Soft Tissue Tumors - Hemosiderotic fibrohistiocytic lipomatous lesion

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Soft Tissue Tumors

Adipose tissue

Hemosiderotic fibrohistiocytic lipomatous lesion

Reviewer: Vijay Shankar, M.D. (see Reviewers page)
Revised: 5 November 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Superficial benign fatty lesion, usually of foot/ankle, with CD34+ spindle cells and abundant hemosiderin
● Possibly a reactive lesion
● Not a WHO diagnosis

Epidemiology
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● Rare (10 per 6000 lipomas), usually women, mean age 51 years (range, 42-63 years)
● Usually feet and ankle region, rarely cheeks, hands, calf, thigh
● Associated with trauma (70%); may be reactive (Mod Pathol 2000;13:1192)
● Associated with venous stasis (Virchows Arch 2005;447:103)
● May be related to early pleomorphic hyalinizing angiectatic tumor (Pathol Int 2006;56:283, Am J Surg Pathol 2004;28:1417)

Case reports
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● 33 year old woman with knee tumor (Sao Paulo Med J 2009;127:174)
● 44 year old woman with recurring foot lesion (Case of the Week #199)
● 55 year old woman with swelling of hand (Malaysian J Pathol 2011;33:43 (pdf))
● 56 year old woman with foot mass for 10 years (Clin Orthop Relat Res 2010;468:2808)
● 66 year old man with thigh lesion (Sarcoma 2008;2008:893918)

Treatment and prognosis
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● Radical surgical excision and follow up
● May recur locally
● No metastases or deaths

Gross description
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● Mean 8 cm (range, 2-17 cm), solid and circumscribed but not encapsulated

Micro description
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● Unencapsulated circumscribed superficial fatty lesion with CD34+ spindle cells and abundant hemosiderin (Stanford University)
● Spindle cells have vesicular nuclei and indistinct nucleoli with occasional hyperchromatism
● Inflammatory background
● No/minimal atypia

Micro images
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Various images

Case of the Week #199

Positive stains
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● CD34, vimentin, calponin

Negative stains
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● S100, desmin

End of Soft Tissue Tumors > Adipose tissue > Hemosiderotic fibrohistiocytic lipomatous lesion

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