title: Floretlike cells in in situ and prolapsed orbital fat.
abstract: OBJECTIVE
  Orbital pleomorphic lipoma has been rarely reported in the literature. Although floretlike cells are characteristic of pleomorphic lipoma, they are not pathognomonic. We reviewed cases of prolapsed orbital fat and exenteration specimens to determine the significance of presence of these cells in the diagnosis of orbital pleomorphic lipoma.
  
  
  METHODS
  Retrospective interventional case series with clinicopathologic correlation.
  
  
  METHODS
  Seventy-two specimens of 45 patients with prolapsed orbital fat and 74 exenteration specimens as controls.
  
  
  METHODS
  Histologic review of the specimens including light microscopy, Masson trichrome staining, immunostaining for S100, CD34, CD68, terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) assay, and transmission electron microscopy and review of clinical records and analysis of the data with generalized estimation equation.
  
  
  METHODS
  Evidence of histologic abnormalities in histologic specimens and clinical and demographic data.
  
  
  RESULTS
  Floretlike cells were present in 31 of 72 (43%) specimens of prolapsed orbital fat and in 12 of 74 (16%) orbital exenterations. Fewer than 6 florets were present in twenty 40x high-power fields in 15 (48%), 6 to 10 in 9 (29%), and >10 in 7 (23%) specimens. The florets stained positive for CD34 but not for S100 or CD68. TUNEL assay revealed significant nuclear pyknosis, and transmission electron microscopy disclosed spindle-shaped cells with abundant rough endoplasmic reticulum and no basement membrane. The mean age of patients with prolapsed orbital fat with florets was 67 years (range, 52-86). Of 31 samples, 29 (94%) were from males. Of 30 samples, 29 (97%) were located in the superotemporal conjunctiva; only one was located in the lower lid. There was significant association between the presence of florets and location of the prolapsed orbital fat (P = 0.0013) and gender (P = 0.0015).
  
  
  CONCLUSIONS
  Floretlike cells may be present in in situ and prolapsed orbital fat as a degenerative process. What some have called "orbital pleomorphic lipoma" is in fact only age-related orbital fat prolapse.
authors.affiliation: Eye Pathology Laboratory, Wilmer Institute, and Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-9248, USA.
authors.forename: Katayoon B
authors.initials: KB
authors.lastname: Ebrahimi
authors.forename: Shiquan
authors.initials: S
authors.lastname: Ren
authors.forename: W Richard
authors.initials: WR
authors.lastname: Green
mesh_terms: D000273:Adipose Tissue / Q000378:metabolism / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D015703:Antigens, CD / Q000378:metabolism; D018952:Antigens, CD34 / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D020287:In Situ Nick-End Labeling; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000378:metabolism / Q000473:pathology*; D011391:Prolapse; D012189:Retrospective Studies; D009418:S100 Proteins / Q000378:metabolism; D000097382:CD68 Molecule