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Presented by Dr. Pedram Argani and prepared by Dr. Kevan Salimian
This is a 48 year old male with a breast mass.
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1. Question
This is a 48 year old male with a breast mass.
Correct
Answer: Spindle cell lipoma
Histologic Description: This is a bland primarily fibrous lesion that involves soft tissue, with no breast epithelium present. One can focally appreciate areas of fat within the tumor. The collagen in areas has a ropey appearance, and there are associated mast cells. The cells associated with the fibrous tissue are bland and have minimal cytoplasm. These are the typical features of a spindle cell lipoma. The lesion was diffusely immunoreactive for CD34, supporting the diagnosis. Estrogen receptor was negative.
Differential Diagnosis: Like spindle cell lipoma, neurofibroma may demonstrate prominent collagen (though the latter has more of a “shredded carrot” appearance in neurofibroma) and mast cells, along with bland stromal cells. However, neurofibromas would label for S100, and have more angulated nuclei. Solitary fibrous tumors would also label for CD34, but would demonstrate a more prominent hemangiopericytomatous vasculature and label for STAT6. Low grade fibromyxoid sarcomas have more curvilinear vessels, greater nuclear atypia, and label for MUC4.
Incorrect
Answer: Spindle cell lipoma
Histologic Description: This is a bland primarily fibrous lesion that involves soft tissue, with no breast epithelium present. One can focally appreciate areas of fat within the tumor. The collagen in areas has a ropey appearance, and there are associated mast cells. The cells associated with the fibrous tissue are bland and have minimal cytoplasm. These are the typical features of a spindle cell lipoma. The lesion was diffusely immunoreactive for CD34, supporting the diagnosis. Estrogen receptor was negative.
Differential Diagnosis: Like spindle cell lipoma, neurofibroma may demonstrate prominent collagen (though the latter has more of a “shredded carrot” appearance in neurofibroma) and mast cells, along with bland stromal cells. However, neurofibromas would label for S100, and have more angulated nuclei. Solitary fibrous tumors would also label for CD34, but would demonstrate a more prominent hemangiopericytomatous vasculature and label for STAT6. Low grade fibromyxoid sarcomas have more curvilinear vessels, greater nuclear atypia, and label for MUC4.