A rare case of adipocytic tumor in subscapular region: hibernoma

Year 2019, , 99 - 101, 01.07.2019

Mehmet Zengin

https://doi.org/10.32322/jhsm.453528

Abstract

Hibernoma is a
rare lipomatous tumor of brown fat origin that emerges from remnants of fetal brown
adipose tissue. They are encapsulated, yellow-tan colored, painless and benign
soft tissue tumors, usually seen in adults and occur with large cells that have
acidophilic, granular and vacuolar cytoplasm and centraly nuclei. Our case is a
33-year-old female who had swelling in the subscapular region. Imaging studies
depicted a lesion compatible with lipoma. Macroscopic evaluation of the
excision specimen revealed brown, tan-yellow colored and hemorrhagic cut
surface compatible with fat tissue. In microscopic examination, a tumor
composed of cells with vacuolar, granular and eosinophilic cytoplasm, centrally
or peripherally localized small, round nuclei, were observed. These cells were
stained with immunhistochemical S-100 and were evaluated to be comparable with
lipocytes. With these findings, the patient was diagnosed as having hibernoma. We
present this case for its rarity, and for the fact that it can be treated with
simple excision, and should be kept in mind especially in the differential
diagnosis of lesions with high vascularity

 

Keywords

Hibernoma, adipocytic tumor, subscapulary region

Subskapular bölgede nadir bir adipositik tümör vakası: hibernoma

Abstract

Hibernoma,
fetal kahverengi adipoz dokusunun kalıntılarından kaynak alan, kahverengi yağ dokusu
kökenli, nadir bir lipomatöz tümördür. Bu tümörler genellikle yetişkinlerde
görülen, asidofilik, granüler ve vakuolar sitoplazmalı ve merkezi çekirdekli
büyük hücrelerden oluşan, sarı-ten renkli, ağrısız ve iyi huylu yumuşak doku
tümörleridir. Olgumuz, subsapular bölgede şişlik şikayeti olan 33 yaşında kadın
hasta. Uygulanan Görüntüleme çalışmaları lipom ile uyumlu bir lezyona işaret
etmiştir. Eksizyon örneğinin makroskopik değerlendirilmesinde tümör yer yer
kahverenkli ve yer yer sarı-ten renkli ve kesit yüzü hemorajik yağ dokusu ile
uyumlu görünümdeydi. Mikroskobik incelemede, santral veya periferik yerleşimli
küçük yuvarlak nükleuslu; köpüksü, granüllü ve eozinofilik sitoplazmalı
hücrelerden oluşan bir tümör gözlendi. Bu hücreler immünhistokimyasal olarak S-100
ile boyandı ve lipositlerle benzer olarak değerlendirildi. Bu bulgularla
hastaya hibernom tanısı konuldu. Bu vakayı nadir görülmesi ve basit eksizyonla
tedavi edilebilmesi ve özellikle yüksek vaskülariteli lezyonların ayırıcı
tanısında akılda tutulması açısından sunmaya karar verdik.

Keywords

Hibernoma, adipozit tümör, subskapular bölge

References

• 1. Anderson SE, Schwab C, Stauffer E, Banic A, Steinbach LS. Hibernoma: imaging characteristics of a rare benign soft tissue tumor. Skeletal Radiol. 2001;30:590–5.
• 2. Liu W, Bui MM, Cheong D, Caracciolog JT. Hibernoma: comparing imaging appearance with more commonly encountered benign or low-grade lipomatous neoplasms. Skeletal Radiol. 2013;42:1073–8.
• 3. 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.
• 4. Merkel H. On a pseudolipoma of the breast. Beitr Pathol Anat. 1906;39:152–7.
• 5. Gery L. In discussion of MF Bonnel’s paper. Bull Mem Soc Anat (Paris) 1914;89:111–2.
• 6. Miettinen MM, Fanburg-Smith JC, Mandahl N. Hibernoma. In: Fletscher CDM, Unni KK, Mertens F, editors. Pathology and Genetics of Tumours of Soft Tissue and Bone. Lyon, France: IARC Press; 2002. pp. 19–46.
• 7. Furlong MA, Fanburg-Smith J, Miettinen M. The morphologic spectrum of hibernoma: a clinicopathologic study of 170 cases. Am J Surg Pathol. 2001;25:809–14.
• 8. Mertens F, Rydholm A, Brosjö O, Willén H, Mitelman F, Mandahl N. Hibernomas are characterized by rearrangements of chromosome bands 11q13-21. Int J Canver.1994;58:503–5.
• 9. Mrózek K, Karakousis CP, Bloomfield CD. Band 11q13 is nonrandomly rearranged in hibernomas. Genes Chrom Cancer. 1994;9:145–7.
• 10. Papathanassiou ZG, Alberghini M, Taieb S, Errani C, Picci P, Vanel D. Imaging of hibernomas: a retrospective study on twelve cases. Clin Sarcoma Res. 2011;1(3):1–11.
• 11. Hardes J, Scheil-Bertram S, Hartwig E, Gebert C, Gosheger G, Schulte M. Sonographic findings of hibernomas. A report of two cases. J Clin Ultrasound. 2005;33:298–301.
• 12. Schmidt F, Cathomas R, Stallmach T, Putora PM, Mueller J. Have you ever heard of hibernoma? A rare but important pitfall in FDG-PET/CT. Nuklearmedizin. 2010;49:N71–3.
• 13. Enterline HT, Lowry LD, Richman AV. Does malignant hibernoma exist? Am J Surg Pathol. 1979;3:265–71.
• 14. Lele SM, Chundru S, Chaljub G, Adegboyega P, Haque AK. Hibernoma: a report of 2 unusual cases with a review of the literature. Arch Pathol Lab Med. 2002;126:975–8.
• 15. Trujillo O, Cui IH, Malone M, Suurna M. An unusual presentation of a rare benign tumor in the head and neck: A review of hibernomas. Laryngoscope. 2015;125(7):1656–9.