Differentiation of Oral Spindle Cell and Pleomorphic Lipomas From Their Mimics via Retinoblastoma Status Through Immunohistochemistry and Fluorescence In Situ Hybridization.

Background: The incidence of spindle cell/pleomorphic lipomas ranges from 2.2% to 47.2%. Its diagnosis is impeded by its diverse histological features, including adipocytes and myxo-collagenous stroma. Accordingly, we aimed to reexamine oral adipocytic tumors, focusing on RB1-deficient tumors, to reveal the diversity of oral spindle cell lipomas.

Methods: We selected 30 cases of spindle cell/pleomorphic lipomas and their mimics from 111 oral adipocytic tumors. Subsequently, we performed analysis using immunohistochemistry for CD34 and RB protein (pRB) and RB1 fluorescence in situ hybridization (FISH) in limited cases.

Results: Among the included cases, 16 were CD34-positive with pRB and/or the RB1 loss. Among them, 15 were spindle cell lipomas (SCLs) with 27% of them being confirmed through FISH in cases where pRB status was mosaic. These included five low-fat SPLs (including one low-fat pleomorphic lipoma), four conventional SCLs, three fibrous SCLs, two myxoid, and one fat-rich SCL. The remaining case was an atypical spindle cell lipomatous tumor. Only prominent spindle cell and myxoid changes showed significant differences between SCL and fibrous lipoma. Two cases, initially identified as spindle cell lipomas, were reclassified as fibrolipoma and lipoma.

Conclusion: Oral spindle cell/pleomorphic lipomas frequently exhibit prominent collagenous stroma, which results in low-fat and fibrous variants that require careful differentiation from fibrous lipomas or non-adipocytic tumors. Given the diverse histological findings, meticulous diagnosis of rare spindle cell lipoma variants and other lipomas in daily surgical pathology is essential. Specifically, it should apply CD34 and retinoblastoma protein immunohistochemistry, as well as RB1 FISH when necessary.