Background: Spindle cell lipoma (SCL) is an uncommon subtype of lipomas. It usually occurs in the posterior side of the trunk such as neck, back and shoulders and rarely touches the extremities. Only four cases of SCL of the knee and no cases of SCL of the popliteal fossa have been reported in the literature. We present herein the largest case of SCL of the popliteal fossa and knee to our knowledge. Case presentation: A 75-year-old woman presented with a slow growing swelling of the left knee. Physical examination showed a 12 cm well-limited painless mass of the left popliteal fossa. The mass was pediculated with a central ulceration. MRI scan showed a tumoral mass of the left popliteal fossa with some non-dilated vessels draining to the long saphenous vein. The mass had no evidence of invasion of the underlying tissues. The patient underwent a surgical resection of the mass with postoperative recovery. The histological examination revealed a tumoral proliferation diffusely expressing CD34 without malignancy evidence, and a Ki67 proliferation index <1%. This morphological and immunohistochemical aspect is typical of a SCL. Clinical discussion: SCL is a rare histological variant of lipoma occurring mostly in the posterior side of the upper trunk. SCL of the knee or the popliteal fossa are exceptional. Clinically, it presents as a gradually increasing painless mass with a long evolving history. Histologically, these tumors are made of spindle-shaped cells, rope-like collagen fibers and mature adipocytes surrounded by a fibrous capsule. Immunohistologically, spindle cell lipomas usually show diffuse and strong expression of CD34, and to a lesser degree vimentin. The optimal treatment of SCL is a surgical marginal resection. Conclusions: SCL represents an infrequent subtype, and its atypical presentation should push clinicians to further investigations in order to rule out more worrisome malignancies.
Introduction/Background The 2020 WHO classification of gynaecological tumors has introduced as the main criteria for classification of vulvar squamous cell carcinomas (VSCC) their etiological relationship with human papillomavirus(HPV) infection, dividing VSCC into two categories: HPV-associated and HPV-independent VSCC. Additionally, recent evidence suggests that HPV-independent tumors should be further divided according to p53 mutational status. We aimed to evaluate the clinical and prognostic implications of these new criteria. Methodology We retrospectively identified patients treated for VSCC in our hospital from 1985 to 2022 (n=196). Tumors were reviewed and classified in compliance with 2020 WHO criteria, according to p16 immunohistochemistry and HPV testing. HPV-independent tumors were subclassified as p53 wild-type and mutant. The clinical and pathological features of tumors were compared and disease free-survival (DFS) and disease-specific survival (DSS) were evaluated using univariate and multivariate analysis.
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