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      Intraoral spindle-cell lipoma with chondroid differentiation: importance in the diagnosis of oral lesions presenting chondroid tissue Translated title: Lipoma de células fusiformes intraoral com diferenciação condroide: importância no diagnóstico de lesões orais contendo tecido cartilaginoso

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          Abstract

          ABSTRACT Lipomas are benign neoplasms of adipose tissue presenting several histologic variants, which can be rarely found in the oral cavity. We present a case of a 62-year-old woman with a submucous nodule located in the tongue. Histopathological examination revealed an encapsulated tumor composed of myxoid tissue, spindle cells and mature adipocytes in transition to cartilaginous tissue. The final diagnosis was spindle-cell lipoma with myxoid change and chondroid differentiation. No sign of recurrence was found after five years. The diagnosis of intraoral mesenchymal lesions with chondroid differentiation requires careful histologic examination, mainly to differentiate between benign and malignant lesions.

          Translated abstract

          RESUMO Lipomas são neoplasias benignas de tecido adiposo que podem apresentar diversas variantes e raramente são encontradas na cavidade oral. Apresentamos o caso de uma mulher de 62 anos de idade com queixa de um nódulo na língua. A análise histopatológica da lesão revelou tumor encapsulado composto de tecido mixoide, células fusiformes e adipócitos maduros em transição para tecido cartilaginoso. Nenhum sinal de recorrência foi observado após acompanhamento de cinco anos. O diagnóstico de lesões mesenquimais intraorais contendo diferenciação condroide requer atenção especial, principalmente para a diferenciação de lesões benignas e malignas.

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          Spindle cell lipoma

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            The ectomesenchymal chondromyxoid tumor: a review.

            The ectomesenchymal chondromyxoid tumor is a relatively recently described neoplasm that appears to involve uniquely the oral cavity, particularly the tongue. Thirty well-accepted cases have been reported since the initial description of this lesion in 1995. While a wide age range (9-78 years) has been documented, most of these tumors are diagnosed from the third to sixth decades of life. No sex predilection is seen. The size of the neoplasm is typically <2 cm, and most affect the anterior dorsal tongue. The duration of the lesion was difficult to gauge, probably due to the asymptomatic nature of the process. Some tumors, however, were well documented to have been present for as long as 10-20 years. Histopathologically, the ectomesenchymal chondromyxoid tumor is characterized by a well circumscribed, but unencapsulated, lobular growth pattern. Varying degrees of cellularity are noted, with the lesional cells often set in a myxoid, chondroid or hyalinized background. Immunohistochemical studies reveal positivity of the lesional cells for antibodies directed against glial fibrillary acidic protein, cytokeratins, S-100 protein and CD-57 in the majority of tumors. Treatment consists of conservative surgical excision, and while recurrence is possible, it has been noted in <10% of reported cases.
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              Chondroid lipoma: an ultrastructural and immunohistochemical analysis with further observations regarding its differentiation.

              Chondroid lipoma was recently described as a unique, benign, pseudosarcomatous lipomatous tumor with chondroid features, often simulating liposarcoma and myxoid chondrosarcoma. An extended histochemical and immunohistochemical analysis of 13 cases, including the proliferation markers, proliferating cell nuclear antigen (PCNA) and Ki67, as well as ultrastructural studies of eight cases were performed with the intent of further elucidating its differentiation. Staining with toluidine blue and alcian blue at controlled pHs indicated the presence of chondroitin sulfates within the myxohyaline matrix. Immunohistochemically, all tumors were positive for vimentin and S100 protein. Focal immunoreactivity for cytokeratins was seen in 3 of 13 cases; one of these also had intracytoplasmic tonofilament bundles ultrastructurally. Scattered tumor cells stained for CD68 antigen with KP1 in 6 of 13 cases. None of the tumors stained for epithelial membrane antigen (EMA) or alpha-smooth muscle actin. Collagen IV immunostains showed a network of fibrils encircling individual tumor cells in 10 of 13 cases. Intracytoplasmic staining for laminin was found in 9 of 13 cases. Ultrastructurally there was a spectrum of differentiation, ranging from primitive cells sharing features of prelipoblasts and chondroblasts, to lipoblasts and preadipocytes, to mature adipocytes. A striking ultrastructural feature in 5 of 8 cases was the presence of knob-like protrusions of the cell membrane, which contained granular, amorphous, and fibrillar material that appeared to be extruded into the adjacent matrix. The myxohyaline matrix had ultrastructural features of cartilage. Numerous mitochondria and lysosomes were absent, indicating that chondroid lipoma is neither a hibernomatous lesion nor a lipogranuloma. Ki67 immunoreactivity was typically very low and detected only in the more primitive cell population. The findings in this analysis indicate that chondroid lipoma is a pseudosarcomatous lipogenic neoplasm with a unique cell population possessing predominantly features of embryonal fat and, to a lesser extent, embryonal cartilage.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                jbpml
                Jornal Brasileiro de Patologia e Medicina Laboratorial
                J. Bras. Patol. Med. Lab.
                Sociedade Brasileira de Patologia Clínica, Sociedade Brasileira de Patologia, Sociedade Brasileira de Citopatologia
                1678-4774
                June 2016
                : 52
                : 3
                : 189-193
                Affiliations
                [1 ] Universidade Estadual de Londrina Brazil
                [2 ] Universidade Federal Fluminense Brazil
                [3 ] Universidade de São Paulo Brazil
                [4 ] Universidade Estadual de Campinas Brazil
                Article
                S1676-24442016000300189
                10.5935/1676-2444.20160032
                6d2e50ec-443e-43da-a24a-e34d853bc506

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1676-2444&lng=en
                Categories
                MEDICAL LABORATORY TECHNOLOGY
                MEDICINE, RESEARCH & EXPERIMENTAL
                PATHOLOGY

                Pathology,Medicine,Clinical chemistry
                microscopy,lipoma,diagnóstico,microscopia,cartilagem,diagnosis,cartilage
                Pathology, Medicine, Clinical chemistry
                microscopy, lipoma, diagnóstico, microscopia, cartilagem, diagnosis, cartilage

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