SKIN AND SUBCUTANEOUS TISSUE, LEFT UPPER BACK, PUNCH BIOPSY:
- ADIPOSE WITH CYTOLOGIC ATYPIA.
- SEE COMMENT.
Sections show unremarkable skin and a fragment of adipose where a
percentage of the cells show nuclear enlargement and pleomorphism. This
case will be sent to the Joint Pathology Center for consultation.
4mm punch, left upper back
CLINICAL DIAGNOSIS AND HISTORY:
35 year old female with a slowly enlarging 6cm soft, mobile, subcutaneous
nodule presumed to be a lipoma. After injecting with lidocaine with
epinephrine, lesions becomes firm and fixed. Ddx include lipoma vs
angiolipoleiomyoma vs liposarcoma vs other soft tissue tumor. Double punch
Operative Findings: SAA
Post-operative Diagnosis: SAA
\"4 mm Punch Left Upper Back\". Received in formalin is a skin punch biopsy
4 mm in diameter and 0.5 cm in depth. Also receveid in the cup are 3
fragments of yellow adipose tissue in aggregate 0.4 x 0.4 x 0.3 cm. TE
multiple in 1.
CONSULTATION RESULTS RECEIVED FROM THE JOINT PATHOLOGY CENTER ON
14 NOVEBER 2018):
SKIN AND SOFT TISSUE, LEFT UPPER BACK: LIPOMATOUS TUMOR.
Received for consultation on are 1 slide and 1 block. Additional
sections are prepared from the tissue block.
The specimen consists of a punch biopsy of essentially unremarkable skin,
as well as fragments of adipose tissue. The adipose has scattered atypical
cells with nuclear enlargement and hyperchromasia. Occasional degenerating
adipocytes are seen, with associated lipophages. Some multi-vacuolated
cells, reminiscent of lipoblasts, are also present. An immunohistochemical
stain for p53 decorates many of the more atypical nuclei. Control tissue
shows appropriate reactivity.
A dysplastic lipoma is favored. Complete excision of this lesion is
advised to prevent recurrence.
This case was reviewed in consultation by the Division of Soft Tissue
Additional testing for MDM2 by fluorescence in-situ hybridization is
currently pending to help exclude an atypical lipomatous tumor. These
results will be addended to this report up on receipt.