Dedifferentiated Liposarcoma of the Descending Colon: A Case Report and Review of the Literature

Dedifferentiated liposarcomas are rare; localization of these tumors in the descending colon is extremely uncommon. We describe the case of a 75-year-old man with a dedifferentiated liposarcoma originating from the descending colon that manifested as partial bowel obstruction. The very uncommon presentation of this rare disease contributed to a challenging diagnostic process. The patient was successfully treated by surgical resection of the mass through left hemicolectomy. Although exceptionally unusual, soft tissue sarcomas should be considered in the differential diagnosis for bowel obstruction. Currently, radical resection of the mass is considered to be the first-line treatment.

Primary retroperitoneal tumor during pregnancy: Case report and review of the literature

OBJECTIVE

To report the case of a pregnant patient diagnosed with a primary retroperitoneal tumor and to conduct a review of the literature pertaining to the diagnosis, treatment and maternal-fetal prognosis of this disease condition during pregnancy.

METHODS

A 19-year-old patient who presented with a retroperitoneal tumor identified on ultrasound. The results of the percutaneous biopsy showed a benign tumor. A healthy neonate was delivered by cesarean section. Surgical resection was performed four months later, and histopathology showed a mature cystic teratoma. A search was conduced in the Medline via PubMed, Lilacs, SciELO and ScienceDirect databases using the terms "pregnancy," "neoplasms," and "retroperitoneal neoplasms," including case reports and case series of retroperitoneal tumors during pregnancy. Diagnosis, treatment and maternal-fetal prognosis were identified.

RESULTS

Overall, 1658 titles were identified. Of these, 34 case reports and 1 case series met the inclusion criteria. Of the cases, 62.9 % were benign. Diagnosis was made as an incidental finding in 63 % of cases, and 77 % of the masses were identified on ultrasound. Percutaneous biopsy was used in 8 % of cases, including the case reported here. Surgical treatment was used in 88 % of cases usually after delivery. Maternal mortality occurred in 8.5 % of cases. Fetal prognosis was good in 65 % of the pregnancies.

CONCLUSIONS

Despite being frequently benign, retroperitoneal tumors during gestation have a reserved maternal and fetal prognosis in a substantial number of cases. There is a need to assess the risks and benefits of percutaneous biopsy.

Dysplastic lipoma: potential diagnostic pitfall of using MDM2 RNA in situ hybridization to distinguish between lipoma and atypical lipomatous tumor

The distinction between lipoma and atypical lipomatous tumor can be challenging in some cases. While detection of MDM2 gene amplification via fluorescence in situ hybridization (FISH) has been well established as a diagnostic tool to distinguish atypical lipomatous tumor and well-differentiated liposarcoma from benign mimics, MDM2 RNA in situ hybridization (RNA-ISH) has recently been proposed as an alternative diagnostic assay. During clinical workup for lipomatous tumors using MDM2 RNA-ISH, we noticed several dysplastic lipomas that were positive for MDM2 RNA-ISH but negative for MDM2 amplification by FISH. In this study, we examined a series of 11 dysplastic lipomas, all confirmed to be negative for MDM2 amplification by FISH. Positive MDM2 RNA-ISH was noted in 10 (91%) dysplastic lipomas. Single-nucleotide polymorphism array on one dysplastic lipoma identified the presence of homozygous deletion of 13q, including the RB1 gene locus with no evidence of MDM2 copy number gain. Our findings on the discordance between MDM2 FISH and MDM2 RNA-ISH highlight the potential utility and pitfalls of using MDM2 RNA-ISH in the distinction of atypical lipomatous tumor and related liposarcomas from dysplastic lipoma.

Oral liposarcoma in elderly: Case report and literature analysis

RATIONALE

Oral liposarcoma is an extremely rare lesion that is often clinically misdiagnosed as a benign lesion because of its asymptomatic and indolent clinical course. we report a case of atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) of buccal mucosa, provisionally diagnosed as lipoma.

PATIENT CONCERNS

A 97-year-old female was referred to dentistry and oral surgery department with an asymptomatic mass on the right buccal mucosa which had been present for an unknown period of time.

DIAGNOSIS

Magnetic resonance imaging demonstrated a well-circumscribed lesion at the right buccal mucosa, and a lipoma was suspected.

INTERVENTIONS

Surgical removal was performed, and a diagnosis of ALT/WDL was made. She and her family refused additional treatment due to her age.

OUTCOMES

At the 10 months follow-up, the patient remained free of disease.

LESSONS

The indolent clinical course and small size of oral liposarcoma can lead to provisional clinical diagnosis of benign lesion.

Retroperitoneal sarcomas: from diagnosis to treatment. Case series and review of the literature

BACKGROUND

Retroperitoneal sarcoma is a rare malignancy arising from mesenchymal cells, most commonly presented as an abdominal mass and is associated with poor prognosis. The most effective treatment modality for retroperitoneal sarcomas is complete surgical resection, including sometimes adjacent organs infiltrated by the tumor. Radiotherapy is frequently applied and has shown some benefit, while the role of chemotherapy and molecular-targeted agents is still not clear. Local recurrence is common for retroperitoneal sarcomas and still remains the main cause of death. The major factors associated with the overall survival are tumor grade, histological subtype, complete macroscopic excision and multifocality.

AIM

To report our experience via the presentation of patients with retroperitoneal sarcomas managed in our department during the period 2014-18; and to review the current literature.

PATIENTS AND METHODS

Eight patients appeared with chronic non-specific complaints including abdominal distension and changes in bowel or bladder habit, while one patient presented with acute abdominal pain due to mass rupture. All of the patients underwent surgical resection of the tumor.

RESULTS

Among the patients, seven were operated for primary disease and one only for recurrent. The most common histologic type was liposarcoma (well-differentiated, dedifferentiated), found in five patients; followed by leiomyosarcoma found in two cases. Fibrous histiocytoma was found in only one case. The masses were removed with macroscopically clear margins (R0 and R1 resections) in four cases. In five patient cases adjuvant therapy was required. Three patients are still alive and free of disease.

CONCLUSIONS

Retroperitoneal sarcomas present to be a therapeutic challenge based on their location, their extent at the time of diagnosis and the high risk of local recurrence or distant metastasis. Their management requires a multidisciplinary approach, with the surgical resection remaining the mainstay of curative treatment, combined with surveillance for early detection of recurrence or metastases.

Atypical lipomatous tumour/well-differentiated liposarcoma and de-differentiated liposarcoma in patients aged ≤ 40 years: a study of 116 patients

AIMS

Limited data exist on atypical lipomatous tumour (ALT)/well-differentiated liposarcoma (WDL) and de-differentiated liposarcoma (DDLPS) in children and young adults.

METHODS AND RESULTS

Cases of ALT/WDL/DDLPS arising in patients aged ≤ 40 years were collected from multiple institutional and consultation archives. A total of 116 cases of ALT/WDL (75) and DDLPS (41) were identified, representing fewer than 5% of these tumours seen at our institutions during this time-period. The patients (59 male/57 female) ranged in age from 8 to 40 years. Sites included deep central (abdomen/retroperitoneum/pelvis/groin) (n = 60), extremity (n = 42), trunk (n = 5), head/neck (n = 8) and mediastinum (n = 1). De-differentiated patterns included: high-grade pleomorphic sarcoma, myxofibrosarcoma-like, heterologous rhabdomyoblastic differentiation, low-grade spindle cell sarcoma and homologous lipoblastic differentiation. Forty-one patients experienced a local recurrence and 11 patients with DDLPS developed metastasis. ALT arising in the extremities had lower recurrence rates than deep central WDL (5-year recurrence-free survival 88.9% versus 59.0%; P = 0.002), while patients with deep central DDLPS experienced significantly more adverse events compared to WDL at this site (5-year event-free survival 11.9% versus 59.0%) (P < 0.0001). Seven (of eight) head/neck tumours had follow-up available; five recurred, and one patient (DDLPS) with recurrence also experienced a metastasis. The single mediastinal tumour (DDLPS) recurred and metastasised.

CONCLUSION

ALT/WDL and DDLPS occurring in patients aged ≤ 40 years is rare, but exhibits similar morphological features to its counterparts in older adults, including potential for heterologous and homologous de-differentiation in the latter. Although case numbers are limited, tumours arising in the head and neck exhibit high rates of adverse events, suggesting that classification as WDL rather than ALT is more appropriate.

Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma With Features Mimicking Spindle Cell Lipoma

Atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) and spindle cell lipoma are lipomatous tumors with distinct clinical, molecular, and prognostic features. Although histological and immunophenotypic features can overlap between ALT/WDL and spindle cell lipoma, the oncogenesis and clinical behavior are markedly different. In borderline cases, molecular analysis for MDM2 or CDK4 amplification can aid in distinguishing ALT/WDL from spindle cell lipoma. Although dedifferentiated liposarcoma has been reported to harbor both MDM2 amplification and loss of the RB1 region, we are not aware of a reported RB1 loss in well-differentiated ALT/WDL. In this article, we present a 69-year-old woman with a lipomatous tumor in the gluteal region that histologically, immunohistochemically, and molecularly mimicked spindle cell lipoma (with positive immunohistochemical staining for CD34 and loss of the RB1 gene region), yet harbored amplification of MDM2 and CDK4 confirmed by fluorescence in situ hybridization, supporting classification as ALT/WDL. This case strengthens the argument that in atypical clinical contexts, molecular studies for MDM2/CDK4 should be considered in tumors resembling spindle cell lipoma.

Giant atypical lipomatous tumor/well-differentiated liposarcoma affects lower limb activity: A case report

RATIONALE

Liposarcomas are locally invasive mesenchymal soft tissue tumors; most deep liposarcomas are large. Liposarcomas have heterogeneous histomorphology, molecular and genetic characteristics, and clinical prognosis, making the diagnosis and treatment of giant liposarcomas difficult for bone tumor surgeons.

PATIENT CONCERNS

A 70-year-old man presented with a mass in the posterior part of his left lower extremity that was first noticed 3 years prior. The mass was initially fist sized but continued to grow and had been affecting lower limb mobility on presentation.

DIAGNOSES

Computed tomography and magnetic resonance imaging revealed a large space-occupying lesion in the left thigh muscles, which was identified as a low-grade malignant tumor. Postoperative pathology results confirmed the diagnosis of atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDLPS).

INTERVENTIONS

The patient underwent open surgery to completely remove the tumor tissue and relieve pain.

OUTCOMES

At the 10-month follow-up appointment, the patient had recovered well, function of the lower extremities had returned to normal, and no signs of recurrence or metastasis were noted.

LESSONS

Although ALT/WDLPS is a locally invasive tumor with good prognosis, delayed treatment is associated with increased tumor size, which can affect lower limb mobility. Therefore, we believe that extensive surgical resection of tumor tissue is a suitable treatment for all ALT/WDLPS cases in order to avoid possible local recurrence. In addition, for ALT/WDLPS tumors that are difficult to extensively excise, long-term follow-ups are necessary due to the possibility of recurrence.

G-CSF-producing Undifferentiated Pleomorphic Sarcoma Adjacent to the Ascending Colon and in the Right Iliopsoas Muscle: A Case Report and Review of the Literature

Undifferentiated pleomorphic sarcoma (UPS) is a soft tissue sarcoma, occurring most commonly on the lower extremities. We herein report a rare case of primary UPS adjacent to the ascending colon and in the right iliopsoas muscle. Computed tomography of the abdomen revealed large masses, and the patient experienced a high-grade fever, leukocytosis, elevated serum C-reactive protein level, and hematopoietic activation on ¹⁸F-fluorodeoxyglucose-positron emission tomography. This inflammatory reaction was caused by granulocyte colony-stimulating factor secreted by tumor cells. Surgical resection was performed, and the inflammatory reaction disappeared immediately. The patient received adjuvant chemotherapy and survived one year after the operation without evidence of recurrence.

[A Surgically Resected Case of Retroperitoneal Liposarcoma with Metastasis]

An 80s man presenting with general malaise and anorexia was referred for treatment of abdominal tumor. Abdominal contrast-enhanced CT revealed a tumor in the left renal cavity. The inside of the tumor coexisted with a fat component and a solid component having a contrast effect. In addition, 2 solid tumors were found to be in contact with the stomach, away from the primary lesion. Based on these findings, retroperitoneal liposarcoma with intraperitoneal metastases was diagnosed. The patient underwent excision of the retroperitoneal tumor and local gastrectomy. The size of the main tumor was 21×18 cm, and the weight was 2.0 kg. Histopathology of the resected specimen showed dedifferentiated liposarcoma and its metastases. The resected margin of the excised tumor was negative. Liposarcoma has a high local recurrence rate, and the status of a resected margin of the tumor is an important factor for prognosis. Here, we report a case of dedifferentiated liposarcoma with metastatic lesions that could be completely resected.

Primary small bowel mesentery de-differentiated liposarcoma causing torsion with no recurrence for 5 years: A case report and review of the literature

RATIONALE

Liposarcoma (LPS) is a rare malignant soft-tissue tumor. Management of LPS is relatively difficult, because there are no characteristic symptoms, or biomarkers, nor any established effective treatment. Hence, the report of the accumulation of each LPS case is necessary. We experienced an extremely rare case of torsion caused by a primary small bowel mesentery LPS.

PATIENT'S CONCERN

A 70-year-old male consulted our hospital with the complaints of abdominal pain and sudden vomiting.

DIAGNOSIS

No lump could be palpated, and tumor markers tested were within normal limits. However, computed tomography revealed an intestinal obstruction caused by torsion of the small bowel due to an LPS tumor.

INTERVENTIONS

After decompression of the intestinal obstruction by use of an ileus tube, surgical treatment was performed with rapidity.

OUTCOME

The torsion was found to be caused by the tumor that originated from the small bowel mesentery. The tumor was resected along with a portion of the small bowel. The growth of adipose tissues of various sizes and containing atypical cells was detected by histopathological examination. Also, immunohistochemical examination resulted in positive immuno-reactions for MDM2, CDK4, and p16INK4, which indicated the tumor to be a de-differentiated LPS. The patient was discharged on postoperative day 14 without any complications, and no recurrence of the tumor was observed at 5 years after the operation.

LESSONS

LPS should be considered in differential diagnosis of bowel torsion, and careful management is required because of the high possibility of recurrence. Patients should be followed carefully for at least 5 years, and further accumulation of data will be required in order to establish the appropriate management of LPS.

Giant primary liposarcoma of the anterior mediastinum: A case report

RATIONALE

Liposarcoma is a cancerous mesenchymal tumor and the most common soft-tissue sarcoma that starts in the adipose tissue. Liposarcoma is commonly found in lower extremities and retroperitoneum, but rarely occurs in the mediastinum.

PATIENT CONCERNS

A 63-year-old male was referred to our clinic with a 6-month history of chronic cough and dyspnea.

DIAGNOSE

Chest x-rays demonstrated a large mass occupying the left hemithorax. Contrast-enhanced computed tomography (CT) revealed a large mass in the anterior mediastinum, which caused the extrinsic compression of the main and left pulmonary artery and the right shift of mediastinum. Diagnosis of liposarcoma was confirmed by microscopic examination and immunohistochemistry analysis.

INTERVENTIONS

The patient underwent a thoracotomy for resection of the mediastinal lesion via left thoracic approach.

OUTCOMES

The patient discharged without any complications and has been continuing to follow up in clinic without any complaints.

LESSONS

The primary mediastinal liposarcoma is rare, and we recommend that the liposarcoma should be considered in the differential diagnosis of a patient presenting with a mediastinal mass.

Laparoscopic resection of large pelvic lipoma causing obstructive uropathy in a 66 year old female - A case report from Greece

Lipomas are benign, usually asymptomatic, tumours and pelvic lipomas are extremely rare. We describe the case of a giant pelvic lipoma causing obstructive uropathy to a 66-year-old morbidly obese female treated in the 4th Surgical Department of the Medical School of Aristotle University of Thessaloniki in General Hospital "G. Papanikolaou" in March 2016. The patient presented with a history of nocturia and frequent daytime urination for 1 year. Her medical history included diffuse lipomatosis. Computer tomography revealed a giant pelvic mass which lead to left side hydronephrosis, hydrouterer and a pear-shaped bladder, with the differential diagnosis including pelvic lipoma or liposarcoma. An ultrasound guided biopsy excluded the diagnosis of liposarcoma. The patient was submitted to laparoscopic resection of the pelvic lipoma, with complete remission of urinary symptoms. The key-point is to consider the possibility that the pelvic mass is a well-differentiated liposarcoma and to manage it adequately and thus, we recommend intact excision of the mass through a wound protector, and extreme caution to avoid any rupture of the capsule.

Liposarcoma of the stomach: Report of two cases and review of the literature

Liposarcoma of the stomach is extremely rare, and only 37 cases have been reported worldwide. We herein report two cases of liposarcoma of the stomach. The first patient was referred to our hospital with upper abdominal discomfort. The endoscopic examination revealed a tumor mass about 3 cm in diameter. The patient underwent a partial gastrectomy and had an uneventful recovery. The histopathological examination revealed a well-differentiated liposarcoma. The second patient had symptoms of upper abdominal discomfort combined with nausea and anorexia. Several palpable masses were found with endoscopy. Endoscopic submucosal dissection was the treatment used, and the postoperative course was uneventful. The histopathological diagnosis was a well-differentiated liposarcoma. The two patients did not undergo any adjuvant therapy. They are both currently in good condition without recurrence. Therefore, we believe that the outcome of liposarcoma of the stomach is positive, and surgical resection may be the first choice for treatment at present.

[Spermatic cord liposarcoma. Report of two cases and bibliographic review.]

OBJECTIVE

We report two cases of patients diagnosed of paratesticular liposarcoma and perform a literature review of this rare entity. Our aim is to clarify its clinical and therapeutic characteristics.

METHODS

Retrospective review of the medical records of two patients diagnosed of liposarcoma of the spermatic cord.

RESULTS

Case 1: 65 year old male, presented a left large scrotal mass of 20 × 14 × 11 cm. He underwent radical orchiectomy. Pathology reported a well differentiated spermatic cord liposarcoma. After one year of follow-up the patient was asymptomatic and there was no evidence of local recurrence. Case 2: A 90 year old man, with past medical history of right orchiectomy for well-differentiated cord liposarcoma 11 years before, and excision of recurrence 7 years ago. On follow up he presented a new 20 × 14 × 11 cm inguinal tumor recurrence. We performed excision of the mass, which was reported by pathology as well differentiated spermatic cord liposarcoma. Ten months after surgery the patient was asymptomatic without recurrence.

CONCLUSIONS

Liposarcoma is a very rare entity and its diagnosis is based on the pathological findings. It is therefore difficult to establish the guidelines for treatment, prognosis and differential diagnosis. As in liposarcomas in other sites, the histological type and grade of the lesion are useful for the prognosis. Radical inguinal orchiectomy and resection of the tumor with a negative microscopic margin is the recommended treatment for liposarcoma of the spermatic cord. It has not been demonstrated the efficacy of adjuvant treatments such as chemotherapy or radiotherapy, except in specific situations. The natural history of disease is slow and it has low mortality, but high recurrence rate, so a long-term monitoring is necessary.

Clinical and pathological characteristics of a series of patients with newly diagnosed primary renal liposarcoma: natural history and effect on survival

OBJECTIVES

Primary renal liposarcoma is an unusual malignant mesenchymal tumor. In this context, all the previous reports were based on cases with insufficient data regarding the natural history of the disease. We decided to fill this gap, reporting the largest single institution series of patients with primary RL and a review of the already available literature.

METHODS

We describe 3 cases with radiologically and histologically-confirmed RL out of 3,224 surgeries performed for primary kidney cancers over 28 years (1987-2015, 0.09%) at a single tertiary care center.

RESULTS

Patients underwent open radical nephrectomy with an anterior transperitoneal access with complete resection of the retroperitoneal mass and retroperitoneal lymph node dissection; all patients died from tumor progression after a mean time of 45 months.

CONCLUSIONS

In conclusion, RL is a very rare mesenchymal renal tumor, with sporadic cases reported. We reported the largest case series of primary RL. The most appropriate approach for RL is nephrectomy with complete resection of all the neoplastic tissue. Stringent follow-up scheme is required due to a high rate of disease recurrence and progression. The role of adjuvant and salvage therapy remains to be investigated.

Lipomas of the Oral Cavity: Utility of MDM2 and CDK4 in Avoiding Overdiagnosis as Atypical Lipomatous Tumor

Traumatized lipomas with degenerative change may demonstrate histopathologic features that mimic atypical lipomatous tumor (ALT). Previously reported series of ALT involving the oral cavity preceded routine use of MDM2 and CDK4 immunohistochemistry. Our aim is to evaluate MDM2 and CDK4 immunohistochemical expression in adipocytic tumors arising in this site, in conjunction with the histiocytic marker PU.1, to determine whether MDM2 and CDK4 impacts classification. 17 cases originally diagnosed as ALT were retrieved and immunohistochemical studies for MDM2, CDK4 and PU.1 were performed. FISH analysis for MDM2 amplification was performed in select cases. For this study group, the male:female ratio was 9:8 and the median age was 62 (range 41-88). All 17 cases presented as well- or predominantly well-circumscribed proliferations of variably sized, mature adipocytes exhibiting uni- or multi-vacuolation with occasional scalloped nuclei and mild nuclear atypia. Variable amounts of fibrous stroma with focal myxoid change and bland spindle cells were identified in 14/17 cases. Lipoblasts or atypical hyperchromatic stromal cells were not identified in any cases. 14 of 17 cases were negative for MDM2 and CDK4 in tumor cells and 11 of these 14 showed weak nuclear positivity for MDM2 in histiocytes. 3 of 17 cases showed weak, multifocal immunohistochemical expression of MDM2 and CDK4. PU.1 highlighted histiocytes in all 17 cases. FISH analysis for MDM2 amplification was negative in all 3 cases with weak MDM2/CDK4 expression. All cases were reclassified as lipoma with degenerative changes. ALT, in all likelihood, is less common than previously thought in this anatomic location and best diagnosed with ancillary studies. MDM2 expression in histiocytes is best interpreted in conjunction with CDK4 immunohistochemistry and confirmatory FISH for MDM2 amplification.

An Unusual Case of Three Synchronous Tumors in a Young Woman

The occurrence in the same young patient of three synchronous tumors deriving from different embryogenic tissues and without a clear correlation with a common etiopathogenic factor is very unusual. We report a case of a Caucasian woman submitted to wide resection of a large retroperitoneal liposarcoma and right radical nephrectomy for suspected tumor infiltration. Histological examination of the right ureter and renal pelvis showed the presence of a multifocal urothelial carcinoma that was clinically asymptomatic. Two months later, during follow-up, chest X-ray and computed tomography documented a coin lesion of the upper left lung, confirmed by positron emission tomography. This nodule was surgically removed and examined histologically, resulting in a diagnosis of sclerosing hemangioma. The patient is alive without evidence of recurrent disease.

[Liposarcoma in the renal compartment: about two cases and literature review]

Retroperitoneal sarcomas are rare and heterogeneous tumors. We here report two cases of liposarcoma in the renal compartment with a literature review in order to emphasize on the anatomical and surgical features of this tumor location and on its possible prognostic implications. The first reported case was a 45-year old female patient with liposarcoma at the level of the left renal compartment. The diagnosis of myxoid liposarcoma was based on anatomo-pathological examination of the surgical specimen. The second reported case was a 70-year old man with liposarcoma at the level of the right renal compartment. The diagnosis of dedifferentiated liposarcoma was based on anatomo-pathological examination of the surgical specimen. Retroperitoneal sarcomas are often diagnosed with a palpable mass. The gold standard treatment is complete tumor resection with healthy resection margins and without damage or rupture. For this purpose resection involving adjacent organs is recommended by some authors. However the anatomical constraints of tretroperitoneal compartment and the often important tumor volume limit the possibilities to achieve a satisfactory resection. CT scan and MRI are very useful imaging techniques. Histological diagnosis poses some problems; therefore immunohistochemistry and sometimes molecular biology are significantly helpful. Patient evolution is marked by the frequent occurrence of recurrences. A specialized multidisciplinary management of these rare and very varied tumors is recommended in order to optimize therapeutic outcomes.

Surgical resection of a massive primary mediastinal liposarcoma with cervical extension

A 73-year-old man was referred for surgical excision of a massive mediastinal and cervical liposarcoma following neoadjuvant chemotherapy. Surgery was performed via a cervical incision, sternotomy and right posterolateral thoracotomy. The tumour arose from the oesophagus, which underwent extensive dissection and was oversewn with pleura after tumour resection. Histology confirmed a completely excised grade 2 de-differentiated liposarcoma with complete macroscopic excision. The patient made an excellent recovery. Oesophageal liposarcomas are rare and, unlike in this case, often extend intraluminally, necessitating oesophagectomy. To our knowledge, this is the largest such tumour found in the literature.

Diagnosis, Classification, and Management of Soft Tissue Sarcomas

BACKGROUND

Soft tissue sarcomas are challenging to oncologists due to their unique character, the infrequency of their occurrence, and the difficulties in predicting outcomes. Advances in imaging, as well as improvements in surgical techniques and adjunctive treatment methods, have improved care for patients with these unusual disorders.

METHODS

The various types of soft tissue tumors are defined, and the statistics for the Orthopaedic Oncology Group in relation to them are reviewed and compared with literature references.

RESULTS

The overall survival rate for 1,220 tumors treated at our institute from June 1972 to June of 2001 was 72%, with a wide range. Patients with leiomyosarcomas, clear cell sarcomas, and malignant fibrous histiocytomas had a poorer survival rate, while those with fibrosarcomas, liposarcomas, and neurofibrosarcomas fared better. Outcome was affected by patient age, tumor anatomic site, tumor stage, and a history of recurrence.

CONCLUSIONS

Competent imaging, predictive immunological and genetic studies, improved surgery, and newer methods of adjunctive and neoadjunctive treatment should result in improvements in outcomes for patients with these tumors.

Well-differentiated inflammatory liposarcoma with metastasis in a 6-y-old cat

Liposarcomas are rare malignant tumors showing adipocytic differentiation. We report a well-differentiated liposarcoma in a 6-y-old, male neutered cat with a prominent inflammatory component and metastatic spread to the lungs. The patient was initially presented because of fever, lethargy, and a firm subcutaneous inguinal mass. A Tru-cut biopsy of the mass revealed a mixture of well-differentiated adipocytes and lymphoplasmacytic-histiocytic inflammation, interpreted as panniculitis. The mass was surgically excised but recurred 4 mo later. A second excisional biopsy yielded similar histologic findings. A third recurrence of the mass was associated with lung nodules. Histopathology of the recurring and metastatic masses confirmed the diagnosis of well-differentiated inflammatory liposarcoma with pulmonary metastases. The neoplasm had an intense inflammatory component, which obscured the underlying features of liposarcoma and made differentiation from steatitis difficult. This inflammatory variant of a well-differentiated liposarcoma should be considered as a differential in tumorous steatitis-like lesions.