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Presented by Terry Barrett, M.D. and prepared by Carol Allan, M.D.
Case 4: Soft subcutaneous tumor on the upper back of an adult
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Week 55: Case 4
Soft subcutaneous tumor on the upper back of an adult/images/d13a.jpg
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/images/d13c.jpgCorrect
Answer: Hibernoma
Histology: This tumor is characterized by cells having one of three different morphologies. The most numerous cell is the multivacuolated adipocyte with a centrally placed round nucleus, commonly referred to as the mulberry cell. Another cell type has similar features but with granular rather than a vacuolated cytoplasm. The third cell type is the mature appearing adipocyte. From low power the tumor has a lobulated appearance. These features are diagnostic of the hibernoma.
Discussion: Hibernoma is an asymptomatic, benign, usually solitary, subcutaneous tumor which usually measures between 3 to 10 cm. It occurs most commonly on the upper back in adulthood and occasionally in childhood. Myxoid liposarcoma is distinguished from hibernoma by the greater degree of pleomorphism and by the characteristic vascular pattern seen in myxoid liposarcoma. Round cell liposarcoma is composed of smaller cells with hyperchromatic nuclei and a small amount of cytoplasm. Tuberous xanthomas are composed of foamy cells rather than the multivacuolated cells of hibernoma and granular cell tumor can be distinguished by its distinctively granular cytoplasm.
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Answer: Hibernoma
Histology: This tumor is characterized by cells having one of three different morphologies. The most numerous cell is the multivacuolated adipocyte with a centrally placed round nucleus, commonly referred to as the mulberry cell. Another cell type has similar features but with granular rather than a vacuolated cytoplasm. The third cell type is the mature appearing adipocyte. From low power the tumor has a lobulated appearance. These features are diagnostic of the hibernoma.
Discussion: Hibernoma is an asymptomatic, benign, usually solitary, subcutaneous tumor which usually measures between 3 to 10 cm. It occurs most commonly on the upper back in adulthood and occasionally in childhood. Myxoid liposarcoma is distinguished from hibernoma by the greater degree of pleomorphism and by the characteristic vascular pattern seen in myxoid liposarcoma. Round cell liposarcoma is composed of smaller cells with hyperchromatic nuclei and a small amount of cytoplasm. Tuberous xanthomas are composed of foamy cells rather than the multivacuolated cells of hibernoma and granular cell tumor can be distinguished by its distinctively granular cytoplasm.
