[Adipocytic tumors]

Pleomorphic Liposarcoma Unraveled: Investigating Histopathological and Immunohistochemical Markers for Tailored Diagnosis and Therapeutic Innovations

Liposarcomas are some of the most challenging soft tissue tumors and are subclassified into multiple subtypes with special histologic and molecular features. The peculiarities of each histopathological subtype influence the clinical behavior, management, and treatment of these neoplasms. For instance, well-differentiated liposarcomas are common soft tissue malignancies and usually display a favorable outcome. On the other hand, pleomorphic liposarcoma is the rarest, yet the most aggressive subtype of liposarcoma. This histopathological diagnosis may be challenging due to the scarce available data and because pleomorphic liposarcomas can mimic other pleomorphic sarcomas or other neoplasms of dissimilar differentiation. Nevertheless, the correct diagnosis of pleomorphic liposarcoma is of utmost importance as such patients are prone to develop local recurrences and metastases. Treatment usually consists of surgical excision along with radiotherapy and follow-up of the patients. Therefore, this review aims to assess the complex clinical, histological, and immunohistochemical features of liposarcomas in order to establish how these characteristics influence the management and prognosis of the patients, emphasizing the particularities of pleomorphic liposarcoma.

<p>Orbital Lipoma as an Uncommon Cause of Unilateral Proptosis: A Case Report</p>

A 36 year old male presented with a two-month history of a progressively increasing proptosis of the right eye associated with redness. MRI of brain and orbit revealed a mass in the intraconal compartment in the lateral aspect of the right orbit that had T1, T2, and FLAIR high signal intensity and was completely suppressed in the STIR image. Excisional biopsy of the mass resolved the proptosis, and histology revealed encapsulated tumor composed of lobules of mature adipocytes along with fibro collagenous septa. Thus, diagnosis of lipoma was established that has uncommon occurrence in the orbital region.

Epidemiological, clinical and histological features of adipose tumors in the hand and wrist: Findings from a continuous series of 37 cases

INTRODUCTION

Adipose tumors are the most common soft tissue tumor in adults; however, their epidemiology and histology in the hand and wrist are not well-defined. The aim of this study was to describe the histology and treatment strategy for this type of tumor at a specialized cancer center.

HYPOTHESIS

The frequency of these tumors is underestimated, and their histology signature varies.

MATERIALS AND METHODS

The clinical and paraclinical data of adults treated for an adipose tumor lesion in the hand or wrist were analyzed retrospectively: age, clinical history, time elapsed between discovery and treatment, type of treatment. The dimensions, location and histology of the tumor were collected. The patients were contacted to inquire about persistent symptoms and sequelae.

RESULTS

Thirty-seven tumors (37 patients) were included between January 2003 and December 2018, thus making up 7.5% of all the soft tissue tumors in the hand or wrist. The mean patient age was 59years (28-84years). Except for one fortuitous discovery, the tumors were discovered because the patient had an unusual lump. The lump was associated with distal paresthesia in six cases. The mean time to treatment was 47.5months (1-240months). The lesion was a conventional lipoma (31 cases) or one of its benign variants (6 cases). The mean size was 3.76cm in the long axis (1-11.5cm) and the mean weight was 9.8g (3-60g). The mean follow-up was 73.5months (2-177months). Tumors in the fingers were smaller and lighter than those in the wrist (p=0.004 and p=0.034).

DISCUSSION

The prevalence of adipose tumors is underestimated within hand and wrist tumors. The most common way these tumors are discovered is due to compressive neuropathy with paresthesia and/or dysesthesia. While these tumors are nearly always benign, this does not justify ignoring the opinion of the multidisciplinary tumor board or underestimating the small possibility of the lesion being a liposarcoma.

LEVEL OF EVIDENCE

IV, retrospective, single-center study.

Giant lipoma of the left mesocolon: Radiological and surgical aspects

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Epidemiology: Lipoma of the mesocolon is a rare tumour less described in the literature.

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Diagnosis: It generally involves large masses. Clinically, it is often asymptomatic. When they exist, these symptoms are less specific and generally due to the large size of the tumour (compression, invagination, hernia). Imaging, especially TDM and MRI are an important step of the preoperative diagnosis. In imaging as in anatomopathology, lipoma-like liposarcoma is the main differential diagnosis. A differential diagnosis with lipoma-like sarcoma must be done.

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Treatment: Treatment is surgical. However, there are variations in the surgical procedures. Some authors had carried out lumpectomy. In our case, we carried out a left colectomy removing the tumour and the mesocolon, as well as the satellite lymph nodes. Each approach has its arguments, i.e. a conserving treatment exposing to repetition if the histological and/or immunochemistry data come out less reassuring, and a more secure and less invasive treatment. There is no consensus on the procedure which depends on the teams.

Introduction

Abdominal masses are common in digestive surgery and gastro-enterology units. However, meso-intestinal lipomas remain rare and lipoma of the left colon uncommon. We report a case of giant lipoma of the left mesocolon whose diagnosis was highly guided by radiological examinations.

Presentation of case

A female patient aged 56, consulted for left subcostal abdominal pains. The clinical examination showed an abdominal mass occupying the left hemiabdomen. The abdominal-pelvic CT scan highlighted a large abdominal-pelvic mass in the left abdomen. Abdominal-pelvic MRI revealed a large fatty mass spreading from the front subphrenic space up to the level of the left iliac fossa, non-suspected and compatible with lipoma. FDG-Pet Scan had not revealed pathological fixing. The mass appeared like a total gap space. Exploratory surgery revealed a lipoma mass in the left mesocolon. Hemicolectomy was performed taking away the mass. Histology confirmed the diagnosis of lipoma and the outcome was favourable.

Discussion

Our case represents the fourth case of mesocolon lipoma described in the literature. Imaging, especially TDM and MRI are an important step of the preoperative diagnosis. The surgery consists of either a lumpectomy or a colectomy.

Conclusion

Lipoma of the left mesocolon is exceptional. Radiological examinations provide most arguments to suggest lipoma. However the organ’s diagnosis is provided by surgical exploration and the certainty diagnosis by pathological examination. Treatment is surgical.

A giant parapharyngeal lipoma causing obstructive sleep apnea

Lipoma is the most common soft tissue mesenchymal neoplasm. Its occurrence is low in the oral cavity (1 to 4%) and in head and neck region (20 to 25%). Usually asymptomatic and slowly growing, lipoma can compress neighboring cervico-facial structures causing dysphagia, dyspnea, or obstructive sleep apnea. We describe an unusual case of giant cervico-parapharyngeal lipoma causing an obstructive sleep apnea in a 69-year-old man and with the complete remove of OSA after surgical procedure.

[Lipoblastoma detected in older children: an unusual case and literature review]

Le lipoblastome est une tumeur bénigne relativement rare. Il est issu de la graisse blanche embryonnaire qui survient presque exclusivement chez le petit enfant, de moins de 3 ans. Nous rapportons un cas de lipoblastome de la cuisse gauche découvert chez un grand enfant (11 ans), avec une revue de la littérature. Le diagnostic était histologique, et le traitement chirurgical consistait à une exérèse totale de la masse. Les suites post-opératoires étaient simples avec un recul de 9 mois.

[Myxoid tumors of deep soft tissues]

Myxoid soft tissue tumors form a heterogeneous group. Their biological potential encompasses the whole spectrum from benign to highly malignant. The present article focuses on myxoid tumors of the deep soft tissues: myxofibrosarcoma, low-grade fibromyxoid sarcoma, myxoma, myxoid liposarcoma, extraskeletal myxoid chondrosarcoma and nodular fasciitis. The last two decades have brought into practice multiple powerful tools that support pathologists in making precise diagnoses, even on small incisional biopsies: detection of fusion transcripts by rt-PCR, detection of chromosomal fusion or breakpoint by FISH, detection of point mutations by PCR and expression of specific markers by immunohistochemistry. Conventional morphology remains the mainstay of diagnosis, and it is essential to obtain adequate clinical and radiological information before interpreting small incisional biopsies. The present article is a summary of morphologic features used to diagnose the most common tumors of the deep soft tissues.