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Brooks JK, Rostami A, Zhou CQ, Sultan AS. Spindle cell lipoma of the buccal mucosa: Uncommon finding in an older adult. Gerodontology 2023; 40:398-401. [PMID: 36465036 DOI: 10.1111/ger.12666] [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] [Received: 08/09/2022] [Revised: 10/12/2022] [Accepted: 11/01/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This article reports a case of a longstanding, slowly enlarging intraoral spindle cell lipoma (SCL) that had become increasingly painful during mastication. BACKGROUND The SCL represents an uncommon variant of the conventional lipoma. There is limited information regarding this lesion in the gerodontologic literature. MATERIALS AND METHODS A 68-year-old patient underwent an excisional biopsy of a 9-mm slightly yellow papule along the buccal mucosa. RESULTS The surgical specimen was composed of mature adipocytes with abundant spindle cell populations and was diagnosed as a SCL. CONCLUSIONS Timely removal of the SCL may reduce the incidence of clinical and surgical complications, particularly in older adults. The management of a SCL is complete excision, and recurrence is rare. Lesions must be carefully distinguished microscopically from its malignant counterpart, the spindle cell liposarcoma.
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Affiliation(s)
- John K Brooks
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Arash Rostami
- Division of General Dentistry, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Cindy Q Zhou
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Ahmed S Sultan
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry and University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA
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2
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Silva EV, Silveira HA, Panucci BZM, Molena KF, Almeida LY, Bufalino A, León JE. Intraoral lipoma with degenerative changes mimicking atypical lipomatous tumor: an immunohistochemical study. Autops Case Rep 2022; 13:e2021413. [PMID: 36619259 PMCID: PMC9815838 DOI: 10.4322/acr.2021.413] [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: 01/12/2022] [Accepted: 11/23/2022] [Indexed: 01/05/2023]
Abstract
Lipomas are mesenchymal neoplasms relatively uncommon in the oral cavity. Lipomas can exhibit histopathological features mimicking atypical lipomatous tumors (ALT) or dysplastic lipoma (DL) in the presence of degenerative changes. Relevantly, immunohistochemistry assists in the correct diagnosis. Herein, we present the case of a 54-year-old male with a sessile nodule located on the dorsum of the tongue. The histopathological analysis showed a diffuse, non-circumscribed adipocytic proliferation constituted by cells of variable size containing cytoplasmic vacuoles and displaced nuclei, some resembling lipoblasts supported by fibrous connective tissue stroma. By immunohistochemistry, tumor cells were positive for vimentin, S100, FASN, CD10, and p16. Rb expression was intact. Moreover, CD34, p53, MDM2, and CDK4 were negative. After 2-year of follow-up, no alteration or recurrence was observed. In conclusion, MDM2, CDK4, p53, and Rb immunomarkers can be used reliably to differentiate benign lipoma with degenerative changes from ALT and DL.
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Affiliation(s)
- Evânio Vilela Silva
- Universidade Estadual Paulista (Unesp), Araraquara Dental School, Oral Medicine, Department of Diagnosis and Surgery, Araraquara, SP, Brasil,Universidade de São Paulo (USP), Ribeirão Preto Dental School, Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto, SP, Brasil
| | - Heitor Albergoni Silveira
- Universidade Estadual Paulista (Unesp), Araraquara Dental School, Oral Medicine, Department of Diagnosis and Surgery, Araraquara, SP, Brasil,Universidade de São Paulo (USP), Ribeirão Preto Dental School, Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto, SP, Brasil
| | - Beatriz Zamboni Martins Panucci
- Universidade de São Paulo (USP), Ribeirão Preto Dental School, Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto, SP, Brasil
| | - Kelly Fernanda Molena
- Universidade de São Paulo (USP), Ribeirão Preto Dental School, Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto, SP, Brasil
| | - Luciana Yamamoto Almeida
- Universidade Estadual Paulista (Unesp), Araraquara Dental School, Oral Medicine, Department of Diagnosis and Surgery, Araraquara, SP, Brasil
| | - Andreia Bufalino
- Universidade Estadual Paulista (Unesp), Araraquara Dental School, Oral Medicine, Department of Diagnosis and Surgery, Araraquara, SP, Brasil
| | - Jorge Esquiche León
- Universidade de São Paulo (USP), Ribeirão Preto Dental School, Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto, SP, Brasil
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3
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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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4
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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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5
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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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6
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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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7
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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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8
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Rapidis AD. Sarcomas of the head and neck in adult patients: current concepts and future perspectives. Expert Rev Anticancer Ther 2014; 8:1271-97. [DOI: 10.1586/14737140.8.8.1271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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9
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Kim YB, Leem DH, Baek JA, Ko SO. Atypical lipomatous tumor/well-differentiated liposarcoma of the gingiva: a case report and review of literature. J Oral Maxillofac Surg 2013; 72:431-9. [PMID: 23992781 DOI: 10.1016/j.joms.2013.06.222] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 06/23/2013] [Accepted: 06/28/2013] [Indexed: 02/07/2023]
Abstract
Liposarcoma, first described by Virchow in 1857, is a common mesenchymal malignant tumor arising from the adipose tissue. The most common of all soft tissue sarcomas, liposarcomas account for approximately 20% of all soft tissue sarcomas. However, it is 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. However, almost no cases of a liposarcoma located on the gingiva have been reported. To our knowledge, only 5 cases of liposarcoma of the gingiva have been previously reported in English language studies. We present a rare case of an atypical lipomatous tumor/well-differentiated liposarcoma of the gingiva of the anterior mandible that occurred in a 77-year-old male patient. Our patient underwent surgical excision and alveolar decortication. We also present a review of the current published data. At 18 months of follow-up, the patient remained free of disease.
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Affiliation(s)
- Young Bin Kim
- Clinical Fellow, Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonbuk National University, Jeonju, Republic of Korea
| | - Dae Ho Leem
- Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonbuk National University, Jeonju, Republic of Korea
| | - Jin A Baek
- Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonbuk National University, Jeonju, Republic of Korea
| | - Seung O Ko
- Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonbuk National University, Jeonju, Republic of Korea.
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10
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Nichols EM, Mirmiran A, Garofalo MC, Sun CCJ, Hatten K, Wolf J. Recurrent myxoid liposarcoma of the buccal mucosa in a young boy: a case report and review of the literature. EAR, NOSE & THROAT JOURNAL 2012; 90:E27-31. [PMID: 22180120 DOI: 10.1177/014556131109001215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Liposarcomas are uncommon in the pediatric population. We present the case of a boy who had experienced multiple recurrences of liposarcoma in the buccal space before he reached the age of 13 years. We also provide a review of the literature and a discussion of adjuvant therapy, which are important to understanding the nature of this disease.
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Affiliation(s)
- Elizabeth M Nichols
- Department of Radiation Oncology, University of Maryland School of Medicine, 16 S. Eutaw St., Baltimore, MD 21201, USA
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11
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Well-differentiated liposarcoma/atypical lipomatous tumor of the oral cavity: report of three cases and review of the literature. Head Neck Pathol 2012; 6:354-63. [PMID: 22234501 PMCID: PMC3422587 DOI: 10.1007/s12105-011-0327-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 12/27/2011] [Indexed: 12/11/2022]
Abstract
Atypical Lipomatous Tumor/Well Differentiated Liposarcoma (ALT/WDLS) is a soft tissue sarcoma of intermediate malignant behavior, most frequently affecting the retroperitoneum and lower extremities. Oral liposarcomas are very rare neoplasms, the most common histological subtype being ALT/WDLS. In this study, three additional cases of ALT/WDLS located on the tongue (2 cases) and the lower lip (1 case), respectively, are described. Analysis of the salient clinicopathologic features of 63 oral ALT/WDLS cases previously reported in the English language literature, as well as of the 3 cases presented in this study, indicates that the indolent biologic behavior of this tumor justifies its designation as a locally spreading malignant neoplasm, affording a rather conservative surgical approach.
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12
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13
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Abstract
The so-called "giant fibrovascular polyps" of the esophagus and hypopharynx typically present as sausage-like pedunculated structures that protrude into the lumen and cause obstructive symptoms. Most are cured by local resection but they may recur. Microscopically, they display an admixture of fibrovascular and adipose tissue that is coated by unremarkable squamous mucosa. Here, we report a case that had scattered hyperchromatic cells and lipoblasts within the adipose tissue component. In other anatomic sites similar appearing lesions have been interpreted as pedunculated liposarcomas/atypical lipomatous tumors that are more prone to local recurrences than classic giant fibrovascular polyps. Reports of dedifferentiation and metastases are lacking thus raising the possibility that the cytologic findings in such lesions are degenerative. To confirm our suspicion of liposarcomatous differentiation, we performed immunohistochemistry for MDM2 and p53, 2 markers that are known to be negative in benign lipomatous lesions and positive in well-differentiated liposarcomas/atypical lipomatous tumors. The scattered atypical hyperchromatic cells and the lipoblasts both exhibited strong nuclear staining for both markers and supported the diagnosis of pedunculated giant hypopharyngeal atypical lipomatous tumor.
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14
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Agir H, MacKinnon C, Tan ST. Li-Fraumeni syndrome: a case with 4 separate primary sarcomas and 5 sequential free flaps in the maxillofacial region. J Oral Maxillofac Surg 2008; 66:1714-9. [PMID: 18634962 DOI: 10.1016/j.joms.2007.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Revised: 06/02/2007] [Accepted: 09/05/2007] [Indexed: 01/10/2023]
Affiliation(s)
- Hakan Agir
- Wellington Regional Plastic, Maxillofacial & Burns Unit, Hutt Hospital, Wellington, New Zealand.
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15
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Chan WY, McHenry IDS, Carter LM, Reall G, Wales CJ. Gingival liposarcoma: An unusual polyp. Br J Oral Maxillofac Surg 2008; 46:150-1. [PMID: 17284338 DOI: 10.1016/j.bjoms.2006.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2006] [Indexed: 11/24/2022]
Abstract
Liposarcomas account for up to 20% of all soft tissue tumours. They are uncommon in the head and neck. Sarcomas of the oral region (excluding lymphoma) account for 5% of all oral cancers, of which 10% are liposarcomas. Fewer than 80 cases have been reported in the world literature, most of which presented as expansile masses. The prognosis of liposarcoma is dependant on the histopathologic type, location, and adequacy of surgical treatment. Well-differentiated types have a good prognosis and minimal metastatic potential. We report a case of well-differentiated liposarcoma (lipoma-like subtype), that presented as a gingival polyp.
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Affiliation(s)
- W Y Chan
- Department of Oral & Maxillofacial Surgery, York District Hospital, Wiggington Road, York YO31 8HE, United Kingdom
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16
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DeWitt J, Heidelman J, Summerlin DJ, Tomich C. Atypical Lipomatous Tumors of the Oral Cavity: A Report of 2 Cases. J Oral Maxillofac Surg 2008; 66:366-9. [DOI: 10.1016/j.joms.2006.10.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Revised: 08/30/2006] [Accepted: 10/23/2006] [Indexed: 12/11/2022]
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17
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Adelson RT, DeFatta RJ, Verret D, Shen Y. Liposarcoma of the Tongue: Case Report and Review of the Literature. EAR, NOSE & THROAT JOURNAL 2006. [DOI: 10.1177/014556130608501117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Liposarcoma is the most common soft-tissue malignancy in adults, but the appearance of a liposarcoma in the head and neck region is distinctly unusual. Intraoral liposarcomas represent a particularly interesting subset of this tumor in that (1) they are exceedingly rare and (2) affected patients tend to have a better prognosis than do patients with a similar lesion located elsewhere in the head and neck. An understanding of the histologic subtypes and corresponding clinical behavior of liposarcomas will assist physicians in appropriately managing these patients. Most of these tumors can be effectively treated with conservative surgery. We report the rare case of a well-differentiated liposarcoma arising in the tongue of a 55-year-old man. We also discuss the typical pathologic findings in these malignancies and review the diagnosis, associated controversies, management, and prognosis.
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Affiliation(s)
- Robert Todd Adelson
- Department of Otolaryngology, University of Florida College of Medicine, Gainesville
| | | | - D.J. Verret
- Department of Otolaryngology–Head and Neck Surgery
| | - Yuenan Shen
- Department of Pathology, University of Texas Southwestern Medical Center at Dallas, and the Department of Pathology, VA Medical Center, Dallas
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18
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Dubin MR, Chang EW. Liposarcoma of the tongue: case report and review of the literature. Head Face Med 2006; 2:21. [PMID: 16872488 PMCID: PMC1553437 DOI: 10.1186/1746-160x-2-21] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Accepted: 07/26/2006] [Indexed: 12/12/2022] Open
Abstract
Background Liposarcoma most commonly arises in the retroperitoneum and lower extremities. Liposarcoma of the head and neck is rare, with only 12 previously reported cases of liposarcoma in the tongue. Case presentation We present a case of well-differentiated liposarcoma of the tongue occuring in a 39 year old man, treated with surgical excision. At 14 years of follow-up, the patient remains free of disease. Conclusion Liposarcoma of the head and neck is rare, and may easily be misdiagnosed clinically. The diagnosis is made histologically. Clinical behavior is related to histopathologic subtype. Wide surgical excision is the treatment of choice, with limited data to support the use of radiation or chemotherapy. Our case represents the longest follow-up period for a tongue liposarcoma, with 14 years disease-free following surgical extirpation.
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Affiliation(s)
- Marika R Dubin
- Department of Otolaryngology – Head and Neck Surgery, Columbia University – New York Presbyterian Hospital, 180 Fort Washington Ave., HP 818, New York 10032, USA
| | - Edward W Chang
- Department of Otolaryngology – Head and Neck Surgery, Columbia University – New York Presbyterian Hospital, 180 Fort Washington Ave., HP 818, New York 10032, USA
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Ballesteros F, Jose Sanz J, Maria Guilemany J, Moragas M, Gaspa A, Bernal-Sprekelsen M. Bulky cervical liposarcoma associated with sleep apnea syndrome. Acta Otolaryngol 2006; 126:209-13. [PMID: 16428202 DOI: 10.1080/00016480500266784] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Sarcomas of the head and neck are relatively infrequent tumors. Liposarcomas represent 10-16% of all soft tissue sarcomas and <5% of them arise from the head and neck. The retropharyngeal area is rarely involved. We present the case of a middle-aged male with clinical symptoms of sleep apnea. A fiber-optic examination revealed a soft submucosal lesion compressing the posterior pharyngeal wall, with partial obstruction of the airway tract. CT showed a large heterogeneous prevertebral mass (6 x 20 cm(2)) occupying the posterior mediastinum. A transoral submucosal biopsy was performed. Histological findings were compatible with a low-grade liposarcoma. The mass was removed in monoblock using a classical laterocervical neck incision. The surgical specimen weighed 500 g. After 24 months of follow-up no signs of tumor recurrence or sleep apnea syndrome were noted.
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Affiliation(s)
- F Ballesteros
- Department of Otolaryngology--Head and Neck Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
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20
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Capodiferro S, Scully C, Maiorano E, Lo Muzio L, Favia G. Liposarcoma circumscriptum (lipoma-like) of the tongue: report of a case. Oral Dis 2005; 10:398-400. [PMID: 15533218 DOI: 10.1111/j.1601-0825.2004.01040.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Liposarcoma, first described by Virchow in 1857, is the second most frequent sarcoma of soft tissues, although it is rare both in the head and neck and the oral cavity. Intra-orally, liposarcoma has been reported in the jawbones (particularly the maxilla) and the soft tissues -- mainly the cheek and floor of mouth, but it is rare in the tongue. A case of well-differentiated, superficial liposarcoma circumscriptum of the tongue is reported. The authors underline the difficulties in the clinical and histopathological diagnosis, as this tumour may be confused with lipoma. In view of the indolent behaviour of this tumour type, local recurrence or metastasis rarely occur; consequently, conservative surgical therapy is advised without adjuvant chemo-radio therapy.
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Affiliation(s)
- S Capodiferro
- Department of Dental Sciences and Surgery, University of Bari, Bari, Italy.
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21
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Nikitakis NG, Sauk JJ, Papanicolaou SI. The role of apoptosis in oral disease: mechanisms; aberrations in neoplastic, autoimmune, infectious, hematologic, and developmental diseases; and therapeutic opportunities. ACTA ACUST UNITED AC 2004; 97:476-90. [PMID: 15088032 DOI: 10.1016/j.tripleo.2003.12.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Apoptosis is a genetically programmed form of cell death, which primarily functions to eliminate senescent or altered cells that are useless or harmful for the multicellular organism. Contrary to necrosis, apoptosis represents a physiologic cellular mechanism, normal function and control of which are critical for the development and homeostasis of multicellular organisms. In contrast, aberrations of the apoptotic mechanisms that cause excessive or deficient programmed cell death have been linked to a wide array of pathologic conditions. This review briefly summarizes the major apoptotic pathways and molecules and presents the most important oral diseases that are related to dysregulation of apoptosis. Knowledge of the association between aberrations in apoptotic mechanisms and human pathology hopefully will be implemented for the design of improved diagnostic and prognostic assays and the development of novel, more efficient, therapeutic strategies.
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Affiliation(s)
- Nikolaos G Nikitakis
- Department of Diagnostic Sciences and Pathology, University of Maryland, Baltimore 21201, USA.
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22
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Nikitakis NG, Salama AR, O'Malley BW, Ord RA, Papadimitriou JC. Malignant peripheral primitive neuroectodermal tumor-peripheral neuroepithelioma of the head and neck: a clinicopathologic study of five cases and review of the literature. Head Neck 2003; 25:488-98. [PMID: 12784241 DOI: 10.1002/hed.10260] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The term primitive neuroectodermal tumor (PNET) encompasses a number of neoplasms of common neuroectodermal origin, but of variable clinical, histopathologic, ultrastructural, and molecular characteristics. Here, we focus on one particular member of the PNET family, the malignant peripheral PNET (pPNET) or peripheral neuroepithelioma of head and neck. METHODS Five patients diagnosed with malignant pPNET-peripheral neuroepithelioma of head and neck were included in the study. All existing literature was reviewed. RESULTS The diagnosis of malignant pPNET-peripheral neuroepithelioma of the head and neck was confirmed in all five cases. All patients are alive after treatment with a combination of therapeutic modalities; only one patient had metastatic disease develop. A literature review revealed another 38 reported cases. CONCLUSIONS Malignant pPNET-peripheral neuroepithelioma should be included in the differential diagnosis of small, round, blue cell tumors of head and neck. A combination of multiple diagnostic modalities is essential for correct diagnosis, and multimodality treatment offers the best outcome.
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Affiliation(s)
- Nikolaos G Nikitakis
- Department of Diagnostic Sciences and Pathology, Dental School, University of Maryland, Baltimore, 666 W Baltimore Street, Room 4-C-02, Baltimore, Maryland 21201-1586, USA.
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Abstract
Liposarcoma of the head and neck is rare. Only 12 cases of scalp liposarcoma have been previously reported. In this report, we describe a case of myxoid/round cell liposarcoma in the scalp of a 28-year-old woman. This case report highlights a histologic pattern rarely reported in the head and neck but consistent with the evolving classification of liposarcomas.
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Affiliation(s)
- Shawn D Newlands
- Department of Otolaryngology, University of Texas Medical Branch, 300 University Boulevard, Galveston, TX 77555-0521, USA
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Nikitakis NG, Drachenberg CB, Papadimitriou JC. MDM2 and CDK4 expression in carcinosarcoma of the esophagus: comparison with squamous cell carcinoma and review of the literature. Exp Mol Pathol 2002; 73:198-208. [PMID: 12565795 DOI: 10.1006/exmp.2002.2465] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Certain tumors of the esophagus that display both sarcomatous and carcinomatous features have long been recognized. The nomenclature, classification, and histogenesis remain controversial and the microscopic differential diagnosis from other esophageal malignancies can be challenging, particularly in small biopsies. In this paper, we review the literature of carcinosarcoma and present two cases of esophageal carcinosarcoma, describing their salient histologic, immunohistochemical, and ultrastructural features. Also, we assess the expression of MDM2 and CDK4 in the carcinomatous and sarcomatous compartments of our cases and we compare them with the expression of these oncogenes in selected cases of esophageal squamous cell carcinoma with prominent stromal reaction. In both of our cases, identification of some epithelial ultrastructural and immunohistochemical features in cells of otherwise sarcomatous phenotype lends support to the common epithelial origin of these neoplasms. Moreover, positive staining for MDM2 and CDK4 in our cases with equally strong reactions in both carcinomatous and sarcomatous elements provides evidence of a role for these molecules in the pathogenesis of carcinosarcoma. In contrast, in cases of squamous cell carcinoma with prominent stromal reaction only the epithelial cells stained strongly for MDM2 and CDK4. These differences in the MDM2 and CDK4 immunohistochemical profile between carcinosarcomas and carcinomas of the esophagus may assist in their differential diagnosis.
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Affiliation(s)
- Nikolaos G Nikitakis
- Department of Diagnostic Sciences and Pathology, Dental School, University of Maryland, Baltimore, Maryland 21201-1586, USA.
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