Track: Case Reports

Topic: Other

Abstract:

Introduction: Spindle cell/pleomorphic lipomas are a spectrum of benign lipomatous tumors more often occurring in middle-aged/elderly men in the posterior neck and upper back. 1 in 5 can occur in uncharacteristic locations, and rarely, they arise on the face. This creates diagnostic uncertainty due to its variable morphological appearance, muscle involvement and limited nature of biopsy specimens from this location.

Case: A 54-year-old man presented to clinic with an enlarging cyst above his right ear that appeared 1 year ago and was now uncomfortable and mildly painful. The lesion appeared as a soft subcutaneous nodule with no surface changes or punctum, measuring 1.6 x 1.6 x 0.9 cm. Biopsy of the lesion revealed a myxoid stroma with floret cells, spindle cells, mature fat, prominent vasculature, and ropey collagen bundles, infiltrating muscle. The lesion was positive for CD34 and negative for RB-1, Sox10, and P40.

Discussion: Although infrequently, facial spindle cell/pleomorphic lipomas do occur, majority of cases appearing on the nose, cheek, and forehead. The findings are often rather classic, but some infiltrative growth pattern, prominent vasculature, and pleomorphic cells can be alarming for those that do not think of the diagnosis. Most can be diagnosed by histologic and pertinent ancillary testing.

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Shi Wei, MD