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CASE REPORT Table of Contents   
Year : 2008  |  Volume : 51  |  Issue : 4  |  Page : 541-542
Chondroid lipoma in a child


1 Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, Uttar Pradesh, India
2 Department of Pediatric Surgery, Banaras Hindu University, Varanasi 221 005, Uttar Pradesh, India

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   Abstract 

Chondroid lipoma (CL), a rare lipoma variant, has not been described well for patients younger than 14 years of age. We herein report an extremely unusual instance of CL in a 7-year-old child. The cut surface of the tumor showed peculiar tan-brown and yellow-white areas. Histopathological sections showed the presence of eosinophilic variably vacuolated round- to oval-spindle cells in a myxo-hyaline background. The findings were consistent with CL. The case is reported because of its extreme rarity.

Keywords: Chondroid lipoma, child, India, pseudosarcomatous

How to cite this article:
Patne SC, Aryya N C, Gangopadhyay A N. Chondroid lipoma in a child. Indian J Pathol Microbiol 2008;51:541-2

How to cite this URL:
Patne SC, Aryya N C, Gangopadhyay A N. Chondroid lipoma in a child. Indian J Pathol Microbiol [serial online] 2008 [cited 2014 Oct 23];51:541-2. Available from: http://www.ijpmonline.org/text.asp?2008/51/4/541/43755



   Introduction Top


The appearance of chondroid lipoma (CL) in a child is very unusual and has not been described in literature. Our review of the literature identified 14 years old as the youngest reported case of CL. [1] We herein document a unique occurrence of CL in a 7-year-old child.


   Case Report Top


A 7-year-old male presented to the Pediatric Surgery clinic with a slow growing painless mass in the right thigh of 1 year duration that had rapidly grown in the past 3 months. A physical examination of the patient showed a 7x6 cm, non tender, firm, ovoid mass in the right anterior thigh. The skin overlying the mass showed no signs of inflammation. A detailed systemic examination and laboratory investigations were within the normal limits. An X-ray of the thigh ruled out bony involvement by the tumor and calcification within the tumor mass. A fine-needle aspiration cytology (FNAC) of the lesion produced cytologically benign appearing spindle cells. Keeping neurofibroma as the possible cytological diagnosis, the tumor was resected and sent for histopathological examination in 10% formalin solution.

Grossly, the well-encapsulated tumor measured 8x6x5 cm in size. Serial cut sections showed homogenous tan-brown areas with multiple localized yellow-white areas [Figure 1a]. The yellow-white areas were hard to cut and varied from 0.5 cm to 5 cm in diameter. Paraffin-embedded sections prepared from different parts of the tumor were studied by hematoxylin and eosin (H and E) stain and periodic acid Schiff (PAS) stain with and without diastase treatment and alcian blue stains. Microscopically, H and E stained sections showed mature adipocytes separated by myxo-fibrous strands and areas of chondroid matrix [Figure 1b]. The round to oval-spindle shaped tumor cells were laying in clusters as well as singly in the fibro-myxomatous and cartilaginous backgrounds [Figure 1c]. The individual tumor cells had eosinophilic cytoplasm. Many cells showed univacuolation to multivacuolation in the eosinophilic cytoplasm. The nuclei were centrally placed in most of the cells with moderately dispersed chromatin showing inconspicuous nucleoli. Some of the nuclei were indented by the cytoplasm to give a popcorn-like appearance. Binucleated cells were occasional. While univacuolated to multivacuolated cells were predominant in the tan-brown areas, chondroid elements were mostly present in the hard yellow-white areas of the tumor. Diffuse infiltration of the scattered plasma cells and lymphocytes along with the focal parts of increased vascularity and hemorrhage were also noted. However, mitotic activity, necrosis, and cellular atypia were absent.

A PAS stain without diastase pre-treatment showed variable positivity with the presence of eosinophilic finely granular material in vacuolated cells [Figure 1d], which disappeared on diastase treatment. The matrix showed moderate to strong metachromatic staining with alcian blue at pH 2.5. The alcian blue staining was pronounced in sections of the tumor prepared from the yellow-white areas. These histological and histochemical features favored the diagnosis of CL. Four years postoperatively, the patient did not show any evidence of local recurrence or metastasis.


   Discussion Top


The appearance of CL in a 7-year-old child is an exceptionally rare finding. The youngest case of CL in the reported literature is an adolescent aged 14 years old. [1] Lipomatous tumors as such are rare in children and adolescents, constituting only 6% of the soft tissue tumors. [2] We are not aware of any published literature citing CL in a child as young as 7 years old. In another case series, CL predominantly occurred in adults with a clear female preponderance. [1],[3] Therefore, this case would probably represent the first occurrence of CL in a child.

Commonly, CL is situated in the subcutis, superficial muscular fascia, or skeletal muscle of the limb and limb girdles. [1] CL usually demonstrates calcification but was absent in this child. [4] Grossly, the tumors range from 2-11 cm in greatest dimensions and usually appear as encapsulated, multilobular, yellow to white masses. [1],[4] We feel the dual appearance of the tan-brown and the localized yellow-white areas reflect an organized pattern being distinguished predominantly into chondroid and lipomatous compartments. FNAC of CL has been described in literature. [5] However, as FNAC did not yield histologic architectural details, it is considered insufficient for the diagnosis of CL. [5] For a definitive diagnosis, the cytological findings should be confirmed by histopatholgical and histochemical studies. The cells of CL are eosinophilic, variably vacuolated, and contain both the fat droplets and the glycogen; thus showing a resemblance to the brown fat cells, the lipoblasts, and the chondroblasts. [6] Our case also fulfills the histomorphological and histochemical criteria described for the diagnosis of CL.

CL represents a distinct entity in the spectrum of lipomatous tumors and has to be distinguished microscopically from a number of benign and malignant lesions. These include myxoid/spindle cell lipoma, chondromyxoid fibroma, chondroid chordoma, chondrolipoma, extraskeletal chondroma, hibernoma, lipoblastoma, chondrolipoangioma, myoepithelioma, myxoid/round cell liposarcoma, and extraskeletal myxoid chondrosarcoma. [3],[7],[8] Of these, CL most closely simulates the later two malignant conditions. [1] The pseudosarcomatous appearance of CL is distinguished from extraskeletal myxoid chondrosarcoma and myxoid liposarcoma by the lack of nuclear atypia, mitotic activity, characteristic vascular pattern, and the presence of both the chondroid elements and the mature fat cells. [7] Moreover, unlike CL, these lesions have a propensity for metastasis and recurrence.

Chondrolipoma is the mature adipocytic lesion displaying cartilaginous metaplasia (mature cartilage); whereas, CL in addition to the mature fat, contains the immature cartilage and the lipoblast-like cells. [8] In contrast to CL, hibernoma, a tumor of brown fat cells, exhibits the characteristic vascular pattern and absence of the vacuolated cells containing both fat and glycogen. [4] Lipoblastoma is typically a lesion that occurs during childhood; it occurs in the subcutaneous tissue of the extremities and recurs if incompletely excised. Further, lipoblastoma characteristically shows the lobulated appearance and the prominent blood vessels not observed in CL. [9]

In a nutshell, the present case is unique in being the first instance of CL in a child. This should be differentiated from the other soft tissue tumors, notably malignant ones because complete surgical removal is curative and over diagnosing a malignancy in this setting would seriously harm the patient.

 
   References Top

1.Meis JM, Enzinger FM. Chondroid lipoma: A unique tumor simulating liposarcoma and myxoid chondrosarcoma. Am J Surg Pathol 1993;17:1103-12.  Back to cited text no. 1  [PUBMED]  
2.Stocker JT, Dehner LP. Pediatric Pathology. 1 st ed. Philadelphia, PA: Lippincott; 1992.  Back to cited text no. 2    
3.Mentzel T, Remmler K, Katenkemp D. Chondroid lipoma: Clinicopathological, immunohistochemical, and ultrastructural analysis of six cases of a distinct entity in the spectrum of lipomas. Pathologe 1999;20:330-4.  Back to cited text no. 3    
4.Murphey MD, Carroll JF, Flemming DJ, Pope TL, Gannon FH, Kransdorf MJ. From the arhives of AFIP: Benign musculoskeletal lipomatous lesions. Radiographics 2004;24:1433-66.  Back to cited text no. 4    
5.Yang YJ, Damron TA, Ambrose JL. Diagnosis of chondroid lipoma by fine needle aspiration biopsy. Arch Pathol Lab Med 2001;125:1224-6.  Back to cited text no. 5    
6.Kindblom LG, Meis-Kindblom JM. Chondroid lipoma: An ultrastructural and immunohistochemical analysis with further observations regarding its differentiation. Hum Pathol 1995;26:706-15.  Back to cited text no. 6    
7.Darling MR, Daley TD. Intraoral chondroid lipoma: A case report and immunohistochemical investigation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:331-3.  Back to cited text no. 7    
8.Boltze C, Hribaschek A, Lippert H, Roessner A. Intermuscular chondrolipoma of the thigh: The diagnostic way of a rare entity. Pathol Res Pract 2003;199:503-7.  Back to cited text no. 8    
9.Collins MH, Chatten J. Lipoblastoma/lipoblastomatosis: A clinicopathologic study of 25 tumors. Am J Surg Pathol 1997;21:1131-7.  Back to cited text no. 9    

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Correspondence Address:
Shashikant C.U Patne
D-14, Bakhtawarram Nagar, Near Tilak Nagar, Indore 452 018, Madhya Pradesh
India
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DOI: 10.4103/0377-4929.43755

PMID: 19008590

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    Figures

  [Figure 1a], [Figure 1b], [Figure 1c], [Figure 1d]

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