Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] ## Overview[edit | edit source] Lipoma must be differentiated from liposarcoma, normal adipose tissue, adrenal myelolipoma, angiomyolipoma, and other lipomatous tumors. ## Differentiating Lipoma from other Diseases[edit | edit source] Lipoma must be differentiated from liposarcoma, normal adipose tissue, adrenal myelolipoma, angiomyolipoma, and other lipomatous tumors. * Lipoma should be differentiated from other lipomatous tumors. Table below compares and describes the characteristics of different lipomatous tumors: Lipomatous tumor | Age of onset | Gender preponderance | Location | Clinical features | Pathologic features | Other features | Histologic view | | | | | | | Angiolipoma[1][2] | * Second and third decades of life * Female < male * More commonly seen in forearm * May also affect trunk and upper arm * Subcutaneous nodule * Tender to palpation * Less than 2 cm * Encapsulated, yellow nodules with a reddish tinge * A combination of fatty tissue and vascular channels * Fibrin thrombi is present in vascular channels (characteristic finding) * Benign [3] Myolipoma[4] | * Fifth and sixth decades of life * Female > male * More commonly seen in retroperitoneum, abdomen, pelvis, inguinal region, or abdominal wall * May also affect extremities * Subcutaneous mass which may also engage superficial muscular fascia * Size differs depending on the location * Partially encapsulated mass with partially yellow-white cut surface * A combination of mature adipocytes and sheets of well-differentiated smooth muscle cells * No nuclear atypia * Sieve-like appearance at low magnification (due to interspersed location of smooth muscle component) * Benign * Usually large and located in the deep soft tissues [5] Myelolipoma[6][7] | * Fifth decade of life * Female = male * More commonly seen in adrenal glands * Other possible locations include: * Thoracic * Retroperitoneum * Presacral region * Usually asymptomatic * May cause abdominal pain, nausea, and constipation (depending on the location and size) * Uncommonly, may cause retroperitoneal hemorrhage * 3 to 7 cm * A combination of bone marrow elements and adipose tissue in varying proportions * May show myxoid changes * Well-circumscribed radiolucent mass in radiologic imaging * May have hromonal activity [8] Spindle Cell/Pleomorphic Lipoma[9] | * Fifth to seventh decades of life * Female < male * More commonly seen in posterior neck, shoulder, and back * It is also reported in oral cavity * Subcutaneous nodule with firm consistency * Slowly growing and painless * Mostly between 3 to 5 cm * Similar to ordinary lipoma * A combination of mature fat cells and spindle cell or pleomorphic elements * Lipomatous component may vary in amount * Immunohistochemically positive for CD34 * Benign [10] Chondroid Lipoma[11] | * Third or fourth decade of life * Female > male * More commonly seen in limbs and limb girdles * May also involve trunk, and the head and neck region, particularly the oral cavity * Slowly growing painless mass * Sizes ranges from 1 to 11 cm * Encapsulated tumor with a yellow, white, or pink-tan cut surface * A combination of mature adipocytes in association with nests of vacuolated cells in a myxochondroid or hyalinized fibrous background * Heterogeneous soft tissue mass in radiologic imaging * Benign [12] Hibernoma[13] | * Third decade of life * Female = male * Most commonly seen in thigh * May also affect shoulder, back, neck, chest, arm, and abdominal cavity/retroperitoneum * Slowly growing, painless, subcutaneous mass * Affects intramuscular in 10% of the cases * Size varies between 5 to 15 cm * Well-defined, soft, and mobile mass * A combination of vacuolated granular eosinophilic cells with abundant mithochondria and high vascular content * Immunohistochemically positive for S-100 * Benign [14] Intramuscular and Intermuscular Lipomas[15] | * Fourth to seventh decades of life * Female < male * Most commonly seen in large muscles of the extremities, especially in thigh, shoulder, and upper arm * Painless, slowly growing mass * Visible during muscle contraction * Infiltrative adipose thissue within the muscle * Absence of nuclear atypia * May be very small or more than 20 cm [16] Thymolipoma[17] | * Median age of onset is 33 * Female = male * Anterior mediastinum * Asymptomatic * Symptoms may present if the mass compress the surrounding thoracic structures. * Possible symptoms include: * Cough * Dyspnea * Hemoptysis * Chest pain * Hoarseness * A combination of mature fat cells with interspersed thymic epithelial cells * Anterior mediastinal mass * Benign [18] Lipomas of Tendon Sheaths and Joints[19] | * Second and third decades of life * Female = male * Lipoma of joints affects men more frequently than women * Most commonly seen in wrist and hand * May also affect ankle and foot * Bilateral and symmetric location in 50% of the cases * May cause severe pain, trigger finger, or even symptoms of carpal tunnel syndrome * May have 2 different shape: * A single adipose tissue extending along the tendon sheet * A lipomatous lesion composed mostly from hypertrophic synovial villi * Radiologic imaging may show a lesion of less density than the surrounding tissue | _ Lumbosacral Lipoma[20][21] | * First decade of life * Female > male * It occurs in the lumbosacral region and overlies the spine * Initially, asymptomatic * Later signs and symptoms of progressive myelopathy or radiculopathy in the lower legs, bladder, or bowel * Uncapsulated mass that consists of lobulated adipose tissue * Vascular proliferation and smooth muscle tissue may be present * Almost always associated with spina bifida or a similar laminar defect (lipomyeloschisis) | _ Neural Fibrolipoma (Lipofibromatous Hamartoma of Nerves)[22] | * First three decades of life * Female > male (in the presence of macrodactyly) * Most commonly affect median nerve and its branches * May also affect ulnar, radial, peroneal, and cranial nerves * May cause neuropathy, pain, paresthesia, and decreased sensation * Carpal tunnel syndrome may also occur * A sausage-shaped mass with soft texture that has diffusely infiltrated a large nerve and its branches * Fibrofatty tissue surronding and infiltrating the nerve trunk * Overgrowth of bone and macrodactyly may be seen in one third of the cases | _ In general, there is little differential for a classic lipoma. The main differential is[23]: * Liposarcoma * Normal adipose tissue In certain locations then other fatty masses should be considered : * Retroperitoneum * Adrenal myelolipoma * Angiomyolipoma (AML) * Chest * Thymolipoma Disease | Clinical feature | Laboratory findings | Imaging findings | | | Fever | Weight loss | Abdominal pain Retroperitoneal hematoma | _ | _ | ✔ | Anemia | MRI is the best radiologic tool to differentiate between retroperitoneal masses. Retroperitoneal abscess | ✔ | _ | ✔ | Leukocytosis, positive inflammatory markers Retroperitoneal tumors (.e.g. liposarcoma) | ✔ | ✔ | ✔ | positive tumor marker Chronic pancreatitis | _ | ✔ | ✔ | DM type II, amylase and lipase levels may be slightly elevated Differentiating Liposarcoma from Other Diseases Disease entity | Etiology (Genetic or others) | Histopathological findings | Immunohistochemical staining | Risk factors | Common site of involvement | Clinical manifestations | Other associated features | | | | | | | Liposarcoma[24][25][26][27][28][29][30][31][32][33] | Atypical lipomatous tumor/well differentiated liposarcoma and dedifferentiated liposarcoma are associated with: * Presence of a large/giant markerchromosome and/or ring chromosomes at 12q13-15 region * Amplification of this chromosome region rich in protooncogenes, including CHOP, CDK4, MDM2, HMGI-C, GLI, SAS, OS1, HMGA2 andOS9 Myxoid liposarcoma is associated with: * t(12:16)(q13;p11) - CHOP(DDIT3) / FUSor t(12;22)(q13;q22) - CHOP(DDIT3) / EWS Pleomorphicliposarcoma is associated with: * Complex karyotypicaberrations | Well-differentiated liposarcoma: * Sclerosing liposarcoma (distinctive stromal cells distributed across the tissue, associated with lipoblasts filled with multiple vacuoles, and collagenous background of fibrillary appearance) * Adipocyticliposarcoma (adipocytes with different cell sizes, hyperchromasia, and nuclear atypia. Fibrous septacontaining hyperchromatic stromal cells surrounding adipocytes) * Inflammatoryliposarcoma (heavy chronic inflammatoryinfiltrate composed of different lympho-plasmacytic aggregates) * Spindle cellliposarcoma(proliferation of neural-like spindle cells organized in a fibrous structurecontaining lipoblasts) De-differentiated liposarcoma: * Myxoid liposarcoma ( non-homogenous appearance with cystic and solid components) * Round cellliposarcoma (small, round, or spindle cells with sparse eosinophilic and granular cytoplasmand large nuclei,scattered lipoblasts and areas of necrosis) * Pleomorphicliposarcoma (pleomorphic cells with enlarged round to bizarre nuclei) | Atypical lipomatous tumor/well differentiated liposarcoma is positive for: * MDM2 * CDK4 * p16 * S100 (stainsadipocytes and lipoblasts) * Chemical carcinogens * Phenoxyacetic herbicides * Chlorophenols * Dioxincontaminations * Arsenic * Thorium dioxide (Thorotrast) * Radiation (dose of 50 GY) * Immunodeficiency(regional acquiredimmunodeficiency) * Genetic susceptibility * * Li-Fraumeni syndrome * Neurofibromatosis(NF1; von Recklinghausen disease) * Gardner syndrome (Familial adenomatous polyposis) * Retinoblastoma * Werner syndrome * Nevoid basal cell carcinoma (Gorlin syndrome) * Viral infections * Retroperitoneum * Esophagus * Bowel * Mediastinum * Retroperitonealliposarcoma maybe asymptomatic or causes: * Weight loss * Abdominal pain * Oliguria * renal failure (due to ureters or kidneys' compression) * Palpable abdominalmass * Abdominal tenderness * Abdominal distention * Esophageal liposarcoma may cause: * Dysphagia * Vomiting * Cough * Gastrointestinal bleeding * Hoarseness * Bowel liposarcoma may cause: * Gastrointestinalbleeding * Mediastinal liposarcoma may cause: * Dyspnea * Cough * Chest pain * Weight loss | _ Neurofibroma[34][35][36][37][38][39][40][37][41][42][43][44] | Can be sporadic or as a part of Neurofibromatosis 1 and 2 * NF1 gene located at chromosomal region 17q11.2, codes forneurofibromin * Functional part of neurofibromin GAP (or GTPase-activating protein) accelerates the conversion of the active GTP-bound RAS to its inactive GDP-bound form * Loss of RAS controlleads to increased activity of other signaling pathwaysincluding RAF, ERK1/2, PI3K, PAK, MAPK, SCF/c-kit and mTOR-S6 kinase * Uniphasic, low to moderate cellularity * No peripheral perineural capsule * Random pattern, only rare palisading * No well formed verocy bodies * Hypocellular with abundant mucinous/myxoid matrix without hypercellular areas * Frequent mast cells * Contains neural fibroblasts and fibrillary or shredded carrot collagen * Random proliferation of Schwann cells and scattered admixed axons * No nevoid cells * No epithelial component * Diffuse growth pattern * Scant cytoplasm * Wavy spindle cells with buckled nuclei * Pseudomeissnerian bodies representing specific differentiation may be present * Lacks storiform pattern Neurofibroma with degenerative atypia ("ancient change") has following microscopic features: * Localized cells with large pleomorphic nuclei, cytoplasmic nuclear inclusions, smudgy chromatin, and inconspicuous nuclei * Absent or very low mitotic activity * Low to moderate cellularity | Positive for: * S100 (weaker) * SOX10 * Neurofilament (and Bielshowsky) * GFAP * CD34 (stronger) * Factor XIIIa * Calretinin (focal) * MBP (myelin-basic protein) Negative for: * EMA (except in plexiform neurofibromas) * Neurofibromatosis 1 * Neurofibromatosis 2(multiple neurofibromas, meningiomas of the brainor spinal cord, and ependymomas of the spinal cord) * Can occur anywhere * Diffuse neurofibromas commonly involve scalp * * Soft masses/bumps on or under skin (internal or superficial) * Transient itching (mast cells release histamine) * Transient pain * Numbness and tingling in the affected area * Severe bleeding (sign of tumor growth) * Physical disfiguration * Cognitive disability * Stinging * Neurological deficits * Changes in movement (clumsiness in hands, trouble walking) * Bowel incontinence * Scoliosis (an abnormal curvature of the spine, if the tumor creates muscular imbalance or erodes bones of the spine) * Following symptoms may occur with genitourinary tract involvement (rarely): * Urinary tract infection (most common clinical manifestation) * Urinary retention * Urinary frequency * Urgency * Hematuria * Pelvic mass * Hydronephrosis * Urinary incontinence (decreased bladder capacity or compliance) * Appears as a focal mass or diffuse bladder wall thickening in case of a plexiform neurofibroma * Nerve often not identified, incorporates nerve, axons often present in lesion * Seldom cystic * Frequently multiple * Widespread soft tissue infiltration * Tends to displace adnexa * <2cm in diameter * Lacks distinct lobulation * Lacks fat * Affects individuals between 20-40 years of age * Men and women are equally affected * Plexiform neurofibroma are thought to be congenital and occur earlier in life Schwannoma[45][46][47][48][49] | * Loss of function of the tumor suppressor gene merlin (schwannomin) * Direct genetic change involving the NF2 gene on chromosome 22 * Can occur spontaneously * Mutations and biallelic inactivation of SMARCB1 (spinal schwannomas) * Encapsulated * Aggregates of spindled cells with indistinct cytoplasm and elongated nuclei with blunt pointed ends * Ancient changes may show nuclear pleomorphism and occasionally nuclear inclusions as well * Infrequent extracellular collagen * Biphasic: majority entirely, and compactly hypercellular Antoni A & myxoid hypocellular Antoni B areas (may be absent in small tumors) * Nuclear palisading evident around fibrillary process (Verocay bodies) in cellular areas * Large, irregularly spaced vessels prominent in Antoni B areas * Narrow, elongated and wavy cells with tapered ends, interspersed with collagen fibers * Tumor cells with ill defined cytoplasm, dense chromatin * Often displays degenerative nuclear atypia (ancient change) * Rare mitotic figures * Blood vessels may show gaping tortuous lumina having thickened hyalinized walls; may have thrombi * Dilated vessels surrounded/invested by hemorrhage * Foamy macrophages * Lymphoid aggregates * Amianthoid fibers or collagenous spherules: large nodular masses of collagen with radiating edges * No axons except where nerve is attached * Malignant transformation may have malignant epithelioid cells and rarely shows divergent differentiation as angiosarcoma-like areas | Positive for: * S-100 * SOX10 * CD56 * Podoplanin * CD34 (weak) * Neurofilament (and Bielshowsky) * Factor XIIIa (focal) * Calretinin * GFAP * EMA (capsule) highlights the perineural fibroblasts * Laminin * Type IV collagen * Vimentin * CD68 Negative for: * Cytokeratin * Desmin * SMA * NF-2 associated * Schwannomatosis * Carney complex * Upper limbs * Head and neck area (oral cavity, orbit and salivary glands) * Deeply seated tumors are mainly in: * Posterior mediastinum * Retroperitoneum * Posterior spinal roots * Bone * Gastrointestinal tract * Pancreas * Liver * Thyroid * Adrenal glands * Lymph nodes * Penis (rarely) * Vulva (rarely) Symptoms of schwannoma depend on the location of the tumor: * Intracranial schwannoma: * Acoustic neuroma (most common): * Sensorineural hearing loss * Vertigo * Tinnitus * Facial weakness * Facial numbness and tingling * Headaches * Dizziness * Difficulty swallowing and hoarseness * Taste changes * Confusion * Trigeminal schwannoma: * Trigeminal nerve dysfunction * Facial nerve schwannoma: * Facial nerve dysfunction * Jugular foramen schwannoma: * Hearing loss * Tinnitus * Dysphagia * Ataxia * Hoarseness * Hypoglossal schwannomas: * Hypoglossal nerve dysfunction * Spinal schwannoma: * Back pain * Urinary incontinence * Urinary retention * Clumsiness * Weakness * Paresthesias * Intercostal nerve schwannoma: * Usually asymptomatic * Intramuscular schwannoma: * Painless mass * Nerve often identifiable * Eccentric to nerve, axons generally absent within lesion * Occasionally cystic * Can cause other neoplasms including: * Meningioma * Mesothelioma * Glioma multiforme * Breast cancer * Colorectal cancer * Kidney (clear cell type) carcinoma * Hepatocellular carcinoma * Prostatic cancer * Dermal cancer * Affects individuals between 20-50 years of age * Men and women are equally affected Palisaded encapsulated neuroma (PEN) /solitary circumscribed neuroma[50] | * Spontaneous development * RET proto-oncogene genetic mutations (inherited PEN) * Solitary dermal or subcutaneous tumor * Encapsulated by perineurium * Club-like extension in the subcutaneous tissue * Moderately cellular lesion with proliferation of schwann cells and axons * Nuclear palisading may be present * Rare mast cells * Silver stains show the axons traversing the Schwann cells | Positive for: * EMA * S100 (schwann cells) * Neurofilament (axons) * Collagen type IV * EMA (perineurium) * Neuron-specific Enolase * CD57 (Leu-7) * Myelin basic proteins Negative for: * GFAP * Positive family history of tumor occurrence * Multiple mucosal neuroma syndrome * Multiple endocrine neoplasia syndrome (MEN 2B) | 90% lesions affect the face involving: * Eyelid * Nose * Oral mucosa Remaining 10% can occur anywhere in body involving: * Shoulder * Arm * Hand * Foot * Glans of penis * Small, solitary, raised, dome-shaped, firm, flesh-colored painless nodule on skin * Cosmetic issues due to facial involvement * Scar after surgery * Benign tumor of the nerve fibers * Affects middle aged people (40-60 years) * No known familial association * Affects females more frequently than males Traumatic neuroma[51][52][53][54] | * Tangle of neural fibers and connective tissue that develops following a peripheral nerve injury * Interruption in continuity of nerve causing wallerian degeneration (loss of axons in proximal stump and retraction of axons in distal segment), followed by exuberant regeneration of nerve and formation of mass of Schwann cells, axons and fibrous cells * Numerous well formed small nerve twigs * Limited soft tissue infiltration * Contains axons in haphazardly arranged nerves within mature collagenous scar with entrapped smooth muscle | Positive for: * S100 * History of trauma to a nerve (especially during a surgery) * Cone biopsy (rare complication) * 55% of hysterectomy patients have microneuromas, associated with childbirth | Most common oral locations are: * Tongue * Near mental foramen of mouth Rarely involves: * Head * Neck * Firm, oval, whitish, slowly growing, palpable nodule on skin (no discoloration of skin on the top of nodule) * 3.0.co;2-k. PMID 7459800. 10. ↑ Contributed by Nephron in Wikimedia commons 11. ↑ Gokhale U, Pillai GR, Varghese PV, Samarsinghe D (April 2008). "Chondroid lipoma: a case report". Oman Med J. 23 (2): 116–7. PMC 3282416. PMID 22379550. 12. ↑ Contributed by Dr. Dharam Ramnani in Webpathology 13. ↑ Furlong, Mary A.; Fanburg–Smith, Julie C.; Miettinen, Markku (2001). "The Morphologic Spectrum of Hibernoma". The American Journal of Surgical Pathology. 25 (6): 809–814. doi:10.1097/00000478-200106000-00014. ISSN 0147-5185. 14. ↑ Contributed by Nephron in Wikimedia commons 15. ↑ Nishida, Jun; Morita, Tetsuro; Ogose, Akira; Okada, Kyoji; Kakizaki, Hiroshi; Tajino, Takahiro; Hatori, Masahito; Orui, Hiroshi; Ehara, Shigeru; Satoh, Takashi; Shimamura, Tadashi (2007). "Imaging characteristics of deep-seated lipomatous tumors: intramuscular lipoma, intermuscular lipoma, and lipoma-like liposarcoma". Journal of Orthopaedic Science. 12 (6): 533–541. doi:10.1007/s00776-007-1177-3. ISSN 0949-2658. 16. ↑ Contributed by Dr. Dharam Ramnani in Webpathology 17. ↑ Guimarães, Marcos D.; Benveniste, Marcelo F.K.; Bitencourt, Almir G.V.; Andrade, Victor P.; Souza, Liliana P.; Gross, Jefferson L.; Godoy, Myrna C.B. (2013). "Thymoma Originating in a Giant Thymolipoma: A Rare Intrathoracic Lesion". The Annals of Thoracic Surgery. 96 (3): 1083–1085. doi:10.1016/j.athoracsur.2013.01.031. ISSN 0003-4975. 18. ↑ Contributed by Dr. Dharam Ramnani in Webpathology 19. ↑ Gurich RW, Pappas ND (December 2015). "Lipoma of the Tendon Sheath in the Fourth Extensor Compartment of the Hand". Am J. Orthop. 44 (12): 561–2. PMID 26665243. 20. ↑ Kang, Hyun-Seung; Wang, Kyu-Chang; Kim, Kwang Myung; Kim, Seung Ki; Cho, Byung Kyu (2006). "Prognostic factors affecting urologic outcome after untethering surgery for lumbosacral lipoma". Child's Nervous System. 22 (9): 1111–1121. doi:10.1007/s00381-006-0088-5. ISSN 0256-7040. 21. ↑ Jones, Victoria; Wykes, Victoria; Cohen, Nicki; Thompson, Dominic; Jacques, Tom S (2018). "The pathology of lumbosacral lipomas: macroscopic and microscopic disparity have implications for embryogenesis and mode of clinical deterioration". Histopathology. 72 (7): 1136–1144. doi:10.1111/his.13469. ISSN 0309-0167. 22. ↑ Al-Jabri T, Garg S, Mani GV (September 2010). "Lipofibromatous hamartoma of the median nerve". J Orthop Surg Res. 5: 71. doi:10.1186/1749-799X-5-71. PMC 2955673. PMID 20920178. 23. ↑ Lipoma.Dr Ahmed Abd Rabou and Dr Frank Gaillard, et al. Radiopaedia.org 2015.http://radiopaedia.org/articles/lipoma 24. ↑ Khin Thway, Rashpal Flora, Chirag Shah, David Olmos & Cyril Fisher (2012). "Diagnostic utility of p16, CDK4, and MDM2 as an immunohistochemical panel in distinguishing well-differentiated and dedifferentiated liposarcomas from other adipocytic tumors". The American journal of surgical pathology. 36 (3): 462–469. doi:10.1097/PAS.0b013e3182417330. PMID 22301498. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link) 25. ↑ J. Rosai, M. Akerman, P. Dal Cin, I. DeWever, C. D. Fletcher, N. Mandahl, F. Mertens, F. Mitelman, A. Rydholm, R. Sciot, G. Tallini, H. Van den Berghe, W. Van de Ven, R. Vanni & H. Willen (1996). "Combined morphologic and karyotypic study of 59 atypical lipomatous tumors. Evaluation of their relationship and differential diagnosis with other adipose tissue tumors (a report of the CHAMP Study Group)". The American journal of surgical pathology. 20 (10): 1182–1189. PMID 8827023. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link) 26. ↑ Dal Cin, Paola; Kools, Patrick; Sciot, Raf; De Wever, Ivo; Van Damme, Boudewijn; Van de Ven, Wim; Van Den Berghe, Herman (1993). "Cytogenetic and fluorescence in situ hybridization investigation of ring chromosomes characterizing a specific pathologic subgroup of adipose tissue tumors". Cancer Genetics and Cytogenetics. 68 (2): 85–90. doi:10.1016/0165-4608(93)90001-3. ISSN 0165-4608. 27. ↑ Dei Tos, Angelo P.; Doglioni, Claudio; Piccinin, Sara; Sciot, Raf; Furlanetto, Alberto; Boiocchi, Mauro; Dal Cin, Paola; Maestro, Roberta; Fletcher, Christopher D. M.; Tallini, Giovanni (2000). "Coordinated expression and amplification of theMDM2,CDK4, andHMGI-C genes in atypical lipomatous tumours". The Journal of Pathology. 190 (5): 531–536. doi:10.1002/(SICI)1096-9896(200004)190:5<531::AID-PATH579>3.0.CO;2-W. ISSN 0022-3417. 28. ↑ Dei Tos, A (2000). "Liposarcoma: New entities and evolving concepts". Annals of Diagnostic Pathology. 4 (4): 252–266. doi:10.1053/adpa.2000.8133. ISSN 1092-9134. 29. ↑ M. D. Kraus, L. Guillou & C. D. Fletcher (1997). "Well-differentiated inflammatory liposarcoma: an uncommon and easily overlooked variant of a common sarcoma". The American journal of surgical pathology. 21 (5): 518–527. PMID 9158675. Unknown parameter `|month=` ignored (help) 30. ↑ P. Argani, F. Facchetti, G. Inghirami & J. Rosai (1997). "Lymphocyte-rich well-differentiated liposarcoma: report of nine cases". The American journal of surgical pathology. 21 (8): 884–895. PMID 9255251. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link) 31. ↑ H. L. Evans (1979). "Liposarcoma: a study of 55 cases with a reassessment of its classification". The American journal of surgical pathology. 3 (6): 507–523. PMID 534388. Unknown parameter `|month=` ignored (help) 32. ↑ A. P. Dei Tos, T. Mentzel, P. L. Newman & C. D. Fletcher (1994). "Spindle cell liposarcoma, a hitherto unrecognized variant of liposarcoma. Analysis of six cases". The American journal of surgical pathology. 18 (9): 913–921. PMID 8067512. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link) 33. ↑ D. C. Dahlin, K. K. Unni & T. Matsuno (1977). "Malignant (fibrous) histiocytoma of bone--fact or fancy?". Cancer. 39 (4): 1508–1516. PMID 192432. Unknown parameter `|month=` ignored (help) 34. ↑ Rodriguez, Fausto J.; Folpe, Andrew L.; Giannini, Caterina; Perry, Arie (2012). "Pathology of peripheral nerve sheath tumors: diagnostic overview and update on selected diagnostic problems". Acta Neuropathologica. 123 (3): 295–319. doi:10.1007/s00401-012-0954-z. ISSN 0001-6322. 35. ↑ Choi, Kwangmin; Komurov, Kakajan; Fletcher, Jonathan S.; Jousma, Edwin; Cancelas, Jose A.; Wu, Jianqiang; Ratner, Nancy (2017). "An inflammatory gene signature distinguishes neurofibroma Schwann cells and macrophages from cells in the normal peripheral nervous system". Scientific Reports. 7 (1). doi:10.1038/srep43315. ISSN 2045-2322. 36. ↑ Liao, Chung-Ping; Booker, Reid C.; Brosseau, Jean-Philippe; Chen, Zhiguo; Mo, Juan; Tchegnon, Edem; Wang, Yong; Clapp, D. Wade; Le, Lu Q. (2018). "Contributions of inflammation and tumor microenvironment to neurofibroma tumorigenesis". Journal of Clinical Investigation. 128 (7): 2848–2861. doi:10.1172/JCI99424. ISSN 0021-9738. 37. ↑ 37.0 37.1 Staser, K.; Yang, F.-C.; Clapp, D. W. (2010). "Mast cells and the neurofibroma microenvironment". Blood. 116 (2): 157–164. doi:10.1182/blood-2009-09-242875. ISSN 0006-4971. 38. ↑ Muir, David; Neubauer, Debbie; Lim, Ingrid T.; Yachnis, Anthony T.; Wallace, Margaret R. (2001). "Tumorigenic Properties of Neurofibromin-Deficient Neurofibroma Schwann Cells". The American Journal of Pathology. 158 (2): 501–513. doi:10.1016/S0002-9440(10)63992-2. ISSN 0002-9440. 39. ↑ Wilkinson, Lana M.; Manson, David; Smith, Charles R. (2004). "Best Cases from the AFIP". RadioGraphics. 24 (suppl_1): S237–S242. doi:10.1148/rg.24si035170. ISSN 0271-5333. 40. ↑ Bernthal, Nicholas; Jones, Kevin; Monument, Michael; Liu, Ting; Viskochil, David; Randall, R. (2013). "Lost in Translation: Ambiguity in Nerve Sheath Tumor Nomenclature and Its Resultant Treatment Effect". Cancers. 5 (4): 519–528. doi:10.3390/cancers5020519. ISSN 2072-6694. 41. ↑ Mautner, V. F.; Friedrich, R. E.; von Deimling, A.; Hagel, C.; Korf, B.; Knöfel, M. T.; Wenzel, R.; Fünsterer, C. (2003). "Malignant peripheral nerve sheath tumours in neurofibromatosis type 1: MRI supports the diagnosis of malignant plexiform neurofibroma". Neuroradiology. 45 (9): 618–625. doi:10.1007/s00234-003-0964-6. ISSN 0028-3940. 42. ↑ Shen, M H; Harper, P S; Upadhyaya, M (1996). "Molecular genetics of neurofibromatosis type 1 (NF1)". Journal of Medical Genetics. 33 (1): 2–17. doi:10.1136/jmg.33.1.2. ISSN 1468-6244. 43. ↑ Rubin, Joshua B.; Gutmann, David H. (2005). "Neurofibromatosis type 1 — a model for nervous system tumour formation?". Nature Reviews Cancer. 5 (7): 557–564. doi:10.1038/nrc1653. ISSN 1474-175X. 44. ↑ Gray, Mark H. (1990). "Immunohistochemical Demonstration of Factor XIIIa Expression in Neurofibromas". Archives of Dermatology. 126 (4): 472. doi:10.1001/archderm.1990.01670280056009. ISSN 0003-987X. 45. ↑ Schwannoma. Dr Tim Luijkx and Dr Sara Wein et al. http://radiopaedia.org/articles/schwannoma 46. ↑ Vestibular Schwannoma. Wikipedia(2015) https://en.wikipedia.org/wiki/Vestibular_schwannoma Accessed on October 2 2015 47. ↑ Giordano J, Rogers LV (1989). "Peripherally administered serotonin 5-HT3 receptor antagonists reduce inflammatory pain in rats". European Journal of Pharmacology. 170 (1–2): 83–6. PMID 2612565. `|access-date=` requires `|url=` (help) 48. ↑ Kolvenbach H, Lauven PM, Schneider B, Kunath U (1989). "Repetitive intercostal nerve block via catheter for postoperative pain relief after thoracotomy". The Thoracic and Cardiovascular Surgeon. 37 (5): 273–6. doi:10.1055/s-2007-1020331. PMID 2588243. Retrieved 2015-11-20. 49. ↑ Opaleva-Stegantseva VA, Ivanov AG, Gavrilina IA, Khar'kov EI, Ratovskaia VI (1986). "[Incidence of sudden death cases in acute coronary insufficiency and acute myocardial infarction at the pre-hospital stage in Krasnoyarsk]". Kardiologiia (in Russian). 26 (5): 23–6. PMID 3735913. `|access-date=` requires `|url=` (help)CS1 maint: Unrecognized language (link) 50. ↑ Misago N, Inoue T, Narisawa Y (2007). "Unusual benign myxoid nerve sheath lesion: myxoid palisaded encapsulated neuroma (PEN) or nerve sheath myxoma with PEN/PEN-like features?". Am J Dermatopathol. 29 (2): 160–4. doi:10.1097/01.dad.0000256688.91974.09. PMID 17414438.CS1 maint: Multiple names: authors list (link) 51. ↑ Lee EJ, Calcaterra TC, Zuckerbraun L (1998). "Traumatic neuromas of the head and neck". Ear Nose Throat J. 77 (8): 670–4, 676. PMID 9745184.CS1 maint: Multiple names: authors list (link) 52. ↑ Hanna SA, Catapano J, Borschel GH (2016). "Painful pediatric traumatic neuroma: surgical management and clinical outcomes". Childs Nerv Syst. 32 (7): 1191–4. doi:10.1007/s00381-016-3109-z. PMID 27179535.CS1 maint: Multiple names: authors list (link) 53. ↑ Foltán R, Klíma K, Spacková J, Sedý J (2008). "Mechanism of traumatic neuroma development". 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