Breast spindle cell lipoma

Case contributed by Kamel Mahmoud Alkhateeb

Presentation

Left breast painless lump

Patient Data

Age: 30 years
Gender: Female
ultrasound

Large hyperechoic lesion with echogenic interfaces seen in the retroglandular region, measuring  11 x 3.4 cm.

mri

There is large well-defined oval shaped focal in upper part of left breast, measuring about 11x 8 x 6 cm in AP x CC x transverse dimensions respectively. The lesion looks heterogeneous, exhibiting predominantly high signal on T1 and T2 with small amount of central irregular stroma could be seen. The T1/T2 hypersignal intensity are suppressed on STIR and FS sequences, denoting large fat component.  
The central stoma shows slight enhancement on post contrast images with progressive enhancement pattern, (type I curve).

 

Case Discussion

Histopathology Report:
Sections show predominantly lobules and sheet of mature adipocytes with intervening expansile areas composed of spindle shaped cells with ovoid nucleus with fine chromatin, inconspicuous nucleoli and admixed collagen fibers. There are areas of stromal hemorrhage, myxoid change, dispersed chronic inflammatory cells and fat necrosis. No mammary ductulolobular units or malignancy. Immunohistochemistry ( blocks 2 and 5): The spindle cells are positive for CD34 (Clone: QBEnd10) and negative for Desmin (Clone: D33), SMA (Clone: IA4) and Melan A (Clone: A103).

Final diagnosis: Spindle cell Lipoma with fat necrosis.

Spindle cell lipomas are rare, benign, slow growing tumors. It is a rare variant of breast lipoma.. The common clinical presentation for spindle cell lipomas is painless mobile palpable mass.

 

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