Clinical Orthopaedics and Related Research®

, Volume 468, Issue 10, pp 2808–2813 | Cite as

Case Report: Hemosiderotic Fibrohistiocytic Lipomatous Lesion: A Clinicopathologic Characterization

  • Vincent M. Moretti
  • John S. J. Brooks
  • Christian M. Ogilvie
Case Report

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.

Notes

Acknowledgments

We thank Carol A. Dolinskas MD, for helping with interpretation of the radiographic images and preparation of this manuscript.

References

  1. 1.
    Browne TJ, Fletcher CD. Haemosiderotic fibrolipomatous tumour (so-called haemosiderotic fibrohistiocytic lipomatous tumour): analysis of 13 new cases in support of a distinct entity. Histopathology. 2006;48:453–461.CrossRefPubMedGoogle Scholar
  2. 2.
    de Vreeze RS, Koops W, Haas RL, van Coevorden F. An unusual case of hemosiderotic fibrohistiocytic lipomatous lesion: correlation of MRI and pathologic findings. Sarcoma. 2008;2008:893918.PubMedGoogle Scholar
  3. 3.
    Folpe AL, Weiss SW. Pleomorphic hyalinizing angiectatic tumor: analysis of 41 cases supporting evolution from a distinctive precursor lesion. Am J Surg Pathol. 2004;28:1417–1425.CrossRefPubMedGoogle Scholar
  4. 4.
    Gaskin CM, Helms CA. Lipomas, lipoma variants, and well-differentiated liposarcomas (atypical lipomas): results of MRI evaluations of 126 consecutive fatty masses. AJR Am J Roentgenol. 2004;182:733–739.PubMedGoogle Scholar
  5. 5.
    Hallor KH, Sciot R, Staaf J, Heidenblad M, Rydholm A, Bauer HC, Astrom K, Domanski HA, Meis JM, Kindblom LG, Panagopoulos I, Mandahl N, Mertens F. Two genetic pathways, t(1;10) and amplification of 3p11–12, in myxoinflammatory fibroblastic sarcoma, haemosiderotic fibrolipomatous tumour, and morphologically similar lesions. J Pathol. 2009;217:716–727.CrossRefPubMedGoogle Scholar
  6. 6.
    Hosono M, Kobayashi H, Fujimoto R, Kotoura Y, Tsuboyama T, Matsusue Y, Nakamura T, Itoh T, Konishi J. Septum-like structures in lipoma and liposarcoma: MR imaging and pathologic correlation. Skeletal Radiol. 1997;26:150–154.CrossRefPubMedGoogle Scholar
  7. 7.
    Kazakov DV, Sima R, Michal M. Hemosiderotic fibrohistiocytic lipomatous lesion: clinical correlation with venous stasis. Virchows Arch. 2005;447:103–106.CrossRefPubMedGoogle Scholar
  8. 8.
    Luzar B, Gasljevic G, Juricic V, Bracko M. Hemosiderotic fibrohistiocytic lipomatous lesion: early pleomorphic hyalinizing angiectatic tumor? Pathol Int. 2006;56:283–286.CrossRefPubMedGoogle Scholar
  9. 9.
    Marshall-Taylor C, Fanburg-Smith JC. Hemosiderotic fibrohistiocytic lipomatous lesion: ten cases of a previously undescribed fatty lesion of the foot/ankle. Mod Pathol. 2000;13:1192–1199.CrossRefPubMedGoogle Scholar
  10. 10.
    West AT, Toms AP, Murphy J, Sultan M. Haemosiderotic fibrohistiocytic lipomatous lesion/tumour of the foot: MRI and histopathology. Skeletal Radiol. 2008;37:71–74.CrossRefPubMedGoogle Scholar
  11. 11.
    Wettach GR, Boyd LJ, Lawce HJ, Magenis RE, Mansoor A. Cytogenetic analysis of a hemosiderotic fibrolipomatous tumor. Cancer Genet Cytogenet. 2008;182:140–143.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Vincent M. Moretti
    • 1
  • John S. J. Brooks
    • 2
  • Christian M. Ogilvie
    • 3
  1. 1.Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of PathologyPennsylvania Hospital of the University of Pennsylvania Health SystemPhiladelphiaUSA
  3. 3.Department of Orthopaedic SurgeryUniversity of MinnesotaMinneapolisUSA

Personalised recommendations