Soft tissue

Adipose tissue tumors

Other benign lesions

Hibernoma


Resident / Fellow Advisory Board: Josephine K. Dermawan, M.D., Ph.D.
Deputy Editor-in-Chief: Borislav A. Alexiev, M.D.
Saba Anjum, M.B.B.S.
Nasir Ud Din, M.B.B.S.

Last author update: 23 November 2022
Last staff update: 23 November 2022

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PubMed Search: Hibernoma

Saba Anjum, M.B.B.S.
Nasir Ud Din, M.B.B.S.
Page views in 2022: 12,190
Page views in 2023 to date: 1,421
Cite this page: Anjum S, Ashfaq Z, Ud Din N. Hibernoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/softtissueadiposehibernoma.html. Accessed February 8th, 2023.
Definition / general
  • Rare, benign, adipocytic tumor composed of variable proportions of brown fat cells admixed with white adipose tissue
Essential features
Terminology
ICD coding
Epidemiology
Sites
Pathophysiology
  • Intraosseous hibernoma: osteoblasts and adipocytes have common origin from mesenchymal stem cells
  • Brown fat cell differentiation is associated with PRD1-BF1-RIZ1 homologous domain containing 16 (PRDM16) underregulated by bone morphogenetic protein 7 (BMP7), which also stimulates bone formation
  • This explains how brown fat cells and sclerotic bony trabeculae are mixed in intraosseous hibernomas (J Pathol Transl Med 2017;51:499)
Etiology
Clinical features
Diagnosis
Radiology description
Radiology images

Images hosted on other servers:
Intraosseous hibernoma (MRI, CT and PET)

Intraosseous hibernoma (MRI, CT and PET)

Posterior cervical triangle hibernoma (MRI)

Well demarcated lesion in right hip joint (MRI)

Mass within the left external oblique muscle (MRI)

Prognostic factors
Case reports
Treatment
Clinical images

Images hosted on other servers:
Lower limb subcutaneous hibernoma

Lower limb subcutaneous hibernoma

Hibernoma in proximal thigh

Hibernoma in proximal thigh

Gross description
Gross images

Contributed by Nasir Ud Din, M.B.B.S.
Well defined, encapsulated, hibernoma

Well defined, encapsulated hibernoma

Lipoma-like hibernoma

Lipoma-like hibernoma

Frozen section description
Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Nasir Ud Din, M.B.B.S.
Peripheral well defined borders

Peripheral well defined borders

Benign adipocytes

Benign adipocytes

Sheets of brown cells and vasculature

Sheets of brown cells and vasculature

Eosinophilic granulated cells with central nuclei

Eosinophilic granulated cells with central nuclei

Hibernoma with all benign features

Hibernoma with all benign features

Rich vascularization

Rich vascularization


Eosinophilic cells with granular vacuolated cytoplasm

Granular vacuolated cytoplasm

Mixture of multivacuolated and univacuolated cells

Multivacuolated and univacuolated cells

Variable proportions of brown cells and mature adipocytes

Brown cells and mature adipocytes

Mixture of brown and white fat cells

Mixture of brown and white fat cells

Lipoma-like hibernoma Lipoma-like hibernoma

Lipoma-like hibernoma


Lipoma-like hibernoma

Lipoma-like hibernoma

Well defined border

Well defined border

No signs of malignancy

No signs of malignancy

Univacuolated and granular eosinophilic cells

Univacuolated and granular eosinophilic cells

S100 S100

S100

Cytology description
  • Uniform, polygonal multivacuolated cells with finely abundant granular cytoplasm, bland round nucleus and inconspicuous to prominent nucleoli
  • Occasional spindle shaped cells can be present
  • No nuclear atypia, mitosis or necrosis
  • Benign granular cell tumor is a close differential on cytology (J Clin Diagn Res 2017;11:ED01)
Cytology images

Images hosted on other servers:
Regular nuclei and granular cytoplasm (Giemsa stain)

Regular / eccentric
nuclei, granular
cytoplasm
(Giemsa / Pap)

Positive stains
Electron microscopy description
  • Hibernoma cells have several large mitochondria with high electron density matrix and dense cristae, lipid droplets, undulating plasmalemmal invaginations, pinocytic vesicles, free ribosomes, high glycogen content and small amount of smooth endoplasmic reticulum (J Clin Diagn Res 2017;11:ED01)
Molecular / cytogenetics description
Videos

Hibernoma: 5 minute pathology pearls

Sample pathology report
  • Thigh lump, excision:
    • Hibernoma (see comment)
    • Microscopic description: The sections reveal a well circumscribed neoplastic lesion comprising large polygonal cells arranged in sheets. These cells have multivacuolated, granular cytoplasm with small central nucleus admixed with variable amount of univacuolated cells. There is no significant cytological atypia, necrosis or mitosis.
    • Comment: Hibernoma is a benign neoplasm with no significant potential for recurrence.
Differential diagnosis
Board review style question #1

A 32 year man presented with a mass in his right thigh; MRI revealed circumscribed lobulated lesion and microscopy is shown in the picture above. What is the diagnosis?

  1. Atypical lipomatous tumor
  2. Fat necrosis
  3. Hibernoma
  4. Lipoblastoma
  5. Lipoma
Board review style answer #1
C. Hibernoma

Comment Here

Reference: Hibernoma
Board review style question #2
Hibernoma has an association with which one of the following syndromes?

  1. Anders syndrome
  2. Gardner syndrome
  3. Lynch syndrome
  4. MEN1 syndrome
  5. MEN2 syndrome
Board review style answer #2
D. MEN1 syndrome

Comment Here

Reference: Hibernoma
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