Differentiating Lipoma from other diseases: Difference between revisions

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Revision as of 19:16, 22 November 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]

Overview

Lipoma must be differentiated from liposarcoma, normal adipose tissue, adrenal myelolipoma, angiomyolipoma, and other lipomatous tumors.

Differentiating Lipoma from other Diseases

Lipoma must be differentiated from liposarcoma, normal adipose tissue, adrenal myelolipoma, angiomyolipoma, and other lipomatous tumors.

  • Lipoma should be differentiated from other lipomatous tumors. Table below compares and describes the characteristics of different lipomatous tumors:


Lipomatous tumor Age of onset Gender preponderance Location Clinical features Pathologic features Other features Pathologic view
Angiolipoma[1][2]
  • Second and third decades of life
  • Female < male
  • More commonly seen in forearm
  • May also affect trunk and upper arm
  • Subcutaneous nodule
  • Tender to palpation
  • Less than 2 cm
[3]
Myolipoma[4]
  • Fifth and sixth decades of life
  • Female > male
  • Subcutaneous mass which may also engage superficial muscular fascia
  • Size differs depending on the location
  • Partially encapsulated mass with partially yellow-white cut surface
  • A combination of mature adipocytes and sheets of well-differentiated smooth muscle cells
  • No nuclear atypia
  • Sieve-like appearance at low magnification (due to interspersed location of smooth muscle component)
[5]
Myelolipoma[6][7]
  • Fifth decade of life
  • Female = male
  • Well-circumscribed radiolucent mass in radiologic imaging
  • May have hromonal activity
[8]
Spindle Cell/Pleomorphic Lipoma[9]
  • Fifth to seventh decades of life
  • Female < male
  • Subcutaneous nodule with firm consistency
  • Slowly growing and painless
  • Mostly between 3 to 5 cm
  • Similar to ordinary lipoma
  • A combination of mature fat cells and spindle cell or pleomorphic elements
  • Lipomatous component may vary in amount
[10]
Chondroid Lipoma[11]
  • Third or fourth decade of life
  • Female > male
  • More commonly seen in limbs and limb girdles
  • May also involve trunk, and the head and neck region, particularly the oral cavity
  • Slowly growing painless mass
  • Sizes ranges from 1 to 11 cm
  • Encapsulated tumor with a yellow, white, or pink-tan cut surface
  • A combination of mature adipocytes in association with nests of vacuolated cells in a myxochondroid or hyalinized fibrous background
[12]
Hibernoma[13]
  • Third decade of life
  • Female = male
  • Slowly growing, painless, subcutaneous mass
  • Affects intramuscular in 10% of the cases
  • Size varies between 5 to 15 cm
  • Well-defined, soft, and mobile mass
  • A combination of vacuolated granular eosinophilic cells with abundant mithochondria and high vascular content
[14]
Intramuscular and Intermuscular Lipomas[15]
  • Fourth to seventh decades of life
  • Female < male
  • Most commonly seen in large muscles of the extremities, especially in thigh, shoulder, and upper arm
  • Painless, slowly growing mass
  • Visible during muscle contraction
  • Infiltrative adipose thissue within the muscle
  • Absence of nuclear atypia
  • May be very small or more than 20 cm
[16]
Thymolipoma[17]
  • Median age of onset is 33
  • Female = male
  • Anterior mediastinum
[18]
Lipomas of Tendon Sheaths and Joints[19]
  • Second and third decades of life
  • Female = male
  • Lipoma of joints affects men more frequently than women
  • Most commonly seen in wrist and hand
  • May also affect ankle and foot
  • Bilateral and symmetric location in 50% of the cases
  • May have 2 different shape:
  • A single adipose tissue extending along the tendon sheet
  • A lipomatous lesion composed mostly from hypertrophic synovial villi
  • Radiologic imaging may show a lesion of less density than the surrounding tissue
_
Lumbosacral Lipoma[20][21]
  • First decade of life
  • Female > male
  • Almost always associated with spina bifida or a similar laminar defect (lipomyeloschisis)
_
Neural Fibrolipoma (Lipofibromatous Hamartoma of Nerves)[22]
  • First three decades of life
  • Female > male (in the presence of macrodactyly)
  • A sausage-shaped mass with soft texture that has diffusely infiltrated a large nerve and its branches
  • Fibrofatty tissue surronding and infiltrating the nerve trunk
  • Overgrowth of bone and macrodactyly may be seen in one third of the cases
_


In general, there is little differential for a classic lipoma. The main differential is[23]:

In certain locations then other fatty masses should be considered :

  • Retroperitoneum
  • Chest
  • Thymolipoma
Disease Clinical feature Laboratory findings Imaging findings
Fever Weight loss Abdominal pain
Retroperitoneal hematoma _ _ Anemia MRI is the best radiologic tool to differentiate between retroperitoneal masses.
Retroperitoneal abscess _ Leukocytosis, positive inflammatory markers
Retroperitoneal tumors (.e.g. liposarcoma) positive tumor marker
Chronic pancreatitis _ DM type II, amylase and lipase levels may be slightly elevated
Differentiating Liposarcoma from Other Diseases
Disease entity Etiology (Genetic or others) Histopathological findings Immunohistochemical staining Risk factors Common site of involvement Clinical manifestations Other associated features
Liposarcoma[24][25][26][27][28][29][30][31][32][33] Atypical lipomatous tumor/well differentiated liposarcoma and dedifferentiated liposarcoma are associated with:

Myxoid liposarcoma is associated with:

Pleomorphicliposarcoma is associated with:

Well-differentiated liposarcoma:

De-differentiated liposarcoma:

Atypical lipomatous tumor/well differentiated liposarcoma is positive for: _
Neurofibroma[34][35][36][37][38][39][40][37][41][42][43][44]

Can be sporadic or as a part of Neurofibromatosis 1 and 2

Neurofibroma with degenerative atypia ("ancient change") has following microscopic features:

Positive for:

Negative for:

Schwannoma[45][46][47][48][49] Positive for:

Negative for:

Symptoms of schwannoma depend on the location of the tumor:

Palisaded encapsulated neuroma (PEN) /solitary circumscribed neuroma[50] Positive for:

Negative for:

90% lesions affect the face involving:

Remaining 10% can occur anywhere in body involving:

Traumatic neuroma[51][52][53][54] Positive for: Most common oral locations are:

Rarely involves:

Also known as:
Neurotized melanocytic nevus[55][56][57][58] Positive for:

Negative for:

Can occur anywhere in body, mostly involving following areas: _
Cutaneous myxoma (Superficial angiomyxoma)[59][60][61][62] Positive for:

Negative for:

Associated with Carney's complex/syndrome which includes following:

May be associated with NAME or LAMB syndrome

Nerve sheath myxoma[63][64][65][66][67][68] Positive for: _ Can occur anywhere in body:
Malignant peripheral nerve sheath tumor (MPNST)/malignant schwannoma[69][70][71][72][73][74]

Electron microscopy shows:

Positive for:

In case of glandular differentiation (malignant), positive for:

Negative for:

Associated with:

May be associated with:

Bulky deep-seated tumor usually arising from major nerves in:
Dermatofibrosarcoma protuberans (DFSP) Positive for:

Negative for:

_
Spindle cell lipoma Positive for:

Spindle cells are negative for:

_
  • Multiple well-circumscribed painless nodules involving several body parts
_
Ganglioneuroma[75][76] Genes involved in the pathogenesis of ganglioneuroma include:

Two histologic subtypes:

Positive for:

Negative for:

Ganglioneuromas may be associated with:

Located along distribution of sympathetic nervous system:

Symptoms of ganglioneuroma vary depending on the location of tumor, and include the following:

Patients with ganglioneuroma may also have paraneoplastic syndrome, which may manifest with:

Ganglioneuromas are included in the neuroblastic tumors group, which includes:

Leiomyoma[77][78][79][80][81][82][83][84][78][81][85]

Positive for:

Negative for:

_
Inflammatory myofibroblastic tumor(IMT)[77][78][79][80][81][82][83][84][78][81][85]

Unknown underlying etiology, may be due to inflammatory reaction to:

Mutations such as:

Positive for:

Negative for:

Also known as:

Fibroepithelial polyp/Acrochordon[86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101][102][103][104][105] Associated with: Positive for:

Negative for:

Associated with:

Also known as:


References

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