[Kombinovaná léčba měkkotkáňového sarkomu v oblasti pánve]

Soft tissue sarcomas (STS) constitute a heterogeneous group of rare malignant tumors of mesenchymal cell origin and they may develop in any part of the body. They can form enormous masses in certain localizations. A case report of a young woman with locally advanced liposarcoma in the pelvic cavity is presented. This example emphasizes the significance of early diagnosis, as only radical surgery can be potentially curative in sarcoma therapy.Key words: advanced pelvic sarcoma multimodal treatment multidisciplinary.

Spermatic cord dedifferentiated liposarcoma presenting as a recurrent inguinal hernia

Paratesticular sarcomas are a rare entity and provide a unique clinical challenge due to their slow growing, often painless natural course. Adding to this challenge is the complex anatomy of the scrotum that allows these masses to mimic other conditions, including inguinal hernia, cysts, or fluid collections. We report such a case and our approach to an 83-year-old male with dedifferentiated liposarcoma of the spermatic cord with a history of inguinal hernia. In doing so, we highlight the need for thorough evaluation of scrotal masses and the management of these rare, though well-described, tumors.

A dedifferentiated large posterior mediastinal liposarcoma - An incidental finding successfully resected

This is a case of a posterior mediastinal mass in an asymptomatic gentleman, which was resected successfully and he has been disease free for more than a year of follow up. The histopathology findings happen to be a rare occurrence.

Significant partial response of metastatic intra-abdominal and pelvic round cell liposarcoma to a small-molecule VEGFR-2 tyrosine kinase inhibitor apatinib: A case report

INTRODUCTION

Myxoid/round cell liposarcoma is the second most common subtype of liposarcoma. Chemotherapy and radiotherapy have a limited efficacy for treating advanced myxoid/round cell liposarcoma, with relatively serious side effects.

CASE PRESENTATION

We herein present a 68-year-old Chinese woman initially diagnosed with advanced multiple intra-abdominal and pelvic round cell liposarcoma.She refused to receive cytotoxic chemotherapy and received apatinib as the first-line therapy, a novel tyrosine kinase inhibitor of vascular endothelial growth factor receptor-2 that has been used in the treatment of patients with metastatic gastric cancer who progressed with 2 or more chemotherapy regimens. This patient was partially responsive to apatinib with a dose of 500 mg daily. No serious drug-related side effects were observed.

CONCLUSION

Our findings indicate that some cases of liposarcoma may be responsive to antiangiogenic agent apatinib. Randomized clinical studies are needed to further confirm the efficacy and safety of apatinib in the clinical treatment of liposarcoma.

Recurrence After Marginal Excision for Atypical Lipomatous Tumors Versus Lipomas of the Extremities

This study reviewed the medical records of 90 patients with lipomas (47 patients) and atypical lipomatous tumors (ALT)/well-differentiated liposarcomas (WDL) (43 patients) of the extremities treated from 2006 to 2012. All patients had preoperative biopsy and postoperative histologic analysis of the tumors; surgical margins were marginal in all cases. Histologic sections of the tissue blocks from the excised specimens were re-reviewed for all patients; a consensus with postoperative histologic analysis was confirmed. Molecular chromosome analysis was performed on fluorescence in situ hybridization in tissue sections from the tissue blocks in all cases for the purpose of this study; a ratio greater than 2 was considered to represent murine double-minute 2 (MDM2) amplification consistent with a diagnosis of ALT/WDL. Mean follow-up was 52 months (range, 14-96 months). Local recurrence and metastasis rates and the relationship of patient age and sex with tumor size and location were evaluated. None of the patients with lipomas experienced local recurrence compared with 6 patients (13.9%) with ALT/WDL who experienced local recurrence within a mean of 48 months (range, 33-96 months); this difference was statistically significant. None of the patients in either group experienced metastasis prior to the study period. Local recurrence did not correlate statistically with patient age or sex, or with tumor size or location. [Orthopedics. 2016; 39(4):e610-e614.].

Patient With Slow-Growing Mediastinal Mass Presents With Chest Pain and Dyspnea

A 52-year-old white woman presented with severe pain over the right upper abdomen and nonpleuritic, right-sided, lower chest-wall pain. Her pain had progressively gotten more frequent and severe over the last 5 months. It was also associated with a nonexertional, pressure-like sensation in the central chest. The patient denied any shortness of breath, fevers, cough, or any sputum production. She was taking levothyroxine for hypothyroidism and was a 30-pack-year current smoker; there was no history of drug abuse or occupational exposure. Previous chest radiographs dating back to 5 years consistently showed an elevated right-sided hemidiaphragm without any infiltrates or effusions; cardiomediastinal structures were unremarkable. She had not had a previous workup for these abnormal findings.

Sclerosing Mesenteritis Presenting as a Pseudotumor of the Greater Omentum

OBJECTIVE

The aim was to demonstrate a diagnostic challenge of sclerosing mesenteritis initially considered as liposarcoma.

CLINICAL PRESENTATION AND INTERVENTION

A 45-year-old man was admitted with a painful abdominal mass. Abdominal computed tomography demonstrated a well- demarcated tumor in his left hemiabdomen, with a large fat component and areas of soft tissue attenuation suggestive of liposarcoma. Intraoperative findings showed a tumor arising from the greater omentum. The tumor was completely removed, and histopathology confirmed a pseudotumorous type of sclerosing mesenteritis with dominant mesenteric lipodystrophy.

CONCLUSION

This case showed that a pseudotumorous type of sclerosing mesenteritis should be considered in the differential diagnosis of the mesenteric tumors.

Near-infrared autofluorescence spectroscopy of in vivo soft tissue sarcomas

Soft tissue sarcomas (STS) are a rare and heterogeneous group of malignant tumors that are often treated via surgical resection. Inadequate resection can lead to local recurrence and decreased survival rates. In this study, we investigate the hypothesis that near-infrared (NIR) autofluorescence can be utilized for tumor margin analysis by differentiating STS from the surrounding normal tissue. Intraoperative in vivo measurements were acquired from 30 patients undergoing STS resection and were characterized to differentiate between normal tissue and STS. Overall, normal muscle and fat were observed to have the highest and lowest autofluorescence intensities, respectively, with STS falling in between. With the exclusion of well-differentiated liposarcomas, the algorithm's accuracy for classifying muscle, fat, and STS was 93%, 92%, and 88%, respectively. These findings suggest that NIR autofluorescence spectroscopy has potential as a rapid and nondestructive surgical guidance tool that can inform surgeons of suspicious margins in need of immediate re-excision.

Multidetector Computed Tomography Features in Differentiating Exophytic Renal Angiomyolipoma from Retroperitoneal Liposarcoma: A Strobe-Compliant Observational Study

This study aims to evaluate the multidetector computed tomography (CT) imaging features in differentiating exophytic renal angiomyolipoma (AML) from retroperitoneal liposarcoma. We retrospectively enrolled 42 patients with confirmed exophytic renal AML (31 patients) or retroperitoneal liposarcoma (11 patients) during 8 years period to assess: renal parenchymal defect at site of tumor contact, supply from branches of renal artery, tumoral vessel extending through the renal parenchyma, dilated intratumoral vessels, hemorrhage, non-fat-containing intratumoral nodules with postcontrast enhancement, calcification, renal sinus enlargement, anterior displacement of kidneys, and other associated AML. Renal parenchymal defect, renal arterial blood supply, tumoral vessel through the renal parenchyma, dilated intratumoral vessels, intratumoral/perirenal hemorrhage, renal sinus enlargement, and associated AML were seen only or mainly in exophytic renal AML (all P value < 0.05); however, non-fat-attenuating enhancing intratumoral nodules, intratumoral calcification, and anterior displacement of the kidney were more common in liposarcoma (all P value < 0.05). AMLs reveal renal parenchymal defect at the site of tumor contact, supply from renal artery, tumoral vessel extending through the renal parenchyma, dilated intratumoral vessels, intratumoral and/or perirenal hemorrhage, renal sinus enlargement, and associated AML. Non-fat-attenuating enhancing intratumoral nodules, intratumoral calcifications, and anterior displacement of kidney were more commonly seen in liposarcoma.

Lipoma and liposarcoma of the larynx: case reports and literature review

OBJECTIVE

Two cases of laryngeal lipomatous tumors are presented. Their diagnoses and management are discussed and contrasted.

METHODS

Case report and literature review.

RESULTS

Patient 1 is a 58 year old male presenting with five years of progressive shortness of breath, dysphagia, and globus sensation. Clinical exam and imaging study showed a 3.5 cm hypodense laryngeal mass, and he underwent transoral robotic-assisted surgery for complete excision. Final pathology revealed a well-differentiated liposarcoma. Patient 2 is a 79 year old female presenting with one year of non-progressive hoarseness and globus sensation. Clinical examination and imaging study revealed a 1.8 cm hypodense laryngeal mass. Transoral endoscopic complete excision of the submucosal mass was performed. Final pathology revealed benign spindle-cell lipoma.

CONCLUSION

Liposarcoma and lipoma may present with similar symptomatology, clinical, and imaging findings. Pathology evaluation is of utmost importance for definitive diagnosis. Therefore, diagnosis and treatment of laryngeal lipomatous lesions are best accomplished with complete excision of the mass.

Immunohistochemical, cytogenetic, and molecular cytogenetic characterization of both components of a dedifferentiated liposarcoma: implications for histogenesis

Dedifferentiated liposarcoma (DDLS) is a malignant adipocytic tumor showing transition from an atypical lipomatous tumor (ALT)/well-differentiated liposarcoma (WDLS) to a non-lipogenic sarcoma of variable histological grades. We present the immunohistochemical, cytogenetic, and molecular cytogenetic findings of DDLS arising in the right chest wall of a 76-year-old man. Magnetic resonance imaging exhibited a large mass composed of two components with heterogeneous signal intensities, suggesting the coexistence of a fatty area and another soft tissue component. The grossly heterogeneous mass was histologically composed of an ALT/WDLS component transitioning abruptly into a dedifferentiated component. Immunohistochemistry was positive for murine double-minute 2 (MDM2), cyclin-dependent kinase 4 (CDK4), and p16 in both components, although a more strong and diffuse staining was found in the dedifferentiated area. The MIB-1 labeling index was extremely higher in the dedifferentiated area compared to the ALT/WDLS area. Cytogenetic analysis of the ALT/WDLS component revealed the following karyotype: 46,X,-Y,+r. Notably, cytogenetic analysis of the dedifferentiated component revealed a similar but more complex karyotype. Spectral karyotyping demonstrated that the ring chromosome was entirely composed of material from chromosome 12. Interphase fluorescence in situ hybridization analysis revealed amplification of MDM2 and CDK4 in both components. These findings suggest that multiple abnormal clones derived from a single precursor cell would be present in DDLS, with one or more containing supernumerary rings or giant marker chromosomes.

Application of molecular biology to individualize therapy for patients with liposarcoma

Liposarcomas are one the most common of over 50 histologic subtypes of soft tissue sarcomas that are mostly resistant to chemotherapy. Histologically, liposarcomas themselves are heterogeneous and fall into four distinct subtypes: well-differentiated/atypical lipomatous tumor, dedifferentiated liposarcoma, myxoid (round cell) liposarcoma, and pleomorphic liposarcoma. Surgical resection with negative margins remains the mainstay for definitive treatment for operable disease. For unresectable disease, retrospective studies have identified myxoid (round cell) and pleomorphic sarcomas to be relatively responsive to chemotherapy. Recent studies have identified distinct genetic aberrations that not only aid in the diagnosis of particular liposarcoma subtypes, but represent actionable targets as they are considered central to disease pathogenesis. Cyclin-dependent kinase 4 (CDK4) and murine double minute 2 (MDM2) are overexpressed in well-differentiated and dedifferentiated liposarcomas and offer tantalizing opportunities that are being pursued in clinical trials. Myxoid (round cell) liposarcomas appear to be sensitive to trabectedin, which is currently under U.S. Food and Drug Administration (FDA) review. Liposarcomas do not represent a uniform disease and understanding the underlying molecular mechanism will help not only in accurate diagnosis but in selecting the appropriate treatment.

A large well-differentiated spindle cell liposarcoma (atypical spindle cell lipomatous tumor): clinicopathologic and immunohistochemical analysis. Diagnostic and therapeutic features

Liposarcoma is one of the more common types of soft tissue sarcomas, presenting with a wide spectrum of clinical behaviour. It is subdivided into five distinct histologic subtypes: well-differentiated, mixoid, pleomorphic, dedifferentiated and mixed-type. Well-differentiated liposarcoma accounts for about 40% to 45% of all liposarcomas therefore representing the larger subgroup of adipocytic malignancies. Well-differentiated spindle cell liposarcoma is an extremely rare subtype of well-differentiated liposarcoma/atypical lipomatous tumor which is different from the other subtypes clinicopathologically, genetically and prognostically. The most common frequent locations of lipomatous tumours are: limbs, groin, scrotum, abdominal wall and retroperitoneal area. MRI examination is a highly reliable method in the diagnosis of these neoplasms. Surgical management includes wide resection of the tumour with or without additional postoperative radiotherapy and/or chemotherapy. We describe a case of 68-year old patient with large well-differentiated spindle cell liposarcoma of the left thigh. We are discussing the clinical findings, diagnosis and therapeutic approach. In these cases, a preoperative disease classification discriminating the tumour nature is closely linked to the correct surgical management of patients.

A pedunculated giant esophageal liposarcoma: a case report and literature review

INTRODUCTION

The majority of esophageal tumors arise from the mucosal layer; only 5 % are of mesenchymal origins. Of the latter, barely 0.5 % are liposarcomas. We present a case of an esophageal liposarcoma with a review of the literature.

CASE REPORT

A 64-year-old male was referred with 5 years of progressive dysphagia. Preoperative evaluation initially suggested a leiomyoma. The polypoid lesion was then resected through a cervical esophagotomy, once endoscopic resection proved to be not feasible. The definitive pathologic diagnosis confirmed a well-differentiated liposarcoma.

LITERATURE REVIEW

Esophageal liposarcomas are very rare and only 40 such cases have been reported in the literature. Most patients were male (80 %), the median age was 62 years (range 38-83 years), and the most common symptom was dysphagia (85 %). Only in two cases was a liposarcoma detected on preoperative biopsy. The most common histological subtype was well-differentiated liposarcoma. Overall, 77.5 % of the patients were successfully treated with surgery, 20 % endoscopically, and 2.5 % were ablated with CO2 laser.

CONCLUSION

Esophageal liposarcoma is an extremely rare tumor. The majority of patients are males; dysphagia is the most common initial symptom, and preoperative biopsy is unreliable. Because these tumors are pedunculated, well-circumscribed, and well-differentiated, they can be safely resected locally. All patients need long-term follow-up as this disease can recur many decades after treatment.

Lipomatous tumours of the hand and wrist A series of 25 cases and review of the literature

consequently reports in the international literature are mainly of individual cases and small series.

MATERIAL OF STUDY

This is a retrospective review of a series of 25 patients with lipomatous tumours of the hand and wrist treated between 2001 and 2009. All patients underwent clinical and radiological assessment and a marginal excisional biopsy. 23 lipomas, 1 fibrolipomatous hamartoma (FLH) and 1 well differentiated lipoma-like liposarcoma/atypical lipomatous tumour (WDLLL/ALT) were identified.

CONCLUSION

Choosing the most appropriate investigations is mandatory for a correct diagnosis and planning. Ultrasound should always be considered as the first line investigation. MRI helps delineating the anatomy of the lesions and their relationships with the surrounding structures in the hand and wrist, enabling more accurate surgical planning. Histological examination of the excised specimen remains the gold standard for the formulation of the definitive diagnosis and should be performed in every case.

KEY WORDS

Digits tumours, Fibrolipomatous hamartoma, Hand tumours, Lipoma, Lipoma-like liposarcoma, Wrist tumours.

[Most musculoskeletal soft tissue tumors are benign]

Most musculoskeletal soft tissue tumors are benign, lipoma being the most common. Malignant soft tissue tumors may be difficult to clinically distinguish from benign. Scandinavian recommendations are that all lesions suspicious for sarcoma be referred to a sarcoma center. This has led to improved tumor control and less post-operative functional deficits. Magnetic resonance imaging (MRI) can reliably diagnose lipomas, and further work-up is not necessary. Lipomas can be treated at the local hospital. All deep seated musculoskeletal tumors (under the muscle fascia) not unequivocally lipomas should be referred to a sarcoma center. All superficial (subcutaneous) musculoskeletal tumors larger than 5 cm and not unequivocally lipomas should be referred to a sarcoma center.

[Liposarcoma in the lung misinterpreted as an infection of Echinococcus multicularis]

Primary liposarcoma of the lung is an extremely rare disease. Only 14 cases have been reported in the literature in English. Liposarcoma is not sensitive to chemotherapy or radiotherapy. Surgical resection is considered the only therapeutic option. We present a case of a giant liposarcoma occupying two thirds of the right thoracic cavity.

Differentiation of lipoma from liposarcoma on MRI using texture and shape analysis

RATIONALE AND OBJECTIVES

To determine if differentiation of lipoma from liposarcoma on magnetic resonance imaging can be improved using computer-assisted diagnosis (CAD).

MATERIALS AND METHODS

Forty-four histologically proven lipomatous tumors (24 lipomas and 20 liposarcomas) were studied retrospectively. Studies were performed at 1.5T and included T1-weighted, T2-weighted, T2-fat-suppressed, short inversion time inversion recovery, and contrast-enhanced sequences. Two experienced musculoskeletal radiologists blindly and independently noted their degree of confidence in malignancy using all available images/sequences for each patient. For CAD, tumors were segmented in three dimensions using T1-weighted images. Gray-level co-occurrence and run-length matrix textural features, as well as morphological features, were extracted from each tumor volume. Combinations of shape and textural features were used to train multiple, linear discriminant analysis classifiers. We assessed sensitivity, specificity, and accuracy of each classifier for delineating lipoma from liposarcoma using 10-fold cross-validation. Diagnostic accuracy of the two radiologists was determined using contingency tables. Interreader agreement was evaluated by Cohen kappa.

RESULTS

Using optimum-threshold criteria, CAD produced superior values (sensitivity, specificity, and accuracy are 85%, 96%, and 91%, respectively) compared to radiologist A (75%, 83%, and 80%) and radiologist B (80%, 75%, and 77%). Interreader agreement between radiologists was substantial (kappa [95% confidence interval]=0.69 [0.48-0.90]).

CONCLUSIONS

CAD may help radiologists distinguish lipoma from liposarcoma.

D-dimer levels in the differential diagnosis between lipoma and well-differentiated liposarcoma

BACKGROUND

Lipoma and well-differentiated liposarcoma (WDLS) are two representative lipogenic soft tissue tumors that have similar clinical, radiological, and pathological characteristics. Accordingly, it is difficult to distinguish these tumors preoperatively. Plasma D-dimer levels are associated with the status of tumor progression, and we hypothesized that D-dimer levels could contribute to differential diagnosis. The D-dimer levels of these two entities have not yet been reported.

PATIENTS AND METHODS

We investigated 43 cases of lipoma and 14 cases of WDLS. We evaluated the utility of D-dimer levels and other clinicopathological factors for preoperative differential diagnosis between the two entities.

RESULTS

Receiver operating characteristic analysis revealed that the D-dimer level may contribute to differential diagnosis (area under the curve=0.73). Univariate and multivariate models demonstrated that plasma D-dimer levels (p=0.001 (univariate), and p=0.006 (multivariate)) and lower extremity location (p=0.006 (univariate), and p=0.03 (multivariate)) were independent risk factors for WDLS.

CONCLUSION

The D-dimer level may be a helpful marker for preoperative differential diagnosis between lipoma and WDLS.

Retroperitoneal sarcomas: patterns of care in advanced stages, prognostic factors and focus on main histological subtypes: a multicenter analysis of the French Sarcoma Group

BACKGROUND

Retroperitoneal sarcomas (RPS) are heterogeneous. Advanced stages include unresectable locoregional (LR) disease, abdominal sarcomatosis and distant metastasis. There is no available report assessing palliative chemotherapy in advanced RPS. This study analyzes management and outcome in a large cohort of patients with advanced RPS, considering main histological subtypes separately.

PATIENTS AND METHODS

We conducted a retrospective analysis of adult patients diagnosed with a RPS between 1 January 1988 and 31 December 2008 across 12 centers of the French Sarcoma Group. All cases were centrally reviewed by an expert pathologist.

RESULTS

Five-hundred eighty-six patients were included, 299 patients received palliative chemotherapy, with a median of two lines (range 0-8). Fifty patients underwent palliative surgery. Two hundred fifty-five patients (85%) were assessable for response after first line of chemotherapy. Among them, 69 patients (27%) had progressive disease, 145 (57%) had stable disease, 37 (14.5%) had partial response and 4 (1.5%) complete response. Median time from first line of palliative chemotherapy to progression was 5.9 months [4.9-7.3] and median overall survival (OS), 15.8 months [13-18]. In multivariate analysis, prognosis factors independently associated with poor OS were male gender, performance status (PS) >1 and grade >1. There was no difference according to stage of disease. Palliative surgery did not appear to add any survival benefit.

CONCLUSION

These results emphasize the scarcity of available options for RPS in the advanced setting and the urgent need to develop new strategies. Patients with good PS should be included in clinical trials and best supportive care should be considered in those with poor PS.