Letter to the Editor
Re: Co-existence of intramuscular spindle cell lipoma with an intramuscular ordinary lipoma: Report of a case Ivan Chernev, Shane Mctighe, Dirk P. Stanley

Dear Editor,
We read the Letter to the Editor submitted by Chernev et al., in which the authors challenge the description of our case which concerned the co-existence of an intramuscular spindle cell lipoma with an intramuscular ordinary lipoma with great interest [1]. It is quite unusual to question so intensely data which have been presented by colleagues. Certainly, our description of this rare case only includes data of complete verity.
Chernev et al. contend that since no MRI of the ordinary lipoma was provided, its anatomical relationship with the spindle cell lipoma had not been demonstrated. Since the number of figures in a case report is usually limited, simply mentioning its image findings in the manuscript should be considered sufficient Thus, we had not included radiographic images of the ordinary lipoma in our manuscript. As described, the synchronous existence of both lesions was initially detected at a CT scan made for staging, as sarcoma was suspected after core needle biopsy. Unfortunately, we cannot provide an appropriate 3D reconstruction of the area of interest, since we have only films and no digital CT scan file. However, the ordinary CT films provide clear evidence that this case concerns two different chest wall tumors (Fig. 1A-H of this response letter).
Further, Chernev et al. questioned whether the spindle cell lipoma was intramuscular, as noted in our manuscript, and suggest that its localization might be intermuscular instead. As demonstrated in Fig. 1 (MRI) and 2 (surgical specimen) of our case report, the lesion was evidently intramuscular. This observation can be further supported by Fig. 1A and 1B of this response letter.
The authors of the Letter to the Editor expressed their interest in the type of the ordinary lipoma. We had not specified whether the lipoma was well-circumscribed or infiltrative, since we considered this fact of minor importance. However, for their information, it concerned a well-circumscribed type (Fig. 2 of this response letter) which had been simply enucleated out of its pseudocapsule during the surgical procedure.
Subsequently, we cordially thank Chernev et al. for their comment that the other four cases with concurrent spindle cell and ordinary lipoma, which have been previously published and are referred to in the discussion of our manuscript, concern cases with subcutaneous or unspecified localization of the spindle cell lipoma or with existence of a spindle cell...


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