Clinicopathological Analysis of Lipomatous Tumors in a Tertiary Care Center

Background and aim Adipocytic tumors are among the most common soft tissue neoplasms, ranging from benign to malignant forms. Accurate differentiation between these entities is essential due to differences in prognosis and management. This study aims to evaluate the clinicopathological spectrum of lipomatous tumors, including their demographic profile, anatomical distribution, and histopathological spectrum, and to analyze factors associated with malignancy. Methods A retrospective observational study was conducted in the Department of Pathology at a tertiary care center from October 2019 to September 2025. A total of 114 histopathologically confirmed cases of adipocytic tumors were included. Clinical and pathological data were retrieved and analyzed. Tumors were classified according to the WHO classification. Ancillary techniques, including immunohistochemistry (MDM2 and CDK4), were performed in selected cases. Associations between tumor size, site, radiological features, and malignancy were assessed. Results The majority of patients were in the fourth to sixth decade age group (52 cases, 45%), with a male predominance (68 cases, 60%). The upper extremity was the most common site (32 cases, 28%), followed by the lower extremity (30 cases, 26%) and trunk (28 cases, 25%). Conventional lipoma was the most common tumor type (72 cases, 63%), followed by other variants such as fibrolipoma (12 cases, 11%) and angiolipoma (10 cases, 9%). The most common anatomical location was subcutaneous tissue, followed by deep soft tissue and intramuscular locations. Atypical lipomatous tumor/well-differentiated liposarcoma and myxoid liposarcoma were identified in a subset of cases. Radiologically, benign lesions showed homogeneous fat density, whereas malignant tumors demonstrated septal thickening, nodularity, and non-adipose components. Most tumors measured less than 5 cm (64 cases, 56%). MDM2/CDK4 immunohistochemistry findings indicate that atypical/malignant adipocytic neoplasms were positive in four cases. Conclusions Lipomatous tumors are predominantly benign, with lipoma being the most common subtype. Tumor size and location serve as important indicators of malignancy. Comprehensive histopathological evaluation, supplemented by ancillary techniques where necessary, is crucial for accurate diagnosis and appropriate management.