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Presented by Jonathan Epstein, M.D. and prepared by Ali Ansari-Lari, M.D.,Ph.D.
Case 3: 47 year-old male with a 26 cm intramuscular circumscribed mass in the thigh.
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1. Question
Week 130: Case 3
47 year-old male with a 26 cm intramuscular circumscribed mass in the thigh./images/EPJ3a.JPG
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Answer: Hibernoma
Histology: This needle biopsy shows multiple fragments of adipose tissue ranging from mature adipocytes to multivacuolated eosinophilic cells with multiple small lipid droplets.
Discussion: This lesion has the classic appearance of a hibernoma, with areas of the tumor resembling brown fat. Unusual features of this lesion are its large size and intramuscular location. Most hibernomas are under 10 cm and typically occur in the subcutaneous tissue. This lesion, nonetheless is diagnostic of hibernoma. Whereas areas of hibernoma may be indistinguishable from ordinary lipoma, and the proportion of hibernoma cells to cells resembling mature lipocytes vary, typical lipomas lack any hibernoma cells. Fat necrosis consists of histiocytes with a xanthomatous appearance, admixed with inflammatory cells. None of the variants of liposarcoma contain brown fat, and hibernomas have never been associated with malignant behavior.
Incorrect
Answer: Hibernoma
Histology: This needle biopsy shows multiple fragments of adipose tissue ranging from mature adipocytes to multivacuolated eosinophilic cells with multiple small lipid droplets.
Discussion: This lesion has the classic appearance of a hibernoma, with areas of the tumor resembling brown fat. Unusual features of this lesion are its large size and intramuscular location. Most hibernomas are under 10 cm and typically occur in the subcutaneous tissue. This lesion, nonetheless is diagnostic of hibernoma. Whereas areas of hibernoma may be indistinguishable from ordinary lipoma, and the proportion of hibernoma cells to cells resembling mature lipocytes vary, typical lipomas lack any hibernoma cells. Fat necrosis consists of histiocytes with a xanthomatous appearance, admixed with inflammatory cells. None of the variants of liposarcoma contain brown fat, and hibernomas have never been associated with malignant behavior.