Hemosiderotic Fibrolipomatous Tumour and Similar Lesions: Case Report and Literature Review

Case Presentation

Austin Pathol. 2019; 2(1): 1006.

Hemosiderotic Fibrolipomatous Tumour and Similar Lesions: Case Report and Literature Review

Bourhroum N1,2*, Elouazzani H1, Chadi F1,2 and Zouaidia F1,2*

1Department of Pathology, Ibn Sina University Hospital of Rabat, Morocco

2Faculty of Medicine and Pharmacy, Mohammed V University of Rabat Morocco

*Corresponding author: Bourhroum N, Department of Pathology, Ibn Sina University Hospital, Mohammed V University of Rabat, Rabat, Morocco

Received: October 10, 2018; Accepted: April 10, 2019; Published: April 17, 2019

Abstract

Hemosiderotic Fibrolipomatous Tumor (HFLT) is a rare mesenchymal neoplasm occurring mostly in the subcutaneous tissues of the lower extremity (leg), with a potential for aggressive behaviour. Morphologic evidence strongly suggests that HFLT is related to another rare, locally aggressive tumor of the distal extremities, Pleomorphic Hyalinizing Angiectatic Tumor (PHAT), this morphologic evidence is further supported by molecular genetic data, showing recurrent TGFBR3 and/or MGEA5 rearrangements in both HFLT and PHAT. A complete surgical excision is used to treatment. The prognosis is generally excellent on adequate treatment; however, the chances of tumor recurrence are high (when incompletely removed). We describe here in this case that has brought together the different morphological patterns observed in the two entities.

Keywords: Hemosiderotic Fibrolipomatous Tumor; Pleomorphic Hyalinizing Angiectatic Tumor

Abbreviations

HFLT: Hemosiderotic Fibrolipomatous Tumor; PHAT: Pleomorphic Hyalinizing Angiectatic Tumor, TGFBR3: Transforming Growth Factor Beta Receptor 3; MGEA5: Meningioma Expressed Antigen 5; MIFS: Myxoinflammatory Fibroblastic Sarcoma

Introduction

HFLT is rare, experience in diagnosing this lesion is limited and as a result it may be mistaken for a more aggressive neoplasm. The cause of tumor formation is not well defined. Some studies report the development of the tumor appears as a single mass that can grow to large size, usually on the foot or ankle. HFLT can cause pain and discomfort, thereby affecting the quality of life.

Case Presentation

Our patient was a 50 years old woman with pain and lump in her right ankle. Two years earlier, she had been presenting pain and progressive swelling. On physical examination, there was a largevolume soft tumor next to the external malleolus. It were painful but without signs of inflammation. She also presented difficulty in flexing of right foot and external rotation, with pain on touching and when walking.

Ultrasound showed an expansive heterogeneous mass, 7cm in diameter. Tomography revealed a heterogeneous lesion with lacy highlighting, affecting subcutaneous tissue. Magnetic resonance characterized it as lipoma.

Excisional biopsy demonstrated a solid mass in the subcutaneous soft tissue composed of bland spindle cells with fibrohistiocytic morphology without a specific growth pattern that was intermixed with mature adipose tissue and scattered clusters of chronic inflammatory cells. A conspicuous feature of the lesion was the presence of abundant hemosiderin pigment. The spindle cells demonstrated vesicular chromatin, small indistinct nucleoli, and no significant cytologic atypia or mitotic activity. A diagnosis of hemosiderotic fibrohistiocytic lipomatous lesion was made.

The patient underwent surgery with an incision measuring 1.5cm on the extern face of the ankle. The lesion was excised with free margins. The material consists of a nodular mass, measured 7 x 7 x 6 cm and weighed 60g. It was whitish to the cut with presence of brown area; it develops in a homogeneous fatty tissue (Figures1,2).