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Massive Spindle Cell Lipoma
Otolaryngology–Head and Neck Surgery (2006) 134, 164-165
CLINICAL PHOTOGRAPH
Massive Spindle Cell Lipoma Ali Ghazanfari, MD, and Randy Oppenheimer, MD, Phoenix, Arizona
L
ipomas are the most common soft-tissue tumor with an estimated annual incidence of one per 1000 persons. Composed of adipocytes, lipomas are generally slow-growing nodules with a firm, rubbery consistency that form a lobulated soft mass enclosed by a thin fibrous capsule.2 While about 80% of lipomas are less than 5 cm in diameter, some can reach more than 20 cm and weigh several kg. Most such tumors are asymptomatic but can cause pain when they compress nerves.2 Lipomas tend to occur on the trunk, shoulders, posterior neck, and axillae, although almost all subcutaneous locations have been reported.
fibroadipose tissue measuring 23.2 ⫻ 15.8 ⫻ 7.4 cm and weighing 1 kilogram. The final diagnosis was a benign spindle cell lipoma.
DISCUSSION
A 74-year-old African-American male presented to the head and neck clinic with a mass in the posterior neck which had been growing slowly for 14 years and recently became cumbersome for him (Fig 1). The physical exam demonstrated a 20 ⫻ 15 ⫻ 5-cm soft semi-fluctuant mass in post aspect of the neck slightly to the left. The mass was nontender, and the skin overlaying the mass appeared normal in color and texture. The mass was just below the dermis and did not appear to be adherent to any other structures. The rest of the physical exam was unremarkable. CT scan of the head and neck was performed showing a localized mass encapsulated with regions of relatively homogeneous fat density with no obvious intracranial or cervical extension. The mass was excised through a 10-cm transverse incision. The mass was yellow and adherent to the surrounding subcutaneous tissue. The mass appeared to be a lipoma on visual inspection. It was lobulated with an extensive vascular network. A 12 ⫻ 5-cm segment of excess skin was removed from the post neck and the wound was closed primarily. Pathological examination of the specimen showed it to be
Lipomas are most often asymptomatic. They usually arise from fatty tissue between the skin and deep fascia. Typical features include a soft fluctuant feel, lobulation, and the free mobility of overlying skin. Solitary lesions are seen about 80% of the time, while multiple lesions are most common in young men. Although the etiology is uncertain, solitary lipomas are associated with rearrangements of chromosome 12.2 Lipomas are not removed unless there is concern for cosmesis, compression of surrounding structures, or if the diagnosis is uncertain.2 Tumors that have characteristics consistent with a malignant liposarcoma include those that are greater than 5 cm in diameter, located on the thigh, deep (beneath or fixed to superficial fascia), and exhibit malignant behavior (rapid growth or invasion into nerve or bone). These tumors should be evaluated radiographically before excision is performed. Lipomas generally do not infiltrate into surrounding tissue, and they can be shelled out easily during excision.2 An alternative to standard excision is to manually squeeze the lipoma through a small incision created with a scalpel or 4-mm punch. This technique is especially useful in areas with thin dermis, such as the face and extremities.2 Liposuction-assisted lipectomy can be successful in removing even large lipomas with minimal scarring.2 Although the overwhelming majority of lipomas are of the simple type described previously, there are many rare lipoma variants. Hibernomas are benign encapsulated tumors consisting of brown fat. Infiltrating intramuscular lipomas consist of unencapsulated adipose tissue insinuating
From the Section of Otolaryngology–Head and Neck Surgery, Phoenix VA Medical Center. Reprint requests: Randy Oppenheimer, MD, Chief, Otolaryngology-
Head and Neck Surgery, Maricopa Medical Center, 2601 E. Roosevelt St., Phoenix, AZ 85008. E-mail address: [email protected].
CASE REPORT
0194-5998/$32.00 © 2006 American Academy of Otolaryngology–Head and Neck Surgery Foundation, Inc. All rights reserved. doi:10.1016/j.otohns.2005.05.660
Ghazanfari and Oppenheimer
165 of other connective tissue material. These variants include fibrolipoma, angiolipoma, spindle cell lipoma, pleomorphic lipoma, and myolipoma.3 Spindle cell lipoma is a benign CD34⫹ lipomatous tumor that characteristically arises in the posterior neck or shoulder girdle of adult men. Patients with multiple spindle cell lipomas have recently been described in the literature, and in some cases a familial tendency was identified.1 Dermatofibrosarcoma protuberans (DFSP) is a CD34⫹ neoplasm of intermediate malignancy, which may recur if incompletely excised, but practically never metastasizes.
REFERENCES
Figure 1
Seventy-four year old male with posterior neck mass.
between muscles fibers with resultant enlargement of the muscle.3 Lipoblastomas consist of immature fat found in infants. The other lipoma variants contain a variable amount
1. Luba MC. Common benign skin tumors. Am Fam Physician 2003; 67(4):729 –38. 2. Eskey CJ. Imaging of benign and malignant soft tissue tumors of the neck. Radiol Clin North Am 2000;38(5):1091–104. 3. Harvell JD. Multiple spindle cell lipomas and dermatofibrosarcoma protuberans within a single patient: Evidence for a common neoplastic process of interstitial dendritic cells. J Am Acad Dermatol 2003;48(1): 82–5.
CLINICAL PHOTOGRAPH
Massive Spindle Cell Lipoma Ali Ghazanfari, MD, and Randy Oppenheimer, MD, Phoenix, Arizona
L
ipomas are the most common soft-tissue tumor with an estimated annual incidence of one per 1000 persons. Composed of adipocytes, lipomas are generally slow-growing nodules with a firm, rubbery consistency that form a lobulated soft mass enclosed by a thin fibrous capsule.2 While about 80% of lipomas are less than 5 cm in diameter, some can reach more than 20 cm and weigh several kg. Most such tumors are asymptomatic but can cause pain when they compress nerves.2 Lipomas tend to occur on the trunk, shoulders, posterior neck, and axillae, although almost all subcutaneous locations have been reported.
fibroadipose tissue measuring 23.2 ⫻ 15.8 ⫻ 7.4 cm and weighing 1 kilogram. The final diagnosis was a benign spindle cell lipoma.
DISCUSSION
A 74-year-old African-American male presented to the head and neck clinic with a mass in the posterior neck which had been growing slowly for 14 years and recently became cumbersome for him (Fig 1). The physical exam demonstrated a 20 ⫻ 15 ⫻ 5-cm soft semi-fluctuant mass in post aspect of the neck slightly to the left. The mass was nontender, and the skin overlaying the mass appeared normal in color and texture. The mass was just below the dermis and did not appear to be adherent to any other structures. The rest of the physical exam was unremarkable. CT scan of the head and neck was performed showing a localized mass encapsulated with regions of relatively homogeneous fat density with no obvious intracranial or cervical extension. The mass was excised through a 10-cm transverse incision. The mass was yellow and adherent to the surrounding subcutaneous tissue. The mass appeared to be a lipoma on visual inspection. It was lobulated with an extensive vascular network. A 12 ⫻ 5-cm segment of excess skin was removed from the post neck and the wound was closed primarily. Pathological examination of the specimen showed it to be
Lipomas are most often asymptomatic. They usually arise from fatty tissue between the skin and deep fascia. Typical features include a soft fluctuant feel, lobulation, and the free mobility of overlying skin. Solitary lesions are seen about 80% of the time, while multiple lesions are most common in young men. Although the etiology is uncertain, solitary lipomas are associated with rearrangements of chromosome 12.2 Lipomas are not removed unless there is concern for cosmesis, compression of surrounding structures, or if the diagnosis is uncertain.2 Tumors that have characteristics consistent with a malignant liposarcoma include those that are greater than 5 cm in diameter, located on the thigh, deep (beneath or fixed to superficial fascia), and exhibit malignant behavior (rapid growth or invasion into nerve or bone). These tumors should be evaluated radiographically before excision is performed. Lipomas generally do not infiltrate into surrounding tissue, and they can be shelled out easily during excision.2 An alternative to standard excision is to manually squeeze the lipoma through a small incision created with a scalpel or 4-mm punch. This technique is especially useful in areas with thin dermis, such as the face and extremities.2 Liposuction-assisted lipectomy can be successful in removing even large lipomas with minimal scarring.2 Although the overwhelming majority of lipomas are of the simple type described previously, there are many rare lipoma variants. Hibernomas are benign encapsulated tumors consisting of brown fat. Infiltrating intramuscular lipomas consist of unencapsulated adipose tissue insinuating
From the Section of Otolaryngology–Head and Neck Surgery, Phoenix VA Medical Center. Reprint requests: Randy Oppenheimer, MD, Chief, Otolaryngology-
Head and Neck Surgery, Maricopa Medical Center, 2601 E. Roosevelt St., Phoenix, AZ 85008. E-mail address: [email protected].
CASE REPORT
0194-5998/$32.00 © 2006 American Academy of Otolaryngology–Head and Neck Surgery Foundation, Inc. All rights reserved. doi:10.1016/j.otohns.2005.05.660
Ghazanfari and Oppenheimer
165 of other connective tissue material. These variants include fibrolipoma, angiolipoma, spindle cell lipoma, pleomorphic lipoma, and myolipoma.3 Spindle cell lipoma is a benign CD34⫹ lipomatous tumor that characteristically arises in the posterior neck or shoulder girdle of adult men. Patients with multiple spindle cell lipomas have recently been described in the literature, and in some cases a familial tendency was identified.1 Dermatofibrosarcoma protuberans (DFSP) is a CD34⫹ neoplasm of intermediate malignancy, which may recur if incompletely excised, but practically never metastasizes.
REFERENCES
Figure 1
Seventy-four year old male with posterior neck mass.
between muscles fibers with resultant enlargement of the muscle.3 Lipoblastomas consist of immature fat found in infants. The other lipoma variants contain a variable amount
1. Luba MC. Common benign skin tumors. Am Fam Physician 2003; 67(4):729 –38. 2. Eskey CJ. Imaging of benign and malignant soft tissue tumors of the neck. Radiol Clin North Am 2000;38(5):1091–104. 3. Harvell JD. Multiple spindle cell lipomas and dermatofibrosarcoma protuberans within a single patient: Evidence for a common neoplastic process of interstitial dendritic cells. J Am Acad Dermatol 2003;48(1): 82–5.