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Devaraja K, Aggarwal S, Pillai S, Singh BMK. Large atypical lipomatous tumour of the neck with mediastinal extension managed by transcervical excision. BMJ Case Rep 2024; 17:e258292. [PMID: 38789269 DOI: 10.1136/bcr-2023-258292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024] Open
Abstract
Tumours of adipose tissue origin are relatively rare in the head and neck. Here, we report a case of an unfamiliar lipomatous lesion that involved the neck and mediastinum. A nil-comorbid man in his 40s presented with a slowly progressive anterior neck swelling of 3 years, which was diagnosed as lipoma by histopathological sampling. Computed tomography demonstrated the lesion to be involving parapharyngeal and retropharyngeal spaces with mediastinal extension. The lesion was removed by the transcervical approach. The final histology of the excised specimen, with immunohistochemistry for mouse double minute 2 (MDM2) and p16, suggested an atypical lipomatous tumour (ALT). This report accentuates the occurrence of this rare neoplasm in the neck, which often mimics lipoma clinically. Although radiology can demonstrate suggestive features, histology with MDM2 and/or p16 positivity can confirm the diagnosis of ALT as against the lipoma. A successful transcervical excision, despite the deeper extension of the lesion between the critical structures of the neck and mediastinum, demonstrates the non-infiltrating nature of the tumour.
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Affiliation(s)
- K Devaraja
- Division of Head and Neck Surgery, Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India
| | - Shruti Aggarwal
- Division of Head and Neck Surgery, Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India
| | - Suresh Pillai
- Division of Head and Neck Surgery, Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India
| | - Brij Mohan Kumar Singh
- Department of Pathology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India
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2
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Singh M, Napit AR, Piya G, Thakur PC, Mohanty S, Shinde S, Jain E, Dhakal HP. Well-differentiated liposarcoma of tongue: A case report. Clin Case Rep 2023; 11:e8237. [PMID: 38028061 PMCID: PMC10663532 DOI: 10.1002/ccr3.8237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/16/2023] [Accepted: 05/29/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message It is important to consider WDLS as a potential cause of tongue lesions and include it in the list of differential diagnoses. When performing surgical intervention, it is crucial to remove enough tissue around the lesion, and regular follow-up is necessary due to the high risk of recurrence, despite its rarity, when margins are positive. Abstract Liposarcoma (LS) is the most common soft tissue sarcomas (STSs) that arise from embryonic mesenchymal tissue. Though these sarcomas commonly arise at retroperitoneal locations and extremities, the appearance of these tumors in the head and neck region is rare, with the tongue as a preferred site. As per WHO 2020, LS is classified into four subtypes based on morphology, namely, Well-differentiated liposarcoma (WDLS), Dedifferentiated liposarcoma (DDLS), Myxoid liposarcoma (MLS), and Pleomorphic liposarcoma (PLS). WLS is the most common variant among all. Here, we had a case of 55 years old male with the complaint of swelling in the left lateral border of the tongue with the preliminary diagnosis of pleomorphic adenoma. The patient underwent a left partial glossectomy with adequate margins. Further evaluation of the lesion revealed a clear cell tumor that was ultimately confirmed as liposarcoma on immunohistochemistry that showed tumor cells positive for S100, CDK4, and MDM2 with 2% Ki-67. Postsurgical status of the patient was evaluated by F18 FDG PET CTscan, which was normal. Currently, the patient is under regular follow-up.
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Affiliation(s)
- Moushami Singh
- Department of Pathology and Laboratory MedicineNepal Cancer Hospital and Research CenterLalitpurNepal
| | - Arun R. Napit
- Department of Pathology and Laboratory MedicineNepal Cancer Hospital and Research CenterLalitpurNepal
| | - Gunja Piya
- Department of Pathology and Laboratory MedicineNepal Cancer Hospital and Research CenterLalitpurNepal
| | - Prabhat Chandra Thakur
- Department of Head and Neck Surgical OncologyNepal Cancer Hospital and Research CenterLalitpurNepal
| | | | - Sayali Shinde
- Core Diagnostics National reference LabGurugramIndia
| | - Ekta Jain
- Core Diagnostics National reference LabGurugramIndia
| | - Hari Prasad Dhakal
- Department of Pathology and Laboratory MedicineNepal Cancer Hospital and Research CenterLalitpurNepal
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3
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Lee YJ, Choi SY. Atypical lipomatous tumour/well-differentiated liposarcoma found in the buccal mucosa: A rare case report. Gerodontology 2023; 40:142-144. [PMID: 36468370 DOI: 10.1111/ger.12620] [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: 08/30/2021] [Revised: 11/03/2021] [Accepted: 01/16/2022] [Indexed: 12/07/2022]
Abstract
Oral liposarcomas are uncommon diseases, the most predominant histopathological subtype being atypical lipomatous tumour/well-differentiated liposarcoma. In regard to its clinical aspects in the oral cavity, it is challenging to confirm a diagnosis and develop a treatment plan. In this case report, we present a rare case of atypical lipomatous tumour/well-differentiated liposarcoma in the right cheek of a 77-year-old male patient. Conservative surgery was performed considering the histopathological subtype of the neoplasm. Knowledge of the clinical and histopathological characteristics of this rare disease is essential to maintaining function and aesthetics through conservative treatment in older patients.
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Affiliation(s)
- You-Jung Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - So-Young Choi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea
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4
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Kuang Y, Liang L, Li X, Li T. A case of liposarcoma with osteolysis of the maxilla as the first symptom and review of the literature. Oral Oncol 2023; 139:106340. [PMID: 36821984 DOI: 10.1016/j.oraloncology.2023.106340] [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: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Abstract
Liposarcomas are extremely rare in the oral cavity and mainly observed in the buccal mucosa, tongue, floor of the mouth, gingiva, and lips, while those occurring in the jaws have not been reported so far. Clinically, the initial presentation of liposarcoma is usually a painless soft tissue mass. The aim of this study was to report a case of liposarcoma with osteolysis of the maxilla as the first symptom, and review the relevant literature to summarize its clinical features, imaging features, pathological features and treatment methods.
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Affiliation(s)
- Yishen Kuang
- The Department of Stomatology of The Fifth Affiliated Hospital, Sun Yat-Sen University, Guangdong, Zhuhai 519000, China
| | - Lizhong Liang
- The Department of Stomatology of The Fifth Affiliated Hospital, Sun Yat-Sen University, Guangdong, Zhuhai 519000, China
| | - Xiangwei Li
- The Department of Stomatology of The Fifth Affiliated Hospital, Sun Yat-Sen University, Guangdong, Zhuhai 519000, China
| | - Tong Li
- The Department of Stomatology of The Fifth Affiliated Hospital, Sun Yat-Sen University, Guangdong, Zhuhai 519000, China.
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5
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Kugimoto T, Yamagata Y, Ohsako T, Hirai H, Nishii N, Kayamori K, Ikeda T, Harada H. Massive low-grade myxoid liposarcoma of the floor of the mouth: A case report and review of literature. World J Clin Cases 2022; 10:12742-12749. [PMID: 36579093 PMCID: PMC9791511 DOI: 10.12998/wjcc.v10.i34.12742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Oral liposarcoma is an extremely rare lesion that is often clinically misdiagnosed as a benign tumor due to its asymptomatic and indolent clinical course. Here, we report a case of massive low-grade myxoid liposarcoma (MLS) of the floor of the mouth.
CASE SUMMARY A 71-year-old man presented with a huge mass in the left floor of the mouth. A biopsy was performed, and a diagnosis of a myxoid tumor suspicious for low-grade MLS or myxoma was made. Gadolinium-enhanced T1-weighted magnetic resonance imaging showed an intensely enhanced tumor lesion that occupies the left sublingual space and extends to the submandibular space. Submandibular dissection, tumor resection, and reconstruction with a radial forearm flap were performed. The surgical specimen exhibited histologically low-grade MLS. Fused in sarcoma (FUS, also known as TLS) and DNA damage-inducible transcript 3 (DDIT3, also known as CHOP) break-apart was not detected in the fluorescence in situ hybridization analysis. The tumor was completely encapsulated and did not require additional treatment. Furthermore, no recurrence was reported 40 mo after surgery.
CONCLUSION We experienced an extremely rare, massive, low-grade MLS emerging from the floor of the mouth. Oftentimes, an MLS of the floor of the mouth lacks significant clinical findings and is often misdiagnosed. Although no FUS-DDIT3 fusion gene was detected, a low-grade MLS was ultimately diagnosed based on the histological findings.
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Affiliation(s)
- Takuma Kugimoto
- Department of Oral and Maxillofacial Surgical Oncology, Division of Oral Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku 113-8549, Tokyo, Japan
| | - Yuko Yamagata
- Department of Oral and Maxillofacial Surgical Oncology, Division of Oral Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku 113-8549, Tokyo, Japan
| | - Toshimitsu Ohsako
- Department of Oral and Maxillofacial Surgical Oncology, Division of Oral Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku 113-8549, Tokyo, Japan
| | - Hideaki Hirai
- Department of Oral and Maxillofacial Surgical Oncology, Division of Oral Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku 113-8549, Tokyo, Japan
| | - Naoto Nishii
- Department of Oral and Maxillofacial Surgical Oncology, Division of Oral Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku 113-8549, Tokyo, Japan
| | - Kou Kayamori
- Department of Oral Pathology, Division of Oral Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku 113-8549, Tokyo, Japan
| | - Tohru Ikeda
- Department of Oral Pathology, Division of Oral Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku 113-8549, Tokyo, Japan
| | - Hiroyuki Harada
- Department of Oral and Maxillofacial Surgical Oncology, Division of Oral Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku 113-8549, Tokyo, Japan
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Iro S, Maadane A, Hassani FEZA, Raiteb M, Kerdoud O, Slimani F. Well-differentiated liposarcoma of the cheek misdiagnosed for lipoma: A case report. Int J Surg Case Rep 2021; 84:106116. [PMID: 34153693 PMCID: PMC8220591 DOI: 10.1016/j.ijscr.2021.106116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Liposarcoma is the most common sarcoma entity and accounts for 17% to 30% of soft tissue sarcomas. There are several histological types including well-differentiated liposarcoma. This paper aims to underline the interest of immunohistochemical and cytogenetic studies to diagnose well-differentiated liposarcoma and to show the delicacy of performing a surgical procedure in the cheek area. CASE PRESENTATION The authors report the case of a 48-year-old female patient who presented with the recurrence of a right jugal mass initially diagnosed as a lipoma on the resection specimen. The patient was reoperated 5 years later and further immunohistochemical and cytogenetic studies confirmed the diagnosis of well-differentiated jugal liposarcoma. DISCUSSION Sarcomas are rare malignant tumors of mesenchymal origin, arising from connective and supporting tissues. It should be noted that certain MRI features can distinguish liposarcoma from lipoma. Conventional histology and immunohistochemistry are the basic means for the diagnosis and classification of liposarcomas. However, molecular biology can add to the pathologist's analysis and rule out differential diagnoses Liposarcoma of the maxillofacial region has a better prognosis compared to other parts of the human body. CONCLUSION This paper underlines the interest of complementary immunohistochemical and cytogenetic studies to differentiate well-differentiated liposarcoma from lipoma as well as the potential for local recurrence of liposarcomas.
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Affiliation(s)
- Salissou Iro
- Oral and Maxillofacial Surgery Department, CHU Ibn Rochd, Casablanca, Morocco.
| | - Amina Maadane
- Oral and Maxillofacial Surgery Department, CHU Ibn Rochd, Casablanca, Morocco
| | | | - Mohamed Raiteb
- Oral and Maxillofacial Surgery Department, CHU Ibn Rochd, Casablanca, Morocco
| | - Ouassime Kerdoud
- Oral and Maxillofacial Surgery Department, CHU Ibn Rochd, Casablanca, Morocco
| | - Faiçal Slimani
- Oral and Maxillofacial Surgery Department, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
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de Arruda JAA, Arantes DAC, Schuch LF, Abreu LG, de Andrade BAB, Romañach MJ, Mesquita RA, Watanabe S, de Oliveira JC, Mendonça EF. Inflammatory Variant of Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma of the Buccal Mucosa: An Overview and Case Report with a 10-Year Follow-Up. Head Neck Pathol 2020; 15:1031-1040. [PMID: 33091145 PMCID: PMC8384926 DOI: 10.1007/s12105-020-01242-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
Liposarcomas of the oral cavity are rare. Those originating in the buccal mucosa cause challenging diagnostic and therapeutic issues since less than 40 cases of liposarcomas of the buccal mucosa and cheek have been reported in the worldwide literature. Herein, we present a case of atypical lipomatous tumor/well-differentiated liposarcoma affecting a 45-year-old female patient. Ultrasonography and magnetic resonance imaging confirmed a well-defined mass located in the right buccal mucosa, extending to the submucosal layers of the cheek. Histopathologically, a well-differentiated fatty neoplasm with presence of prominent stromal inflammatory cells was observed. Multifocally scattered bizarre hyperchromatic stromal cells, some of which multinucleated, were also observed. An immunohistochemical panel comprising vimentin, S-100, CD10, CD34, CD20, CD3, CD68, CD138, MDM2, Ki-67, and P53 was employed to better characterize the lesion. A local recurrence event occurred during a 10-year follow-up period. Surgical resection was performed during both episodes. We also provided an overview of demographic and clinicopathological characteristics, immunohistochemical features, imaging findings, and the differential diagnosis of liposarcoma of the oral cavity. Knowledge of the etiopathological and clinical aspects of this rare neoplasm is fundamental in order to rule out other conditions, including lipomatous lesions that affect the buccal mucosa.
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Affiliation(s)
- José Alcides Almeida de Arruda
- grid.8430.f0000 0001 2181 4888Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, room 3202 D. Pampulha, Belo Horizonte, MG CEP: 31.270-901 Brazil
| | - Diego Antônio Costa Arantes
- grid.411195.90000 0001 2192 5801Department of Stomatology (Oral Pathology), School of Dentistry, Universidade Federal de Goiás, Goiânia, GO Brazil
| | - Lauren Frenzel Schuch
- grid.8430.f0000 0001 2181 4888Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, room 3202 D. Pampulha, Belo Horizonte, MG CEP: 31.270-901 Brazil
| | - Lucas Guimarães Abreu
- grid.8430.f0000 0001 2181 4888Department of Child’s and Adolescent’s Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG Brazil
| | - Bruno Augusto Benevenuto de Andrade
- grid.8536.80000 0001 2294 473XDepartment of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ Brazil
| | - Mário José Romañach
- grid.8536.80000 0001 2294 473XDepartment of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ Brazil
| | - Ricardo Alves Mesquita
- grid.8430.f0000 0001 2181 4888Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, room 3202 D. Pampulha, Belo Horizonte, MG CEP: 31.270-901 Brazil
| | - Satiro Watanabe
- Department of Oral Surgery, School of Dentistry, Universidade de Anápolis, Anápolis, GO Brazil
| | | | - Elismauro Francisco Mendonça
- grid.411195.90000 0001 2192 5801Department of Stomatology (Oral Pathology), School of Dentistry, Universidade Federal de Goiás, Goiânia, GO Brazil
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Kim YC, Ryu S, Won SJ, Park JJ. Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma Arising from the Tongue: case report. KOSIN MEDICAL JOURNAL 2020. [DOI: 10.7180/kmj.2020.35.1.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
<p>Liposarcomas are common mesenchymal malignant tumors arising from adipose tissue. Although liposarcomas are the most frequent type of soft tissue sarcomas, accounting for approximately 20% of all soft tissue sarcomas, they are rare in the head and neck, particularly in the oral cavity. Oral liposarcomas have been reported to occur mainly on the buccal mucosa, with other sites including the floor of the mouth, tongue, palate, and mandible. This report describes a 76-year-old male patient with an atypical lipomatous tumor/well-differentiated liposarcoma of the tongue that underwent surgical excision. This report also reviews published data on these rare tumors.
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9
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Fritchie K, Ghosh T, Graham RP, Roden AC, Schembri-Wismayer D, Folpe A, Rivera M. Well-Differentiated/Dedifferentiated Liposarcoma Arising in the Upper Aerodigestive Tract: 8 Cases Mimicking Non-adipocytic Lesions. Head Neck Pathol 2020; 14:974-981. [PMID: 32410132 PMCID: PMC7669978 DOI: 10.1007/s12105-020-01171-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/28/2020] [Accepted: 05/03/2020] [Indexed: 02/06/2023]
Abstract
Well-differentiated (WDL) and dedifferentiated liposarcomas (DL) of the pharynx, larynx and oral cavity are rare, often mimicking benign lipomatous neoplasms or non-lipogenic mesenchymal tumors. Cases of WDL/DL arising in the upper aerodigestive tract, exclusive of the cervical esophagus, were reviewed. Morphologic features, ancillary studies, including fluorescence in situ hybridization (FISH) studies for CPM/MDM2, and clinical data was catalogued. Eight WDL/DL (4 WDL, 4 DL); were identified in patients ranging from 32 to 77 years (median 52.5 years; 6 males, 2 females) with sites of origin including hypopharynx (5 cases), larynx (2 cases) and oral cavity (1 case). Six of the 8 cases were received for expert consultation, and the remaining 2 cases were initially misdiagnosed as benign lymphangiomatous or fibroepithelial polyps. Morphologically, 4 tumors had areas mimicking various non-lipomatous soft tissue tumors including nodular fasciitis, mammary-type myofibroblastoma, low-grade myofibroblastic sarcoma and undifferentiated pleomorphic sarcoma, 2 cases simulated benign hypopharyngeal polyps, and 1 lesion was notable for a dense lymphoplasmacytic infiltrate suggestive of hematolymphoid neoplasm or IgG4-related sclerosing disease. FISH showed amplification of CPM/MDM2 (8/8 cases). All cases (4/4) with longer than 1-year of follow-up recurred (45-118 months) with 1 tumor showing progression to DL. WDL/DL presenting in the upper aerodigestive tract are rare and diagnostically challenging. Awareness of the morphologic spectrum of WDL/DL coupled with appropriate use of MDM2 FISH is essential for accurate classification and management, as these tumors appear to have a high risk for local recurrence and eventual dedifferentiation in these anatomical locations.
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Affiliation(s)
- Karen Fritchie
- grid.66875.3a0000 0004 0459 167XAnatomic Pathology – Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | - Toshi Ghosh
- grid.66875.3a0000 0004 0459 167XAnatomic Pathology – Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | - Rondell P. Graham
- grid.66875.3a0000 0004 0459 167XAnatomic Pathology – Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | - Anja C. Roden
- grid.66875.3a0000 0004 0459 167XAnatomic Pathology – Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | - David Schembri-Wismayer
- grid.66875.3a0000 0004 0459 167XAnatomic Pathology – Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | - Andrew Folpe
- grid.66875.3a0000 0004 0459 167XAnatomic Pathology – Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | - Michael Rivera
- grid.66875.3a0000 0004 0459 167XAnatomic Pathology – Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
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10
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Pontes FSC, de Souza LL, Vulcão ÉNC, de Abreu MC, Menezes SN, Rezende D, Pontes HAR. Liposarcoma of oral cavity: Systematic review of cases reported to date and analysis of prognostic factors. Head Neck 2020; 42:2626-2634. [PMID: 32309895 DOI: 10.1002/hed.26160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/20/2020] [Accepted: 03/24/2020] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to integrate the available data published on Liposarcomas (LPSs) of the oral cavity into an analysis of its clinical features, treatment modalities, and prognostic factors. An electronic search was undertaken in January 2019. The eligibility criteria included publications that had enough clinical and histological information to confirm the diagnosis. Forty-five publications (104 LPSs) were included. The lesion was more prevalent in males from the fifth to seventh decades of life. Treatment (P = .03) and distant metastasis (P = .0001) were independently associated with survival. A lower possibility of recurrence was statistically associated with age (younger patients) (P = .03), tumor size (smaller than 2.8 cm) (P = .001), and treatment (radical surgery) (P = .04). LPS presents a good survival for patients after 5 years of follow-up (66.4%). Patients who were treated with conservative surgery and presented with distant metastasis showed poor prognosis.
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Affiliation(s)
- Flávia S C Pontes
- Oral Surgery and Pathology Department, João de Barros Barreto University Hospital/Federal University of Pará, Belém, Brazil
| | - Lucas L de Souza
- Oral Surgery and Pathology Department, João de Barros Barreto University Hospital/Federal University of Pará, Belém, Brazil
| | - Élida N C Vulcão
- Oral Surgery and Pathology Department, João de Barros Barreto University Hospital/Federal University of Pará, Belém, Brazil
| | - Michelle C de Abreu
- Oral Surgery and Pathology Department, João de Barros Barreto University Hospital/Federal University of Pará, Belém, Brazil.,Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Sarah N Menezes
- Oral Surgery and Pathology Department, João de Barros Barreto University Hospital/Federal University of Pará, Belém, Brazil
| | - Diogo Rezende
- Oral Surgery and Pathology Department, João de Barros Barreto University Hospital/Federal University of Pará, Belém, Brazil.,Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Hélder A R Pontes
- Oral Surgery and Pathology Department, João de Barros Barreto University Hospital/Federal University of Pará, Belém, Brazil.,Oral Diagnosis Department, Semiology and Oral Pathology Areas, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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11
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Abstract
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.
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Affiliation(s)
- Keiichi Ohta
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences
| | - Hitoshi Yoshimura
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences
| | - Shinpei Matsuda
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences
| | - Yoshiaki Imamura
- Division of Surgical Pathology, University of Fukui Hospital, Fukui, Japan
| | - Kazuo Sano
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences
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12
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Stojanov IJ, Mariño-Enriquez A, Bahri N, Jo VY, Woo SB. Lipomas of the Oral Cavity: Utility of MDM2 and CDK4 in Avoiding Overdiagnosis as Atypical Lipomatous Tumor. Head Neck Pathol 2018; 13:169-176. [PMID: 29748845 PMCID: PMC6513928 DOI: 10.1007/s12105-018-0928-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/04/2018] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Ivan J Stojanov
- Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA.
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Adrian Mariño-Enriquez
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Nacef Bahri
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Vickie Y Jo
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sook-Bin Woo
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
- Center for Oral Pathology, StrataDx, Lexington, MA, USA
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Mascarenhas MRM, Mutti LDA, Paiva JMGD, Enokihara MMSES, Rosa IP, Enokihara MY. Giant atypical lipoma. An Bras Dermatol 2017; 92:546-549. [PMID: 28954109 PMCID: PMC5595607 DOI: 10.1590/abd1806-4841.20174447] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 07/13/2015] [Indexed: 11/22/2022] Open
Abstract
Liposarcomas correspond to the most common histological subtype of soft tissue sarcomas. They can be subdivided into: well differentiated or atypical lipoma, undifferentiated, myxoid, round, and pleomorphic cells. Atypical lipomas are the most prevalent and usually appear as asymptomatic softened tumors. They are locally aggressive but rarely lead to distant metastases. The diagnosis of this tumor is based on the imaging and histopathologic findings. Treatment consists of excision surgery with complete tumor removal. It has a good prognosis due to the low percentage of distant metastases. We report a rare case of giant atypical lipoma as well as the adopted therapy and evolution.
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Affiliation(s)
| | - Lais de Abreu Mutti
- Dermatology Department, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | | | - Ival Peres Rosa
- Dermatology Department, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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14
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Nili F, Baghai F, Aghai A, Etebarian A. Well-differentiated liposarcoma of the floor of the mouth: Report of a rare case and review of the literature. J Oral Maxillofac Pathol 2016; 20:312-5. [PMID: 27601829 PMCID: PMC4989567 DOI: 10.4103/0973-029x.185984] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Liposarcomas are extremely rare in the oral cavity. Less than 100 cases of oral liposarcoma have been reported in the world wide literature, mostly occurring in the buccal mucosa, whereas only <10 cases have been reported in the floor of the mouth. We present a rare case of oral liposarcoma that occurred in the floor of the mouth of a 45-year-old female patient. She had a history of two previous recurrences and underwent surgical excision with 24 months of follow-up. Clinical as well as histopathological features and therapeutic approaches of liposarcomas are discussed here, and a literature review is presented. Intraoral liposarcomas have a high rate of local recurrences but generally favorable prognosis based on the histopathologic subtype, location and clear surgical margins. Conservative surgical therapy without adjuvant chemoradiotherapy is recommended, due to the rarity of distant metastasis.
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Affiliation(s)
- Fatemeh Nili
- Department of Pathology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran, Iran
| | - Fereshteh Baghai
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Aghai
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Arghavan Etebarian
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Alborz University of Medical Sciences, Karaj, Iran
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Treatment for intramuscular lipoma frequently confused with sarcoma: a 6-year restrospective study and literature review. BIOMED RESEARCH INTERNATIONAL 2014; 2014:867689. [PMID: 25574469 PMCID: PMC4276111 DOI: 10.1155/2014/867689] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/15/2014] [Accepted: 09/15/2014] [Indexed: 01/26/2023]
Abstract
Introduction. Intramuscular lipoma is a very rare form of lipoma, known to be categorized as an infiltrating lipoma due to its tendencies to infiltrate the muscle or the synovium. Contrary to other subcutaneous lipomas, even after surgical removal, the rate of local recurrence ranges at a high rate from 50∼80% and differential diagnosis with liposarcoma is very difficult. Patients and Methods. A retrospective chart review was conducted for a total of 27 patients. Before performing a surgery based on the types of mass, a radiologic imaging study was performed. An intraoperative frozen biopsy was performed on every patient and the results were compared. The progress was monitored every 3 to 6 months for recurrence or struggles with rehabilitation. Results. There were 13 male and 14 female patients with an average age of 54.6. The average tumor size was 8.2 cm (1.1 cm∼31.6 cm). Excision was performed using a wide excision. All 27 individuals were initially diagnosed as intramuscular lipoma; however, 1 of the patients was rediagnosed as liposarcoma in the final checkup. The patients had an average of 3 years and 1 month of follow-up and did not suffer recurrences.
Conclusion. Thus, it is essential that a frozen biopsy is performed during the surgery in order to identify its malignancy. And a wide excision like malignant tumor operation is a principle of treatment.
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