1
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Zhang T, Liu B. MRI Differential Diagnosis and Guidance for Puncture Biopsy of Musculoskeletal Dedifferentiated Liposarcoma and Well Differentiated Liposarcoma. Cancer Manag Res 2024; 16:455-463. [PMID: 38774493 PMCID: PMC11107907 DOI: 10.2147/cmar.s457504] [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: 02/18/2024] [Accepted: 05/07/2024] [Indexed: 05/24/2024] Open
Abstract
Objective The study aimed to investigate the significantly different imaging characteristics of musculoskeletal dedifferentiated liposarcoma (DDLP) and well differentiated liposarcoma (WDLP) on MRI, which in turn could guide puncture biopsy. Materials and Methods This study included 14 patients with DDLP and 16 patients with WDLP, all of whom were confirmed by histopathological examination. The MRI manifestations of these two pathologies were retrospectively reviewed and compared. Furthermore, a step-by-step procedure regarding preoperative puncture biopsy of fatty masses that are suspicious for WD/DD was designed. Results Fatty signals can be found in almost all WDs, with a greater proportion of non-fatty areas in DD compared to WD, and it is reasonable to consider WD more likely when the non-fatty areas of the tumor are <25% (p < 0.05), while it is reasonable to consider DD more likely when the non-fatty areas of the tumor are >50% (p < 0.05), and the MRI signals in DD are more complex, inhomogeneous (p < 0.01), usually showed significant enhancement (p < 0.01), and the margins of the tumor were usually indistinct (p < 0.01); and imaging features such as tumor size, vascularity, necrosis, and peritumoral edema did not serve as distinguishing features between the two (p > 0.05). Conclusion DD has a greater proportion of non-fatty components, with more complex and inhomogeneous MRI signals, and typically shows significant enhancement, with usually indistinct margins of the tumor, in which the inhomogeneous manifestations are associated with the histological components. The possibility of DD should be considered in fatty tumors with non-fatty areas > 25%, for which puncture biopsy is necessary, while simultaneous puncture of low, moderate, high-signal areas within the non-fatty area could improve the accuracy of preoperative puncture pathology.
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Affiliation(s)
- Tianwen Zhang
- Department of Orthopaedic Soft Tissue Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, People’s Republic of China
| | - Bin Liu
- Department of Orthopaedic Soft Tissue Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, People’s Republic of China
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2
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Kilpatrick SE. Atypical lipomatous tumor/well differentiated liposarcoma and related mimics with updates. When is molecular testing most cost-effective, necessary, and indicated? Hum Pathol 2024; 147:82-91. [PMID: 38135062 DOI: 10.1016/j.humpath.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/19/2023] [Indexed: 12/24/2023]
Abstract
The classification and work-up of adipocytic neoplasms remains challenging and sometimes controversial. Since its initial description by Dr. Enterline, the variety of subtypes and morphological appearances considered to represent the spectrum of atypical lipomatous tumor/well differentiated liposarcoma (ALT/WDL) has expanded, resulting in significant morphologic overlap with other entities, including the recently described atypical spindle cell/pleomorphic lipomatous tumor (ASPLT), conventional spindle cell/pleomorphic lipoma (SPL), and so-called "low-grade" forms of dedifferentiated liposarcoma (DL). Nevertheless, the distinction of most examples of ALT/WDL from lipomas/lipoma-like lesions is easily performed on routine histologic examination but can be problematic if the characteristic atypical cells are poorly represented, particularly in small biopsy specimens, obscured by other cellular elements (inflammation), or simply not recognized. The discovery that lipomatous tumors harbor specific and unique karyotypes and molecular events has resulted in ancillary tests that can help provide more accurate diagnoses, especially in less-than-optimal scenarios. Confirmation of MDM2 immunohistochemical over-expression and detection of the MDM2 gene rearrangement via fluorescent in situ hybridization (FISH) have proven particularly reliable and useful. While FISH analysis for MDM2 gene amplification may be helpful for confirming (or excluding) ALT/WDL, it also can lead to overutilization and overdependence. Furthermore, a small subset of otherwise typical ALT/WDL lack MDM2 gene amplification, employing alternative molecular pathways. The recent recognition of ASPLT has introduced a tumor easily mistaken morphologically for ALT/WDL, often exhibiting bizarre and pleomorphic lipoblasts, but lacking the underlying molecular abnormalities and subsequent risk of dedifferentiation. ASPLT also have overlapping features with the better-established SPL but with a greater tendency to locally recur and more frequent involvement of the distal extremities. The precise criteria separating cellular forms of ALT from what some consider "low grade" forms of DL remains controversial and inconsistently applied, even among individual pathologists within institutions. Given their underlying shared cytogenetic abnormality, molecular testing has no utility in this distinction. Herein is a comprehensive historical overview of ALT/WDL, with updates on its distinction from other similar lipomatous tumors and DL, including practical evidence-based criteria for the appropriate cost-effective use of MDM2 testing.
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Affiliation(s)
- Scott E Kilpatrick
- Cleveland Clinic, Department of Anatomic Pathology, L25, Cleveland, OH, 44195, USA.
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3
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Perret R, Charville GW, Alame M, Rebier F, Soubeyran I, Gross JM, Graham D, Green DC, Kerr DA, Khan WA, Cloutier JM. Atypical Spindle Cell/Pleomorphic Lipomatous Tumor With Sarcomatous Transformation: Clinicopathologic and Molecular Analysis of 4 Cases. Mod Pathol 2024; 37:100454. [PMID: 38417627 PMCID: PMC11058475 DOI: 10.1016/j.modpat.2024.100454] [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: 11/01/2023] [Revised: 01/26/2024] [Accepted: 02/04/2024] [Indexed: 03/01/2024]
Abstract
Atypical spindle cell/pleomorphic lipomatous tumor (ASPLT) is a recently described adipocytic tumor predominantly affecting the subcutaneous soft tissues of adults. Previous studies have shown that ASPLT follows a benign clinical course with a 4% to 12% local recurrence rate and no risk of dedifferentiation. Herein, we describe the clinicopathologic and molecular findings of 4 cases of ASPLT showing unequivocal sarcomatous transformation. Three patients were male and one was female, aged 65, 70, 74, and 78 years. Two cases presented as mass-forming lesions, while 1 case was incidentally discovered. The tumors measured 30, 55, 80, and 110 mm and occurred in the chest wall (n = 2) or arm (n = 2); all were subcutaneous. Microscopically, they showed a biphasic appearance comprising a low-grade ASPLT component and a high-grade sarcomatous component. The low-grade components showed features in the spectrum of either atypical pleomorphic lipomatous tumor (n = 2) or atypical spindle cell lipomatous tumor (n = 2). The high-grade components displayed leiomyosarcoma-like (n = 2), pleomorphic liposarcoma-like (n = 1) or undifferentiated sarcoma-like (n = 1) morphology. On immunohistochemistry, tumors were negative for MDM2 and showed loss of RB1 expression. In addition, the leiomyosarcoma-like areas seen in 2 cases were positive for smooth muscle actin and H-caldesmon. Single-nucleotide polymorphism array, performed in 3 cases, showed deletions of TP53, RB1, and flanking genes in both components. In contrast, the sarcomatous components showed more complex genomic profiles with rare segmental gains and recurrent loss of PTEN (n = 3), ATM (n = 2), and CDKN2A/B (n = 2) among other genes. Whole exome sequencing identified a TP53 variant in one case and an ATRX variant in another, each occurring in both tumor components. Limited clinical follow-up showed no recurrence or metastasis after 1 to 13 months (median, 7.5 months) postsurgical excision. Altogether, our data support that ASPLT can rarely develop sarcomatous transformation and offer insights into the molecular mechanisms underlying this event.
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Affiliation(s)
- Raul Perret
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France.
| | - Gregory W Charville
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Melissa Alame
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - Flora Rebier
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - Isabelle Soubeyran
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France
| | - John M Gross
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Daniel Graham
- Clinical Labs of Hawaii, Aiea Heights, Honolulu, Hawaii
| | - Donald C Green
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire
| | - Darcy A Kerr
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire
| | - Wahab A Khan
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire
| | - Jeffrey M Cloutier
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire.
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4
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Bourgeau M, Gandhi JS, Deeb KK, Bahrami A. Superficial dedifferentiated liposarcoma: A clinicopathologic study. Hum Pathol 2024; 145:63-70. [PMID: 38423223 DOI: 10.1016/j.humpath.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Dedifferentiation occurs in approximately 10% of atypical lipomatous tumors/well-differentiated liposarcomas (ALT/WDLPS), primarily in retroperitoneal or deep-seated tumors, conferring metastatic potential. Superficial dedifferentiated liposarcoma (sDDLPS) is rare, and its progression and natural history are poorly documented. METHODS We performed a 15-year retrospective review of our pathology database to identify cases of DDLPS in the skin or subcutaneous tissue. Diagnosis of primary sDDLPS required evidence of non-lipogenic sarcoma in the skin or subcutis, with concurrent ALT/WDLPS and/or MDM2 amplification. RESULTS We identified 14 cases of DDLPS involving skin or subcutis: 7 primary sDDLPS and 7 secondary lesions (3 from recurrent deep DDLPS and 4 from metastasis). Primary sDDLPS cases (4 females, 3 males; median age: 74) mainly presented as undifferentiated spindle cell or pleomorphic sarcoma. Tumor grades were grade 2 (5 cases) and grade 3 (2 cases), with three cases also showing grade 1 areas. MDM2 amplification was confirmed in 6 sDDLPSs for which FISH was successfully performed. Follow-up available for 6 sDDLPS patients showed 2 local recurrences, treated with re-excision and radiation therapy, with all disease-free at last follow-up (5-126 months). Of the 7 secondary cases, 2 had ongoing disease after multiple recurrences, 1 was disease-free, and all 4 with cutaneous metastasis died of disease (follow-up range: 24-263 months). CONCLUSION These findings emphasize the importance of distinguishing between primary sDDLPS and secondary lesions due to their distinct prognoses. Metastasis or superficial extensions from deep DDLP correlate with a considerably worse prognosis than those originating in superficial tissues.
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Affiliation(s)
- Melanie Bourgeau
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Jatin S Gandhi
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Kristin K Deeb
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Armita Bahrami
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA.
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5
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Tu Y, Zhu P, Lao IW, Yu L, Wang J. Epithelioid dedifferentiated liposarcoma: A clinicopathological and molecular study of 6 cases. Ann Diagn Pathol 2023; 67:152203. [PMID: 37634346 DOI: 10.1016/j.anndiagpath.2023.152203] [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: 07/24/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023]
Abstract
In this study, we present six cases of epithelioid dedifferentiated liposarcoma to further characterize its clinical and pathological features. The patients are all adult men with age at presentation ranging from 46 to 64 years (median 58.5 years). The patients presented with nonspecific symptoms of retroperitoneal mass, intermittent dull pain or discomfort. None of the patients had any prior history of a primary tumor. Radiological examinations revealed the presence of ill-demarcated heterogenous mass located in the deep soft tissue, including retroperitoneum (4 cases), pelvis and trunk (1 case each). Grossly, they appeared as solid tumors with focal areas of necrosis being presented in 2 cases. Histologically, all tumors were characterized by sheets of epithelioid cells that displayed marked cellular atypia and brisk mitotic activity. Variable portion of atypical lipomatous tumor/well-differentiated liposarcoma was present in 3 cases. By immunohistochemistry, the high-grade epithelioid component in all 6 cases showed strong and diffuse nuclear staining of MDM2, CDK4 and P16, with partial expression of AE1/AE3 in 3 cases. Fluorescence in situ hybridization analysis revealed high-level amplification of MDM2 in all 6 cases, with co-amplification of CDK4 in 3 cases. Follow up information showed that two patients died of the disease within one year despite multidisciplinary treatment. Due to the striking epithelioid appearance, this rare variant of dedifferentiated liposarcoma may be confused with undifferentiated epithelioid sarcoma, poorly differentiated carcinoma, mesothelioma or other malignancies with epithelioid phenotype. The study presented herein further highlights the aggressive clinical behavior of this unique tumor type. For patients with advanced disease, CDK4 inhibitor may provide an optional targeted treatment.
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Affiliation(s)
- Yuan Tu
- Department of Pathology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Department of Pathology, No.2 Hospital of Chengdu 610017, China
| | - Peipei Zhu
- Department of Pathology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
| | - I Weng Lao
- Department of Pathology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Lin Yu
- Department of Pathology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jian Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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6
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Apte SS, Mor E, Mitchell C, Gyorki DE. Practical Management of Adult Ultra-Rare Primary Retroperitoneal Soft Tissue Sarcoma: A Focus on Perivascular Epithelioid Tumours and Extraosseous Ewing Sarcoma. Curr Oncol 2023; 30:5953-5972. [PMID: 37504306 PMCID: PMC10377910 DOI: 10.3390/curroncol30070445] [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: 03/22/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/29/2023] Open
Abstract
With the exception of well-differentiated liposarcoma, dedifferentiated liposarcoma, leiomyosarcoma, solitary fibrous tumour, malignant peripheral nerve sheath tumour, and undifferentiated pleomorphic sarcoma, the majority of the ≈70 histologic subtypes of retroperitoneal sarcoma are defined as 'ultra-rare' sarcomas, with an incidence of ≤1-5/1,000,000 persons/year. For most of these ultra-rare RPS subtypes, diagnosis and treatment follows international guidelines for the management of more common RPS histologies, with en bloc surgical resection as the mainstay of curative treatment, and enrolment in clinical trials where possible. Because the treatment of RPS is heavily driven by histology, the surgeon must be familiar with specific issues related to the diagnosis and management of ultra-rare sarcoma subtypes. Expert radiological and surgeon reviews are required to differentiate similarly presenting tumours where surgery can be avoided (e.g., angiomyolipoma), or where upfront systemic therapy is indicated (e.g., extraosseous Ewing's sarcoma). Thus, the management of all retroperitoneal sarcomas should occur at a sarcoma referral centre, with a multidisciplinary team of experts dedicated to the surgical and medical management of these rare tumours. In this focused review, we highlight how diagnosis and management of the ultra-rare primary RPS histologies of malignant perivascular epithelioid cell tumour (PEComa), extraosseous Ewing sarcoma (EES), extraosseous osteosarcoma (EOS), and rhabdomyosarcoma (RMS) critically diverge from the management of more common RPS subtypes.
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Affiliation(s)
- Sameer S Apte
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Division of General Surgery, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
| | - Eyal Mor
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Catherine Mitchell
- Division of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
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7
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La Ferlita A, Sp N, Goryunova M, Nigita G, Pollock RE, Croce CM, Beane JD. Small Non-Coding RNAs in Soft-Tissue Sarcomas: State of the Art and Future Directions. Mol Cancer Res 2023; 21:511-524. [PMID: 37052491 PMCID: PMC10238653 DOI: 10.1158/1541-7786.mcr-22-1008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/06/2023] [Accepted: 02/22/2023] [Indexed: 04/14/2023]
Abstract
Soft-tissue sarcomas (STS) are a rare and heterogeneous group of tumors that arise from connective tissue and can occur anywhere in the body. Among the plethora of over 50 different STS types, liposarcoma (LPS) is one of the most common. The subtypes of STS are characterized by distinct differences in tumor biology that drive responses to pharmacologic therapy and disparate oncologic outcomes. Small non-coding RNAs (sncRNA) are a heterogeneous class of regulatory RNAs involved in the regulation of gene expression by targeting mRNAs. Among the several types of sncRNAs, miRNAs and tRNA-derived ncRNAs are the most studied in the context of tumor biology, and we are learning more about the role of these molecules as important regulators of STS tumorigenesis and differentiation. However, challenges remain in translating these findings and no biomarkers or therapeutic approaches targeting sncRNAs have been developed for clinical use. In this review, we summarize the current landscape of sncRNAs in the context of STS with an emphasis on LPS, including the role of sncRNAs in the tumorigenesis and differentiation of these rare malignancies and their potential as novel biomarkers and therapeutic targets. Finally, we provide an appraisal of published studies and outline future directions to study sncRNAs in STS, including tRNA-derived ncRNAs.
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Affiliation(s)
- Alessandro La Ferlita
- Department of Cancer Biology and Genetics, The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Nipin Sp
- Department of Surgery, Division of Surgical Oncology, The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Marina Goryunova
- Department of Surgery, Division of Surgical Oncology, The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Giovanni Nigita
- Department of Cancer Biology and Genetics, The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Raphael E. Pollock
- Department of Surgery, Division of Surgical Oncology, The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Carlo M. Croce
- Department of Cancer Biology and Genetics, The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Joal D. Beane
- Department of Surgery, Division of Surgical Oncology, The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
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8
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Updates in Pathology for Retroperitoneal Soft Tissue Sarcoma. Curr Oncol 2022; 29:6400-6418. [PMID: 36135073 PMCID: PMC9497884 DOI: 10.3390/curroncol29090504] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Retroperitoneal tumors are extremely rare. More than 70% of primary retroperitoneal soft tissue tumors are malignant. The most common sarcomas in the retroperitoneum include liposarcomas and leiomyosarcoma, however other sarcomas, along with benign mesenchymal tumors, can occur. Sarcomas are a heterogenous group of tumors with overlapping microscopic features, posing a diagnostic challenge for the pathologist. Correct tumor classification has become important for prognostication and the evolving targeted therapies for sarcoma subtypes. In this review, the pathology of retroperitoneal soft tissue sarcomas is discussed, which is important to the surgical oncologist. In addition, less common sarcomas and benign mesenchymal tumors of the retroperitoneum, which may mimic sarcoma clinically and pathologically, are also discussed.
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9
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Chaudhary R, Lisa M, Kumari P, Kumar A. Dedifferentiated Liposarcoma: A Rare Case Report of Retroperitoneal Myxoid Soft Tissue Tumour with Diagnostic Dilemma. CLINICAL PATHOLOGY (THOUSAND OAKS, VENTURA COUNTY, CALIF.) 2022; 15:2632010X221112455. [PMID: 35874849 PMCID: PMC9301116 DOI: 10.1177/2632010x221112455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 11/17/2022]
Abstract
Background: The retroperitoneum can host a wide spectrum of soft tissue lesions. These
tumours pose a challenge to the pathologist as the morphology is not of much
help and immunohistochemistry becomes a necessity. Case report: Sixty years old male presented with 2 months history of abdominal lump, pain
and dyspepsia. The MRI revealed a heterogeneous mass in the retroperitoneum
involving right para spinal muscle, right iliac fossa and right perinephric
region with destruction of right transverse process and erosion of adjacent
L3 vertebra. Trucut biopsy of the mass was reported as fibroliposarcoma at
an outside lab. Patient underwent a wide local excision. Grossly the tumour
gave an impression of a liposarcoma but the microscopy showed areas of
spindle cells, epitheloid cells, focal areas of ganglion like cells and
large areas of myxoid change. IHC panel of S-100, SMA, caldesmon, myogenin,
myoglobin and Alk-1 was negative. MDM2, CDK4 and p16 IHC came positive
proving it to be a dedifferentiated liposarcoma. Conclusion: We report a curious case of retroperitoneal soft tissue tumour with complex
morphology and IHC features diagnosed as dedifferentiated liposarcoma based
on MDM2, CDK and p16 positivity.
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Affiliation(s)
| | - Mona Lisa
- Department of Pathology, IGIMS, Patna, Bihar, India
| | - Payal Kumari
- Department of Pathology, IGIMS, Patna, Bihar, India
| | - Aman Kumar
- Department of Surgery, UNC School of Medicine, Chapel Hill, NC, USA
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10
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Thway K. What’s new in adipocytic neoplasia? Histopathology 2021; 80:76-97. [DOI: 10.1111/his.14548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Khin Thway
- Sarcoma Unit Royal Marsden Hospital London UK
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11
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Boyraz B, Hung YP. Spindle Cell Tumors of the Pleura and the Peritoneum: Pathologic Diagnosis and Updates. APMIS 2021; 130:140-154. [PMID: 34942046 DOI: 10.1111/apm.13203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/23/2021] [Indexed: 11/30/2022]
Abstract
A diverse group of both benign and malignant spindle cell tumors can involve the pleura or the peritoneum. Due to their rarity and overlapping morphologic features, these tumors can pose considerable diagnostic difficulty in surgical pathology. As these tumors differ in their prognosis and clinical management, their correct pathologic diagnosis is critical. In addition to histologic assessment, select immunohistochemical and molecular tools can aid the distinction among these tumors. In this review, we consider some of the major histologic differential diagnosis of spindle cell tumors involving these serosal membranes. This list of tumors includes: solitary fibrous tumor, inflammatory myofibroblastic tumor, desmoid fibromatosis, synovial sarcoma, sarcomatoid carcinoma, spindle cell melanoma, dedifferentiated liposarcoma, epithelioid hemangioendothelioma, and sarcomatoid mesothelioma. We describe their salient clinicopathologic and genetic findings, with a review on some of the recent discoveries on their molecular pathogenesis.
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Affiliation(s)
- Baris Boyraz
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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12
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Thway K, Fisher C. Undifferentiated and dedifferentiated soft tissue neoplasms: Immunohistochemical surrogates for differential diagnosis. Semin Diagn Pathol 2021; 38:170-186. [PMID: 34602314 DOI: 10.1053/j.semdp.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/14/2021] [Accepted: 09/27/2021] [Indexed: 12/23/2022]
Abstract
Undifferentiated soft tissue sarcomas (USTS) are described in the current World Health Organization Classification of Soft Tissue and Bone Tumours as those showing no identifiable line of differentiation when analyzed by presently available technologies. This is a markedly heterogeneous group, and the diagnosis of USTS remains one of exclusion. USTS can be divided into four morphologic subgroups: pleomorphic, spindle cell, round cell and epithelioid undifferentiated sarcomas, with this combined group accounting for up to 20% of all soft tissue sarcomas. As molecular advances enable the stratification of emerging genetic subsets within USTS, particularly within undifferentiated round cell sarcomas, other groups, particularly the category of undifferentiated pleomorphic sarcomas (UPS), still remain difficult to substratify and represent heterogeneous collections of neoplasms often representing the common morphologic endpoints of a variety of malignant tumors of various (mesenchymal and non-mesenchymal) lineages. However, recent molecular developments have also enabled the identification and correct classification of many tumors from various lines of differentiation that would previously have been bracketed under 'UPS'. This includes pleomorphic neoplasms and dedifferentiated neoplasms (the latter typically manifesting with an undifferentiated pleomorphic morphology) of mesenchymal (e.g. solitary fibrous tumor and gastrointestinal stromal tumor) and non-mesenchymal (e.g. melanoma and carcinoma) origin. The precise categorization of 'pleomorphic' or 'undifferentiated' neoplasms is critical for prognostication, as, for example, dedifferentiated liposarcoma typically behaves less aggressively than other pleomorphic sarcomas, and for management, including the potential for targeted therapies based on underlying recurrent molecular features. In this review we focus on undifferentiated and dedifferentiated pleomorphic and spindle cell neoplasms, summarizing their key genetic, morphologic and immunophenotypic features in the routine diagnostic setting, and the use of immunohistochemistry in their principal differential diagnosis, and highlight new developments and entities in the group of undifferentiated and dedifferentiated soft tissue sarcomas.
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Affiliation(s)
- Khin Thway
- Sarcoma Unit, Royal Marsden Hospital, London, SW3 6JJ, United Kingdom; Division of Molecular Pathology, The Institute of Cancer Research, 237 Fulham Rd, London, SW3 6JB, United Kingdom.
| | - Cyril Fisher
- Division of Molecular Pathology, The Institute of Cancer Research, 237 Fulham Rd, London, SW3 6JB, United Kingdom; Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
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13
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Choi JH, Ro JY. Mesenchymal Tumors of the Mediastinum: An Update on Diagnostic Approach. Adv Anat Pathol 2021; 28:351-381. [PMID: 34050062 DOI: 10.1097/pap.0000000000000306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mesenchymal tumors of the mediastinum are a heterogenous group of rare tumors with divergent lineages. Mediastinal mesenchymal tumors are diagnostically challenging due to their diversity and morphologic overlap with nonmesenchymal lesions arising in the mediastinum. Accurate histologic diagnosis is critical for appropriate patient management and prognostication. Many mediastinal mesenchymal tumors affect distinct age groups or occur at specific mediastinal compartments. Neurogenic tumors, liposarcoma, solitary fibrous tumor, and synovial sarcoma are common mesenchymal tumors in the mediastinum. Herein, we provide an update on the diagnostic approach to mediastinal mesenchymal tumors and a review of the histologic features and differential diagnosis of common benign and malignant mesenchymal tumors of the mediastinum.
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Affiliation(s)
- Joon Hyuk Choi
- Department of Pathology, Yeungnam University College of Medicine, Daegu, South Korea
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX
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14
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Tseng WW, Barretta F, Baia M, Barisella M, Radaelli S, Callegaro D, Yoon DH, Fiore M, Gronchi A. Dedifferentiation within well-differentiated liposarcoma of the extremity or trunk: Implications for clinical management. J Surg Oncol 2021; 124:838-845. [PMID: 34254688 DOI: 10.1002/jso.26590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND In extremity or trunk liposarcoma, the implications of a dedifferentiated (DD) component within a well-differentiated (WD) tumor are unclear. We evaluated outcomes after surgery and identified potential predictors of survival in these patients compared to those with an entirely WD tumor. METHODS Retrospective data were collected for patients who underwent complete resection from 2009 to 2019. Cumulative incidences of local recurrence (LR) and distant metastasis (DM) were calculated, and overall survival (OS) was estimated. Associations between OS and clinicopathologic variables were evaluated by univariable models. RESULTS A total of 210 patients with MDM2-verified tumors were studied, including 58 (27.6%) with DD. In primary disease, LR occurred only in DD and worse OS was observed versus WD (p < 0.001). In recurrent disease, the LR incidences were similar between WD and DD (p = 0.559); however, worse OS persisted in DD (p = 0.004). The incidence of DM was extremely low (3.8%) and limited to DD. Higher grade (p < 0.001) and DD size (p = 0.043), but not overall tumor size were associated with worse OS. CONCLUSIONS In extremity or trunk liposarcoma, the presence of DD leads to significantly worse outcomes in both primary and recurrence diseases. Further study is needed to determine if these patients benefit from adjunct therapies (e.g., radiation).
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Affiliation(s)
- William W Tseng
- Division of Breast, Endocrine and Soft Tissue Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Francesco Barretta
- Clinical Epidemiology and Trials Organization Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Baia
- Department of Surgery, Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Barisella
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Radaelli
- Department of Surgery, Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dario Callegaro
- Department of Surgery, Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dong Hum Yoon
- Division of Breast, Endocrine and Soft Tissue Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Marco Fiore
- Department of Surgery, Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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15
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Volkov AY, Kozlov NA, Nered SN, Stilidi IS, Stroganova AM, Arkhiri PP, Antonova EY, Privezentsev SA. [Retroperitoneal dedifferentiated liposarcomas: semi-quantitative assessment of the dedifferentiated component and prognosis]. Arkh Patol 2020; 82:25-32. [PMID: 33054029 DOI: 10.17116/patol20208205125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the impact of malignancy grade and the proportion of the dedifferentiated component (DC) in retroperitoneal dedifferentiated liposarcomas (DDLS) on the course and prognosis of the disease. MATERIAL AND METHODS The retrospective study enrolled 74 patients with primary retroperitoneal DDLS who underwent radical surgical treatment in the N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia. Histological surgery specimens from all cases of DDLS were reexamined and reclassified. According to malignancy grades and the proportion of the dedifferentiated component in the tumor, the patients were divided into the comparison groups included in the intergroup analysis of overall and relapse-free survival (OS and RFS) rates. The authors also analyzed the relationship between the proportion of the dedifferentiated component in DDLS and the frequency of adjacent organ invasion. RESULTS Patients with a more than 15% dedifferentiated component had significantly lower OS rates than those with a less than 15% one (p=0.0001; log-rank test). The median OS in the DDLS group with a less than 15% dedifferentiated component was 91 months (95% CI, 82-100); that in the DDLS group with a more than 15% dedifferentiated component was 29 months (95% CI 17-41). The 5-year overall survival rates in the groups with less than 15% and more than 15% dedifferentiated components were 69% and 2%, respectively. The group with a more than 15% dedifferentiated component had significantly lower RFS rates than that with a less than 15% one (p=0.0001; log-rank test). In the DDLS groups with less than 15% and more than 15% dedifferentiated components, the median RFS rates were 25 months (95% CI 23-27) and 13 months (95% CI 8-18), respectively. In these groups, the 2-year RFS rates were equal to 50% and 9%, respectively. In the DDLS groups with less than 15% and more than 15% dedifferentiated components, pathologically confirmed invasion into the adjacent organs was observed in 32% and 63% of cases, respectively. There were no statistically significant differences in the OS and RFS of patients with DDLS according to tumor grade (p=0.069; p=0.102). CONCLUSION This investigation suggests that DDLS have a more aggressive course with an increasing proportion of the dedifferentiated component in the tumor. Considering the histological variability in the dedifferentiated component, which is demonstrated in the research and scientific literature, as well as lack of a prognostic impact of histological grade, the authors believe that semi-quantitative assessment of the proportion of the dedifferentiated component in DDLS is able to serve as a simple and efficient morphological marker for the course of the disease and prognosis in retroperitoneal DDLS.
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Affiliation(s)
- A Yu Volkov
- Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - N A Kozlov
- Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - S N Nered
- Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - I S Stilidi
- Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - A M Stroganova
- Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - P P Arkhiri
- Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - E Yu Antonova
- Blokhin National Medical Research Center of Oncology, Moscow, Russia
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16
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Retroperitoneal Sarcomas: An Update on the Diagnostic Pathology Approach. Diagnostics (Basel) 2020; 10:diagnostics10090642. [PMID: 32867125 PMCID: PMC7555595 DOI: 10.3390/diagnostics10090642] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 02/07/2023] Open
Abstract
Retroperitoneal sarcomas are a heterogenous group of rare tumors arising in the retroperitoneum. Retroperitoneal sarcomas comprise approximately 10% of all soft tissue sarcomas. Though any soft tissue sarcoma histologic types may arise in the retroperitoneal space, liposarcoma (especially well-differentiated and dedifferentiated types) and leiomyosarcoma do so most commonly. Retroperitoneal sarcomas are diagnostically challenging, owing to their diversity and morphological overlap with other tumors arising in the retroperitoneum. An accurate diagnosis is necessary for correct management and prognostication. Herein, we provide an update on the diagnostic approach to retroperitoneal sarcomas and review their key histologic findings and differential diagnoses.
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17
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Kukull BJ, Khalighi MA, Gundle KR, Hansford BG, Corless CL, Davis JL. Low-grade Osteosarcomatous Dedifferentiation of an Atypical Lipomatous Tumor in a Pediatric Patient. Pediatr Dev Pathol 2020; 23:240-246. [PMID: 31739757 DOI: 10.1177/1093526619889130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atypical and malignant lipomatous tumors are infrequent in the pediatric population. Within this uncommon cohort, the morphologically and genetically related spectrum of atypical lipomatous tumor/well-differentiated liposarcoma/dedifferentiated liposarcoma (ALT/WDL/DDLS) is markedly rare. Their shared characteristic molecular aberration is a genomic amplicon of a region of chromosome 12q, including the oncogenes MDM2 and CDK4. We present an unusual case of a pediatric patient with an ALT, with recurrence after 2 years in the form of a bone-forming mass, radiologically and pathologically mimicking parosteal osteosarcoma, a tumor also molecularly characterized by amplification of MDM2 and CDK4. However, with ample histologic sampling, a single focus of lipogenic differentiation was identified, thus representing the first near complete low-grade osteosarcomatous dedififferentation reported within ALT/WDL/DDLS and the first ever in pediatric patient. The case serves a reminder of a diagnosis differential and pitfalls within MDM2-amplified tumors.
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Affiliation(s)
- Benjamin J Kukull
- Department of Pathology, Oregon Health & Science University, Portland, Oregon
| | - Mazdak A Khalighi
- Department of Pathology, Oregon Health & Science University, Portland, Oregon
| | - Kenneth R Gundle
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon.,Operative Care Division, Portland VA Medical Center, Portland, Oregon
| | - Barry G Hansford
- Department of Radiology, Oregon Health & Science University, Portland, Oregon
| | - Christopher L Corless
- Department of Pathology, Oregon Health & Science University, Portland, Oregon.,Knight Cancer Institute, Portland, Oregon
| | - Jessica L Davis
- Department of Pathology, Oregon Health & Science University, Portland, Oregon
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18
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Chen HG, Zhang K, Wu WB, Wu YH, Zhang J, Gu LJ, Li XJ. Combining surgery with 125I brachytherapy for recurrent mediastinal dedifferentiated liposarcoma: A case report and review of literature. World J Clin Cases 2020; 8:939-945. [PMID: 32190631 PMCID: PMC7062618 DOI: 10.12998/wjcc.v8.i5.939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/12/2020] [Accepted: 02/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Dedifferentiated liposarcoma in the mediastinum is an extremely rare malignant neoplasm. A few previous case reports indicate that surgical resection is the major treatment, but frequent recurrence occurs locally. Due to its rarity, its clinical characteristics, optimal treatment and clinical outcomes remain unclear. Here, we report a case of multifocal recurrent dedifferentiated liposarcoma in the posterior mediastinum treated by combining surgery with 125I brachytherapy, and summarize its clinical features, treatment and prognosis.
CASE SUMMARY A 75-year-old man was admitted to our hospital with a history of gradual dysphagia for one year and aggravated dysphagia for 3 mo. Contrast-enhanced computed tomography (CT) revealed several large cystic-solid masses with lipomatous density, and calcification in the posterior-inferior mediastinum. The patient received a wide excision by video-assisted thoracoscopic surgery. Pathological analysis confirmed the tumors were dedifferentiated liposarcomas. The tumor locally relapsed 24 mo later, and another operation was performed by video-assisted thoracoscopic surgery. Fifteen months after the second surgery, the tumor recurred again, and the patient received CT-guided radioactive seeds 125I implantation. After 8 mo, follow-up chest CT showed an enlarged tumor. Finally, his condition exacerbated with severe dysphagia and dyspnea, and he died of respiratory failure in July 2018.
CONCLUSION We reviewed the literature, and suggest that surgical resection provides beneficial effects for dedifferentiated liposarcoma in the mediastinum, even in cases with local recurrence. 125I brachytherapy may be beneficial for recurrent unresectable patients.
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Affiliation(s)
- Hui-Guo Chen
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Kai Zhang
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Wei-Bin Wu
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Yong-Hui Wu
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Jian Zhang
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Li-Jia Gu
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Xiao-Jun Li
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
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19
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Chen HG, Zhang K, Wu WB, Wu YH, Zhang J, Gu LJ, Li XJ. Combining surgery with 125I brachytherapy for recurrent mediastinal dedifferentiated liposarcoma: A case report and review of literature. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i5.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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20
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Shon W, Billings SD. Soft Tissue Special Issue: Selected Topics in the Pathology of Adipocytic Tumors. Head Neck Pathol 2020; 14:1-11. [PMID: 31950475 PMCID: PMC7021849 DOI: 10.1007/s12105-019-01112-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/02/2019] [Indexed: 12/11/2022]
Abstract
Our understanding of adipocytic tumors classification and diagnosis continues to evolve. We present a brief review and updated summary of selected adipocytic tumors involving the head and neck region. For the practicing pathologist, knowledge of these established and emerging entities is critical for the correct pathologic diagnosis and treatment of the patient.
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Affiliation(s)
- Wonwoo Shon
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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21
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McCarthy AJ, Carroll P, Vajpeyi R, Darling G, Chetty R. Well-Differentiated Liposarcoma (Atypical Lipomatous Tumor) Presenting as an Esophageal Polyp. J Gastrointest Cancer 2020; 50:589-595. [PMID: 29349606 DOI: 10.1007/s12029-018-0052-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Aoife J McCarthy
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto General Hospital, 200 Elizabeth Street, 11th Floor, Eaton Wing, Toronto, Ontario, M5G 2C4, Canada. .,University of Toronto, Toronto, Canada.
| | - Paul Carroll
- University of Toronto, Toronto, Canada.,Surgery and Critical Care Program, Departments of Thoracic Surgery and Surgical Oncology, University Health Network and University of Toronto, Toronto, Canada
| | - Rajkumar Vajpeyi
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto General Hospital, 200 Elizabeth Street, 11th Floor, Eaton Wing, Toronto, Ontario, M5G 2C4, Canada.,University of Toronto, Toronto, Canada
| | - Gail Darling
- University of Toronto, Toronto, Canada.,Surgery and Critical Care Program, Departments of Thoracic Surgery and Surgical Oncology, University Health Network and University of Toronto, Toronto, Canada
| | - Runjan Chetty
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto General Hospital, 200 Elizabeth Street, 11th Floor, Eaton Wing, Toronto, Ontario, M5G 2C4, Canada.,University of Toronto, Toronto, Canada
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22
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Olson N, Gularte-Mérida R, Selenica P, Da Cruz Paula A, Alemar B, Weigelt B, Lefferts J, Linos K. Molecular Characterization of a Rare Dedifferentiated Liposarcoma With Rhabdomyosarcomatous Differentiation in a 24 Year Old. Int J Surg Pathol 2019; 28:454-463. [PMID: 31801397 PMCID: PMC8302235 DOI: 10.1177/1066896919890401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Aims. The aim of this study was to identify potential driver genetic alterations in a dedifferentiated liposarcoma (DDLPS) with rhabdomyosarcomatous differentiation. Methods and Results. A 24-year-old female underwent resection of an abdominal mass, which on a previous biopsy demonstrated rhabdomyosarcomatous differentiation concerning for embryonal rhabdomyosarcoma. Histologically the resected tumor displayed a high-grade sarcoma with rhabdomyosarcomatous differentiation in the background of well-differentiated liposarcoma consistent with DDLPS. Fluorescence in situ hybridization confirmed MDM2 amplification, as did array-based copy number profiling. Whole-exome sequencing revealed a somatic FGFR1 hotspot mutation and RNA sequencing an LMNB2-MAP2K6 fusion only within the dedifferentiated component. Conclusions. This study represents an in-depth examination of a rare DDLPS with rhabdomyosarcomatous differentiation in a young individual. Additionally, it is also instructive of a potential pitfall when assessing for MDM2 amplification in small biopsies. Despite exhaustive analysis, mutation and gene copy number analysis did not identify any molecular events that would underlie the rhabdomyoblastic differentiation. Our understanding of what causes some tumors to dedifferentiate as well as undergo divergent differentiation is limited, and larger studies are needed.
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Affiliation(s)
- Nicholas Olson
- Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Lebanon, NH, USA
| | | | - Pier Selenica
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,University of Maastricht, Maastricht, Netherlands
| | | | - Barbara Alemar
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Britta Weigelt
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joel Lefferts
- Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Lebanon, NH, USA
| | - Konstantinos Linos
- Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Lebanon, NH, USA
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23
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Diagnostic classification of soft tissue malignancies: A review and update from a surgical pathology perspective. Curr Probl Cancer 2019; 43:250-272. [DOI: 10.1016/j.currproblcancer.2019.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/15/2019] [Indexed: 02/07/2023]
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24
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Codenotti S, Mansoury W, Pinardi L, Monti E, Marampon F, Fanzani A. Animal models of well-differentiated/dedifferentiated liposarcoma: utility and limitations. Onco Targets Ther 2019; 12:5257-5268. [PMID: 31308696 PMCID: PMC6613351 DOI: 10.2147/ott.s175710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 06/04/2019] [Indexed: 12/31/2022] Open
Abstract
Liposarcoma is a malignant neoplasm of fat tissue. Well-differentiated and dedifferentiated liposarcoma (WDL/DDL) represent the two most clinically observed histotypes occurring in middle-aged to older adults, particularly within the retroperitoneum or extremities. WDL/DDL are thought to represent the broad spectrum of one disease, as they are both associated with the amplification in the chromosomal 12q13-15 region that causes MDM2 and CDK4 overexpression, the most useful predictor for liposarcoma diagnosis. In comparison to WDL, DDL contains additional genetic abnormalities, principally coamplifications of 1p32 and 6q23, that increase recurrence and metastatic rate. In this review, we discuss the xenograft and transgenic animal models generated for studying progression of WDL/DDL, highlighting utilities and pitfalls in such approaches that can facilitate or impede the development of new therapies.
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Affiliation(s)
- Silvia Codenotti
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Walaa Mansoury
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Luca Pinardi
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Eugenio Monti
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Francesco Marampon
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Alessandro Fanzani
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
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25
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Wang GY, Lucas DR. Dedifferentiated Liposarcoma With Myofibroblastic Differentiation. Arch Pathol Lab Med 2019; 142:1159-1163. [PMID: 30281365 DOI: 10.5858/arpa.2018-0205-ra] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Liposarcoma is divided into myxoid, pleomorphic, well-differentiated, and dedifferentiated subtypes. Dedifferentiated liposarcoma displays the greatest histomorphologic diversity, including a subset with myofibroblastic differentiation that shares similarities with a spectrum of reactive, benign, and malignant soft tissue lesions. Misdiagnosis may lead to deleterious consequences, as dedifferentiated liposarcoma differs significantly in its prognosis and treatment from its mimics. OBJECTIVE.— To review the clinicopathologic, immunohistochemical, and molecular features of the myofibroblastic variant of dedifferentiated liposarcoma as well as the key distinguishing features from its mimics. DATA SOURCES.— Review of pertinent literature on major features and current understanding of dedifferentiated liposarcoma with myofibroblastic differentiation. CONCLUSIONS.— The myofibroblastic variant of dedifferentiated liposarcoma is an uncommon and underrecognized sarcoma with several important differential diagnoses, and likely represents the major subset of aggressive retroperitoneal tumors that may have been misdiagnosed as desmoid-type fibromatosis, inflammatory myofibroblastic tumor, or another type of sarcoma in the past.
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Affiliation(s)
| | - David R Lucas
- From the Department of Pathology, University of Michigan, Ann Arbor
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26
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Karakas C, Christensen P, Baek D, Jung M, Ro JY. Dedifferentiated gastrointestinal stromal tumor: Recent advances. Ann Diagn Pathol 2019; 39:118-124. [DOI: 10.1016/j.anndiagpath.2018.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/16/2018] [Indexed: 12/19/2022]
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27
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Abstract
Well-differentiated liposarcoma (WDL)/atypical lipomatous tumor and dedifferentiated liposarcoma (DDL) together comprise the largest subgroup of liposarcomas, and constitute a histologic and behavioral spectrum of one disease. WDL and DDL typically occur in middle-aged to older adults, particularly within the retroperitoneum or extremities. WDL closely resembles mature adipose tissue, but typically shows fibrous septation with variable nuclear atypia and enlargement. WDL does not metastasize, but can dedifferentiate to DDL, which is associated with more aggressive clinical behavior, with a greater propensity for local recurrence and the capacity for metastasis. Although distant metastasis is rarer in DDL compared with other pleomorphic sarcomas, behavior is related to location, with a significantly worse outcome in retroperitoneal tumors. DDL typically has the appearance of undifferentiated pleomorphic or spindle cell sarcoma, and is usually a non-lipogenic sarcoma that is adjacent to WDL, occurs as a recurrence of WDL or which can arise de novo. WDL and DDL share similar background genetic aberrations; both are associated with high-level amplifications in the chromosomal 12q13-15 region, which includes the CDK4 and MDM2 cell cycle oncogenes. In addition, DDL harbor further genetic changes, particularly 6q23 and 1p32 coamplifications. While surgical excision remains the treatment mainstay with limited medical options for patients with aggressive recurrent disease or metastases, novel targeted therapies towards the gene products of chromosome 12 are being evaluated. This review summarizes the pathology of WDL and DDL, discussing morphology, immunohistochemistry, genetics and the differential diagnosis.
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Affiliation(s)
- Khin Thway
- Sarcoma Unit, Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, United Kingdom.
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28
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Hornick JL. Subclassification of pleomorphic sarcomas: How and why should we care? Ann Diagn Pathol 2018; 37:118-124. [PMID: 30340082 DOI: 10.1016/j.anndiagpath.2018.10.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 01/15/2023]
Abstract
Pleomorphic sarcomas are a heterogeneous group of mesenchymal neoplasms with widely varied clinical behavior but overlapping histologic appearances. The following guidelines are helpful when approaching the diagnosis of a pleomorphic sarcoma. (1) Be aware of the relative incidence of the various sarcoma types: several pleomorphic sarcomas are relatively common (e.g., dedifferentiated liposarcoma and undifferentiated pleomorphic sarcoma), whereas others are exceptionally rare. (2) Pay attention to anatomic location: some pleomorphic sarcomas have a predilection for somatic soft tissues, especially the thigh (e.g., undifferentiated pleomorphic sarcoma, pleomorphic liposarcoma, pleomorphic rhabdomyosarcoma), whereas other pleomorphic sarcomas most often arise in the retroperitoneum (e.g., dedifferentiated liposarcoma). (3) Carefully sample the resection specimen, paying particular attention to areas with differences in gross appearances (e.g., fleshy, fibrous, mucoid, or gritty). (4) Search for histologic clues (i.e., myxoid stroma, lipoblasts, and osteoid matrix, in order to diagnose myxofibrosarcoma, pleomorphic liposarcoma, and extraskeletal osteosarcoma, respectively); these critical diagnostic features may be limited in extent. (5) Apply immunohistochemistry judiciously, after generating a differential diagnosis; always exclude metastatic sarcomatoid carcinoma and melanoma before diagnosing a pleomorphic sarcoma. This review will present an approach to the diagnosis of pleomorphic sarcomas, emphasizing differential diagnosis and the application of ancillary studies (immunohistochemistry and FISH), when relevant.
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Affiliation(s)
- Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
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29
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Hung YP, Hornick JL. Immunohistochemical Biomarkers of Mesenchymal Neoplasms in Endocrine Organs: Diagnostic Pitfalls and Recent Discoveries. Endocr Pathol 2018; 29:189-198. [PMID: 29340997 DOI: 10.1007/s12022-018-9513-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mesenchymal neoplasms rarely present in or adjacent to endocrine organs. In this context, the recognition of these rare tumor types can be challenging, with significant potential for misdiagnosis as sarcomatoid carcinomas (i.e., anaplastic thyroid carcinoma and sarcomatoid adrenal cortical carcinoma) or neuroendocrine carcinomas, depending upon the dominant histologic patterns. In this review, we address potential pitfalls in diagnosing selected mesenchymal neoplasms arising within or near endocrine organs, including dedifferentiated liposarcoma, synovial sarcoma, angiosarcoma, PEComa, proximal-type epithelioid sarcoma, Ewing sarcoma, and neuroblastoma. For each of these tumor types, we review clinical and pathologic features, histologic clues to distinguish them from endocrine neoplasms, and recently developed immunohistochemical markers that can be particularly useful for establishing the correct diagnosis.
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Affiliation(s)
- Yin P Hung
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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30
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McCarthy AJ, Chetty R. Tumours composed of fat are no longer a simple diagnosis: an overview of fatty tumours with a spindle cell component. J Clin Pathol 2018; 71:483-492. [PMID: 29358476 DOI: 10.1136/jclinpath-2017-204975] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 12/24/2017] [Indexed: 12/16/2022]
Abstract
This is a review of the morphological spectrum of fatty tumours containing a component of spindle cells, highlighting the immunohistochemical and cytogenetic workup that is now mandatory for accurate diagnosis, with the goal of providing a practical approach for practising surgical pathologists. There have been significant advances in recent years in classifying and understanding the pathogenesis of fatty tumours with spindle cells, based on the correlation of histological, immunohistochemical and cytogenetic/molecular findings. In spite of this, morphological diagnosis and accurate classification of fatty tumours with spindle cells can be challenging to diagnostic pathologists. A group of three lesions: spindle cell lipoma, mammary-type myofibroblastoma and cellular angiofibroma share morphological features and are united by retinoblastoma protein (pRb) loss. Closely allied to these lesions, especially spindle cell lipoma is the newly designated atypical spindle cell lipomatous tumour, which shares morphological, immunohistochemical and cytogenetic features with the trio of tumours lacking nuclear pRb. All of these lesions lack MDM2 and CDK4 amplification as well and separation is based on clinical features, principally location. Atypical lipomatous tumour or well-differentiated liposarcoma shows retention of pRb but overexpression and amplification of MDM2. Fatty tumours with spindle cells need to be extensively sampled, with careful attention paid to cellular atypia and location, and they need to have immunohistochemical workup with pRb, MDM2, desmin, CD34 and p16. In addition, cytogenetic analysis for MDM2 and CDK4 amplification has become crucial for the proper identification of these lesions.
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Affiliation(s)
- Aoife J McCarthy
- Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada
| | - Runjan Chetty
- Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Canada
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Yamashita K, Kohashi K, Yamada Y, Ishii T, Nishida Y, Urakawa H, Ito I, Takahashi M, Inoue T, Ito M, Ohara Y, Oda Y, Toyokuni S. Osteogenic differentiation in dedifferentiated liposarcoma: a study of 36 cases in comparison to the cases without ossification. Histopathology 2017; 72:729-738. [DOI: 10.1111/his.13421] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/16/2017] [Accepted: 10/24/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Kyoko Yamashita
- Department of Pathology and Biological Responses; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Kenichi Kohashi
- Department of Anatomic Pathology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Yuichi Yamada
- Department of Anatomic Pathology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Takeaki Ishii
- Department of Anatomic Pathology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Yoshihiro Nishida
- Department of Orthopedic Surgery; Nagoya University Graduate School and School of Medicine; Nagoya Japan
| | - Hiroshi Urakawa
- Department of Orthopedic Surgery; Nagoya University Graduate School and School of Medicine; Nagoya Japan
| | - Ichiro Ito
- Department of Pathology; Shizuoka Cancer Center Hospital; Shizuoka Japan
| | - Mitsuru Takahashi
- Division of Orthopaedic Oncology; Shizuoka Cancer Center Hospital; Shizuoka Japan
| | - Takeshi Inoue
- Department of Pathology; Osaka City General Hospital; Osaka Japan
| | - Masafumi Ito
- Department of Pathology; Japanese Red Cross Nagoya First Hospital; Nagoya Japan
| | - Yuuki Ohara
- Department of Pathology and Biological Responses; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Shinya Toyokuni
- Department of Pathology and Biological Responses; Nagoya University Graduate School of Medicine; Nagoya Japan
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Hollowoa B, Lamps LW, Mizell JS, English GW, Bridge JA, Ram R, Gardner JM. Dedifferentiated Liposarcoma Mimicking a Primary Colon Mass. Int J Surg Pathol 2017; 26:174-179. [PMID: 28950740 DOI: 10.1177/1066896917731517] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dedifferentiated liposarcoma is typically a nonlipogenic high-grade sarcoma that arises from well-differentiated liposarcoma. It most commonly presents as a large mass in the retroperitoneum. Significant involvement of the gastrointestinal tract by dedifferentiated liposarcoma is uncommon. We present a unique case of dedifferentiated liposarcoma radiographically mimicking a primary colon mass with resulting intussusception; stranding of the adjacent adipose tissue was presumed to be a secondary reactive change. On histopathologic analysis of the hemicolectomy specimen, a high-grade sarcoma was seen growing through the colonic wall, and the majority of the surrounding pericolonic adipose tissue was actually composed of well-differentiated liposarcoma with characteristic fibrous bands rather than benign fat with reactive fibrosis. This case raises awareness that well-differentiated liposarcoma and dedifferentiated liposarcoma can rarely present as a primary intestinal mass mimicking colon cancer or other more common entities. When radiographic examination shows a perigastrointestinal or retroperitoneal fatty mass and/or stranding of the fat adjacent to a solid gastrointestinal mass, this unusual scenario should be considered in the radiologic differential diagnosis. Pathologists should keep dedifferentiated liposarcoma in the initial histologic differential diagnosis for any high-grade spindle cell tumor of the retroperitoneum or intra-abdominal visceral organs.
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Affiliation(s)
- Blake Hollowoa
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Jason S Mizell
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | - Roopa Ram
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jerad M Gardner
- 1 University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Van Haverbeke C, Van Dorpe J, Lecoutere E, Flucke U, Ferdinande L, Creytens D. Dedifferentiated Liposarcoma of the Retroperitoneum With Heterologous Osteosarcomatous Differentiation and a Striking Aneurysmal Bone Cyst–Like Morphology. Int J Surg Pathol 2017; 25:374-378. [DOI: 10.1177/1066896917693093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 69-year-old woman with a 10-year medical history of recurrent retroperitoneal dedifferentiated liposarcoma presented with a 3-cm large hemorrhagic and multicystic left-sided retroperitoneal mass. Histopathological examination of the resected specimen showed a heterogeneous, high-grade mesenchymal nonlipogenic tumor with areas of osteoblastic/osteosarcomatous differentiation and aneurysmal bone cyst–like features. Based on the clinical presentation, the morphology, and the supportive immunohistochemical and molecular findings (MDM2 overexpression and amplification of the MDM2 gene, respectively), a diagnosis of a dedifferentiated liposarcoma with heterologous osteosarcomatous differentiation and an aneurysmal bone cyst–like morphology was made. To the best of our knowledge, this is the first description of aneurysmal bone cyst–like morphology in dedifferentiated liposarcoma, further expanding the broad morphological spectrum of dedifferentiated liposarcoma.
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Affiliation(s)
| | - Jo Van Dorpe
- Ghent University Hospital, Ghent University, Ghent, Belgium
| | | | - Uta Flucke
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - David Creytens
- Ghent University Hospital, Ghent University, Ghent, Belgium
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Bill KLJ, Casadei L, Prudner BC, Iwenofu H, Strohecker AM, Pollock RE. Liposarcoma: molecular targets and therapeutic implications. Cell Mol Life Sci 2016; 73:3711-8. [PMID: 27173057 PMCID: PMC7175098 DOI: 10.1007/s00018-016-2266-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 04/07/2016] [Accepted: 05/03/2016] [Indexed: 01/07/2023]
Abstract
Liposarcoma (LPS) is the most common soft tissue sarcoma and accounts for approximately 20 % of all adult sarcomas. Current treatment modalities (surgery, chemotherapy, and radiotherapy) all have limitations; therefore, molecularly driven studies are needed to improve the identification and increased understanding of genetic and epigenetic deregulations in LPS if we are to successfully target specific tumorigenic drivers. It can be anticipated that such biology-driven therapeutics will improve treatments by selectively deleting cancer cells while sparing normal tissues. This review will focus on several therapeutically actionable molecular markers identified in well-differentiated LPS and dedifferentiated LPS, highlighting their potential clinical applicability.
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Affiliation(s)
- Kate Lynn J Bill
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Division of Surgical Oncology, Department of Surgery, Wexner Medical Center, The Ohio State University, 410W 10th Ave., Columbus, OH, 43210, USA
| | - Lucia Casadei
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Division of Surgical Oncology, Department of Surgery, Wexner Medical Center, The Ohio State University, 410W 10th Ave., Columbus, OH, 43210, USA
| | - Bethany C Prudner
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Division of Surgical Oncology, Department of Surgery, Wexner Medical Center, The Ohio State University, 410W 10th Ave., Columbus, OH, 43210, USA
| | - Hans Iwenofu
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Anne M Strohecker
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Division of Surgical Oncology, Department of Surgery, Wexner Medical Center, The Ohio State University, 410W 10th Ave., Columbus, OH, 43210, USA
- Department of Molecular Virology, Immunology, and Medical Genetics, The Ohio State University, Columbus, OH, USA
| | - Raphael E Pollock
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
- Division of Surgical Oncology, Department of Surgery, Wexner Medical Center, The Ohio State University, 410W 10th Ave., Columbus, OH, 43210, USA.
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Bi P, Yue F, Karki A, Castro B, Wirbisky SE, Wang C, Durkes A, Elzey BD, Andrisani OM, Bidwell CA, Freeman JL, Konieczny SF, Kuang S. Notch activation drives adipocyte dedifferentiation and tumorigenic transformation in mice. J Exp Med 2016; 213:2019-37. [PMID: 27573812 PMCID: PMC5030803 DOI: 10.1084/jem.20160157] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/26/2016] [Indexed: 12/25/2022] Open
Abstract
Adipocyte-specific activation of Notch signaling suppresses lipid metabolism pathways that provide ligands to Pparγ, leading to adipocyte dedifferentiation and development of liposarcomas (LPSs) resembling human dedifferentiated LPSs with complete penetrance. Pparγ ligand supplementation prevents liposarcoma development. Liposarcomas (LPSs) are the most common soft-tissue cancer. Because of the lack of animal models, the cellular origin and molecular regulation of LPS remain unclear. Here, we report that mice with adipocyte-specific activation of Notch signaling (Ad/N1ICD) develop LPS with complete penetrance. Lineage tracing confirms the adipocyte origin of Ad/N1ICD LPS. The Ad/N1ICD LPS resembles human dedifferentiated LPS in histological appearance, anatomical localization, and gene expression signature. Before transformation, Ad/N1ICD adipocytes undergo dedifferentiation that leads to lipodystrophy and metabolic dysfunction. Although concomitant Pten deletion normalizes the glucose metabolism of Ad/N1ICD mice, it dramatically accelerates the LPS prognosis and malignancy. Transcriptomes and lipidomics analyses indicate that Notch activation suppresses lipid metabolism pathways that supply ligands to Pparγ, the master regulator of adipocyte homeostasis. Accordingly, synthetic Pparγ ligand supplementation induces redifferentiation of Ad/N1ICD adipocytes and tumor cells, and prevents LPS development in Ad/N1ICD mice. Importantly, the Notch target HES1 is abundantly expressed in human LPS, and Notch inhibition suppresses the growth of human dedifferentiated LPS xenografts. Collectively, ectopic Notch activation is sufficient to induce dedifferentiation and tumorigenic transformation of mature adipocytes in mouse.
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Affiliation(s)
- Pengpeng Bi
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907
| | - Feng Yue
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907
| | - Anju Karki
- Department of Biological Sciences, Purdue University, West Lafayette, IN 47907
| | - Beatriz Castro
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907
| | - Sara E Wirbisky
- School of Health Sciences, Purdue University, West Lafayette, IN 47907
| | - Chao Wang
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907
| | - Abigail Durkes
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907
| | - Bennett D Elzey
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907 Center for Cancer Research, Purdue University, West Lafayette, IN 47907
| | - Ourania M Andrisani
- Department of Basic Medical Sciences, Purdue University, West Lafayette, IN 47907 Center for Cancer Research, Purdue University, West Lafayette, IN 47907
| | | | - Jennifer L Freeman
- School of Health Sciences, Purdue University, West Lafayette, IN 47907 Center for Cancer Research, Purdue University, West Lafayette, IN 47907
| | - Stephen F Konieczny
- Department of Biological Sciences, Purdue University, West Lafayette, IN 47907 Center for Cancer Research, Purdue University, West Lafayette, IN 47907
| | - Shihuan Kuang
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907 Center for Cancer Research, Purdue University, West Lafayette, IN 47907
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Panoussopoulos D, Theodoropoulos G, Lazaris AC, Papadimitriou K. Focal Divergent Chondrosarcomatous Differentiation in a Primary Pleomorphic Liposarcoma and Expression of Transforming Growth Factor 3. Int J Surg Pathol 2016; 12:79-85. [PMID: 14765280 DOI: 10.1177/106689690401200115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A rare case of primary pleomorphic liposarcoma of the thigh with a myxoid component, in which divergent differentiation to a well-differentiated chondrosarcoma was focally present, is described. Presence of heterologous elements has mainly been recognized in the context of dedifferentiated liposarcomas. Few cases of benign mesenchymal tissue have also been reported in well-differentiated and myxoid liposarcomas, while divergent sarcomatous differentiation in liposarcomas appears to be also rare in the absence of dedifferentiation. Positive immunostaining of transforming growth factor-n, which seems to play a role in the formation of bone and cartilage, was demonstrated in our case. Review of the existing literature on the subject has been carried out.
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Berenson M, Drachenberg CB, Papadimitriou JC, Mergner WJ. Morphologic and Immunohistochemical Evidence of Continuity Between Different Components of Malignant Mesenchymoma of the Retroperitoneum. Int J Surg Pathol 2016. [DOI: 10.1177/106689699800600204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A malignant mesenchymoma with predominant leiomyosarcomatous component and significant chondrosarcomatous and focal osteosarcomatous elements is presented. Transitional areas with overlapping morphologic and immunohistochemical features were found between the smooth muscle and cartilaginous components. Stains for actin were strongly positive in leiomyosarcoma, and in scattered malignant chondrocytes. Malignant chondrocytes and scattered neoplastic smooth muscle cells were positive for S-100. Both components were strongly positive for p53. Ultrastructurally there were calcified particles in the matrix of both chondrosarcoma and leiomyosarcoma. These findings support the concept that malignant mesenchymoma results from divergent differentiation of primitive mesenchymal cell with pluripotential capability. A literature review of retroperitoneal malignant mesenchymomas with similar differentiation is presented.
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Affiliation(s)
- Mark Berenson
- Department of Pathology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore; Maryland 21201 USA
| | | | | | - Wolfgang J. Mergner
- Department of Pathology, University of Maryland at Baltimore, School of Medicine
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40
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Vartanian RK, O'Connell JX, Holden JK, MacFarlane J, Owen DA. Primary Jej unal Well-differentiated Liposarcoma (Atypical Lipomatous Tumor) With Leiomyosarcomatous Dedifferentiation. Int J Surg Pathol 2016. [DOI: 10.1177/106689699600400106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary small intestinal malignant mesenchymal tumors are uncommon, and liposarcomas originating in the small bowel are extraordinarily rare. To the authors' best knowledge, no well-documented case of a primary small intestinal dedifferentiated well-differentiated liposarcoma (atypical lipomatous tumor) has been reported in the English language literature. A 72-year-old demented man presented with fatigue, weight loss, and anemia. He was discovered on gastrointestinal series with follow-through to have a 7-cm pedunculated, polypoid jejunal tumor with an adjacent 2.5-cm submucosal fatty mass. Microscopically, the smaller tumor was a well-differentiated liposarcoma (atypical lipomatous tumor) containing microscopic foci of benign smooth muscle. Based on classic light microscopic and immunohistochemical findings, the adjacent larger mass proved to be a moderately differentiated (Coindre grade II) leiomyosarcoma. We report the clinical, radiologic, and pathologic findings of this primary jejunal dedifferentiated liposarcoma. The possibly relevant association of myogenous elements in tumors showing adipocytic differentiation with leiomyosarcomatous dedifferentiation in the present case is also discussed.
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Affiliation(s)
| | | | - Janet K. Holden
- Department of Anatomical Pathology, St. Paul's Hospital and Vancouver Hospital and Health Sciences Center, Vancouver, British Columbia, Canad
| | - John MacFarlane
- Department of Surgery, St. Paul's Hospital and Vancouver Hospital and Health Sciences Center, Vancouver, British Columbia, Canada
| | - David A. Owen
- Department of Anatomical Pathology, St. Paul's Hospital and Vancouver Hospital and Health Sciences Center, Vancouver, British Columbia, Canad
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Tseng WW, Chopra S, Engleman EG, Pollock RE. Hypothesis: The Intratumoral Immune Response against a Cancer Progenitor Cell Impacts the Development of Well-Differentiated versus Dedifferentiated Disease in Liposarcoma. Front Oncol 2016; 6:134. [PMID: 27376027 PMCID: PMC4901033 DOI: 10.3389/fonc.2016.00134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/23/2016] [Indexed: 12/26/2022] Open
Abstract
Well-differentiated/dedifferentiated (WD/DD) liposarcoma is a rare malignancy of adipocyte origin (“fat cancer”). Tumors may be entirely WD, WD with a DD component, or rarely DD without a clear WD component. WD tumors are low grade and generally indolent, while tumors with a DD component are high grade and behave much more aggressively, with a modest potential for distant metastasis. The presence of cancer progenitor cells in WD/DD liposarcoma is suggested by clinical evidence and reported research findings. In addition, there are emerging data to support the existence of a naturally occurring, antigen-driven, and adaptive immune response within the tumor microenvironment. We hypothesize that the intratumoral immune response is directed against a cancer progenitor cell and that the outcome of this response impacts the development of WD versus DD disease. Further study will likely provide interesting insights into the disease biology of WD/DD liposarcoma that may be readily translated to other more common cancers.
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Affiliation(s)
- William W Tseng
- Section of Surgical Oncology, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Sarcoma Program, Hoag Family Cancer Institute, Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA
| | - Shefali Chopra
- Department of Pathology, Keck School of Medicine, University of Southern California , Los Angeles, CA , USA
| | - Edgar G Engleman
- Department of Pathology, Stanford University School of Medicine , Palo Alto, CA , USA
| | - Raphael E Pollock
- Division of Surgical Oncology, Department of Surgery, The James Comprehensive Cancer Center, Ohio State University , Columbus, OH , USA
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Dedifferentiated Liposarcoma: Updates on Morphology, Genetics, and Therapeutic Strategies. Adv Anat Pathol 2016; 23:30-40. [PMID: 26645460 DOI: 10.1097/pap.0000000000000101] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Well-differentiated liposarcoma (WDL) and dedifferentiated liposarcoma (DDL) form the largest subgroup of liposarcomas, and represent a morphologic and behavioral spectrum of 1 disease entity, which arises typically in middle to late adult life, most frequently within the retroperitoneum or extremities. DDL is defined as nonlipogenic sarcoma that is juxtaposed to WDL, occurs as a recurrence of WDL or which can arise de novo, and typically has the appearance of undifferentiated pleomorphic or spindle cell sarcoma. DDL have a propensity for local recurrence, whereas distant metastasis is rarer, and behavior is related to anatomic site, with retroperitoneal neoplasms showing a significantly worse prognosis. Surgical resection remains the mainstay of treatment, and medical options for patients with aggressive recurrent or metastatic disease are limited. DDL share similar genetic abnormalities to WDL, with high-level amplifications of chromosome 12q14-15, including the MDM2 and CDK4 cell cycle oncogenes, and DDL harbor additional genetic changes, particularly coamplifications of 6q23 and 1p32. Novel therapies targeted at the gene products of chromosome 12 are being tested in clinical trials. We review the pathology and genetics of DDL, discussing morphologic patterns, immunohistochemical and genetic findings, the differential diagnosis, and future therapeutic strategies.
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Matthyssens LE, Creytens D, Ceelen WP. Retroperitoneal liposarcoma: current insights in diagnosis and treatment. Front Surg 2015; 2:4. [PMID: 25713799 PMCID: PMC4322543 DOI: 10.3389/fsurg.2015.00004] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/28/2015] [Indexed: 12/15/2022] Open
Abstract
Retroperitoneal liposarcoma (RLS) is a rare, biologically heterogeneous tumor that present considerable challenges due to its size and deep location. As a consequence, the majority of patients with high-grade RLS will develop locally recurrent disease following surgery, and this constitutes the cause of death in most patients. Here, we review current insights and controversies regarding histology, molecular biology, extent of surgery, (neo)adjuvant treatment, and systemic treatment including novel targeted agents in RLS.
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Affiliation(s)
| | - David Creytens
- Department of Pathology, Ghent University Hospital , Ghent , Belgium
| | - Wim P Ceelen
- Department of Surgery, Ghent University Hospital , Ghent , Belgium
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45
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Klijanienko J, Pierron G, Sastre-Garau X, Theocharis S. Value of combined cytology and molecular information in the diagnosis of soft tissue tumors. Cancer Cytopathol 2014; 123:141-51. [DOI: 10.1002/cncy.21496] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/17/2014] [Accepted: 10/27/2014] [Indexed: 12/16/2022]
Affiliation(s)
| | - Gaelle Pierron
- Department of Tumor Biology; Curie Institute; Paris France
| | | | - Stamatios Theocharis
- Department of Tumor Biology; Curie Institute; Paris France
- First Department, Department of Pathology; Medical School; University of Athens; Athens Greece
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46
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Weissferdt A, Moran CA. Lipomatous tumors of the anterior mediastinum with muscle differentiation: a clinicopathological and immunohistochemical study of three cases. Virchows Arch 2014; 464:489-93. [PMID: 24558031 DOI: 10.1007/s00428-014-1556-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/24/2014] [Accepted: 02/09/2014] [Indexed: 02/03/2023]
Abstract
Three cases of primary lipomatous tumors of the anterior mediastinum with prominent muscle differentiation are presented. The patients were two women and one man between the age of 52 and 68 years. All patients presented with progressive shortness of breath. Radiographically, all patients demonstrated anterior mediastinal tumors which were surgically resected. In two cases, the gross findings were those of circumscribed tumors, while one lesion was described as an ill-defined and unencapsulated neoplasm. Histologically, two cases corresponded to a well-differentiated liposarcoma, while the third was a thymolipoma. Extensive areas of smooth muscle were identified in one of the liposarcomas, while the other contained areas of mature skeletal muscle. The thymolipoma displayed a prominent myoid component. Immunohistochemical studies for muscle markers including smooth muscle actin, desmin, and myoglobin showed positive staining in the corresponding components. Follow-up information showed that one patient with liposarcoma died 60 months after initial diagnosis, while the other two patients remain alive and well 16 and 36 months after diagnosis, respectively. The current cases highlight the spectrum of muscle differentiation that can be seen in adipose tumors of the anterior mediastinum and also emphasize the difficulty that such a diagnosis can pose when confronted with limited mediastinoscopic biopsies.
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Affiliation(s)
- Annikka Weissferdt
- Department of Pathology, MD Anderson Cancer Center, Houston, TX, 77030, USA,
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47
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Abstract
We herein describe a 60-year-old Japanese man with a giant retroperitoneal liposarcoma undergoing leiomyosarcomatous differentiation. He was admitted to our hospital because of a 5-month history of dysphagia and abdominal distention. Abdominal computed tomography showed a giant tumor that occupied the entire retroperitoneal space. The majority of the mass was lipomatous and low density; both a heterogenous and solid mass were also present. A giant retroperitoneal liposarcoma was diagnosed, and tumor resection was performed. At surgery, the tumor was mostly isolated from the retroperitoneum and other organs. Histopathologically, the tumor comprised well-differentiated and dedifferentiated liposarcoma with heterologous differentiation of the leiomyosarcomatous components, which is a rare phenomenon in liposarcoma. The patient was alive 3 years after the first treatment, although he has had 3 local recurrences (approximately one recurrence yearly) and has been treated by repeated resection and radiotherapy.
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48
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Dei Tos AP. Liposarcomas: diagnostic pitfalls and new insights. Histopathology 2013; 64:38-52. [PMID: 24118009 DOI: 10.1111/his.12311] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 10/10/2013] [Indexed: 12/14/2022]
Abstract
Liposarcomas represent the most common histotype among soft tissue sarcomas. However, liposarcomas in fact constitute a heterogeneous group of distinctive lesions that pose several diagnostic difficulties. The current World Health Organization classification of soft tissue and bone tumours recognizes four major liposarcoma subtypes: (i) atypical lipomatous tumour/well-differentiated liposarcoma; (ii) de-differentiated liposarcoma; (iii) myxoid liposarcoma; and (iv) pleomorphic liposarcoma. These four main subgroups are characterized by distinctive morphologies, unique genetic findings as well as distinct clinical behaviour. Accurate classification requires the integration of morphological, immunohistochemical and (in selected situations) genetic findings, and is essential for providing patients with the best available treatments. This review will focus upon the main diagnostic pitfalls encountered in the routine diagnosis of liposarcoma, underlining the diagnostic value of combining morphology with cytogenetics and molecular genetics.
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Affiliation(s)
- Angelo P Dei Tos
- Departments of Pathology and Oncology, General Hospital of Treviso, Treviso, Italy
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49
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Thway K, Hayes A, Ieremia E, Fisher C. Heterologous osteosarcomatous and rhabdomyosarcomatous elements in dedifferentiated solitary fibrous tumor: further support for the concept of dedifferentiation in solitary fibrous tumor. Ann Diagn Pathol 2013; 17:457-63. [DOI: 10.1016/j.anndiagpath.2012.08.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 08/15/2012] [Indexed: 01/08/2023]
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Okano S, Yamamoto H, Kono S, Fujii H, Shirabe K, Maehara Y, Oda Y. Dedifferentiated liposarcoma of the spermatic cord with a hemangioendothelioma-like component: a case report and review of the literature. Pathol Res Pract 2013; 209:596-604. [PMID: 23910173 DOI: 10.1016/j.prp.2013.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 06/15/2013] [Accepted: 06/17/2013] [Indexed: 10/26/2022]
Abstract
Atypical lipomatous tumor or well-differentiated liposarcoma/dedifferentiated liposarcoma (DDLPS) is the most frequent subtype of malignant adipocytic tumor. This tumor typically presents in late adult life, most commonly in the retroperitoneum, extremities, or spermatic cord. It has been reported that the dedifferentiated component consists mainly of high-grade sarcoma, including undifferentiated pleomorphic sarcoma, fibrosarcoma, and myxofibrosarcoma, and it has been recently reported that the dedifferentiated component can be also made up of a low-grade sarcomatous component. Therefore, the dedifferentiated areas exhibit a wide morphological spectrum that commonly includes fibroblastic/myofibroblastic and fibrohistiocytic tumors but very rarely includes vascular tumors. We present here the first reported case of DDLPS with a hemangioendothelioma-like component in the spermatic cord.
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Affiliation(s)
- Shinji Okano
- Department of Innovative Applied Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; Division of Diagnostic pathology, Kyushu University Hospital, Fukuoka 812-8582, Japan.
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