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Year : 2008  |  Volume : 51  |  Issue : 2  |  Page : 312-313
Ossifying parosteal lipoma of shoulder: Diagnostic dilemma


Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

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How to cite this article:
Das P, Safaya R. Ossifying parosteal lipoma of shoulder: Diagnostic dilemma. Indian J Pathol Microbiol 2008;51:312-3

How to cite this URL:
Das P, Safaya R. Ossifying parosteal lipoma of shoulder: Diagnostic dilemma. Indian J Pathol Microbiol [serial online] 2008 [cited 2019 Oct 14];51:312-3. Available from: http://www.ijpmonline.org/text.asp?2008/51/2/312/41711


Sir,

We encountered a 42-year-old male who presented with a progressively increasing swelling in the posterior aspect of right shoulder since the preceding 10 months. There was no history of trauma, fever, weight loss or any history of diabetes, tuberculosis or similar problems in the family. The findings of general clinical examination were within normal limits. On local examination, a nontender, oval, firm swelling was felt in the posterior aspect of the right shoulder. Mobility was restricted and overlying shoulder muscles were mildly flattened over the mass. All laboratory and biochemical parameters were normal. Shoulder skiagram suggested a calcified mass; and on MRI-T1-weighted image, a partially calcified mass with soft tissue component was identified, which was stretching the rotator cuff tendons. On MRI, the mass was noted to be intimately adherent with the shaft of humerus. Tru-cut biopsies performed thrice within a span of 6 months led to the diagnosis of lipoma. In one biopsy, a tiny fragment of cartilage was noted along with fat.

Subsequently, the mass was excised with subparosteal dissection under general anesthesia and sent for histopathology. On microscopy a well-circumscribed mass comprising of mature adipose tissue with interspersed mature lamellar bony trabeculae was identified [Figure 1] and [Figure 2]. No hematopoietic elements were seen. Based on the histomorphological findings, a diagnosis of parosteal or ossifying lipoma was made.

Subparosteal lipoma is a rare benign soft tissue neoplasm intimately adherent with the underlying bone. It constitutes 0.3% of all lipomas. [1] It was first described by Seering, [2] and around 150 cases have been registered in the Armed Forces Institute of Pathology (AFIP) archives. [1] This lesion is most commonly seen along the bones of extremities, ribs and scapula. [1],[2] MRI and CT scans show characteristic underlying periosteal reaction in the form of bony spicules or mere cortical thickening in 50% to 70% of the cases. [3] No continuity with the medullary cavity is seen. The lesion may be symptomatic due to compression of adjacent nerves and tendons. [4] Characteristic histology of mature fat with lamellar or woven bony trabeculae is diagnostic. [5] However, before making a diagnosis, it should be differentiated from intraosseous lipoma, liposclerosing myxofibromatous tumor of bone, or parosteal liposarcomas. [1] The major difference between subparosteal lipoma and a conventional soft tissue lipoma is the presence of bony spicules within the lesion and adhesion with the underlying bone, [5] which even on repeated biopsy, we failed to pick up. However, retrospective analysis of the characteristic radiological findings would have indicated an initial excision to reach a diagnosis. A nerve-sparing subparosteal dissection is adequate. [1],[2] Local recurrence or malignant transformation is very rare. Our patient is still symptom free after 3 years of surgery.

This case is being reported to create awareness about this rare entity, which has an excellent postoperative prognosis. This lesion has been reported very rarely from the Indian subcontinent. [ 6] Though recently tru-cut biopsies are most often tried from bone masses for a diagnosis, a lesion like this may be missed, leading to incomplete surgical excision. As this lesion is adherent with underlying periosteum, subperiosteal resection is mandatory.

 
   References Top

1.Murphey MD, Carroll JF, Flemming DJ, Pope TL, Gannon FH, Kransdorf MJ. From the archives of the AFIP: Benign musculoskeletal lipomatous lesions. Radiographics 2004;24:1433-66.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Rosenberg AE, Bridge JA. Lipoma of bone in pathology and genetics tumors of soft tissue and bone. In: Fletcher CD, Unni KK, Mertens F, editors. Lyon: IARC Press; 2002. p. 328 -9.  Back to cited text no. 2    
3.Murphey MD, Johnson DL, Bhatia PS, Neff JR, Rosenthal HG, Walker CW. Parosteal lipoma: MR imaging characteristics. AJR Am J Roentgenol 1994;162:105-10.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Nishida J, Shimamura T, Ehara S, Shiraishi H, Sato T, Abe M. Posterior interosseous nerve palsy caused by parosteal lipoma of proximal radius. Skeletal Radiol 1998;27:375-9.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Krajewska I, Vernon-Roberts B, Sorby-Adams G. Parosteal (periosteal) lipoma. Pathology 1988; 20:179-83.  Back to cited text no. 5  [PUBMED]  
6.Singh R, Grewal DS, Bansal VP. Periosteal lipoma of bone. Indian J Orthop 1974;8:60.  Back to cited text no. 6    

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Correspondence Address:
Rajni Safaya
Department of Pathology, All India Institute of Medical Sciences, Academic Building, Ansari Nagar, New Delhi -110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.41711

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    Figures

  [Figure 1], [Figure 2]

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