Department of Orthopaedic Surgery, University of Pennsylvania, Duncan Building, 301 S 8th Street, Suite 2C, Philadelphia, PA 19106-6192, USA.
Clin Orthop Relat Res. 2010 Oct;468(10):2808-13. doi: 10.1007/s11999-010-1242-7. Epub 2010 Feb 2.
A hemosiderotic fibrohistiocytic lipomatous lesion, also called hemosiderotic fibrolipomatous tumor, is a rare and recently described fibrolipomatous entity. Initially considered the result of a reactive inflammatory process from trauma or vascular disease, newer evidence suggests it may be neoplastic in origin.
We report the case of a 56-year-old woman with a painful mass in the dorsal aspect of the foot diagnosed as a hemosiderotic fibrohistiocytic lipomatous lesion.
We reviewed all 31 published cases of hemosiderotic fibrohistiocytic lipomatous lesions looking for common clinical, imaging, and histologic patterns. Hemosiderotic fibrohistiocytic lipomatous lesions occur predominantly in the fifth and sixth decades of life (average age, 49.5 years; range, 0.67-74 years). Females predominate 22 to 9. Thirteen of 28 patients had histories of trauma or vasculopathy. Twenty-six of 31 lesions were in the foot. The MRI signal of a hemosiderotic fibrohistiocytic lipomatous lesion follows fat in all sequences. Stranding or septations also frequently are seen. Histologically, the lesions are composed of three main elements in varying proportions: mature adipocytes, spindle cells, and hemosiderin pigment. Ten of 27 resected lesions recurred. Resection types are not reported in many cases. Four of 15 lesions recurred after marginal/intralesional excision, whereas none of three lesions treated by wide excision recurred.
The high recurrence rate may be related to the difficulty in determining intraoperatively that a resection is complete, secondary to the lack of anatomic boundaries such as a pseudocapsule. Any attempt at wide resection must weigh the morbidity of this surgery against that of a recurrence after a resection which seemed complete intraoperatively. There have been no reports of metastasis.
含铁血黄素性纤维组织细胞性脂肪瘤样病变，也称为含铁血黄素性纤维脂肪瘤瘤，是一种罕见且最近描述的纤维脂肪瘤实体。最初认为它是创伤或血管疾病引起的反应性炎症过程的结果，而新的证据表明它可能起源于肿瘤。
我们报告了一例 56 岁女性足部疼痛性肿块的病例，诊断为含铁血黄素性纤维组织细胞性脂肪瘤样病变。
我们回顾了所有 31 例已发表的含铁血黄素性纤维组织细胞性脂肪瘤样病变病例，寻找常见的临床、影像学和组织学模式。含铁血黄素性纤维组织细胞性脂肪瘤样病变主要发生在第五和第六个十年（平均年龄 49.5 岁；范围 0.67-74 岁）。女性占 22 至 9 例。28 例患者中有 13 例有创伤或血管病史。31 例病变中有 26 例位于足部。含铁血黄素性纤维组织细胞性脂肪瘤样病变的 MRI 信号在所有序列中均遵循脂肪信号。也经常可见条索状或分隔。组织学上，病变由三种主要成分以不同比例组成：成熟脂肪细胞、梭形细胞和含铁血黄素色素。27 例切除病变中有 10 例复发。许多病例未报告切除类型。边缘/肿瘤内切除后 4 例复发，而广泛切除后 3 例无一例复发。
高复发率可能与术中难以确定切除是否完整有关，这是由于缺乏解剖边界（如假包膜）所致。任何广泛切除的尝试都必须权衡手术的发病率与术中似乎完整切除后复发的发病率。尚无转移的报道。
