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.
Background: Ewing’s sarcoma (ES) of the scapula is a rare entity. It is often discovered late at the metastatic stage of the disease because of its deep location. This neoplasm is common in children and adolescents. We present the first reported case of a localized Ewing’s sarcoma of the scapula in an adult over 40 years-old. Case presentation: A 48-year-old man presented with left shoulder pain evolving for one year. Physical examination showed a painful, ill-defined swelling of the left shoulder measuring 5 x 3 cm. Magnetic resonance imaging (MRI) was performed showing a mass of the left scapula invading the soft tissues of the shoulder suggestive of a sarcoma. The patient underwent a surgical biopsy finding an ES of the scapula with no secondary localization on the computerized tomography (CT) scan nor on the bone scintigraphy. Neo-adjuvant multiagent chemotherapy was started obtaining a total response. Therefore, the patient underwent a total left scapulectomy. Histopathological examination confirmed the diagnosis of ES with a complete response to chemotherapy. Adjuvant chemotherapy was then indicated. After 3 years of follow-up, no local or distant recurrence was found. Discussion: ES is a high-grade aggressive lesion that most commonly originates in bone. The ES may affect any bone but is frequent in femur, tibia and ilium, the tumors arising from the scapula comprise fewer than 4% of all ES. No cases of localized Ewing’s sarcoma in adults have been reported to our knowledge. The diagnosis is confirmed by immunohistochemical examination and cytogenic. A multimodal treatment approach including a combination of chemotherapy, surgery, and radiation can modestly improve local tumor outcomes. Metastatic tumors still have poor diagnosis. Conclusions: ES occurs rarely in adults greater than 20 years-old, and tumors localized in the scapula are even rarer. Histopathology differentiates it from other primary bone/soft tissues tumors.
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