Resident Dermatologist: Philip Milam, MD

Attending Dermatologist: Susan Massick, MD

Dermatopathologist: Catherine Chung, MD

HISTORY:

40 year old man with no significant past medical history comes in to the office with concerns for bumps on his arms, trunk and thighs that have developed over the past couple of years. These are painful, especially one growth on his arm which started about 2 years ago and has grown slowly over the years. It is tender and is starting to get in the way of his daily activities. It doesn’t itch or bleed, and has never drained any pus or discharge. He is otherwise healthy and he doesn’t have any other skin concerns.

On exam, he has a 3cm, tender, mobile, semi-firm subcutaneous nodule with a jam-like consistency on the left ulnar forearm without overlying epidermal changes or punctum.

At low power, there is a well-circumscribed neoplasm composed predominantly of clear cells.

Higher magnification reveals the clear cells to be mature-appearing adipocytes. There are also focal proliferations of capillary-sized blood vessels.

The blood vessels are capillary in size and characterized by small lumina containing red blood cells.

Fibrin thrombi within capillaries is a common finding.

What is the most likely diagnosis?

  1. Lymphadenopathy
  2. Angiolipoma
  3. Osteosarcoma
  4. Keratoacanthoma
  5. Epidermal inclusion cyst
Angiolipoma