Recurrent Lipoma-Like Hibernoma

This is the fifth report of the rare lipoma-like variant of hibernoma, the 19th case reported, and the first documented as recurring after excision. Our patient was a 56-year-old man whose painful lipoma-like hibernoma (LLH) in the pelvis/buttock was initially treated with marginal excision 15 years earlier. Nine years after treatment, the LLH recurred locally. The recurrence was treated with partial excision and embolization, which alleviated symptoms. The disease was stable 26 months after repeat excision and 202 months after initial treatment.

LLH is 1 of the 4 histologic variants of hibernomas, which are rare benign lipomatous tumors distinguished from other lipomas by their brown-fat component. Only minimal information is available regarding the clinicopathologic characteristics of the individual variants. Reviewing the literature, we found that LLH predominantly develops in the fifth and sixth decades, and mean age at diagnosis is 41 years (age range, 2-66 years). LLH has a slight male predilection of 10:9. It most commonly develops in the thigh, with other occurrences reported in the hip, trunk, knee, and calf. The magnetic resonance imaging signal of LLH mirrors fat in all sequences. Presence of internal septations and enhancement with contrast are variable. Histologically, LLH is defined as a hibernoma composed predominantly of univacuolated white-fat cells and only scattered granular or pale hibernoma cells. The literature provides only a few treatment details regarding this variant.