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Merino-Rueda LR, Casas-Ramos P, Honrado-Franco E, Izquierdo-García FM, Ramos-Pascua LR. [Translated article] Comparative study of deep lipomas and atypical lipomatous tumours: Malignancy risk factors. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T383-T389. [PMID: 38508379 DOI: 10.1016/j.recot.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/17/2023] [Accepted: 01/02/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The diagnostic suspicion of an atypical lipomatous tumour (ALT) is difficult. The aim of this study is to delve into the most controversial diagnostic aspects of the subject. MATERIAL AND METHOD Observational, longitudinal and retrospective study of a series of 96 deep adipose tumours (75 lipomas and 21 TLA) from 2006 to 2016: demographic, clinical, imaging and pathological variables were analysed and compared, as well as other variables related to treatment and oncological outcomes of the patients. A descriptive analysis of the collected variables was performed for the statistical study. To evaluate the potential predictor variables of malignancy, a multivariate logistic regression analysis was performed, including those that were statistically significant in the univariate analysis. RESULTS Older age at diagnosis, lower limb location and larger size were significantly more frequent in ALTs. MRI findings showed no statistically significant differences between the two groups. In multivariate analysis, the same clinical variables were confirmed as predictors of malignancy. In the ROC curve, an optimal cut-off point of 134.0mm was used as a predictor of malignancy. CONCLUSIONS Advanced age, location in the lower limbs and larger size are risk factors for malignancy in the differential diagnosis of deep lipomas and atypical lipomatous tumours. No radiological variable on MRI reached significance as a predictor of malignancy in our series.
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Affiliation(s)
- L R Merino-Rueda
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, Spain; Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz, Madrid, Spain.
| | - P Casas-Ramos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de León, León, Spain
| | - E Honrado-Franco
- Servicio de Anatomía Patológica, Hospital Universitario de León, León, Spain
| | | | - L R Ramos-Pascua
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, Spain
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Merino-Rueda LR, Casas-Ramos P, Honrado-Franco E, Izquierdo-García FM, Ramos-Pascua LR. Comparative study of deep lipomas and atypical lipomatous tumours: Malignancy risk factors. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:383-389. [PMID: 38199434 DOI: 10.1016/j.recot.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/17/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The diagnostic suspicion of an atypical lipomatous tumour (ALT) is difficult. The aim of this study is to delve into the most controversial diagnostic aspects of the subject. MATERIAL AND METHOD Observational, longitudinal, and retrospective study of a series of 96 deep adipose tumours (75 lipomas and 21 TLA) from 2006 to 2016: demographic, clinical, imaging and pathological variables were analysed and compared, as well as other variables related to treatment and oncological outcomes of the patients. A descriptive analysis of the collected variables was performed for the statistical study. To evaluate the potential predictor variables of malignancy, a multivariate logistic regression analysis was performed, including those that were statistically significant in the univariate analysis. RESULTS Older age at diagnosis, lower limb location and larger size were significantly more frequent in ALTs. MRI findings showed no statistically significant differences between the two groups. In multivariate analysis, the same clinical variables were confirmed as predictors of malignancy. In the ROC curve, an optimal cut-off point of 134.0 mm was used as a predictor of malignancy. CONCLUSIONS Advanced age, location in the lower limbs and larger size are risk factors for malignancy in the differential diagnosis of deep lipomas and atypical lipomatous tumours. No radiological variable on MRI reached significance as a predictor of malignancy in our series.
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Affiliation(s)
- L R Merino-Rueda
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España; Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz, León, Madrid, España.
| | - P Casas-Ramos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de León, León, España
| | - E Honrado-Franco
- Servicio de Anatomía Patológica, Hospital Universitario de León, León, España
| | | | - L R Ramos-Pascua
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España
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Ono Y, Okubo Y, Washimi K, Mikayama Y, Doiuch T, Hasegawa C, Yoshioka E, Ono K, Shiozawa M, Yokose T. Primary omental smooth muscle tumor in an adult male: a diagnostic dilemma for leiomyoma: a case report. J Med Case Rep 2024; 18:222. [PMID: 38704583 PMCID: PMC11070120 DOI: 10.1186/s13256-024-04537-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/02/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The greater omentum comprises peritoneal, adipose, vascular, and lymphoid tissues. Most omental malignancies are metastatic tumors, and the incidence of primary tumors is rare. We report on a prior omental smooth muscle tumor case in an adult male patient. CASE PRESENTATION A 54-year-old Japanese male patient with no relevant medical history was diagnosed with an abdominal mass during a routine medical checkup. Subsequent contrast-enhanced computed tomography revealed a mass of approximately 3 cm in size in the greater omentum, and a laparotomy was performed. A 27 × 25 × 20 mm raised lesion was found in the omentum. Microscopically, spindle cells were observed and arranged in whorls and fascicles. Individual tumor cells had short spindle-shaped nuclei with slightly increased chromatin and were characterized by a slightly eosinophilic, spindle-shaped cytoplasm. The mitotic count was less than 1 per 50 high-power fields. The tumor cells showed positive immunoreactivity for α smooth muscle actin, HHF35, and desmin on immunohistochemical examination. The Ki-67 labeling index using the average method was 1.76% (261/14806). No immunoreactivity was observed for any of the other tested markers. We considered leiomyoma owing to a lack of malignant findings. However, primary omental leiomyoma has rarely been reported, and it can be difficult to completely rule out the malignant potential of smooth muscle tumors in soft tissues. Our patient was decisively diagnosed with a primary omental smooth muscle tumor considering leiomyoma. Consequently, the patient did not undergo additional adjuvant therapy and was followed up. The patient was satisfied with treatment and showed neither recurrence nor metastasis at the 13-month postoperative follow-up. DISCUSSION AND CONCLUSION We encountered a primary smooth muscle tumor of the greater omentum with no histological findings suggestive of malignancy in an adult male patient. However, omental smooth muscle tumors are extremely difficult to define as benign, requiring careful diagnosis. Further case reports with long-term follow-up and case series are required to determine whether a true omental benign smooth muscle tumor (leiomyoma) exists. In addition, proper interpretation of the Ki-67 labeling index should be established. This case study is a foundation for future research.
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Affiliation(s)
- Yukari Ono
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Yoichiro Okubo
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan.
| | - Kota Washimi
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Yo Mikayama
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Tsunehiro Doiuch
- Department of Diagnostic and Interventional Radiology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Chie Hasegawa
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Emi Yoshioka
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Kyoko Ono
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Manabu Shiozawa
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Tomoyuki Yokose
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
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Washimi K, Hiroshima Y, Sato S, Ueno M, Kobayashi S, Yamamoto N, Hasegawa C, Yoshioka E, Ono K, Okubo Y, Yokose T, Miyagi Y. Evaluation of pancreatic cancer specimens for comprehensive genomic profiling. Pathol Int 2024; 74:252-261. [PMID: 38477638 DOI: 10.1111/pin.13416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/30/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024]
Abstract
Inadequate specimen quality or quantity hinders comprehensive genomic profiling in identifying actionable mutations and guiding treatment strategies. We investigated the optimal conditions for pancreatic cancer specimen selection for comprehensive genomic profiling. We retrospectively analyzed 213 pancreatic cancer cases ordered for comprehensive genomic profiling and compared results from pancreatic biopsy, liver biopsy of pancreatic cancer metastases, pancreatectomy, liquid, and nonliver metastatic organ specimens. We examined preanalytical conditions, including cellularity (tumor cell count/size). The successfully tested cases were those that underwent comprehensive genomic profiling tests without any issues. The successfully tested case ratio was 72.8%. Pancreatic biopsy had the highest successfully tested case ratio (87%), with a high tumor cell percentage, despite the small number of cells (median, 3425). Pancreatic biopsy, liver biopsy of pancreatic cancer metastases, and non-liver metastatic organ had higher successfully tested case ratios than that for pancreatectomy. Liver biopsy of pancreatic cancer metastases and pancreatectomy cases with tumor size (mm2) × tumor ratio (%) > 150 and >3000, respectively, had high successfully tested case ratios. The success of comprehensive genomic profiling is significantly influenced by the tumor cell ratio, and pancreatic biopsy is a potentially suitable specimen for comprehensive genomic profiling.
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Affiliation(s)
- Kota Washimi
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Yukihiko Hiroshima
- Division of Advanced Cancer Therapeutics, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa, Japan
- Center for Cancer Genome Medicine, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Shinya Sato
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
- Division of Molecular Pathology and Genetics, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa, Japan
| | - Makoto Ueno
- Department of Gastoroenterology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Satoshi Kobayashi
- Department of Gastoroenterology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Naoto Yamamoto
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Chie Hasegawa
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Emi Yoshioka
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Kyoko Ono
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Yoichiro Okubo
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Tomoyuki Yokose
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Yohei Miyagi
- Center for Cancer Genome Medicine, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
- Division of Molecular Pathology and Genetics, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa, Japan
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Kaltsas A, Zachariou A, Tien DMB, Takenaka A, Sofikitis N. An Atypical Case of Bladder Lipoma Presenting as Gross Hematuria: A Case Report. Cureus 2023; 15:e42471. [PMID: 37521590 PMCID: PMC10375420 DOI: 10.7759/cureus.42471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/01/2023] Open
Abstract
While conventional lipomas represent the most commonly seen benign mesenchymal tumor in adults, their occurrence in the bladder wall is exceptionally rare. This report details a rare case of a bladder lipoma, a benign tumor primarily composed of mature adipocytes, presenting as gross hematuria in a 68-year-old male. Despite the patient's previous history of left nephrectomy, no significant pathological findings were initially observed. The bladder lipoma was detected via cystoscopy as a polypoid mass on the posterior bladder wall and confirmed through transurethral resection of the bladder tumor (TUR-BT). Histopathological analysis verified the mass as a bladder lipoma composed of mature adipocytes. Following a specific postoperative follow-up period, no recurrence of the tumor was observed, suggesting successful treatment. This case underscores the clinical significance of considering bladder lipoma in differential diagnoses of bladder tumors, especially in patients presenting with gross hematuria, given its exceptional rarity.
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Affiliation(s)
- Aris Kaltsas
- Department of Urology, University of Ioannina, Ioannina, GRC
| | | | - Dung Mai Ba Tien
- Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, VNM
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago, JPN
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Gambella A, Bertero L, Rondón-Lagos M, Verdun Di Cantogno L, Rangel N, Pitino C, Ricci AA, Mangherini L, Castellano I, Cassoni P. FISH Diagnostic Assessment of MDM2 Amplification in Liposarcoma: Potential Pitfalls and Troubleshooting Recommendations. Int J Mol Sci 2023; 24:ijms24021342. [PMID: 36674856 PMCID: PMC9863600 DOI: 10.3390/ijms24021342] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
MDM2 amplification represents the leading oncogenic pathway and diagnostic hallmark of liposarcoma, whose assessment is based on Fluorescence In Situ Hybridization (FISH) analysis. Despite its diagnostic relevance, no univocal interpretation criteria regarding FISH assessments of MDM2 amplification have been established so far, leading to several different approaches and potential diagnostic misinterpretations. This study aims to address the most common issues and proposes troubleshooting guidelines for MDM2 amplification assessments by FISH. We retrospectively retrieved 51 liposarcomas, 25 Lipomas, 5 Spindle Cell Lipoma/Pleomorphic Lipomas, and 2 Atypical Spindle Cell Lipomatous Tumors and the corresponding MDM2 FISH analysis. We observed MDM2 amplification in liposarcomas cases only (43 out of 51 cases) and identified three MDM2-amplified patterns (scattered (50% of cases), clustered (14% of cases), and mixed (36% of cases)) and two nonamplified patterns (low number of signals (82% of cases) and polysomic (18% of cases)). Based on these data and published evidence in the literature, we propose a set of criteria to guide MDM2 amplification analysis in liposarcoma. Kindled by the compelling importance of MDM2 assessments to improve diagnostic and therapeutic liposarcoma management, these suggestions could represent the first step to develop a univocal interpretation model and consensus guidelines.
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Affiliation(s)
- Alessandro Gambella
- Division of Liver and Transplant Pathology, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | - Luca Bertero
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | - Milena Rondón-Lagos
- School of Biological Sciences, Universidad Pedagógica y Tecnológica de Colombia, Tunja 150003, Colombia
| | - Ludovica Verdun Di Cantogno
- Department of Laboratory Medicine, Azienda Ospedaliera Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Nelson Rangel
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá 110231, Colombia
| | - Chiara Pitino
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | | | - Luca Mangherini
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | | | - Paola Cassoni
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
- Correspondence: ; Tel.: +39-011-633-5588
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Rottmann D, Abdulfatah E, Pantanowitz L. Molecular testing of soft tissue tumors. Diagn Cytopathol 2023; 51:12-25. [PMID: 35808975 PMCID: PMC10084007 DOI: 10.1002/dc.25013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/27/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The diagnosis of soft tissue tumors is challenging, especially when the evaluable material procured is limited. As a result, diagnostic ancillary testing is frequently needed. Moreover, there is a trend in soft tissue pathology toward increasing use of molecular results for tumor classification and prognostication. Hence, diagnosing newer tumor entities such as CIC-rearranged sarcoma explicitly requires molecular testing. Molecular testing can be accomplished by in situ hybridization, polymerase chain reaction, as well as next generation sequencing, and more recently such testing can even be accomplished leveraging an immunohistochemical proxy. CONCLUSION This review evaluates the role of different molecular tests in characterizing soft tissue tumors belonging to various cytomorphologic categories that have been sampled by small biopsy and cytologic techniques.
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Affiliation(s)
- Douglas Rottmann
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Eman Abdulfatah
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Liron Pantanowitz
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Clinicopathological Features of Intrathoracic Liposarcoma-A Systematic Review with an Illustrative Case. J Clin Med 2022; 11:jcm11247353. [PMID: 36555969 PMCID: PMC9781777 DOI: 10.3390/jcm11247353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/03/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Liposarcoma (LPS) is one of the most common soft-tissue sarcomas. However, intrathoracic LPS is rare, as only 1% of all LPS cases are found in the thorax. METHODS A systematic literature review through PubMed and Embase databases was performed. Only eligible case reports and case series reporting intrathoracic LPS in adult patients were included. Kaplan-Meier curves were calculated to evaluate the survival rate of included patients based on the histological subtype of LPS. RESULTS 123 studies reporting 197 patients were included. We added a case of a 69-year-old female patient with recurrent giant intrathoracic LPS. The primary tumor measured 15.1cm × 22.9 cm × 21.9 cm and weighed 3100 g. Six months later, the patient was admitted to the hospital with another intrathoracic tumor measuring 9.5 cm × 9 cm× 1.4 cm. The immunohistochemical studies showed expression of murine double minute 2 (MDM2) antigen in both primary and recurrent tumor cells. CONCLUSIONS Dyspnea, chest pain, and cough were the most common symptoms reported in included studies. Overall, the 5-year survival rate was 62%. The highest survival was observed in well-differentiated LPS patients (80%) and the lowest in myxoid LPS (31%).
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