Surgical Pathology Criteria

Hemosiderotic Fibrohistiocytic Lipomatous Lesion

Differential Diagnosis

Combination of bland spindle cells and fat

Combination of spindle cells, histiocytes and multinucleated cells

Hemosiderotic Fibrohistiocytic Lipomatous Lesion Dermatofibrosarcoma Protuberans
Fat forms mass Infiltrates fat peripherally
Septal spindle cells Storiform pattern
Abundant hemosiderin Lacks hemosiderin
Both surround fat cells

Hemosiderotic Fibrohistiocytic Lipomatous Lesion Fibromatosis
Fat forms the mass Infiltrates fat
Abundant hemosiderin Lacks hemosiderin
Inflammation present Lacks inflammation

Hemosiderotic Fibrohistiocytic Lipomatous Lesion Atypical Lipomatous Tumor, Spindle Cell Variant
Uniform size of adipocytes Variably sized adipocytes
No lipoblasts Lipoblasts in most cases
No significant atypia Large atypical cells

Hemosiderotic Fibrohistiocytic Lipomatous Lesion Spindle Cell Lipoma
Predominantly on foot and ankle Predominantly restricted to back of neck, upper back and shoulder
Lacks ropy collagen bundles Ropy collagen bundles
Abundant hemosiderin Lacks hemosiderin

Hemosiderotic Fibrohistiocytic Lipomatous Lesion Lipofibromatosis
Circumscribed Poorly circumscribed
Prominent hemosiderin Lacks hemosiderin
Includes histiocytes and other inflammatory cells Histiocytes and inflammation not integral to lesion
Occasional floret cells Lacks floret cells

plexiform fibrohistiocytic tumor pending

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