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Presented by Hind Nassar, M.D. and prepared by Andrea Subhawong, M.D.
Case 2: 50 year old male with a posterior neck mass
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1. Question
Week 394: Case 2
50 year old male with a posterior neck massimages/6.8.09.02a.jpg
images/6.8.09.02b.jpg
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images/6.8.09.02e.jpgCorrect
Answer: Spindle cell lipoma
Histology: The lesion is a bland proliferation of spindled cells admixed with fat, with thick collagen bundles. No atypical cells or lipoblasts are identified.
Discussion: Spindle cell lipoma (and pleomorphic lipoma) is a circumscribed subcutaneous lesion that usually occurs in the neck and back of male patients (median age 55 y). Only 10% of the lesions occur in women. It is composed of an admixture of bland spindle cells, and fat cells with ropey collagen. A large number of mast cells can be seen in the lesion. The spindle cells are positive for CD34 and rarely for S100. Spindle cell lipoma is a benign lesion and conservative excision is considered sufficient for treatment. Local recurrence can occur very rarely even if the tumor is not completely excised. Dedifferentiation and metastases do not occur.
The differential diagnosis includes DFSP, angiomyofibroblastoma, nodular fasciitis, schwannoma, neurofibroma, myofibroblastoma, SFT and hemangiopericytoma, myxoid liposarcoma, and spindle cell liposarcoma.
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Incorrect
Answer: Spindle cell lipoma
Histology: The lesion is a bland proliferation of spindled cells admixed with fat, with thick collagen bundles. No atypical cells or lipoblasts are identified.
Discussion: Spindle cell lipoma (and pleomorphic lipoma) is a circumscribed subcutaneous lesion that usually occurs in the neck and back of male patients (median age 55 y). Only 10% of the lesions occur in women. It is composed of an admixture of bland spindle cells, and fat cells with ropey collagen. A large number of mast cells can be seen in the lesion. The spindle cells are positive for CD34 and rarely for S100. Spindle cell lipoma is a benign lesion and conservative excision is considered sufficient for treatment. Local recurrence can occur very rarely even if the tumor is not completely excised. Dedifferentiation and metastases do not occur.
The differential diagnosis includes DFSP, angiomyofibroblastoma, nodular fasciitis, schwannoma, neurofibroma, myofibroblastoma, SFT and hemangiopericytoma, myxoid liposarcoma, and spindle cell liposarcoma.
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