General
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• Prolapse of subconjunctival intraconal orbital fat
• Rarely causes intraorbital mass lesion
• May histologically resemble adipose tissue neoplasm
• Mean age 65 years, 90% men
• Prolapsed fat in superotemporal quadrant or lateral canthus around rectus muscle below lacrimal gland
• Unilateral or bilateral
• References: Am J Surg Pathol 2007;31:193

Treatment
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• Excision, does not recur

Micro description
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• Mature fat, fibrous septa without hyperchromatic cells, Lochkern cells (adipocytes with intranuclear vacuoles), floret cells (multinucleated giant cells with wreathlike nuclei) and variable inflammatory cells

Positive stains
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• Floret cells: CD34 and vimentin
• Lochkern cells: CD34, vimentin and S100

Differential diagnosis
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• Pleomorphic lipoma: aggregates of bland spindled cells with wiry collagen
• Well differentiated liposarcoma: enlarged hyperchromatic cells within fibrous septae

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