Soft Tissues >

Lipoma

View full-size image

Definition
Benign soft tissue tumor composed of differentiated fat cells.

Clinical Features
 Benign
 Any location containing fat1
 Most:
o upper half of body, particularly:
 trunk
 neck
o subcutaneous
 Can occur in deep soft tissues:
o intramuscular:
 most common in trunk
o intermuscular:
  most common in anterior abdominal wall2
 Usually:
o adult
o fifth or sixth decade of life
 Single or multiple:
o multiple:
 more common in women
 many in familial setting
 some in:
 neurofibromatosis
 multiple endocrine neoplasia
o Diffuse lipomatosis:
 massive enlargement of a limb may result from diffuse
proliferation of mature adipose tissue
 in familial variant symmetric distribution3

Gross Pathology
 Can be large
 Usually encapsulated in superficial soft tissues
 Tend to be poorly circumscribed in deeper structures4,5
 Bright yellow fat separated by fine fibrous trabeculae (Fig. 1

Fig. 1: Gross appearance of lipoma. Except for the circumscription, the

appearance is indistinguishable from that of normal fat.

Histopathology
 Mature adipose tissue
 No cellular atypia.
 May be:
o fat necrosis
o infarct
 ocalcification
 Important not to confuse histiocytes associated with fat necrosis with lipoblasts:
o often seen arranged circumferentially around large lipid droplet (as in fat
necrosis at other sites)
 helpful diagnostic sign
 Rarely foci of mature metaplastic:
o cartilage
o bone6
 Ultrastructurally:
o univacuolar mature adipocytes7

Diagnosis
Variants

Fibrolipoma

 Prominent bundles of mature fibrous tissue traversing fatty lobules

 Should not be equated with spindle cell lipoma

Myxolipoma

 Focally well-developed myxoid changes

 Should not be overdiagnosed as myxoid liposarcoma

Chondroid Lipoma

 Usually deep-seated (Fig. 2

Fig. 2: Gross appearance of chondroid lipoma.

 Component of eosinophilic vacuolated cells containing glycogen

 Lipid resembles brown fat cells, lipoblasts and chondroblasts10 (Fig. 3
 Fig. 3: Microscopic appearance of chondroid lipoma, showing admixture of
mature fat and chondroid tissue.

 Immunoreactive for:
o vimentin
o S-100 protein
o CD68
 Some positive for keratin10,11

Myolipoma

 Admixture in variable proportions of:

o mature adipose tissue
o bundles of well-differentiated smooth muscle12

Spindle Cell Lipoma

 Benign
 Usually shoulder and posterior neck of adults
 Many other locations including:
o limbs
o face
o oral cavity
o trunk
o anus13,14
 Admixture of:
o mature lipocytes
o uniform spindle cells
 Mucinous fibrous background15 (Figs 4 and 5
 Fig. 4: Spindle cell lipoma. The oval to spindle cells are concentrated in the
fibrous bands within lobules of mature adipose tissue.

Fig. 5: Spindle cell lipoma. The oval to spindle cells are concentrated in the
fibrous bands within lobules of mature adipose tissue.

 Distinguished from myxoid liposarcoma by:

o absence of:
 lipoblasts
 prominent plexiform vascular pattern
o thick (‘ropy') collagen bundles
o great uniformity of proliferating spindle cells
 Sometimes irregular branching spaces with villiform projections:
o results in a pseudoangiomatous appearance16 (Figs 6 and 7
 Fig. 6: Spindle cell lipoma with pseudoangiomatous appearance resulting
from accumulation of tumor cells beneath artifactual tissue spaces.

Fig. 7: Spindle cell lipoma with pseudoangiomatous appearance resulting

from accumulation of tumor cells beneath artifactual tissue spaces.

 Ultrastructurally:
o mixture of:
 spindle mesenchymal cells
 mature lipocytes17

Pleomorphic Lipoma

 Hyperchromatic multinucleated (‘floret-like') tumor cells within fibrous septa

traversing neoplasm (Figs 8 and 9
Fig. 8: Pleomorphic lipoma.

Fig. 9: Pleomorphic lipoma. This high-power view highlights the floret cells.

)
  Most commonly shoulder and posterior neck18
 Also:
o dermis
o beneath mucosal membranes
 Most difficult differential diagnosis is sclerosing form of well-differentiated
liposarcoma (atypical lipomatous tumor):
o location is important clue
o proportion of floret-type giant cells and lipoblasts most important
distinguishing feature microscopically19

Angiolipoma

 Well-circumscribed
 Small
 Occur shortly after puberty
 Often:
o painful:
 correlates with degree of vascularity20
o multiple
 In subcutis
 Most commonly on trunk or extremities
 Vascularity often limited to band of tissue on periphery (Fig. 10

Fig. 10: Angiolipoma showing intimate admixture of blood vessels and mature
adipose tissue.

 Hyaline thrombi common:

o important diagnostic sign21 (Fig. 11
 Fig. 11: Numerous hyaline thrombi in angiolipoma.

 Vascular component may predominate (cellular angiolipoma):

o can be confused with Kaposi's sarcoma or angiosarcoma22 (Fig. 12

Fig. 12: Cellular angiolipoma. This benign tumor should not be confused
with Kaposi's sarcoma.

 No chromosomal aberrations:
o like hemangiomas and unlike lipomas
o suggests they are hemangiomas with fat and not true mixed tumors23

Infiltrating Angiolipoma

 Unrelated to angiolipoma
 Probably:
o not true mixed tumors
o intramuscular large-vessel hemangioma with portions of affected muscle
tissue replaced by fat24

Other Investigations
  Lipid content:
o determined by biochemical extraction activity of lipoprotein lipase
o differs from that of normal adult fat8,9

Differential Diagnosis
Select up to 2 differential diagnoses to compare with Lipoma

Pleomorphic Liposarcoma [Soft Tissues] (View full diagnosis)

Compare Differentials

Liposarcoma

 Most lipomas subcutaneous:

 Liposarcoma usually deep-seated
 ≈120 lipomas for every liposarcoma25

Genetics
 80% of solitary lipomas have chromosomal aberrations affecting mainly:
o 12q
o 6p
o 13q26,27
 Marker ring or giant chromosomes are extremely rare:
o in contrast with atypical lipomatous tumors
 Multiple lipomas usually have normal karyotype
 Nearly all spindle cell and pleomorphic lipomas have aberrations of 16q:
o supports:
 close link between these two
 distinct from atypical lipomatous tumors28–30
 Gene involved in chromosome region 12q15 of lipoma cells is HMGI-C:
o encodes ‘architectural’ transcription factor31

References
1 Paarlberg D, Linscheid RL, Soule EH. Lipomas of the hand. Including a case of
lipoblastomatosis in a child. Mayo Clin Proc. 1972;47:121–124.

2 Fletcher CD, Martin-Bates E. Intramuscular and intermuscular lipoma: Neglected

diagnoses. Histopathology. 1988;12:275–287.
3 Enzi G. Multiple symmetric lipomatosis. An updated clinical report. Medicine
(Baltimore). 1984;63:56–64.

4 Greenberg SD, Isensee C, Gonzalez-Angulo A, Wallace SA. Infiltrating lipomas of the

thigh. Am J Clin Pathol. 1963;39:66–72.

5 Kindblom L-G, Angervall L, Stener B, Wickbom I. Intermuscular and intramuscular

lipomas and hibernomas. A clinical, roentgenologic, histologic, and prognostic study of
46 cases. Cancer. 1974;33:754–762.

6 Katzer B. Histopathology of rare chondroosteoblastic metaplasis in benign lipomas.

Pathol Res Pract. 1989;184:437–445.

7 Kin YH, Reiner L. Ultrastructure of lipoma. Cancer. 1982;50:102–106.

8 Popper H, Knipping G. A histochemical and biochemical study of a liposarcoma with

several aspects on the development of fat synthesis. Pathol Res Pract. 1981;171:373–380.

9 Solvonuk PF, Taylor GP, Hancock R, Wood WS, Frohlich J. Correlation of morphologic
and biochemical observations in human lipomas. Lab Invest. 1984;51:469–474.

10 Meis JM, Enzinger FM. Chondroid lipoma. A unique tumor simulating liposarcoma
and myxoid chondrosarcoma. Am J Surg Pathol. 1993;17:1103–1112.

11 Kindblom L-G, Meis-Kindblom JM. Chondroid lipoma. An ultrastructural and

immunohistochemical analysis with further observations regarding its differentiation.
Hum Pathol. 1995;26:706–715.

12 Meis JM, Enzinger FM. Myolipoma of soft tissue. Am J Surg Pathol. 1991;15:121–
125.

13 Fletcher CDM, Martin-Bates E. Spindle cell lipoma. A clinicopathological study with

some original observations. Histopathology. 1987;11:803–817.

14 Robb JA, Jones RA. Spindle cell lipoma in a perianal location. Hum Pathol.
1982;13:1052.

15 Enzinger FM, Harvey DA. Spindle cell lipoma. Cancer. 1975;36:1852–1859.

16 Hawley IC, Krausz T, Evans DJ, Fletcher CD. Spindle cell lipoma – a
pseudoangiomatous variant. Histopathology. 1994;24:565–569.

17 Bolen JW, Thorning D. Spindle cell lipoma. A clinical, light- and electron-microscopic
study. Am J Surg Pathol. 1981;5:435–441.
18 Shmookler BM, Enzinger FM. Pleomorphic lipoma. A benign tumor simulating
liposarcoma. A clinicopathologic analysis of 48 cases. Cancer. 1981;47:126–133.

19 Azzopardi JG, Iocco J, Salm R. Pleomorphic lipoma. A tumour simulating

liposarcoma. Histopathology. 1983;7:511–523.

20 Howard WR, Helwig EB. Angiolipoma. Arch Dermatol. 1960;82:924–931.

21 Dixon AY, McGregor DH, Lee SH. Angiolipomas. An ultrastructural and

clinicopathological study. Hum Pathol. 1981;12:739–747.

22 Hunt SJ, Santa Cruz DJ, Barr RJ. Cellular angiolipoma. Am J Surg Pathol.
1990;14:75–81.

23 Sciot R, Akerman M, Dal Cin P, De Wever I, Fletcher CD, Mandahl N, et al.

Cytogenetic analysis of subcutaneous angiolipoma: further evidence supporting its
difference from ordinary pure lipomas: a report of the CHAMP Study Group. Am J Surg
Pathol. 1997;21:441–444.

24 Enzinger FM. Benign lipomatous tumors simulating a sarcoma. In M.D. Anderson

Tumor Institute. Management of primary bone and soft tissue tumors. Chicago: Year
Book Medical Publishers; 1977.

25 Pack GT, Pierson JC. Liposarcoma. Surgery. 1954;36:687–712.

26 Fletcher CD, Akerman M, Dal Cin P, De Wever I, Mandahl N, Mertens F, et al.

Correlation between clinicopathologic features and karyotype in lipomatous tumors. A
report of 178 cases from the chromosomes and morphology (CHAMP) collaborative
study group. Am J Pathol. 1996;148:623–630.

27 Rubin BP, Dal Cin P. The genetics of lipomatous tumors. Semin Diagn Pathol.
2001;18:286–293.

28 Fletcher CD, Akerman M, Dal Cin P, De Wever I, Mandahl N, Mertens F, Mitelman F,

Rosai J, Rydholm A, Sciot R, Tallini G, Van den Berghe H, Van de Ven W, Vanni R,
Willen H. Correlation between clinicopathologic features and karyotype in lipomatous
tumors. A report of 178 cases from the chromosomes and morphology (CHAMP)
collaborative study group. Am J Pathol (in press).

29 Heim S, Mandahl N, Rydholm A, Willen H, Mitelman F. Different karyotypic features

characterize different clinico-pathologic subgroups of benign lipogenic tumors. Int J
Cancer. 1988;42:863–867.

30 Mandahl N, Heim S, Arheden K, Rydholm A, Willen H, Mitelman F. Three major

cytogenetic subgroups can be identified among chromosomally abnormal solitary
lipomas. Hum Genet. 1988;79:203–208.
31 Lovell-Badge R. Living with bad architecture. Nature. 1995;376:725–726.

Last updated: 22 Feb 2006

Lipoma
Back to top

 Definition
 Clinical Features
 Gross Pathology
 Histopathology
 Diagnosis
 Other Investigations
 Differential Diagnosis
 Genetics
 References

Help–Contact Us–Send Us Feedback–Terms and Conditions–Privacy Policy–Registered

User Agreement

Copyright © 2006 Elsevier Inc. All rights reserved.