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Hibernoma

DEFINITION AND PATHOGENESIS

IMPORTANCE

  • Differentiation from liposarcoma on imaging can be difficult but the dx can be considered if aware of the lesion

CLINICAL FEATURES

RADIOLOGIC FEATURES

GROSS PATHOLOGY

  • Gray-tan in color with a thin capsule

HISTOLOGIC FEATURES

  • Mature adipose cells and round to polygonal, multivacuolated cells
  • Well vascularized and innervated
  • 4 variants
    • Typical
    • Lipoma-like
    • Spindle-cell
    • Myxoid
  • Lipid composition
    • Higher amounts of cholesterol and phospholipids in relation to toal fat than in lipomas
    • Total fat in relation to soluble protein lower in hibernomas than in lipomas
    • Concentration of cephalins somewhat higher in hibernomas than in lipomas
    • Concentration of lecithin and sphingomyelin lower in hibernomas than in lipomas
    • Concentration of lysolecithin and lipid phosphorus higher in hibernomas than in lipomas
  • Immunohistochemistry
    • UCP1 expression reported +
      • Brown fat precursors reported in a pericytic position in close association with the capillary wall
  • EM
    • Multivacuolated and univacuolated cells
      • Contain variable numbers of lipid vacuoles
      • Contain abundant moderately pleomorphic mitochondria
      • Have transverse cristae
      • Have lysosomes
      • Have lipofuscin granules
      • Have pinocytotic vesicles
      • Have well-formed basal lamina
      • Have prominent subplasmalemimal condensations

DIFFERENTIAL CLINICOPATHOLOGIC DIAGNOSIS

DISEASE COURSE AND TREATMENT

  • Rarely recurs after marginal resection
  • An atypical, possibly malignant hibernoma has been reported in the retropharynx, treated with excision and XRT

SPECIAL CONSIDERATION

  • Lipoma-like hibernoma

    • Hibernoma composed predominantly of univacuolated white-fat cells and only scattered granular or pale hibernoma cells
    • LR has been reported > 14 yrs after initial marginal excision
  • Myxoid hibernoma

  • Spindle-cell hibernoma

    • ~ 2% of hibernomas
    • Predominantly in 4th-5th decades
      • Average age at dx 42.5 (28-59)
      • M:F = 4:1
    • Sites reported
      • Posterior neck
      • Scalp
      • Groin
    • CT
    • Multivacuolated brown fat with a spindle-cell element without vacuolization
      • CD34 +
  • Hibernoma-like brown fat in the bone marrow

    • Multivacuolated cells demonstrated as brown fat by immunohistochemistry (S-100 +) has been reported in a 61-year-old man with essential thrombocythemia
  • Animal Models

    • Hibernoma in a dog has been reported
    • Ultrastructural characteristics of hibernoma have been reported in a neoplasm in a rat
    • Has been reported in a goose in a subconjunctival location

REFERENCES

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