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Spindle Cell Lipoma : Differential

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SoftTissue_Lipomatous_SpindleCellLipoma26B.jpg

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The differential diagnosis of spindle cell lipoma includes:

Dermatofibrosarcoma protuberans (location in dermis; prominent storiform pattern with infiltrative growth; younger patient; absence of collagen bundles)

Nodular fasciitis (heterogenous appearance; myofibroblastic cells with tissue culture appearance; positive for SMA; lack of CD34 staining)

Angiomyofibroblastoma (genital location; prominent vasculature consisting of thick-walled blood vessels; epithelioid cells)

Solitary Fibrous Tumor (positive for STAT6 by immunohistochemistry; lacks 13q14 deletion)

Cellular angiofibroma and mammary-type myofibroblastoma. Both entities share morphologic and cytogenetic features (deletion of 13q14) and the distinction may not be possible nor clinically relevant.

This image shows a fat-free spindle cell lipoma with prominent myxoid matrix resulting in close resemblance to a myxoma.

(differential diagnosis continues in the next slide).

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