopically, the tumor consisted of both fatty and fibrous elements. There were numerous pleomorphic, hyperchromatic cells present in what was otherwise mature fat (Fig. 1). The pleomorphic cells were sometimes bunched in fibrous areas consisting of dense collagen with spindled cells and were many-times multinucleated, “wreath-like” or “floret-like” (Figs. 2, 3, 4). Both the spindled cells and the floret-like giant cells were positive for CD 34 (Fig. 5).
Diagnosis: “Pleomorphic Lipoma”
Fouad Abdelhalim, M.D., Wafaa Elatre, M.D., Donald R. Chase, M.D,
Department of Pathology, Loma Linda University and Medical Center
California Tumor Tissue Registry
Pleomorphic lipoma (PL) was first reported by Franz Enzinger (1977) as a variant of lipoma that resembles sclerosing liposarcoma and is closely related to his previously-described spindle cell lipoma. PL is quite uncommon, occurring only one tenth as often as spindle cell lipoma, which in turn accounts for only 1.5% of all adipocyte tumors.
Like spindle cell lipoma, PL presents in men older than 45 years as a circumscribed mobile subcutaneous mass most commonly in the posterior neck, shoulder, or back region. Other sites are extremely rare. There is often a long history. The tumor rarely is multiple and virtually never occurs in women ( ................
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