A thoracic wall lipoblastoma in a 3-month-old infant: A case report and review of the literature

Paediatric thoracic wall lipoblastoma in a 7-year old: a rare tumour of childhood

Lipoblastoma is a rare benign mesenchymal tumour derived from embryonic white fat tissue. Lipoblastoma generally occurs in children less than 3 years of age, and fewer than 200 cases have been reported in the English literature. There are hardly a dozen reports describing intrathoracic and thoracic involvement. We report a case of a 7-year-old boy who presented with a slowly growing right thoracic wall mass for a duration of 1 year. Radiological investigations (ultrasonography and contrast-enhanced CT of the chest showed the presence of a fat-containing, low density extrapulmonary soft tissue mass) could not confirm the diagnosis, and repeat biopsies also were not conclusive. The mass was excised and histopathology confirmed it as lipoblastoma. A review of literature pertaining to the clinical presentation, radiological features and histopathology of this rare condition has been discussed.

Cervicothoracic lipoblastoma: three case reports and review of literature

Background

Lipoblastoma is a rare benign mesenchymal tumor of embryonal fat affecting mainly children below 3 years of age. It presents usually as a painless rapidly growing soft lobular mass in the extremities, trunk, and less frequently in the head-neck region. Preoperative imaging is used to assess the extent of disease and aid surgical planning. Complete surgical excision without injury to surrounding vital structures is the treatment of choice.

Case presentation

We report three interesting lipoblastoma cases: mediastinal lipoblastoma with airway compression and ipsilateral diaphragmatic eventration, neck lipoblastoma with intrathoracic extension, and huge thoracic inlet lipoblastoma with compression of common carotid and Lt subclavian arteries, brachial plexus, and ipsilateral diaphragmatic eventration. Complete excision of lipoblastoma mass was done via neck incision in two cases, and the third case required thoracoscopic excision of intrathoracic remnant 6 months later. All three patients had an excellent outcome.

Conclusions

Management of cervicothoracic lipoblastoma is a surgical challenge due to the potential for rapid growth and extension to different fascial planes; however, successful excision can be achieved via a neck approach. Complete surgical excision is essential to prevent local recurrence and improve the outcome.

Lipoblastoma of the left kidney: a case report and review of literature

A lipoblastoma is an infrequent benign tumor derived from embryonal adipose tissue. There are few reports on kidney lipoblastomas; there are fewer than three cases, including our case. An 80-year-old female was detected to have a left renal mass during a routine medical examination. Computed tomography (CT) and magnetic resonance imaging (MRI) indicated a heterogeneous mass before surgery, and histopathological tests subsequently revealed that the mass was a rare lipoblastoma. We present this case as a reminder to consider lipoblastomas in the differential diagnoses of kidney masses.

Cervical lipoblastoma: An uncommon presentation

Lipoblastoma is extremely rare and mainly occurs in children younger than 3 years old. It is predominantly found in the extremities and trunk. Head and neck region occurrences are rare; only 4 such cases involving patients who presented with stridor have been previously reported. We report the fifth case of lipoblastoma of the neck with stridor in a 9-year-old girl, which had gradually worsened over the previous year. Imaging showed a retrotracheal mass extending superiorly to the thyroid level and inferiorly to below the carina of the trachea. Total resection of the tumor was performed, and the histopathologic findings were consistent with lipoblastoma. Postoperatively, the patient was well with no complications.

Undifferentiated myxoid lipoblastoma with PLAG1-HAS2 fusion in an infant; morphologically mimicking primitive myxoid mesenchymal tumor of infancy (PMMTI)--diagnostic importance of cytogenetic and molecular testing and literature review

Lipoblastoma is a benign myxoid neoplasm arising in young children that typically demonstrates adipose differentiation. It is often morphologically indistinguishable from primitive myxoid mesenchymal tumor of infancy (PMMTI), which is characterized by a well-circumscribed myxoid mass with a proliferation of primitive mesenchymal cells with mild cytologic atypia. PMMTI occurs in the first year of life and is known to have locally aggressive behavior. No specific genetic rearrangements have been reported to date. In contrast, the presence of PLAG1 (Pleomorphic Adenoma Gene 1) rearrangement is diagnostic for lipoblastoma. We hereby demonstrate the combined application of multiple approaches to tackle the diagnostic challenges of a rapidly growing neck tumor in a 3-month-old female. An incisional tumor biopsy had features of an undifferentiated, myxoid mesenchymal neoplasm mimicking PMMTI. However, tumor cells showed diffuse nuclear expression by immunohistochemical (IHC) stain. Conventional cytogenetic and fluorescence in situ hybridization (FISH) analyses as well as next generation sequencing (NGS) demonstrated evidence of PLAG1 rearrangement, confirming the diagnosis of lipoblastoma. This experience warrants that undifferentiated myxoid lipoblastoma can mimic PMMTI, and the combination of cytogenetic and molecular approaches is essential to distinguish these two myxoid neoplasms. Literature on lipoblastomas with relevant molecular and cytogenetic findings is summarized. Our case is the first lipoblastoma diagnosed with a PLAG1 fusion defined by NGS technology.

Cytogenetic analysis in the diagnosis and management of lipoblastomas: results from a single institution

BACKGROUND

Lipoblastomas are rare, benign, soft tissue tumors that occur primarily in young children. Treatment includes complete excision and surveillance for recurrence. Lipoblastomas can be indistinguishable from other benign lipomatous tumors and liposarcomas. Cytogenetic analysis can provide the definitive diagnosis in questionable cases, because benign and malignant lipomatous tumors exhibit specific nonrandom cytogenetic abnormalities. The purpose of the present study was to discuss the disease management and outcomes in a large contemporary group of patients with lipoblastoma.

MATERIALS AND METHODS

A retrospective chart review of patients diagnosed with lipoblastoma presenting from 2000-2011 was conducted. The data from these patients were compared with data from a previously published historical group of patients (1985-1999) from the same children's hospital.

RESULTS

We identified 37 patients in the contemporary cohort group and compared them with 25 patients from the historical group. The tumor involvement sites were similar. The current cohort group had a lower recurrence rate, although this might have been underestimated owing to a shorter follow-up period (median 1.4 y, range 2 wk to 11.0 y). Preoperative imaging findings led to an incorrect diagnosis in 62% of the patients. Cytogenetic analysis was used to help determine the final diagnosis in 50% of the cases. In 39% of cases, translocations involved the long arm of chromosome 8, the most common anomaly in lipoblastoma.

CONCLUSIONS

Lipoblastomas are rare tumors in young children that can be misclassified as other malignant or benign lipomatous tumors with markedly different outcomes and treatments. We recommend that cytogenetic analysis be routinely used for all pediatric lipomatous tumors to provide an accurate diagnosis and guide appropriate therapy and follow-up.

Intrathoracic lipoblastoma in a 15-month-old infant

Lipoblastoma is a rare tumor of infancy. It originates from the white fetal fat in soft tissue. The most common location of this rare tumor is extremity and to best of our knowledge less than 10 cases of intrathoracic and mediastinal lipoblastoma has been reported in the English literature. Herein we present our experience with a 15-month-old boy infant who presented with severe dyspnea. Imaging studies showed a mass in the thoracic cavity and mediastinum which was diagnosed as lipoblastoma after pathologic examination of the resected mass. Lipoblastoma has been considered as a tumor of soft tissue, but it should also be considered as a rare cause of intrathoracic masses of young children.

Chest wall tumors in childhood and adolescence

Chest wall tumors in childhood and adolescence can be very heterogeneous and may appear at any age from infancy to late adolescence. They can be benign or malignant and secondary or primary. A careful history and physical examination should be followed by adequate imaging studies to delineate the primary tumor and identify possible sites of dissemination. Diagnosis usually requires either a needle or open biopsy which minimizes dissection so that a complete resection can be done later. Most neoplastic lesions require a complete resection, whereas secondary and infectious processes are treated with chemotherapy or antibiotics. Rigid chest wall re-construction has the advantage of eliminating paradoxical respiration and obviating the need for postoperative ventilation. Another advantage is maintenance of chest wall contour.