1
|
Qu G, Zhang C, Tian Z, Yao W. Diagnosis and Treatment of Myxoid Liposarcoma. Curr Treat Options Oncol 2024:10.1007/s11864-024-01262-9. [PMID: 39302575 DOI: 10.1007/s11864-024-01262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2024] [Indexed: 09/22/2024]
Abstract
OPINION STATEMENT Myxoid liposarcoma (MLS) is a rare subtype of soft tissue sarcoma that distinguishes itself from conventional subtypes through its propensity for extrapulmonary metastasis. The distinctive magnetic resonance imaging (MRI) characteristics of MLS render it an invaluable tool for identifying primary and secondary lesions. Pathologically, MLS is characterized by the FUS-DDIT3 gene fusion. Accurate diagnosis, facilitated by MRI and pathological assessment, is critical for prognostication and the formulation of appropriate treatment strategies. Surgery remains the cornerstone of local management for MLS. The combination of surgery and radiotherapy can significantly reduce the local recurrence rate in MLS, as it is highly sensitive to both radiotherapy and chemotherapy. Additionally, for high-risk MLS cases with a large tumor diameter, chemotherapy has been shown to improve survival. The comprehensive treatment approach for MLS demonstrates superior local recurrence rates and survival rates compared to most soft tissue sarcomas. Current research focuses on developing effective therapies for unresectable or advanced disease based on genomic and phenotypic characteristics as well as the immune-tumor microenvironment.
Collapse
Affiliation(s)
- Guoxin Qu
- Department of Bone and Soft Tissue Cancer, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Dongming Road 127, Zhengzhou, China
| | - Chunlei Zhang
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Dongming Road 127, Zhengzhou, China
| | - Zhichao Tian
- Department of Bone and Soft Tissue Cancer, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Dongming Road 127, Zhengzhou, China
| | - Weitao Yao
- Department of Bone and Soft Tissue Cancer, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Dongming Road 127, Zhengzhou, China.
| |
Collapse
|
2
|
Wakefield C, Hornick JL. Update on immunohistochemistry in bone and soft tissue tumors: Cost-effectively replacing molecular testing with immunohistochemistry. Hum Pathol 2024; 147:58-71. [PMID: 38135060 DOI: 10.1016/j.humpath.2023.12.002] [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: 11/06/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 12/24/2023]
Abstract
Soft tissue tumors form part of a challenging domain in diagnostic pathology owing to their comparative rarity, astonishing histologic diversity, and overlap between entities. Many of these tumors are now known to be defined by highly recurrent, or, in some instances, unique molecular alterations. Insights from gene profiling continue to elucidate the wider molecular landscape of soft tissue tumors; many of these advances have been co-opted by immunohistochemistry (IHC) for diagnostic applications. There now exists a multitude of antibodies serving as surrogate markers of recurrent gene fusions, amplifications, and point mutations, which, in certain settings, can replace the need for more resource and time-intensive cytogenetic and molecular genetic analyses. IHC presents many advantages including rapid turnaround time, cost-effectiveness, and interpretative reproducibility. A sensible application of these immunohistochemical markers complemented by a working knowledge of the molecular pathogenesis of bone and soft tissue tumors permits accurate diagnosis in the majority of cases. In this review, we will outline some of these biomarkers while emphasizing molecular correlates and highlighting interpretative challenges and pitfalls.
Collapse
Affiliation(s)
- Craig Wakefield
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
| |
Collapse
|
3
|
Ciongariu AM, Dumitru AV, Cîrstoiu C, Crețu B, Sajin M, Țăpoi DA, Ciobănoiu AD, Bejenariu A, Marin A, Costache M. The Conundrum of Dedifferentiation in a Liposarcoma at a Peculiar Location: A Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050967. [PMID: 37241198 DOI: 10.3390/medicina59050967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 04/30/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
Dedifferentiated liposarcoma of the deep soft tissue of the lower extremities is an infrequent finding. Myxoid liposarcoma is considered the most common soft tissue neoplasia arising in this anatomic region. Divergent differentiation usually occurs within well-differentiated liposarcoma and is exceedingly rare in a myxoid liposarcoma. We report a 32-year-old man who developed a dedifferentiated liposarcoma of the thigh on the background of a pre-existing myxoid liposarcoma. The gross examination of the surgical specimen showed a 11/7/2 cm tumour mass with solid tan-grey areas and focal myxoid degeneration. The microscopic examination revealed a malignant lipogenic proliferation, containing round cells with hyperchromatic nuclei and atypical lipoblasts, confined to the basophilic stroma with a myxoid aspect. Abrupt transition towards a hypercellular, non-lipogenic area consisting of highly pleomorphic spindle cells with atypical mitotic figures was also noted. Immunohistochemical staining was performed. Tumour cells in the lipogenic area were intensely positive for S100 and p16, and CD34 staining highlighted an arborizing capillary network. The dedifferentiated tumour areas showed positive MDM2 and CDK4 staining within neoplastic cells, with the Ki 67 proliferation marker expressed in approximately 10% of the cells. Wild-type TP53 protein expression pattern was documented. Thus, the diagnosis of a dedifferentiated liposarcoma was established. This paper aims to provide further knowledge about liposarcomas with divergent differentiation at peculiar locations, emphasizing the importance of histopathologic examination and immunohistochemical analysis for establishing the diagnosis and assessing the therapeutic response and prognosis of this condition.
Collapse
Affiliation(s)
- Ana-Maria Ciongariu
- Pathology Department, University Emergency Hospital, 050098 Bucharest, Romania
- Morphology Department, Faculty of Medicine "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adrian-Vasile Dumitru
- Pathology Department, University Emergency Hospital, 050098 Bucharest, Romania
- Morphology Department, Faculty of Medicine "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Cătălin Cîrstoiu
- Morphology Department, Faculty of Medicine "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Orthopedic Surgery and Traumatology Department, University Emergency Hospital, 050098 Bucharest, Romania
| | - Bogdan Crețu
- Morphology Department, Faculty of Medicine "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Orthopedic Surgery and Traumatology Department, University Emergency Hospital, 050098 Bucharest, Romania
| | - Maria Sajin
- Pathology Department, University Emergency Hospital, 050098 Bucharest, Romania
- Morphology Department, Faculty of Medicine "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Dana-Antonia Țăpoi
- Pathology Department, University Emergency Hospital, 050098 Bucharest, Romania
- Morphology Department, Faculty of Medicine "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Aminia-Diana Ciobănoiu
- Pathology Department, University Emergency Hospital, 050098 Bucharest, Romania
- Morphology Department, Faculty of Medicine "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adrian Bejenariu
- Pathology Department, University Emergency Hospital, 050098 Bucharest, Romania
| | - Andrei Marin
- Pathology Department, University Emergency Hospital, 050098 Bucharest, Romania
- Morphology Department, Faculty of Medicine "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Plastic Surgery Department, Faculty of Medicine "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mariana Costache
- Pathology Department, University Emergency Hospital, 050098 Bucharest, Romania
- Morphology Department, Faculty of Medicine "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
| |
Collapse
|
4
|
Magnetic resonance imaging of trunk and extremity myxoid liposarcoma: diagnosis, staging, and response to treatment. Skeletal Radiol 2021; 50:1963-1980. [PMID: 33792747 DOI: 10.1007/s00256-021-03769-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023]
Abstract
Myxoid liposarcoma (MLS) accounts for approximately 30% of all liposarcomas. The majority are intermediate-grade tumours, but the presence of >5% round cell component renders it a high-grade sarcoma with subsequent poorer outcome. MLS most commonly arises in the lower extremities, has a predilection for extra-pulmonary sites of metastatic disease, and is recognized to be radiosensitive. The purpose of the current article is to review the role of MRI in the management of MLS, including the characteristic features of the primary tumour, features which help to identify a round cell component and thus determine prognosis, the role of whole-body MRI for evaluation of extra-pulmonary metastatic disease, and the utility of MRI for assessing treatment response. The MRI differential diagnosis of MLS is also considered.
Collapse
|
5
|
Scapa JV, Cloutier JM, Raghavan SS, Peters-Schulze G, Varma S, Charville GW. DDIT3 Immunohistochemistry Is a Useful Tool for the Diagnosis of Myxoid Liposarcoma. Am J Surg Pathol 2021; 45:230-239. [PMID: 32815829 PMCID: PMC7796975 DOI: 10.1097/pas.0000000000001564] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Myxoid liposarcoma is a malignant adipogenic neoplasm characterized by prominent arborizing capillaries, occasional lipoblasts, and primitive-appearing spindle cells in a myxoid background. A recurrent translocation in myxoid liposarcoma results in an oncoprotein consisting of full-length DDIT3 (CHOP) fused to an N-terminal segment of either FUS (TLS) or, less often, EWSR1. Here, we explore the diagnostic significance of DDIT3 expression in myxoid liposarcoma using a mouse monoclonal antibody recognizing an epitope in the N-terminal region. Studying a total of 300 tumors, we find diffuse, moderate-to-strong nuclear-localized anti-DDIT3 immunoreactivity in all 46 cases of myxoid liposarcoma representing 36 unique tumors, including 6 cases with high-grade (round cell) morphology. DDIT3 immunohistochemistry also highlighted a distinctive vasculocentric growth pattern in 7 myxoid liposarcomas treated with neoadjuvant radiation. In contrast, the vast majority of other examined lipomatous and myxoid neoplasms exhibited no DDIT3 expression; limited, weak immunoreactivity in <10% of cells was infrequently observed in dedifferentiated liposarcoma (6/39, 15%), solitary fibrous tumor (3/12, 25%), pleomorphic liposarcoma (1/15, 7%), and high-grade myxofibrosarcoma (2/17, 12%). Although this minimal DDIT3 expression did not correlate with DDIT3 amplification or myxoid liposarcoma-like morphology in dedifferentiated liposarcoma, there was evidence among sarcomas (excluding myxoid liposarcoma) of a relationship between expression and exposure to neoadjuvant radiation or cytotoxic chemotherapy. The constellation of findings indicates that DDIT3 immunohistochemistry may have utility in the evaluation of myxoid and lipomatous neoplasms to support the diagnosis of myxoid liposarcoma.
Collapse
Affiliation(s)
- Jason V. Scapa
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Jeffrey M. Cloutier
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Shyam S. Raghavan
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Grace Peters-Schulze
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Sushama Varma
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Gregory W. Charville
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
6
|
Ramirez DC, Hwang S, Athanasian EA, Wang L, Hameed M. Atypical lipomatous tumor of the hand with transformation to dedifferentiated liposarcoma: a case report. Skeletal Radiol 2018; 47:703-709. [PMID: 29209735 PMCID: PMC6611678 DOI: 10.1007/s00256-017-2832-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 10/15/2017] [Accepted: 11/21/2017] [Indexed: 02/02/2023]
Abstract
Atypical lipomatous tumor/well-differentiated liposarcoma is the most common sarcoma of soft tissue in adults. We describe the clinical, radiologic, and pathologic features of an atypical lipomatous tumor arising within the soft tissue of the left hand of a 68-year-old female that underwent transformation to dedifferentiated liposarcoma and eventually metastasized. At initial presentation, imaging demonstrated an extensively calcified fatty soft tissue mass with displacement of the digits. Following biopsy and staged debulking, the patient subsequently developed local recurrence, dedifferentiation, and widespread metastases to the lungs, pancreas, bone, and soft tissues. To our knowledge, this is the first case of a cytogenetically proven atypical lipomatous tumor of the hand that has undergone dedifferentiation with widespread metastases.
Collapse
Affiliation(s)
- Daniel C. Ramirez
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Department of Pathology and Laboratory Medicine, Hospital For Special Surgery, New York, NY, USA
| | - Sinchun Hwang
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edward A. Athanasian
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lu Wang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meera Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|