Spindle cell lipoma D17.9

The dermal/subcutaneous spindle cell lipoma presents as a painless, solitary, slowly growing, benign, soft nodule.

Ratio of men to women = 9:1, most often occurring in middle age (average: 57 years).

Mainly the neck or shoulder region is affected; more rarely the upper parts of the trunk. Also located in the area of the oral cavity (tongue). The spindle cell lipoma occurs mainly in the deeper soft tissue.

Solitary, prallelastic, cutaneous or subcutaneous nodular tumor.

Well defined, encapsulated tumor containing mature fat cells and uniform, elongated spindle cells within a mucinous matrix. In some areas pure spindle cell populations without fat cells. Palisade formation of spindle cells can lead to misinterpretation with neurogenic tunors. The (very rare) dermal spindle cell lipomas are uncapsulated.

Variable collagen and mucin content, produced by the spindle cells. Mucin can lead to artificial cavities (pseudovascular clefts) when proliferated strongly. Sometimes numerous mast cells within the tumour. The non-lipogenic portions are reactive for CD34, more rarely for desmin; S100 protein is usually non-reactive.

Pleomorphic lipomas contain giant multinuclear cells with rosette-like nuclei.

Cytogenetically, pleomorphic lipomas show recurrent losses on chromosome 16q13-qter, partial losses on 13q and total losses of chomosome 13 (Jäger M 2018).

The tumour is benign, grows slowly and only in exceptional cases tends to recur postoperatively.

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