Liposarcoma of the musculoskeletal system

Two hundred eleven cases with the diagnosis of liposarcoma of the musculoskeletal system were reviewed. The mean age at diagnosis was 52.9 years. The primary site was the proximal lower extremity in 52%. Myxoid-type liposarcoma was most frequent (60%). Metastasis was observed in 45%. One hundred two patients without prior treatment or distant spread at diagnosis were studied separately. Recurrence was noted in 26%. The median survival time was 7.5 years, with a 5-year survival of 59% and a 10-year survival of 45%. Significant variation in survival time was related to histologic grade, Enneking's stage, tumor size, and histologic type.

Atypical and malignant neoplasms showing lipomatous differentiation. A study of 111 cases

One-hundred-eleven cases of histopathologically atypical or malignant lipomatous lesions in the somatic soft tissue and retroperitoneum were studied. These consisted of 48 differentiated fatty neoplasms of the somatic soft tissues (DFT-S), 21 fatty neoplasms of the retroperitoneum (DFT-R), 33 myxoid liposarcomas from various sites and nine pleomorphic liposarcomas. DFT-S were defined as lipomatous lesions composed of mature fat and containing atypical stromal cells or lipoblasts. In the somatic soft tissues, this group included lesions that would be classified using published criteria as "atypical lipoma", "pleomorphic lipoma", "well-differentiated lipoma-like liposarcoma", and "sclerosing liposarcoma". All of the DFT-R met previously published criteria for "well differentiated liposarcoma" or "sclerosing liposarcoma". We found no consistent histologic differences between the DFT-S and DRT-R. No pure "round cell" liposarcomas were encountered although many myxoid liposarcomas had "round cell" areas. Follow-up data were available in 80 cases (72%) with a mean follow-up period of over 7 years. Among the DFT-S there were no uncontrollable recurrences, distant metastases, or tumor-related deaths. The depth of the neoplasm correlated with the tendency for local recurrence; no neoplasms primary in the subcutis recurred; 29% of the tumors recurred when they originated in the deep soft tissues or within the muscle. None of the recurrent tumors demonstrated "dedifferentiation." DFT-R had a recurrence rate of 67% and, although there were no distant metastases, nine patients (43%) died of tumor. Five retroperitoneal tumors dedifferentiated but did not metastasize. In light of this experience, we believe that the term "atypical lipoma" is warranted for the DFT-S and "well differentiated liposarcoma" is an appropriate label for the DFT-R. The overall mean survival for the 52 cases of liposarcoma (excluding DFT-S) was 13.6 years. The mean survival in "well differentiated liposarcoma" (11.25 years) was between that for myxoid liposarcoma (16.25 years) and that for pleomorphic liposarcoma (7 years). Six patients (29%) with myxoid liposarcoma developed local recurrences and 6 patients (29%) developed distant metastases and died. Metastasis was always associated with a round cell (or pleomorphic) component with increased numbers of mitotic figures in either the primary tumor or a local recurrence.

Prognostic features of pediatric soft-tissue sarcomas

Eight hundred ninety-two patients under 20 years of age with soft-tissue sarcomas histologically diagnosed between 1955 and 1971 (before the era of combined modality therapy) were reviewed to delineate important prognostic variables. Differing histologic findings, extent of disease at initial presentation, and site of the primary tumor correlated with prognosis; age, sex, and race did not affect survival significantly. Patients with fibrosarcomas, liposarcomas, and leiomyosarcomas had improved survival rates when compared with adults with the same histologic findings; patients with localized tumors and extremity primary sites had the best prognosis. Patients with rhabdomyosarcomas, disseminated disease, or retroperitoneal primary sites had the worst prognosis. These data suggest that some childhood sarcomas are not as aggressive as adult sarcomas or childhood rhabdomyosarcomas. Therefore they may not require the adjuvant therapy shown to be beneficial in childhood rhabdomyosarcomas.

Liposarcoma: a ten year experience

A retrospective study of all patients presenting with liposarcoma at Southend General Hospital between the years 1970 and 1979 is presented. There were 13 patients in the group treated with various combinations of surgery and radiotherapy. The histology has been reviewed: 7 patients had myxoid tumours, 2 well differentiated and 4 pleomorphic. The patients were followed up for between 18-109 months with 7 patients followed for more than 5 years. Local recurrence was seen only in myxoid tumours whereas pleomorphic tumours showed a high incidence of distant metastases. The length of survival was found to correlate with the histology, pleomorphic tumours being associated with the shortest survival. The series illustrates that the histological type of liposarcoma predicts the pattern of behaviour of the tumour and is the major determinant in prognosis.

Prognostic factors in liposarcoma

In a series of 99 liposarcomas, the prognostic impact of the various diagnostic and therapeutic factors was analyzed. The analysis indicated that the tumor size, histologic subtype, and x-ray density are important prognostic factors. The prognosis is also influenced by operability and treatment modalities employed. Treatment strategy should be radical, irrespective of the actual prognostic factors.

Childhood liposarcoma. Report of a case and review of the literature

A case of liposarcoma presenting in an adolescent black male is described. Features unique to this case include a mediastinal primary site (the fourth to be documented in a pediatric patient), a demonstrable response to radiotherapy and chemotherapy allowing complete surgical excision of an initially inoperable tumor, and the apparent histologic maturation of the tumor following multimodal therapy. A review of previously published accounts of pediatric liposarcoma revealed the following: (1) peak incidences during infancy and in early adolescence; (2) the extremities to be the most common site of origin (51%); (3) a predominance of myxoid histology (76%); and (4) a lower overall recurrence rate when compared with adult cases (37% versus 72%, respectively). The influence of histology, location of the tumor, and completeness of surgical excision on the prognosis of adult liposarcoma was confirmed in this limited pediatric experience. While the use of radiotherapy and chemotherapy cannot be advocated in all instances of liposarcoma, our experience and that from other reports would support the incorporation of these modalities of treatment in selected patients where the tumor is surgically inaccessible due to size.

[Surgical therapy of liposarcoma]

The clinical course of 17 patients with liposarcoma was followed from 6 months to 20 years. Local recurrence was seen in 11 patients, metastases in 3. Survival was 1 year in one case up to 18 years in another. There was a close correlation of survival and histological findings. There was also a distinct influence of primary surgical therapy on local recurrence rate. In our opinion, the extent of excision of the primary tumor is most important in the treatment of liposarcoma.

Liposarcoma. A clinicopathologic subtyping of 52 cases

Fifty-two cases of liposarcoma were analyzed clinicopathologically, and were grouped into the following five types: myxoid (28 cases), well-differentiated (14 cases), pleomorphic (4 cases), round-cell (3 cases), and mixed (3 cases). Three of the 28 myxoid tumors showed a pleomorphic pattern resembling that of the myxoid variant of malignant fibrous histiocytoma, and one of the 3 round-cell tumors was considered to be a malignant counterpart of hibernoma. Ages ranged from 22 to 86 years with the average age of 49 years, the average patients with myxoid or round-cell liposarcoma being over 10 years younger than those with well-differentiated or pleomorphic liposarcoma. There was also a variation in the site of predilection of the cases: the great majority of myxoid type tumors occurred in the thigh, popliteal fossa and buttock (23 cases), while the majority of well-differentiated type tumors were seen in the retroperitoneum (10 cases). The rate of local recurrence of the tumor was 46%. Four of the 5 well-differentiated liposarcomas which recurred exhibited dedifferentiated pleomorphic components resembling those in malignant fibrous histiocytoma. The prognosis was more favorable in patients with ordinary myxoid tumors than in those with well-differentiated tumors. The overall relative five-year survival rate was 63%.

[Liposarcoma in adults. Prognostic factors in a series of 84 cases (author's transl)]

A retrospective study of 84 patients with liposarcoma treated at the Gustave Roussy Institute between 1956 and 1978 has elicited a number of factors which influence the prognosis, namely: (1) the site of the initial tumour: patients with liposarcoma of the head, trunk and extremities have a better survival rate than those with retroperitoneal tumours or tumours of the pelvic and pectoral girdles; (2) the histological type: differentiated forms have a brighter prognosis than undifferentiated forms; (3) the size of the tumour: tumours of less than 10 cm in diameter have a more favourable prognosis than larger tumours; and (4) the patient's age, which in fact correlates with the histological type. Local recurrences are common but do not seem to worsen the prognosis. The only curative treatment is surgery, but radiotherapy reduces the risk of local recurrences and chemotherapy may be considered in cases with poor prognosis.

Primary retroperitoneal sarcomas: the role of surgical treatment

Attempting to understand the role surgical excision plays in the therapeutic efforts to provide cure or palliation in patients with retroperitoneal sarcomas, the literature on the subject was reviewed and 13 such cases were analyzed. A palpable abdominal mass was recorded in 10 patients. Intravenous pyelography suggested the diagnosis in nine patients. The diagnosis was difficult to establish before celiotomy, which was performed in 12 patients. In six the tumor was unresectable; it was partially resected in five and completely removed in one. This study suggests that the primary mode of spread of these tumors is direct invasion. The only objective benefit of operation was to provide a tissue-proven diagnosis. Radiation therapy, after the diagnosis was established, appeared to be the most effective therapeutic measure for retroperitoneal sarcomas. The value of additional chemotherapy could not be established.

Liposarcomas: prognosis and management

Fifty-one evaluable patients with liposarcomas were reviewed. Two-thirds of the patients were referred after local recurrence. One-third with primary surgery at RPMI had local recurrence rate of 31.6%. Overall, one or more local recurrences presented in 78% of patients. Pulmonary metastases, occurred in 45%, while liver metastases in 13.6%. Most common primary sites were the lower extremity, followed by the retroperitoneal area and upper extremity. Median survival is better for upper and lower extremities than other areas (P less than 0.01). The medium survival was longer in the group that received radiation after resection although the difference was not statistically significant. The high rate of local recurrences suggests the adjuvant use of radiation postoperatively when the surgical margins have not been adequate. Sixteen patients are alive and disease-free, with 10 of them having had five years or longer follow-up.

The relative roles of surgery and radiotherapy in the management of soft tissue sarcomas of adults. A personal appraisal

The literature of the last 25 years pertaining to the treatment of sarcomas of the soft somatic tissues by surgery and radiotherapy, both separately and in combination, has been reviewed. Surgery alone, if it is to be successful in an appreciable proportion of cases, must be radical. There is a growing body of evidence which suggests that less-than-radical surgery in combination with postoperative radiotherapy may give results equal or superior to those of radical surgery alone. There is need for a multicentre controlled clinical trial to compare the results of the two modes of treatment.

Liposarcoma. A review of 60 cases

Sixty cases of liposarcoma are presented. The pathological appearances, clinical features and methods of treatment are described. The overall 5-year survival was 64%.