Posterior Neck Triangle Spindle Cell Lipoma

Abstract

Spindle cell lipomas (SCLs) are a rare variant of lipomas with distinct pathological and immunohistological features. Pathological characteristics of SCLs have been well described and include the following features: a well-circumscribed subcutaneous lesion that contains a variety of mature adipocytes, spindle cells and collagen bundles. Immunohistochemical staining of SCLs is usually positive for CD34. Four cases of posterior neck triangle SCLs have been reported in the literature. We present a further case of SCL presenting in the posterior triangle of the neck. A 51-year-old man with a large right posterior neck triangle mass was referred to our Head & Neck Clinic. Further questioning revealed that this swelling had been growing over a two and a half year period associated with neck pain, difficulty swallowing and recurrent skin infections at the base of the mass. Due to the rare nature of SCLs, such cases should be discussed in a dedicated multi-disciplinary team meeting. Although metastasis from SCLs is rare, experienced pathologists and radiologists should be consulted early in order to distinguish the type of lesion and the risk of metastasis from more sinister lesions such as liposarcoma. Surgical excision of SCLs is currently accepted as the gold standard and mainstay of management.