1 July 2010 – Case of the Week #182


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Thanks to Dr. Ankur Sangoi, El Camino Hospital, Mountain View, California for contributing this case and much of the discussion. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.


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(1) We have updated these chapters / topics:


- Penis/Scrotum by Drs. Alcides Chaux and Antonio L. Cubilla; it now has 90 topics, 311 pages, 684 images and 448 references.


- Stains topic - Topoisomerase II alpha (TOP2A), reviewed by Dr. Semir Vranic, University of Sarajevo.


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- Dr. Asmaa Gaber, Egypt, for contributing images of Spongiotic Dermatitis for the Skin-nontumor chapter.


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Case of the Week #182


Clinical History


A 55 year old man presented with a 3.5 cm mass in his neck, which was excised.


Micro images:




4x                                10x



20x                              60x


Immunohistochemistry images:


CD34                           S100


What is your diagnosis?




























Spindle cell lipoma, pseudoangiomatous variant




Spindle cell lipomas are benign tumors usually found in the neck, shoulders or back of middle-aged men.  They are composed of parallel arrays of CD34+ bland spindle cells with eosinophilic cytoplasm, mixed with myxoid matrix and ropey collagen.  The background has adipose tissue and blood vessels.  There are no mitotic figures. 


The pseudoangiomatous variant is rare, and has branching, irregular spaces with villiform connective tissue projections, giving a striking angiomatoid appearance (Histopathology 1994;24:565).  The authors in a recent study demonstrated that the lining cells are positive for D2-40, a lymphatic marker, and recommend that this variant be called “angiomatous” (Pathol Int 2007;57:26).


Wide local excision of spindle cell lipoma is usually curative, with very rare recurrences (Cancer 1975;36:1852).


The differential diagnosis includes:


- Lipomatous hemangiopericytoma – adipose tissue, CD34+ spindle cells, variable myxoid stroma; vasculature is prominent but has large gaping sinusoidal spaces (“staghorn”)


- Myxoid lipoma: no prominent spindle cells, no vascular appearance, CD34 negative



Additional references: PathologyOutlines.com-Soft Tissue chapter


Nat Pernick, M.D., President,

and Kara Hamilton, M.S., Associate Medical Editor

PathologyOutlines.com, Inc.

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