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Tumors of the Soft Tissues PLATE HIBERNOMA A. Hibernoma of axilla. An encapsulated mass 8X5X2 cm. was removed from beneath the latissimus dorsi muscle of a 32-year-old man who had been aware of its presence for only three weeks. The cut surface was light brown. This photomicrograph of tissue stained with Scharlach R shows the organoid arrangement of the rounded lipoblasts. A. F. I. P. Ace. No. 218822-C7. GIANT CELL TUMORS B. Giant cell tumor of ulnar bursa. A painful swelling had been present in the palm of the left hand of this 15-year-old girl for two months. This 15X12 mm. encapsulated tumor was removed from the ulnar bursa to which it was attached. No recurrence after two years. A. F. I. P. Ace. No. 218822-C8. GRANULAR CELL MYOBLASTOMA C and D. Granular cell myoblastoma. Man 35 years old. The nodule was in the left scapular region and had been first noticed 18 months before. The photographs show the lesion involving the skin and subcutaneous tissue. The nodule measures 13X14X17 mm. A. F. I. P. Ace. Nos. 218822 C9 and CIO. VENOUS HEMANGIOMA E and F. Venous hemangioma of chest wall. This 4X3X1.5 cm. nodule was removed from the subcutaneous fat of the chest wall of a 19-year-old woman where it had been present for years. It is made up of a congeries of anastomosing blood-containing vessels with smooth muscle in their walls. A. F. I. P. Ace. Nos. 218822-C11 and C12. i F5-34
Tumors of the Soft Tissues r~ ,i -i PLATE
Tumors of the Soft Tissues strated relationship to nerves, and the cause of the pain is unknown. These painful lipomas probably have no relationship to adiposis dolorosa (Dercum's disease), which is characterized by painful, diffuse fatty infiltration associated with asthenia and psychic disturbances. When lipomas grow in the skin itself, they become pedunculated and, if not removed, may attain a remarkable size. Examples of these are found in the perineum (fig. 15) and upper inner surface of the thighs, where they may hang down to the ground, and in the occipital region, where the tumor may hang down to the waist and appear like a sack. Lipomas are found in or around muscles and tendons; attached to tendon sheaths; in the knee joint, where the fat may collect beneath the synovial lining in swollen villous projections to form the so-called lipoma arborescens (fig. 16); in the mesentery, and in the omentum or peritoneum; in the retroperitoneum, where tumors of fantastic size may develop especially in the perirenal zone; and in the mediastinumâin fact, there are no areas in the soft tissues where lipomas have not been reported. Some lipomas have areas of increased vascularity with occasional spindle or stellate lipoblasts in inconspicuous numbers. These probably represent growth centers. They are found only by chance in casual sections. The fatty tumors associated with capillary and venous vascular proliferations and areas of smooth muscle, which are usually found in deeper situations, especially in striated muscle, are mixed mesodermal tumors or mesenchymomas. They are referred to here because the fat elemepts may predominate so that grossly they may resemble pure lipomas. The lipomas of the suprarenal medulla, called myelolipomas because they contain bone marrow, seem to be a specialty of that site alone. Some fatty tumors are made up in part of adult fat cells and in part of an embryonal, sticky, myxoid tissue containing spindle and stellate lipoblasts and signet ring cellsâan appearance seen in the developing fat of the embryo and for a short time after birth. Such tumors have often been called myxolipo- mas, lipomyxomas, myxofibrolipomas, ete., and are considered benign. They differ from the ordinary lipoma, however, because they grow by infiltration and are difficult to eradicate except by very wide excision. For that reason it has seemed preferable to this writer to classify them as differentiated liposar- comas even though they do not metastasize. Seemingly, lipomas of adult form undergo malignant transformation into liposarcomas only with the greatest rarity. This writer has seen only one unguestionable example of such transformation, although variations in the degree of differentiation of a liposarcoma may tempt one to suspect it. Hibernoma This name has been applied to a rare subcutaneous tumor composed of congeries of large foamy cells, each distended with multiple lipoid-filled F5-35
Tumors of the Soft Tissues MULTIPLE SYMMETRICAL LIPOMATOSIS f Figure 14. Multiple symmetrical lipomatosis in a 48-year-old chronic alcoholic teamster. Swellings first appeared 15 years before on the back of the neck and spread gradually to the front and chest. Other swellings then appeared on the abdomen, back, arms, and thighs in symmetrical arrangements. There was no familial history of lipomas. The sella turcica was slightly smaller than normal. Normal-appearing fat was removed from the neck to improve the appearance. A. F. I. P. Ace. No. 218822-14. c LIPOMA Figure 15. Pedunculated lipoma of the thigh. At the age of 19 years, this man first noticed a small lump on the upper inner aspect of the right thigh. It grew slowly to reach its present size after four years. It was composed of adipose tissue with one small cyst due to necrosis. A. F. I. P. Ace. No. 218822 16. Figure 16. Lipoma arborescens of knee joint. A mass of villi filled with fat was removed from an arthritic knee joint of a 55-year-old woman. A. F. I. P. Ace. No. 218822-15. i F5-36
Tumors of the Soft Tissues i ' Fig. 14 Fig. 16 F5-37