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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 2961 - 11 November 2021 Posted By: Saleem Taibjee

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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41M, Lump on nape of neck.


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Anil Patki

Posted

Spindle cell lipoma at it's characteristic location and patient profile. 

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vincenzo

Posted

Nice ropey collagen, mast cells, fish schools in a fibrolipomatous tumor should suggest a SCL, shouldn’t it?

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Richard Logan

Posted

Spindle cell lipoma

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Meenakshi Batrani

Posted

Yes. Spindle cell lipoma

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Krishnakumar subramanian

Posted

agree to  Spindle cell lipoma

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Saleem Taibjee

Posted

Yes. This is spindle cell lipoma. The CD34 was nice and positive (see below).

I was quite struck by the variable size of adipocytes in this case (3rd and 4th images above), and very focal lipoblasts (last image) above. I was previously taught that variable sized adipocytes should prompt a close look at a fatty tumour, and can be a clue to malignancy. Since this was a striking feature in this case, I shared it with Dr Raul Perret. He has helpfully refreshed/revised my understanding of this sign. He regards the variable size of adipocytes as a clue to the neoplastic nature of the adipocytes (i.e. fatty tumour lineage), but has reassured me that it does not generally indicate malignancy. Hence the reason for sharing this otherwise typical case.

BW Saleem

09663_2.0x CD34.jpg

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vincenzo

Posted

Thanks for this educating case, Saleem. 

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