Journal List > J Korean Soc Spine Surg > v.13(4) > 1035733

J Korean Soc Spine Surg. 2006 Dec;13(4):306-310. Korean.
Published online December 30, 2006.  https://doi.org/10.4184/jkss.2006.13.4.306
Copyright © 2006 Korean Society of Spine Surgery
Hibernoma in Psoas Muscle - A Case Report -
Jung-Won Ha, M.D.,# Hak-Sun Kim, M.D., Jin-Oh Park, M.D., Jun-Young Chung, M.D., Ju-Yeon Pyo, M.D.,$ and Eun-Su Moon, M.D.
Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
#Department of Orthopaedic Surgery, National Health Insurance Corporation Ilsan Hospital, Seoul, Korea.
$Department of Diagnostic Pathology, Yonsei University College of Medicine, Seoul, Korea.

Address reprint requests to: Eun-Su Moon, M.D. Department of Orthopaedic Surgery, Yong-Dong Severance Hospital, Yonsei University College of Medicine, Dogok-Dong, Kangnam-Ku, Seoul, Korea, 135-720. Tel: 82-2-2109-3418, Fax: 82-2-573-5393, Email: mes1007@yumc.yonsei.ac.kr
Abstract

Hibernoma is a rare benign tumor of a brown fat origin with hypervascularity. Although the magnetic resonance imaging features resemble a liposarcoma, its malignant potential is unknown. A complete local excision with meticulous hemostasis is the treatment of choice. We present a case of hibernoma in the psoas muscle with a review of the relevant literature.

Keywords: Psoas muscle; Hibernoma; Benign tumor

Figures


Fig. 1
On computed tomography, about 4 × 4 cm sized, lobuated and multiseptated fatty mass was noted in right psoas muscle area extending over T12 to L2 vertebra. The mass showed an increased attenuation compared with subcutaneous fat, and decreased attenuation compared with muscle.
Click for larger image


Fig. 2
On preoperative MR imaging, a well marginated and lobulated mass was found on posterior aspect of right kidney being contiguous to right psoas muscle. (A) On T1 weighted imaging, the signal intensity of the mass was intermediate between those of skeletal muscle and subcutaneous fat. (B) On T2 weighted imaging, the mass was heterogenous with somewhat increased signal intensity.
Click for larger image


Fig. 3
On PET scan, there was significantly increased FDG uptake on the mass. However there was no increased uptake in other parts of the body indicating metastasis.
Click for larger image


Fig. 4
Preoperative angiography showed a hypervascular mass being fed from branch vessels of 1-2, 2-3, 3-4 lumbar artery. Preoperative embolization was performed for the prevention of intraoperative massive bleeing and extracompartmental contamination in case of malignancy.
Click for larger image


Fig. 5
On gross examination, the mass was about 7 × 4.5 × 4 cm sized and encapsulated with rubbery hard consistency. On serical sections, the cut surface showed multi-lobulation with intervening streaks.
Click for larger image


Fig. 6
Histologically, the mass showed a mixture of brown and white adipose cells and was divided into lobules by well vascularized connective tissue. The brown adipose cells are characterized by polygonal, multivacuolated cells with abundant , granular cytoplasm and small, central nucleus.(H-E stain, x100)
Click for larger image

References
1. Meckel H. On a Pseudolipoma of the breast. Beitr Pathol Anat 1906;39:152–157.
2. Furlong MA, Fanburg-Smith JC, Miettinen M. The Morphologic Spectrum of Hibernoma: A Clinicopathologic Study of 170 Cases. The American Journal of Surgical Pathology 2001;25:809–814.
3. Enzinger FM, Weiss SW. In: Soft Tissue Tumors. London: CV Mosby; 1983. pp. 234-241.
4. Lee TJ, Park IS, Kim MG, Cho KJ, Moon KH, Lim KY. Axillary Hibernoma: MRI Characteristics. J Korean Ortho Assoc 2004;39:335–338.
5. Lewandowski PJ, Weiner SD. Hibernoma of the Medial Thigh. Clinical Orthopaedics and related research 1996;330:198–201.
6. Cook MA, Stern M, de Silva RD. Case report: MRI of hibernoma. J Comput Assis Tomogr 1996;20:333–335.
7. McLane RC, Meyer LC. Axillary Hibernoma: Review of the literature with report of a case examined angiographically. Radiology 1978;127:673–679.
8. Munk PL, Lee MJ, Janzen DL. Lipoma and liposarcoma : Evaluation using CT and MR imaging. AHR AM J Roentgenol 1997;169:589–594.