Pleomorphic Lipoma - Anticancer Research

ANTICANCER RESEARCH 24: 3157-3160 (2004)
Pleomorphic Lipoma: A Definite Histopathological Entity
Abstract. Pleomorphic lipomas are rare benign tumours
that can resemble a variety of malignant tissue tumour on
histological examination. We describe a case of pleomorphic
lipoma arising on the posterior aspect of the neck of a 70year-old
man, successfully treated by surgical excision. A
review of the literature is presented, summarizing the
principal clinical and morphological characteristics of this
rare tumor.
Lipomas are considered the most common benign soft
tissue neoplasm of the head and neck (1,2). There are many
variants of lipomas, which are differentiated based on the
amount and type of mesenchymal elements present. One
such variant is pleomorphic lipoma. This is a rare, benign,
pseudosarcomatous, soft tissue neoplasm, which typically
occurs in males (4:1) between the ages of 50 and 70 years
(3,4). Its typical location is in the sub-cutis of the neck and
of the shoulder. Currently there are fewer than 150 cases
reported in the world literature (5). We report on a rare
case of pleomorphic lipoma.
Materials and Methods
A 70-year-old man presented in our Department with a 6-year
history of a mass on the posterior aspect of the neck, gradually
increasing in size. Clinically the lesion appeared as an isolated,
Correspondence to: Dott. Alfonso Baldi, Via G. Orsi 25, 80128
Naples, Italy. Fax: +390815569693, e-mail: alfonsobaldi@tiscali.it
Key Words: Pleomorphic lipoma.
PAOLO PERSICHETTI 1 , FILIPPO DI LELLA 1 , GIOVANNI F. MARANGI 1 ,
BARBARA CAGLI 1 , PIERFRANCO SIMONE 1 , STEFANIA TENNA 1 ,
CARLA RABITTI 2 , ROBERTO CASSANDRO 3 , VINCENZO ESPOSITO 4,5 ,
ANGELA M. GROEGER 5,6,7 and ALFONSO BALDI 8
1 Department of Plastic and Reconstructive Surgery and
2 Department of Pathology, Campus BioMedico University, Rome;
3 Institute of Cardio-Thoracic Research, Respiratory Section. V. Monaldi Hospital, Naples;
4 Third Division of Infective Diseases, D. Cotugno Hospital, Naples, Italy;
5 International Society for the Study of Comparative Oncology (ISSCO), Silver Spring, MD, U.S.A.;
6 Division of Vascular Surgery, Cardarelli Hospital, Naples, Italy;
7 Department of Cardio-Thoracic Surgery, University of Vienna, Vienna, Austria;
8 Department of Biochemistry and Biophysic "F. Cedrangolo", Section of Pathology, Second University of Naples, Italy
0250-7005/2004 $2.00+.40
mobile, non-tender subcutaneous mass measuring 5 x 3 cm
transversally oriented situated at C7 level. There was no sign of
cervical adenopathy. Moreover, there was no history of a previous
trauma at this site.
The excisional biopsy specimen was fixed in 10% bufferedformalin
and paraffin-embedded. Sections of 5-Ì were stained with
haematoxylin-eosin, haematoxylin-van Gieson and PAS-haematoxylin.
Other sections were stained with immunohistochemical
procedure, using avidin-biotin peroxidase complex (ABC) and
antibodies specific for CD34 and S100 (all the reagents were from
Dako, Carpinteria, CA, USA).
The patient was treated with surgery and is disease-free at 36
months of follow-up.
Results
Intra-operatively the mass appeared capsulated and well
circumscribed. Light microscopic examination revealed a
completely excised pleomorphic lipoma based on the
presence of mature fat cells, collagen fibers and "floret-like"
multinucleated giant cells (Figure 1). The immunohistochemical
analysis revealed that more than 80% of
neoplastic cells were positive for CD34 and S-100, while
cytokeratin was completely negative (data not shown).
The light microscopy and immunohistochemical findings
were diagnostic for a pleomorphic lipoma.
Discussion
We describe, here, a rare case of pleomorphic lipoma of the
neck in an adult male (70-year-old). The diagnosis of this
rare lesion is difficult and should be considered in every
growing mass of the head and neck region (5). In our case it
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was based on the pathological examination of the tissue
sample guided by immunohistological methods and on the
clinical history of the patient.
Pleomorphic lipoma was first described in the early 80s
and, in recent years, it has been shown that spindle cell
lipoma and pleomorphic lipoma are regarded as a single
clinical, histological, immunohistochemical and
cytogenetic entity in the spectrum of benign lipogenic
neoplasms (1-4). Differential diagnosis between spindle
cell lipoma/pleomorphic lipoma, well-differentiated
liposarcoma and atypical lipomas relies on clinical and
histopathological examination. Pleomorphic lipoma
typically arises in the sub-cutis of the neck and the
shoulder as a progressively enlarging mass. The average
period necessary for diagnosis is 3.3 years. There are still
ANTICANCER RESEARCH 24: 3157-3160 (2004)
Figure 1. Section through the tumour showing loosely-textured fibrous stroma containing pleomorphic hyperchromatic cells, chronic inflammatory cells
incuding occasional mast cells, and characteristic multinucleated floret-like giant cells with multiple peripherally placed nuclei. Haematoxylin and eosin;
original magnification X 40.
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less than 150 cases of pleomorphic lipoma reported in the
literature (5).
Fine-needle aspiration has been reported as being
effective in evaluating subcutaneous lesion especially in the
head and neck region (5). However, pleomorphic lipoma
can masquerade as a malignancy on fine-needle aspiration,
therefore histological confirmation should be obtained prior
to definitive therapy (6,7). In our experience, we do not
usually perform FNA because of the possibility of falsenegative
results. We routinely evaluate subcutaneous masses
by US. Atypical results or difficult interpretation of US are
subsequently evaluated by MRI and eventually by excisional
biopsy. In the case presented, we decided to directly
perform histological examination of the mass, due to clinical
presentation.

Surgical treatment of pleomorphic lipoma involves
complete surgical excision with clear margins, as simple
enucleation is inadequate and is associated with a high
recurrence rate. In the case presented, the patient is
disease-free at 36 months of follow-up, thus confirming the
reported excellent cure rates for this tumor (8).
In conclusion, pleomorphic lipoma is a rare benign,
psueodsarcomatous soft tissue neoplasm typically occurring
in the sub-cutis of the neck and shoulder, that can resemble
a variety of malignant soft tissue tumors. Therefore, careful
examination of the clinical setting, as well as of the
histopathological characteristics of this kind of tumors is
essential for a correct diagnosis and to avoid unnecessary
and often disfiguring surgery.
Acknowledgements
This work was supported by FUTURA-Onlus and I.S.S.C.O.
References
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Persichetti et al: Pleomorphic Lipoma
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aspiration cytology. Diagn Cytopathol 12: 272-279, 1995.
8 Bryant J: Pleomorphic lipoma of the scalp. J Dermatol Surg
Oncol 7: 323-325, 1981.
Received May 18, 2004
Accepted August 2, 2004
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