AJR 2002; 179:1158
© American Roentgen Ray Society
Radiologic—Pathologic Conference of Keller Army Community Hospital at West Point, the United States Military Academy
Spindle Cell Lipoma of the Upper Back
Liem T. Bui-Mansfield1,2,3 and
Keith J. Kaplan4
1 Department of Radiology, Keller Army Community Hospital, 900 Washington Rd.,
West Point, NY 10996-1197.
2 Department of Radiology, Uniformed Services University of Health Sciences,
4301 Jones Bridge Rd., Bethesda MD 20814-4799.
3 Department of Radiology, Wake Forest University School of Medicine, Medical
Center Blvd., Winston-Salem, NC 27157-1088.
4 Department of Pathology, Walter Reed Army Medical Center, 6900 Georgia Ave.
N.W., Washington, DC 20307-5001.
Received March 1, 2002;
accepted after revision March 8, 2002.
The opinions and assertions contained herein are the private views of the
authors and should not be construed as official or as representing the views
of the Department of the Army or the Department of Defense.
Address correspondence to L. T. Bui-Mansfield.
Introduction
A 77-year-old man presented with a 5 x 6 cm soft-tissue mass in the
right upper back. MR imaging revealed a 3 x 3.5 x 4 cm
well-circumscribed heterogeneous mass in the subcutaneous tissue of the right
upper back, approximately 2 cm from the midline. Most of the lesion had signal
intensity similar to that of fat on all pulse sequences
(Fig. 1A). Curvilinear areas in
the mass were hypointense on T1-weighted images and hyperintense on
T2-weighted images (Fig. 1B).
After gadolinium administration, the nonlipomatous components of the mass
enhanced intensely (Fig.
1C).
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Fig. 1A. —Spindle cell lipoma of upper back in 77-year-old man. Axial
T1-weighted MR image shows well-circumscribed, heterogeneous mass in
subcutaneous tissue of right upper back. Most of lesion (L) is isointense to
subcutaneous fat with curvilinear areas of hypointensity (arrow).
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Fig. 1B. —Spindle cell lipoma of upper back in 77-year-old man. Axial
T2-weighted MR image with fat suppression shows that lipomatous component
(arrow) is hypointense and spindle cell component (S) is
hyperintense.
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The mass was completely excised. Histologically, the tumor was composed of
cytologically bland spindle cells in a mature lipoma. The spindle cells were
uniform, with elongated nuclei and bipolar cytoplasmic processes. Mast cells
were also present, a common finding in spindle cell lipoma
(Fig. 1D). The final pathologic
diagnosis was spindle cell lipoma.
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Fig. 1D. —Spindle cell lipoma of upper back in 77-year-old man.
Photomicrograph of histopathologic specimen shows that lipoma (L) contains
uniform, cytologically bland spindle cells (arrowhead) with elongated
nuclei and bipolar cytoplasmic processes. Note mast cells (arrow). (H
and E, x40)
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Spindle cell lipoma is an uncommon variant that is frequently misdiagnosed
as a liposarcoma [1,
2]. The tumor occurs chiefly in
men (male—female ratio, 7.3:1) between 45 and 70 years (mean age, 56
years). About two thirds of lesions affect the subcutaneous tissue of the
shoulder and posterior neck, although these lesions may occur elsewhere in the
body [3]. Grossly, a spindle
cell lipoma resembles an ordinary lipoma with gray-white foci in the lesion
corresponding to areas of spindle cell proliferation. Microscopically, the
tumor consists of an intricate mixture of lipocytes and uniform spindle cells
[1]. Electron microscopy shows
spindled non—fat-storing mesenchymal cells and mature lipocytes
[2].
Scant information exists in the literature about the imaging appearance of
spindle cell lipoma [3,
4]. In our patient, MR imaging
revealed a well-defined, fatty mass containing linear and globular nonfatty
areas that enhanced markedly. In the extremity, the large size of a spindle
cell lipoma may erode adjacent bone
[3], and the heterogeneous MR
imaging appearance of this tumor may mimic that of a liposarcoma. However,
because it has a uniformly favorable clinical course, local excision is the
treatment of choice for spindle cell lipoma
[1].
References
- Enzinger FM, Harvey DA. Spindle cell lipoma.
Cancer
1975;36:1852
-1859[Medline]
- Bolen JW, Thorning D. Spindle cell lipoma: a clinical, light- and
electron-microscopic study. Am J Surg Pathol
1981;5:435
-441[Medline]
- Braunschweig IJ, Stein IH, Dodwad MI, Rangwala AF, Lopano A. Case
report 751: spindle cell lipoma causing marked bone erosion.
Skeletal Radiol
1992;21:414
-417[Medline]
- Kransdorf MJ, Murphey MD. Lipomatous tumors. In: Kransdorf MJ,
Murphey MD, eds. Imaging of soft-tissue tumors.
Philadelphia: Saunders, 1997:64
-67
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Introduction
References
