Verocay and Verocay-Like Bodies: Is There a Distinction? Spindle Cell Lipoma as an Example

Spindle cell lipoma (SCL) is a benign adipocytic tumor commonly occurring in the neck, back, and shoulder of middle-aged men. Although often straightforward, SCL can exhibit unusual histologic patterns that pose diagnostic challenges. Verocay bodies, characterized by palisading nuclei around acellular zones, are a classic feature of schwannoma but are not pathognomonic. We report a SCL on the posterolateral neck of a 48-year-old man that showed prominent palisaded arrangements reminiscent of Verocay bodies, prompting a differential that included schwannoma. Immunohistochemical studies were performed, and the spindle cells were negative for S100 (only scattered adipocytes highlighted), and positive for CD34, and showed loss of nuclear RB staining. These findings are characteristic of SCL and the case underscores the importance of integrating microscopy, immunohistochemical panel selection, and terminology discipline. Recognizing the pitfalls of indiscriminate "Verocay-like body" nomenclature in nonschwannomatous neoplasms is crucial for avoiding misdiagnosis.