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Presented by Dr. Pedram Argani and prepared by Dr. Tricia Cottrell
This is a 42 year old female with a pericardial lesion.
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1. Question
This is a 42 year old female with a pericardial lesion.
Correct
Answer: BHistology: This specimen demonstrates remarkable lobular fat atrophy. While the cells resemble neoplastic lipoblasts, their lesion is consistent with lipoatrophy in that the lipoblasts are set in a lobular configuration, and there is no significant atypia. Scattered within the lesion are multiple enlarged stromal cells, several which represent endothelial cells. These enlarged cells demonstrate nuclear inclusions consistent with cytomegalovirus, which is confirmed by immunohistochemistry. This patient suffered from HIV infection, and the lipoatrophy was likely secondary to cachexia or medication effect, and the CMV infection secondary to the underlying immunodeficiency.
Discussion: Lipoblastoma is typically a lesion of young patients less than 3 years of age, and forms a painless superficial mass. Lipoblastoma demonstrates more primitive lipoblastic cells at the periphery with maturation towards the center. Liposarcoma is suggested by the presence of lipoblasts in this case; however, the lobular nature of the proliferation and absence of atypia argues against liposarcoma.
Incorrect
Answer: BHistology: This specimen demonstrates remarkable lobular fat atrophy. While the cells resemble neoplastic lipoblasts, their lesion is consistent with lipoatrophy in that the lipoblasts are set in a lobular configuration, and there is no significant atypia. Scattered within the lesion are multiple enlarged stromal cells, several which represent endothelial cells. These enlarged cells demonstrate nuclear inclusions consistent with cytomegalovirus, which is confirmed by immunohistochemistry. This patient suffered from HIV infection, and the lipoatrophy was likely secondary to cachexia or medication effect, and the CMV infection secondary to the underlying immunodeficiency.
Discussion: Lipoblastoma is typically a lesion of young patients less than 3 years of age, and forms a painless superficial mass. Lipoblastoma demonstrates more primitive lipoblastic cells at the periphery with maturation towards the center. Liposarcoma is suggested by the presence of lipoblasts in this case; however, the lobular nature of the proliferation and absence of atypia argues against liposarcoma.
