Indian Dermatology Online Journal

SKINDIA QUIZ
Year
: 2019  |  Volume : 10  |  Issue : 1  |  Page : 79--81

SkinIndia Quiz 49: Pigmented nodular growth of the nose


Manas Bajpai, Nilesh Pardhe 
 Department of Oral and Maxillofacial Pathology, NIMS Dental College, Jaipur, Rajasthan, India

Correspondence Address:
Manas Bajpai
Department of Oral and Maxillofacial Pathology, NIMS Dental College, Jaipur, Rajasthan
India




How to cite this article:
Bajpai M, Pardhe N. SkinIndia Quiz 49: Pigmented nodular growth of the nose.Indian Dermatol Online J 2019;10:79-81


How to cite this URL:
Bajpai M, Pardhe N. SkinIndia Quiz 49: Pigmented nodular growth of the nose. Indian Dermatol Online J [serial online] 2019 [cited 2022 Jan 23 ];10:79-81
Available from: https://www.idoj.in/text.asp?2019/10/1/79/245059


Full Text



Sir,

An otherwise healthy 51 year old male presented to our institute for the evaluation of a painless swelling on the right side of his nose from 3 years. It was initially small and gradually reached the current size. Clinical examination revealed a solitary swelling on the right side of the nose, extending from the right lateral wall of the nose to the nasofacial angle and measuring approximately 3 × 2 cm. The color of the swelling was similar to the adjacent skin with hyperpigmentation on one part with brownish color of the overlying skin and depigmentation on another part [Figure 1]. On palpation, the swelling was found to be soft-to-firm, nontender, and flexible. No signs of ulceration and discharge were noted.{Figure 1}

Lateral rhinotomy of the lesion was done under general anesthesia and the excised tissue was sent to the department of Oral and Maxillofacial Pathology for microscopic evaluation. The follow-up period of 1 year was uneventful.

Histopathological examination of hematoxylin and eosin-stained soft tissue section revealed a well-encapsulated mass [Figure 2]. The fibrocellular connective tissue stroma revealed nodules of mature adipocytes separated by numerous spindle-shaped cells having pale eosinophilic cytoplasm [Figure 3]. Immunohistochemical examination revealed a strong positive expression of CD34 for spindle-shaped cells [Figure 4].{Figure 2}{Figure 3}{Figure 4}

 Question



What is your diagnosis?

 View Answer

 Answer



Spindle cell lipoma.

 Discussion



Lipoma is a slow growing, painless, benign tumor that usually occurs in the upper back and neck.[1] Many benign histological variants of lipoma are known and described based on the type of tissue present and predominant in the lesion: fibrolipoma, angiolipoma, myolipoma, myxolipoma, osteolipoma, chondrolipoma, and spindle cell lipoma (SCL).[2]

SCL is a rare variant of lipoma that accounts for 1.5% of all lipomas.[3] It was first described by Enzinger and Harvey as a distinct histological entity derived from prelipoblastic mesenchymal cells. Most cases of SCL have been reported in the neck and upper back similar to conventional lipoma; however, their occurrence on the nose is rare.[4]

SCL is a rare variant of lipoma with characteristic pathological and immunohistochemical features. Histopathologically, they show an admix of mature adipocytes and blend spindled cells in a mucoid or fibrocellular connective tissue stroma.[1]

Although conventional lipomas have characteristic histopathological features, SCL imposes a diagnostic challenge to pathologists owing to the two different cell populations. The histopathological differential diagnoses of SCL include liposarcoma, dermatofibrosarcoma protuberans (DFSP), neurofibroma, and schwannoma.[1],[3],[4] SCL may show areas of myxoid degeneration similar to myxoid liposarcoma; however, the absence of lipoblasts and atypical morphology in SCL can rule out the possibility of liposarcoma.[4] Immunohistochemically, spindle cells of SCL show positive expression for CD34. In the present case also, a diffuse positive expression for CD34 was noted in spindle cells. CD34 may show positive expression in various tumors, including DFSP neurofi broma and schwannoma. Due to the histopathological similarities and CD34 positivity, these lesions can be considered as a differential diagnoses of SCL.[3] S-100 staining shows positive expression in neurofibroma and schwannoma and negative expression in SCL, and can be used as a differentiating marker.[4]

Clinically, SCL is commonly found in males than females with a ratio of 9:1. SCL usually occurs in the 6th and 7th decade of life. The upper back and neck are the most common areas of the occurrence.[1] An exhaustive review of the literature revealed only 2 cases of SCL occurring on the nose.[5]

The treatment of choice is surgical removal and they do not recur.[3] None of the cases of SCL of the nose reported in the literature were found to have undergone malignant transformation.

It can be concluded that, because of an infrequent anatomical location (nose) and admixture of two different cell populations with varied tissue stroma, SCL of the nose may impose a diagnostic difficulty, especially in the present case where it presented as a pigmented lesion. A proper correlation of clinicopathological and imunohistochemical features is needed to arrive at a proper diagnosis. One should remember that, because of the rarity of SCL on the nose, there is a paucity of literature pertaining to its recurrence and long-term consequences.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Agarwal S, Nangia A, Jyotsna PL, Pujani M. Spindle cell lipoma masquerading as lipomatous pleomorphic adenoma: A diagnostic dilemma on fine needle aspiration cytology. J Cytol 2013;30:55-7.
2Bajpai M, Kumar M, Agarwal D, Agrawal S, Gupta S, Kumar M. Osteolipoma of the palate-An unusual presentation. Natl J Maxillofac Surg 2014;5:250-1.
3Mandal RV, Duncan LM, Austen WG, Nielsen GP. Infiltrating intramuscular spindle cell lipoma of face. J Cutan Pathol 2009;36:70-3.
4Enzinger FM, Harvey DA. Spindle cell lipoma. Cancer 1975;36:1852-9.
5Deeplakshami T, Devan PP, Kavitha Ashok K, Rukma B. A rare case of spindle cell lipoma of the nose. J Surg Tech Case Rep 2012;4:110-1.