Journal of Cytology
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Year : 2018  |  Volume : 35  |  Issue : 1  |  Page : 66-67
Cytopathological diagnosis and differential diagnoses of facial spindle cell lipoma


Department of Oral and Maxillofacial Pathology, NIMS Dental College, Jaipur, Rajasthan, India

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Date of Web Publication18-Jan-2018
 

How to cite this article:
Bajpai M, Pardhe N. Cytopathological diagnosis and differential diagnoses of facial spindle cell lipoma. J Cytol 2018;35:66-7

How to cite this URL:
Bajpai M, Pardhe N. Cytopathological diagnosis and differential diagnoses of facial spindle cell lipoma. J Cytol [serial online] 2018 [cited 2021 Jun 15];35:66-7. Available from: https://www.jcytol.org/text.asp?2018/35/1/66/223608




Sir,

Lipoma is a slow growing benign tumor, that usually occurs in the upper back and neck and is clinically asymptomatic.[1] Many benign histological variants of lipoma are known and described based on the type of tissue present and predominance in the lesion: Fibrolipoma, angiolipoma, myolipoma, myxolipoma, spindle cell lipoma, osteolipoma, chondrolipoma and spindle cell lipoma (SCL).[2]

SCL is a distinct histological entity derived from prelipoblastic mesenchymal cells,[3] and occurs predominantly in the posterior neck and upper back of middle-aged to elderly men. However, up to 20% of SCLs occur outside this characteristic location, and rarely, they can be seen on the face.[4] Histopathological features of SCL consist of an admixture of mature fat cells with varying number of spindle-shaped cells.[4],[5]

A 37-year-old man presented to the department of dermatology for the evaluation of a painless swelling on his left cheek from 10 months. Past medical history and family history were noncontributory to the present swelling. Physical examination revealed a soft-to-firm dome-shaped mass on the left lower part of the face measuring approximately 2 × 2 cm in dimension. The overlying skin of the swelling was similar to the color of the face without showing any sign of inflammation [Figure 1]a. Patient was referred for fine needle aspiration (FNA) procedure. Procedure was performed using a 22-gauge needle attached to a 10-ml syringe. A mucoid material was yielded from the lesion. Ninety-five percent alcohol fixed smear was prepared and hematoxylin and eosin staining was carried out. Cytological evaluation of the aspirate revealed numerous benign, spindle-shaped cells with bland, spindle, and wavy nuclei in a loose cohesive myxoid background with collagen fibers [Figure 1]b, as well as abundant mature adipocytes with a cluster of capillaries [Figure 1]c. An initial impression of SCL was made. An incisional biopsy was performed and the tissue was subjected to hematoxylin and eosin staining. Histological examination of the soft tissue section revealed a cellular connective tissue stroma composed of numerous benign spindle cells with abundant myxoid areas, numerous mature adipocytes, and dilated vascular channels [Figure 1]d. Based on the cytological and histological findings, a final diagnosis of SCL was rendered. Surgical excision and reconstruction was performed with the help of a plastic surgeon. No recurrence was occurred.
Figure 1: (a) Clinical picture of the swelling (marked site for FNA procedure). (b) FNAC, spindle cells with, mature adipocytes and mucoid stroma (H and E, x40). (c) FNAC, collection of numerous benign spindle cells, collagen fibers, and mature adipocytes (H and E, x40). (d) Histological examination reveals characteristic features of SCL including collection of numerous typical spindle cells, with mature adipocytes, myxoid areas, and dilated vascular channels (H and E, x40)

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The diagnostic efficacy of FNA cytology (FNAC) is well-known for the diagnosis of tumor in different locations; however, its efficacy as a sole diagnostic tool in soft tissue tumors is debated,[5] especially in case of epithelioid and spindle cell tumors.[4] Hence, histopathology is still considered a gold standard for their evaluation.[1],[2],[5] Diagnosis of SCL based on its FNAC findings is a challenge. Differential diagnoses of SCL in FNA are atypical lipomatous tumor (ALT) and myxolipoma. ALT shows lipoblasts with atypia; on the other hand, SCL comprises blend spindle cells with minimum polymorphism and mitoses.[6] In myxolipomas, the aspirate is usually viscous and spindle cells population is not much pronounced in comparison to SCL.[7] Differentiation between ALT and SCL is of utmost importance; the clinically suspecting lesion with extensive adipocytic component prompts cytopathologist to carry out a meticulous search of lipoblasts to rule out ALT.[6]

This case is an attempt to describe the cytopathological features of SCL that can guide cyotopathologists to permit a definitive diagnosis of SCL on FNA smears.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Fregnani ER, Pires FR, Falzoni R, Lopes MA, Vargas PA. Lipomas of the oral cavity: Clinical findings, histological classification and proliferative activity of 46 cases. Int J Oral Maxillofac Surg 2003;32:49-53.  Back to cited text no. 1
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2.
Bajpai M, Kumar M, Agarwal D, Agrawal S, Gupta S, Kumar M. Osteolipoma of the palate-An unusual presentation. Natl J Maxillofac Surg 2014;5:250-1.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Domanski HA, Carlén B, Jonsson K, Mertens F, Akerman M. Distinct cytologic features of spindle cell lipoma. A cytologic-histologic study with clinical, radiologic, electron microscopic and cytogenetic correlations. Cancer 2001;93:381-9.  Back to cited text no. 3
    
4.
Guo Z, Voytovich M, Kurtycz DF, Hoerl HD. Fine-needle aspiration diagnosis of spindle-cell lipoma: A case report and review of the literature. Diagn Cytopathol 2000;23:362-5.  Back to cited text no. 4
[PUBMED]    
5.
Agarwal S, Nangia A, Jyotsna PL, Pujani M. Spindle cell lipoma masquerading as lipomatous pleomorphic adenoma: A diagnostic dilemma on fine needle aspiration cytology. J Cytol 2013;30:55-7.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Ulivieri S, Olivieri G, Motolese PA, Fruschelli M, Motolese E, Menicacci F, et al. Spindle cell lipoma of the orbit: A case report of an unusual orbital pathology. Neurol Neurochir Pol 2010;44:419-23.  Back to cited text no. 6
[PUBMED]    
7.
Bajpai M, Pardhe N. Myxolipoma of oral cavity. Univ Res J Dent 2016;6:134 -6.  Back to cited text no. 7
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Correspondence Address:
Dr. Manas Bajpai
Department of Oral and Maxillofacial Pathology, NIMS Dental College, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JOC.JOC_89_17

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