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Presented by Dr. Ashley Cimino-Mathews and prepared by Dr. Yembur Ahmad
This case talks about a 50-year-old male with a breast mass.
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Clinical history: A 50 year-old male with a breast mass
Choose the correct diagnosis:
Correct
Diagnosis: A. Angiolipoma
Histology: Histologic sections reveal abundant mature adipose tissue with no appreciable atypia (i.e., no nuclear enlargement or hyperchromasia). The adipose tissue contains small, thin-walled vessels with prominent pericytes, some of which are clustered or nested together but do not appear to be anastomosing. Some of the vessels contain bright red erythrocytes inside their lumens, but some of the vessels contain acellular, pink glassy material within their lumens. These are fibrin thrombi.
Discussion: Angiolipomas are characterized by the presence of mature adipose tissue with small, often clustered thin-walled vessels and fibrin thrombi. They are considered a lipoma variant, not a vascular neoplasm. They are typically subcutaneous nodules that can occur throughout the body, most commonly on the trunk or upper extremities. Angiolipomas are part of the group of painful subcutaneous nodules, which can be remembered with the acronym “ANGEL”: angiolipoma, neuroma, glomus tumor, eccrine spiradenoma, and leiomyoma. Angiolipomas can occur on the breast, in both males and females, and do not require surgical excision unless painful or bothersome to the patient. It is important to recognize an angiolipoma and not mistake it for a vascular neoplasm, which may have different management implications, particularly in the breast.
Incorrect
Diagnosis: A. Angiolipoma
Histology: Histologic sections reveal abundant mature adipose tissue with no appreciable atypia (i.e., no nuclear enlargement or hyperchromasia). The adipose tissue contains small, thin-walled vessels with prominent pericytes, some of which are clustered or nested together but do not appear to be anastomosing. Some of the vessels contain bright red erythrocytes inside their lumens, but some of the vessels contain acellular, pink glassy material within their lumens. These are fibrin thrombi.
Discussion: Angiolipomas are characterized by the presence of mature adipose tissue with small, often clustered thin-walled vessels and fibrin thrombi. They are considered a lipoma variant, not a vascular neoplasm. They are typically subcutaneous nodules that can occur throughout the body, most commonly on the trunk or upper extremities. Angiolipomas are part of the group of painful subcutaneous nodules, which can be remembered with the acronym “ANGEL”: angiolipoma, neuroma, glomus tumor, eccrine spiradenoma, and leiomyoma. Angiolipomas can occur on the breast, in both males and females, and do not require surgical excision unless painful or bothersome to the patient. It is important to recognize an angiolipoma and not mistake it for a vascular neoplasm, which may have different management implications, particularly in the breast.
