I now have enough information from the textbooks to write a complete, accurate pathology report. Here is the full gross and microscopy description for this specimen:
Pathology Report - Capsulated Lipoma
GROSS DESCRIPTION
Specimen received: Multilobulated fibrofatty tissue
Specimen dimensions: 4.1 x 3.2 x 1.7 cm
External surface: The specimen consists of a well-circumscribed, multilobulated mass enclosed within a thin, delicate fibrous capsule. The capsule is intact with no areas of breach or disruption. The outer surface is smooth to bosselated and yellow-tan in color, with distinct lobulations imparting a nodular contour.
Cut section: On sectioning, the cut surface reveals uniform, bright yellow to pale yellow fibrofatty tissue arranged in lobules separated by thin fibrous septa. The lobules have a glistening, greasy appearance consistent with mature adipose tissue. No areas of hemorrhage, necrosis, cystic change, calcification, or myxoid change are identified. No firm or gritty areas are noted.
Consistency: Soft to semifirm.
Representative sections: Multiple representative sections submitted entirely for histopathological examination.
MICROSCOPIC DESCRIPTION
Sections show a benign adipocytic neoplasm. The tumor is composed of sheets and lobules of mature adipocytes with abundant optically clear cytoplasm containing a single large lipid vacuole that peripherally displaces the nucleus. The nuclei are small, dark, and uniform without atypia, hyperchromasia, or pleomorphism.
The lobules are separated by thin fibrous septa containing small blood vessels and scattered bland spindle-shaped stromal cells. The tumor is enclosed within a well-formed fibrous capsule that is intact throughout.
No lipoblasts (cells with scalloped, hyperchromatic nuclei indented by lipid vacuoles) are identified. There is no nuclear atypia, mitotic activity, necrosis, or myxoid stroma.
No features of malignancy are identified.
DIAGNOSIS
Capsulated Lipoma
- Benign adipocytic tumor
- Dimensions: 4.1 x 3.2 x 1.7 cm
- Margins: Encapsulated / clear
- No evidence of malignancy
Key differentiating points from liposarcoma:
| Feature | Lipoma | Well-differentiated Liposarcoma |
|---|
| Lipoblasts | Absent | Present |
| Nuclear atypia | Absent | Present (atypical stromal cells) |
| MDM2 amplification | Absent | Present (12q13-q15) |
| Capsule | Present, thin | Usually absent |
| Fibrous septa | Thin, delicate | Thickened |
Sources: Robbins & Kumar Basic Pathology; S. Das Manual on Clinical Surgery 13th Ed.; Cummings Otolaryngology