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Spindle cell lipoma masquerading as lipomatous pleomorphic adenoma: A diagnostic dilemma on fine needle aspiration cytology.

Agarwal S, Nangia A, Jyotsna PL, Pujani M - J Cytol (2013)

Bottom Line: These are a rare form of lipoma, accounting for 1.5% of all lipomatous tumors, with a low rate of local recurrence and no risk of malignant behavior/dedifferentiation.We present a case of a 55-year-old male with a nodular swelling over left cheek (in the parotid region), which due to its location as well as prominent myxoid background prompted us to include the lipomatous salivary gland lesions in differential diagnosis.Our objective is to document and delineate the characteristic cytological features of spindle cell lipoma, which may permit a confident diagnosis on FNAC smears.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India.

ABSTRACT
Spindle cell lipoma is a relatively uncommon benign adipocytic tumor that usually presents in subcutaneous fat of adult men. These are a rare form of lipoma, accounting for 1.5% of all lipomatous tumors, with a low rate of local recurrence and no risk of malignant behavior/dedifferentiation. Although few studies addressing the histological findings of spindle cell lipoma have been described, only a few descriptions of fine needle aspiration cytology (FNAC) findings have been documented in literature. We present a case of a 55-year-old male with a nodular swelling over left cheek (in the parotid region), which due to its location as well as prominent myxoid background prompted us to include the lipomatous salivary gland lesions in differential diagnosis. Our objective is to document and delineate the characteristic cytological features of spindle cell lipoma, which may permit a confident diagnosis on FNAC smears.

No MeSH data available.


Related in: MedlinePlus

Tissue section revealing intermingled adipocytic and spindle cell component with ropy/wiry collagen fibers (H and E, ×100)
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Figure 2: Tissue section revealing intermingled adipocytic and spindle cell component with ropy/wiry collagen fibers (H and E, ×100)

Mentions: A 55-year-old male presented to the surgical outpatient department with the chief complaint of a slow growing left-sided cheek swelling (in the parotid region) noticed a month ago. On examination, a 3 × 3 cm globular swelling, which was firm, mobile, non-tender, was seen located near the angle of mandible. Patient was referred for an FNA procedure. FNA procedure was performed using a 22-gauge needle attached to a 10-mL syringe that yielded a mucoid aspirate. Both air-dried and 95% alcohol-fixed smears were prepared and stained with Wright's Giemsa and Papanicolaou stain, respectively. Aspirate smears were cellular, showing many spindle-shaped cells in loose cohesive clusters admixed with mature adipocytes with abundant myxoid material in the background. Many clusters show traversing capillaries, scattered mast cells with very occasional epithelial cell cluster [Figure 1]. This occasional epithelial cell cluster could be from adnexal structure/sweat gland from overlying skin; even on complete processing of histopathological specimen, it was not represented in the excision biopsy sample. Due to the site of lesion, abundant myxoid material and adipocytic component, a possibility of lipomatous variant of pleomorphic adenoma/chondroid syringoma and spindle cell lipoma was suggested. Excision biopsy was performed. Peroperatively, an encapsulated lipomatous lesion was seen without any attachment to the parotid. Cut surface was yellowish, gelatinous, and vaguely lobulated. Microscopically, an encapsulated lesion comprising of mature adipose tissue intermingled with benign appearing spindle cells in a myxoid background with ropy collagen fibers and occasional scattered mast cell was noted [Figure 2]. However, no epithelial/myoepithelial component was seen, thus ruling out lipomatous salivary gland lesions. No areas of cellular pleomorphism/floret-like giant cells/lipoblasts/intricately traversing chicken wire capillaries were seen, thus excluding pleomorphic lipoma, liposarcoma, and myxoid liposarcoma.


Spindle cell lipoma masquerading as lipomatous pleomorphic adenoma: A diagnostic dilemma on fine needle aspiration cytology.

Agarwal S, Nangia A, Jyotsna PL, Pujani M - J Cytol (2013)

Tissue section revealing intermingled adipocytic and spindle cell component with ropy/wiry collagen fibers (H and E, ×100)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643365&req=5

Figure 2: Tissue section revealing intermingled adipocytic and spindle cell component with ropy/wiry collagen fibers (H and E, ×100)
Mentions: A 55-year-old male presented to the surgical outpatient department with the chief complaint of a slow growing left-sided cheek swelling (in the parotid region) noticed a month ago. On examination, a 3 × 3 cm globular swelling, which was firm, mobile, non-tender, was seen located near the angle of mandible. Patient was referred for an FNA procedure. FNA procedure was performed using a 22-gauge needle attached to a 10-mL syringe that yielded a mucoid aspirate. Both air-dried and 95% alcohol-fixed smears were prepared and stained with Wright's Giemsa and Papanicolaou stain, respectively. Aspirate smears were cellular, showing many spindle-shaped cells in loose cohesive clusters admixed with mature adipocytes with abundant myxoid material in the background. Many clusters show traversing capillaries, scattered mast cells with very occasional epithelial cell cluster [Figure 1]. This occasional epithelial cell cluster could be from adnexal structure/sweat gland from overlying skin; even on complete processing of histopathological specimen, it was not represented in the excision biopsy sample. Due to the site of lesion, abundant myxoid material and adipocytic component, a possibility of lipomatous variant of pleomorphic adenoma/chondroid syringoma and spindle cell lipoma was suggested. Excision biopsy was performed. Peroperatively, an encapsulated lipomatous lesion was seen without any attachment to the parotid. Cut surface was yellowish, gelatinous, and vaguely lobulated. Microscopically, an encapsulated lesion comprising of mature adipose tissue intermingled with benign appearing spindle cells in a myxoid background with ropy collagen fibers and occasional scattered mast cell was noted [Figure 2]. However, no epithelial/myoepithelial component was seen, thus ruling out lipomatous salivary gland lesions. No areas of cellular pleomorphism/floret-like giant cells/lipoblasts/intricately traversing chicken wire capillaries were seen, thus excluding pleomorphic lipoma, liposarcoma, and myxoid liposarcoma.

Bottom Line: These are a rare form of lipoma, accounting for 1.5% of all lipomatous tumors, with a low rate of local recurrence and no risk of malignant behavior/dedifferentiation.We present a case of a 55-year-old male with a nodular swelling over left cheek (in the parotid region), which due to its location as well as prominent myxoid background prompted us to include the lipomatous salivary gland lesions in differential diagnosis.Our objective is to document and delineate the characteristic cytological features of spindle cell lipoma, which may permit a confident diagnosis on FNAC smears.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India.

ABSTRACT
Spindle cell lipoma is a relatively uncommon benign adipocytic tumor that usually presents in subcutaneous fat of adult men. These are a rare form of lipoma, accounting for 1.5% of all lipomatous tumors, with a low rate of local recurrence and no risk of malignant behavior/dedifferentiation. Although few studies addressing the histological findings of spindle cell lipoma have been described, only a few descriptions of fine needle aspiration cytology (FNAC) findings have been documented in literature. We present a case of a 55-year-old male with a nodular swelling over left cheek (in the parotid region), which due to its location as well as prominent myxoid background prompted us to include the lipomatous salivary gland lesions in differential diagnosis. Our objective is to document and delineate the characteristic cytological features of spindle cell lipoma, which may permit a confident diagnosis on FNAC smears.

No MeSH data available.


Related in: MedlinePlus