Liposarcoma of the thyroid gland mimicking retrosternal goiter

Primary liposarcoma of the thyroid gland is extremely rare with only two previous reports in the literature. We report two further cases, both patients presenting with rapid airways compression. Patient 1 had clinical, radiographic, and biopsy appearances suggesting benign goiter. Patient 2 had a long-term history of benign goiter, a previous partial thyroidectomy, and more recent biopsies showing liposarcoma. The management of such rare conditions is always challenging.

[Diagnosis and treatment of primary mediastinal liposarcoma]

Mediastinal liposarcoma are of rare entity; there are less than one hundred cases published worldwide. Because of the equivocal and inapparent symptomatology clinical signs often are falsely estimated, and in time of surgery there is generally seen a wide spread tumor growth, so that a radical resection often is impossible. Radiotherapy and chemotherapy are of limited value and mean no chance for curative therapy. The case of a 46 years old patient with an extensive primary liposarcoma of the mediastinum and the results of the review of the literature will be discussed.

[Giant retroperitoneal liposarcoma: report of a case]

Liposarcoma is a rare and primary malignancy developed from mesenchymal tissue. We report the case of a 32-year-old woman who had a complete exeresis of a 15 cm retroperitoneal myxoid liposarcoma. Three months later, a 9 cm local recurrence was excised and radiotherapy was performed. In 2000, a local recurrence and an intestinal localisation of the liposarcoma were observed. The retroperitoneal tumor could not be removed and she had an intestinal resection followed by chemotherapy. With the literature data, we review the pathological, therapeutic and prognostic aspects of this tumor.

[Retroperitoneal tumors: a case of liposarcoma]

The Authors report a case of retroperitoneal sarcoma, in the histological subtype "liposarcoma", occasionally diagnosed in a 57 year old woman, who presented aspecific symptoms, characterized by dry cough, vomiting and chest pain. Chest TC showed a neoplasm of the retroperitoneum, close to liver, right colon, duodenum and right kidney. The arteriography of the right renal artery showed a neovascolarization inside the mass. A surgical resection was performed. The histological examination confirmed the diagnosis of liposarcoma. Liposarcomas account for 30% of the retroperitoneal soft tissue sarcomas; symptoms and diagnosis are late and the surgical resection of primary neoplasm, metastases and local recurrences representing the only therapeutic choice.

Unusual variant of liposarcoma with multiple punctate calcifications

We report a case of liposarcoma in a 17-year-old boy in which both the radiographs and histology demonstrated multiple punctate calcifications. In addition, this unusual variant consisting of myxoid, round cell and well-differentiated liposarcoma behaved aggressively resulting in the death of the patient.

Imaging of fatty tumors: distinction of lipoma and well-differentiated liposarcoma

PURPOSE

To review the reliability of computed tomographic (CT) and magnetic resonance (MR) imaging features in distinguishing lipoma and well-differentiated liposarcoma.

MATERIALS AND METHODS

CT (n= 29) and MR (n = 40) images and radiographs (n = 28) of 60 patients with histologically verified fatty tumors (35 lipomas and 25 well-differentiated liposarcomas) were retrospectively reviewed in 31 females and 29 males (mean age, 56 years; age range, 1-88 years). Images were assessed for adipose tissue content, and non-fatty component was classified (thin and/or thick septa and nodular and/or globular components) as absent, mild, moderate, or pronounced. Also assessed were signal intensity and tissue attenuation of the fatty components and non-adipose elements.

RESULTS

Statistically significant imaging features favoring a diagnosis of liposarcoma included lesion larger than 10 cm (P <.001), presence of thick septa (P =.001), presence of globular and/or nodular non-adipose areas (P =.003) or masses (P =.001), and lesion less than 75% fat (P <.001). The most statistically significant radiologic predictors of malignancy were male sex, presence of thick septa, and associated non-adipose masses, which increased the likelihood of malignancy by 13-, nine-, and 32-fold, respectively. Both lipoma and liposarcoma demonstrated thin septa and regions of increased signal intensity on fluid-sensitive MR images.

CONCLUSION

A significant number of lipomas will have prominent non-adipose areas and will demonstrate an imaging appearance traditionally ascribed to well-differentiated liposarcoma. Features that suggest malignancy include increased patient age, large lesion size, presence of thick septa, presence of nodular and/or globular or non-adipose mass-like areas, and decreased percentage of fat composition.

Liposarcoma of the breast: a case report and review of the literature

Sarcoma of the breast constitutes <1% of all malignant breast tumors, and liposarcoma of the breast represents 3-24% of the primary breast sarcomas. We report a case of a 74-year-old woman presenting with liposarcoma of the left breast. The patient presented with a fibrous and hard mass measuring approximately 10 x 5 cm in diameter in the upper part of the left breast. Aspiration breast cytology showed inflammatory changes and had no malignant element. Differential diagnosis with sonography, computed tomography, and magnetic resonance imaging was not successful. A wide excision was performed with a 2-cm margin of healthy tissue. The tumor was diagnosed histologically as a well-differentiated liposarcoma (sclerosing type). The patient was discharged and her recovery was uneventful. We report a case of liposarcoma of the breast and discuss this rare malignant tumor and other types of sarcoma of the breast in light of the previously published literature.

[A case of liposarcoma of the renal capsule]

A 58-year-old woman was referred to our institution for treatment of a left renal tumor revealed by follow-up computed tomography (CT) of a pancreatic tumor. The CT showed a heterogeneous, perirenal mass containing areas of fat density. Angiography showed no feeding artery. Left nephrectomy was performed and pathological examination revealed a well-differentiated liposarcoma of the renal capsule. At the third-month follow-up, the patient was completely asymptomatic and free of recurrence. Primary tumors of the renal capsule are uncommon and liposarcoma of the renal capsule is distinctly rare. There have been only 17 reports of liposarcoma arising from the renal capsule in Japan. We, herein, report a case of liposarcoma of the renal capsule.

[Massive localized lymphedema: a reactive lesion simulating liposarcoma (case report]

The authors present a case-history of massive localized lymphedema in a 54 year old female patient (height 167 cm, weight 113 kg). The history of the lymphedema lasted about 1 year. Its growth was not accompained with subjective complaints. It was diagnosed as a pendulous tumor of soft tissues in the thigh, 70 x 65 cm large. In preoperative diagnosis it was classified as a liposarcoma. The tumor lesion was removed and sent for bioptic examinations. Both histological and immunohistochemical biopsies denied benign or malignant nature of the soft tissue tumors and confirmed the diagnosis of a massive localized lymphedema.

Giant liposarcoma of the esophagus

Liposarcomas of the gastrointestinal tract are exceedingly rare. Only nine cases of esophageal involvement have been described. A 68-year-old woman presented with an episode of vomiting followed by extrusion of a polypoid mass from the mouth. This 10th case of esophageal liposarcoma is the first in the literature to report a recurrence 25 years after the first episode.

[Imaging of lipoma and liposarcoma]

The aim of this paper is to describe the two most frequent lipomatous soft tissue tumors, lipoma and liposarcoma, and to highlight the radiologic features allowing their differentiation.

[Liposarcoma of the spermatic cord: case report and review of the literature]

Liposarcoma of the spermatic cord is rare and is usually discovered during hernia repair operation. We report a 71-year-old patient with spermatic cord liposarcoma. The patient presented with a painless mass in the left scrotum measuring up to 25 cm. The mass had gradually been enlarging during the last 6 months. Clinical examination suggested inguinal hernia and after a routine clinical check-up the patient underwent surgery. During surgery, a large, yellow, lobulated mass adherent to spermatic cord was found. The mass was not spreading to the retroperitoneum, epididymis or testis. Simple orchidectomy was performed. Histopathologic diagnosis was well-differentiated liposarcoma comprising foci of myxoid and dedifferentiated liposarcoma. At present the patient is well and without recurrence 6 months after surgery.

Spindle cell lipoma of the alveolar mucosa: a case report

Spindle cell lipoma of the oral cavity is extremely rare. We report a case occurring on the alveolar mucosa, an oral site that has not been previously reported. A short review of the literature is also presented. The importance of distinguishing this benign lesion from a sarcoma is highlighted. The lesion was excised, and no recurrence has been reported after 2 years.

Giant retroperitoneal sarcoma: a case report and review of the management of retroperitoneal sarcomas

A 42-year-old man presented with lower abdominal pain and a vague abdominal mass. He underwent resection of a well-differentiated liposarcoma arising from his retroperitoneum measuring 50 cm and weighing 11.7 kg (25.8 lb). This is the second largest retroperitoneal soft-tissue sarcoma (RSTS) that has been reported. Over the last 15 years 1123 patients with RSTS in 25 series have been reported with a mean tumor size of 15.7 cm. RSTS represents 0.10 to 0.15 per cent of all malignancies but 45 per cent of all retroperitoneal tumors. Diagnosis and treatment of RSTS can be extremely challenging for a general surgeon. Symptoms are nonspecific and may occur only after the tumor is very large. Abdominal discomfort is the presenting complaint in 60 to 70 per cent of patients and palpable mass in 70 to 80 per cent. Treatment of RSTS remains surgical. Multiple trials of chemotherapy and radiation therapy show no survival benefit. The only successful treatment of this tumor is complete excision; 51.4 per cent of tumors can be completely excised, and 50.2 per cent of these excisions include adjacent organs. Long-term prognosis without complete excision is grim with average 5- and 10-year survival rates of 16.7 and 8.0 per cent. With aggressive surgical therapy survival is increased to 58.0 and 39.6 per cent.

Mediastinal liposarcoma appearing as a tumor arising in the esophageal wall

We report a case of mediastinal liposarcoma, a relatively uncommon neoplasm, in which the mass also appeared as a tumor arising in the esophageal wall. A 76-year-old man diagnosed with a posterior mediastinal mass had the tumor extirpated in local esophageal myectomy due to its unclear margin on the esophageal wall. The resected specimen was diagnosed as well-differentiated liposarcoma. Preoperative angiography showed the tumor received its blood supply from a branch of the left gastric artery, suggesting it arose in the lower esophageal segment close to the hiatus and extended to the mediastinum. Since this tumor's growth pattern differed completely from esophageal liposarcoma described in previous case reports, we concluded that it was mediastinal liposarcoma.

[Subfascial lipomatous tumors: management in a series of 37 consecutive cases]

PURPOSE OF THE STUDY

The prognosis of subfascial lipomatous soft tissue tumors depends greatly on their histological type ranging from benign lipomas that cause little local or general problems to the severe prognosis of liposarcomas that exhibit both local and distant extension. However, the clinical presentation of the two types of tumors may be similar and thus quite misleading, sometimes leading to inappropriate management and severe consequences. The main objective of this study was to determine whether the preoperative work-up in patients treated for musculoskeletal tumors within our recruitment zone is adequate, allowing appropriate therapeutic decisions. In addition, we wanted to know what explorations are most pertinent for the differential diagnosis between benign and malignant subfascial lipomatous soft tissue tumors.

MATERIAL AND METHODS

Thirty-seven patients with subfascial tumors were included in this study. There were 16 with benign lipomas and 21 with liposarcomas. All the patients with benign lipomas but only 9 (43%) of those with liposarcoma had received initial care within our recruitment zone before final diagnosis. Two cases had been referred after biopsy and 1 after resection by morcellation; the 9 others were secondary referrals after tumor recurrence. Only 5 of these 12 referred patients had had an MRI exploration prior to surgery, 2 with an erroneous interpretation. An MRI series was obtained for all the patients with benign lipoma and for the 9 with liposarcomas who attended our units directly. A biopsy was also obtained in case of suspected liposarcoma. Two radiologists blinded to the final diagnosis reviewed the available MRI to assess their diagnostic value for subfascial lipomatous soft tissue tumors.

RESULTS

No case of recurrence, after marginal resection (10 cases) was noted for lipomas. Six are under observation with regular MRI (with no change in size or signal). Four patients with liposarcoma died from their disease (19%) and 2 who had undergone "curative" resection had a recurrence (12%). Incorrect or imprecise (incomplete, incorrectly interpreted or no MRI) preoperative diagnosis led to additional morbidity with 3.4 surgical procedures (mean per patient) compared with 1 in patients who had had undergone a complete work-up and whose diagnosis was established after multidisciplinary discussions. Among the diagnostic elements available before pathology, only MRI findings had diagnostic value for subfascial lipomatous soft tissue tumors: for benign lipoma positive predictive value=92% and negative predictive value=93%.

DISCUSSION

The clinical course of the benign lipomas and the sarcomas in this series confirm the radically different prognosis of these two tumors, both in terms of local extension and survival. Inadequate management in the initial diagnostic stages-i.e. lack of MRI with contrast injection, biopsy and multidisciplinary interpretation prior to treatment-raises the risk of higher morbidity, particularly a significantly greater number of reoperations, and progression to a higher grade of malignancy for two tumors. Our retrospective analysis enabled us to develop a decision making tree for patients with subfascial lipomatous tumors. Prospective validation will be necessary.

Distinction of well-differentiated liposarcoma from lipoma in two patients with multiple well-differentiated fatty masses

This case report describes the features of gadolinium-enhanced MRI in well-differentiated liposarcoma with histologic correlation and addresses the usefulness of this imaging technique in distinguishing well-differentiated liposarcoma from lipoma. Gadolinium-enhanced MRI revealed significantly enhanced signal in well-differentiated liposarcoma in a background of multiple well-differentiated benign fatty masses by showing the increased vascularity in the septa of well-differentiated liposarcoma. Although such signal enhancement can be seen in some types of benign lipomatous tumors with increased blood vessels, this technique is helpful in selection of biopsy site, especially in a clinical setting of multiple fatty masses.

[Scrotal liposarcoma]

OBJECTIVE

To describe an additional case of scrotal liposarcoma and its treatment, which was distinct from conventional treatment.

METHODS

The literature on paratesticular masses is reviewed with special reference to the liposarcomas. An additional case of liposarcoma is described which was treated by tumor excision without involvement of the testis. The diagnosis, classification and treatment of this condition are discussed.

RESULTS

Liposarcoma is a very uncommon tumor and its diagnosis is based on the anatomopathological findings. Treatment is by orchidectomy with high ligation of the spermatic cord. However, the case described herein was treated only by resection of the tumor. Radiotherapy may be indicated in some cases. Chemotherapy does not appear to be useful in this type of tumor.

CONCLUSION

In some cases of scrotal liposarcoma, the tumor can be resected without performing orchidectomy.

Successful removal of a giant recurrent mediastinal liposarcoma involving both hemithoraces

Primary liposarcomas of the mediastinum are unusual tumors. We report herein a case of a 52-year-old woman, who was found to have a mediastinal tumor involving both hemithoraces and radiologically showing non-resectable-invasive features to the adjacent vital structures. She had a history of left thoracotomy for mediastinal schwannoma 14 years previously. The patient underwent an exploratory thoracotomy following a preoperative misdiagnosis of an ancient schwannoma. Complete removal of the tumor was accomplished through a right posterolateral thoracotomy with a subsequent histological diagnosis of a recurrent low-grade liposarcoma. A resectable liposarcoma should be considered in the differential diagnosis of a mediastinal tumor, although radiologically, the tumor presents with invasive features.

Successful resection of a primary liposarcoma in the anterior mediastinum in a child: report of a case

Primary liposarcomas of the mediastinum are very rare. We report on a 13-year-old girl who presented with a huge mediastinal tumor. The tumor was extirpated by a median sternotomy with a right thoracotomy. The tumor included the superior vena cava in the anterior mediastinum. It therefore probably originated from the anterior mediastinal fat tissue, possibly from the thymus. A pathological examination revealed myxoid liposarcoma. At 35 months postoperatively, the patient has not shown any recurrence.