|LETTER TO EDITOR
|Year : 2015 | Volume
| Issue : 1 | Page : 24-25
Solitary type of nevus lipomatosus cutaneous superficialis - An uncommon lesion clinically masquerading as a papilloma
Sharmila Dudani1, Ajay Malik2, Porandla S Patel3, Kavita Sahai4
1 Department of Pathology, Army College of Medical Sciences, Base Hospital, Delhi Cantt, New Delhi, India
2 Department of Pathology and Oncopathology, Base Hospital, Delhi Cantt, New Delhi, India
3 Department of Surgery, Base Hospital, Delhi Cantt, New Delhi, India
4 Department of Pathology, Base Hospital, Delhi Cantt, New Delhi, India
|Date of Web Publication||16-Jul-2015|
Department of Pathology and Oncopathology, Base Hospital, Delhi Cantt, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dudani S, Malik A, Patel PS, Sahai K. Solitary type of nevus lipomatosus cutaneous superficialis - An uncommon lesion clinically masquerading as a papilloma. Indian J Dermatopathol Diagn Dermatol 2015;2:24-5
|How to cite this URL:|
Dudani S, Malik A, Patel PS, Sahai K. Solitary type of nevus lipomatosus cutaneous superficialis - An uncommon lesion clinically masquerading as a papilloma. Indian J Dermatopathol Diagn Dermatol [serial online] 2015 [cited 2020 Jan 19];2:24-5. Available from: http://www.ijdpdd.com/text.asp?2015/2/1/24/160987
Nevus Lipomatosus cutaneous superficialis (NLCS) is a rare nevoid form of lipoma characterized by the ectopic presence of mature adipocytes in the reticular dermis, first reported by Hoffman and Zurhelle in 1921. Clinically, two types are seen.  The easily recognized classical type is characterized by multiple, non-tender, soft, pedunculated, cerebriform, yellowish papules or nodules on the pelvic and gluteal region, occurring in a linear or zosteriform distribution. The uncommon, solitary type manifests as a dome shaped or sessile papule on the trunk which is often clinically misdiagnosed.
We report a case of solitary type of NLCS on the medial aspect of left upper thigh because of its rarity, unusual location, large size and clinical appearance of a papilloma.
A 42-year-old man presented to the Surgery outpatient department with a single large papulo-nodular lesion measuring 5 × 3 cm on the medial aspect of left thigh since 1 year, which was diagnosed as a papilloma and excised. There was no family history of similar lesions. Specimen received was a solitary tissue measuring 5 × 3 cm. Cut section was yellowish [Figure 1]. Microscopic examination revealed a normal epidermis. The dermis showed proliferation of mature adipocytes in the reticular dermis forming large aggregates interposed between collagen bundles and dermal blood vessels. These did not communicate with the subcutaneous fat. Adnexal structures appeared reduced [Figure 2]. A diagnosis of NLCS was made.
|Figure 1: Gross examination revealed a single tissue covered with skin, measuring 5 × 3 cm. Cut section showed yellowish areas|
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|Figure 2: Photomicrograph reveals a normal epidermis composed of keratinized stratified squamous epithelium. The dermis shows proliferation of mature adipocytes in the reticular dermis which were seen to form large aggregates around blood vessels and interposed between collagen bundles (H and E, ×100)|
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The common, classical type of NLCS, presents at birth or by 20 years of age. The solitary form is uncommon and presents in adults as a small nodule commonly on the trunk. Only a single study has reported a predominance of solitary form comprising 13 cases spanning 12 years.  Rare sites include scalp,  calf,  and thigh as in the present case. This is the first case of solitary form of NLCS having attained such a large size. The solitary form is usually misdiagnosed at presentation as documented in a study of eight cases over 11 years. 
The characteristic histopathologic finding is the presence of mature adipocytes ranging from 10% to 50% in the reticular dermis, forming small aggregates around blood vessels or eccrine glands and separating the collagen bundles. These may extend to the papillary dermis.  Adnexal structures may be normal, reduced or show perifollicular fibrosis.  Epidermal changes can include mild to moderate acanthosis, basket weave hyperkeratosis, and focal elongation of rete ridges. 
NLCS needs to be differentiated histologically from focal dermal hypoplasia (Goltz syndrome) and lipofibromas, both of which show adipocytes in the dermis. The etiopathogenesis of NLCS is poorly understood. Various hypotheses include origin of adipocytes from pericytes of dermal blood vessels, adipose metaplasia of dermal connective tissue or their representing a true nevus resulting from focal heterotopic development during embryonic life. 
Surgical excision is usually curative and no recurrence or malignancy is reported.
To conclude, readers should be aware of the solitary type of NLCS as it is a rare, benign hamartomatous lesion of the skin which can occur at unusual sites or attain large sizes.
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[Figure 1], [Figure 2]