Multiple spindle cell lipomas: a report of 7 familial and 11 nonfamilial cases.

Soft Tissue Pathology Department, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
American Journal of Surgical Pathology (Impact Factor: 4.59). 01/1998; 22(1):40-8.
Source: PubMed

ABSTRACT Spindle cell lipoma, a variant of a benign lipoma, usually occurs as a solitary, subcutaneous, circumscribed lesion in the posterior back, neck, or shoulders of older men. Multiple lesions are exceedingly rare. To our knowledge, there have been no previous series reported of patients with multiple subcutaneous spindle cell lipomas. We examine the clinicopathologic findings of a group of patients with multiple spindle cell lipomas, including seven with a familial occurrence of this disease. The Soft Tissue Registry of the Armed Forces Institute of Pathology and the consultation files of one of the authors (S.W.W.) from the Department of Pathology at the University of Michigan were searched for patients with multiple spindle cell lipomas. All patients' records, clinical history, and pathology were reviewed. All patients had a minimum of two tumors that met strict morphologic criteria for spindle cell lipoma. Pleomorphic cells, typical of pleomorphic lipoma, were observed in some cases and were acceptable as part of the spectrum of spindle cell lipomas. Associated lesions, family history, ethnic background, daily habits, and natural progression of disease were recorded and compared. Eighteen patients in our files met the criteria for multiple spindle cell lipomas; 4 of the 18 patients were from the same family. Three additional patients had a family history of multiple spindle cell lipomas. The ratio of patients with multiple spindle cell lipomas to all patients with spindle cell lipoma in the two consultation files was 0.5 and 3%, respectively. All of the patients in our study were male; three had a family history of females with less severe disease (fewer and smaller spindle cell lipomas); however, no material from these female patients was available for review. All but four patients presented in their sixth through eighth decades of life; yet, several older patients stated that their first lesion occurred in their fifth decade. Patients had between 2 and >220 lesions, which usually commenced on the posterior neck or back, commonly followed by additional bilateral lesions on the shoulders and upper torso. The natural history of this disease revealed development of multicentric lesions over several years, for both familial and nonfamilial cases. The tumors became more cellular as the disease progressed, often with features of pleomorphic lipoma; however, no patients developed spindle cell liposarcoma. Multiple spindle cell lipomas are rare. The clinical presentation may mimic Madelung's disease (symmetrical lipomatosis). As mentioned above, some cases are familial. Genetic predisposition must be further examined. There appears to be no common ethnic background, environmental exposure, medical condition, or syndrome of associated lesions with multiple spindle cell lipomas.

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    ABSTRACT: A spindle cell lipoma (SCL) is a relatively common tumor that can be challenging to the radiologist, pathologist, or surgeon to diagnose, particularly when internal fat content is scant or absent. Although these lesions may be found at various locations, the typical presentation for this lesion is a well-circumscribed and non-aggressive subcutaneous mass in the posterior neck presenting in a middle-aged to elderly man. In this article, the typical and atypical imaging characteristics of a spindle cell lipoma (SCL) will be reviewed. Knowledge of the common imaging and pathologic features of SCLs can help suggest the diagnosis and guide patient management.
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