Clinical Orthopaedics and Related Research®

, Volume 468, Issue 10, pp 2808–2813

Case Report: Hemosiderotic Fibrohistiocytic Lipomatous Lesion: A Clinicopathologic Characterization

Authors

    • Department of Orthopaedic SurgeryUniversity of Pennsylvania
  • John S. J. Brooks
    • Department of PathologyPennsylvania Hospital of the University of Pennsylvania Health System
  • Christian M. Ogilvie
    • Department of Orthopaedic SurgeryUniversity of Minnesota
Case Report

DOI: 10.1007/s11999-010-1242-7

Cite this article as:
Moretti, V.M., Brooks, J.S.J. & Ogilvie, C.M. Clin Orthop Relat Res (2010) 468: 2808. doi:10.1007/s11999-010-1242-7

Abstract

Background

A hemosiderotic fibrohistiocytic lipomatous lesion, also called hemosiderotic fibrolipomatous tumor, is a rare and recently described fibrolipomatous entity. Initially considered the result of a reactive inflammatory process from trauma or vascular disease, newer evidence suggests it may be neoplastic in origin.

Case report

We report the case of a 56-year-old woman with a painful mass in the dorsal aspect of the foot diagnosed as a hemosiderotic fibrohistiocytic lipomatous lesion.

Literature review

We reviewed all 31 published cases of hemosiderotic fibrohistiocytic lipomatous lesions looking for common clinical, imaging, and histologic patterns. Hemosiderotic fibrohistiocytic lipomatous lesions occur predominantly in the fifth and sixth decades of life (average age, 49.5 years; range, 0.67–74 years). Females predominate 22 to 9. Thirteen of 28 patients had histories of trauma or vasculopathy. Twenty-six of 31 lesions were in the foot. The MRI signal of a hemosiderotic fibrohistiocytic lipomatous lesion follows fat in all sequences. Stranding or septations also frequently are seen. Histologically, the lesions are composed of three main elements in varying proportions: mature adipocytes, spindle cells, and hemosiderin pigment. Ten of 27 resected lesions recurred. Resection types are not reported in many cases. Four of 15 lesions recurred after marginal/intralesional excision, whereas none of three lesions treated by wide excision recurred.

Purpose and clinical relevance

The high recurrence rate may be related to the difficulty in determining intraoperatively that a resection is complete, secondary to the lack of anatomic boundaries such as a pseudocapsule. Any attempt at wide resection must weigh the morbidity of this surgery against that of a recurrence after a resection which seemed complete intraoperatively. There have been no reports of metastasis.

Copyright information

© The Association of Bone and Joint Surgeons® 2010