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Alsalem AA, Alessa MA, Almanea KA, Almanea BA, Khan A. Hypopharyngeal lipomatous hamartoma in piriform fossa: A case report and review of literature. J Taibah Univ Med Sci 2022; 18:132-136. [DOI: 10.1016/j.jtumed.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022] Open
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Fritchie K, Ghosh T, Graham RP, Roden AC, Schembri-Wismayer D, Folpe A, Rivera M. Well-Differentiated/Dedifferentiated Liposarcoma Arising in the Upper Aerodigestive Tract: 8 Cases Mimicking Non-adipocytic Lesions. Head Neck Pathol 2020; 14:974-981. [PMID: 32410132 PMCID: PMC7669978 DOI: 10.1007/s12105-020-01171-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/28/2020] [Accepted: 05/03/2020] [Indexed: 02/06/2023]
Abstract
Well-differentiated (WDL) and dedifferentiated liposarcomas (DL) of the pharynx, larynx and oral cavity are rare, often mimicking benign lipomatous neoplasms or non-lipogenic mesenchymal tumors. Cases of WDL/DL arising in the upper aerodigestive tract, exclusive of the cervical esophagus, were reviewed. Morphologic features, ancillary studies, including fluorescence in situ hybridization (FISH) studies for CPM/MDM2, and clinical data was catalogued. Eight WDL/DL (4 WDL, 4 DL); were identified in patients ranging from 32 to 77 years (median 52.5 years; 6 males, 2 females) with sites of origin including hypopharynx (5 cases), larynx (2 cases) and oral cavity (1 case). Six of the 8 cases were received for expert consultation, and the remaining 2 cases were initially misdiagnosed as benign lymphangiomatous or fibroepithelial polyps. Morphologically, 4 tumors had areas mimicking various non-lipomatous soft tissue tumors including nodular fasciitis, mammary-type myofibroblastoma, low-grade myofibroblastic sarcoma and undifferentiated pleomorphic sarcoma, 2 cases simulated benign hypopharyngeal polyps, and 1 lesion was notable for a dense lymphoplasmacytic infiltrate suggestive of hematolymphoid neoplasm or IgG4-related sclerosing disease. FISH showed amplification of CPM/MDM2 (8/8 cases). All cases (4/4) with longer than 1-year of follow-up recurred (45-118 months) with 1 tumor showing progression to DL. WDL/DL presenting in the upper aerodigestive tract are rare and diagnostically challenging. Awareness of the morphologic spectrum of WDL/DL coupled with appropriate use of MDM2 FISH is essential for accurate classification and management, as these tumors appear to have a high risk for local recurrence and eventual dedifferentiation in these anatomical locations.
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Affiliation(s)
- Karen Fritchie
- grid.66875.3a0000 0004 0459 167XAnatomic Pathology – Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | - Toshi Ghosh
- grid.66875.3a0000 0004 0459 167XAnatomic Pathology – Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | - Rondell P. Graham
- grid.66875.3a0000 0004 0459 167XAnatomic Pathology – Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | - Anja C. Roden
- grid.66875.3a0000 0004 0459 167XAnatomic Pathology – Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | - David Schembri-Wismayer
- grid.66875.3a0000 0004 0459 167XAnatomic Pathology – Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | - Andrew Folpe
- grid.66875.3a0000 0004 0459 167XAnatomic Pathology – Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | - Michael Rivera
- grid.66875.3a0000 0004 0459 167XAnatomic Pathology – Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
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Polypoid fibroadipose tumors of the esophagus: 'giant fibrovascular polyp' or liposarcoma? A clinicopathological and molecular cytogenetic study of 13 cases. Mod Pathol 2018; 31:337-342. [PMID: 28984298 DOI: 10.1038/modpathol.2017.140] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 12/27/2022]
Abstract
Giant fibrovascular polyp of the esophagus is a descriptive diagnostic term intended to encompass rare, large, polypoid esophageal masses composed of fibroadipose tissue. Despite sometimes dramatic clinical presentations, they have historically been considered to represent reactive, non-neoplastic proliferations. Recently, however, a small number of reports have described well-differentiated liposarcomas of the esophagus, mimicking giant fibrovascular polyps. In order to clarify the relationship between esophageal liposarcoma and giant fibrovascular polyp, we retrieved esophageal cases coded as 'giant fibrovascular polyp,' 'lipoma' and 'liposarcoma' from our archives and re-examined their clinicopathologic features and MDM2 amplification status. Thirteen cases were identified (lipoma (n=1), giant fibrovascular polyp (n=5), well-differentiated liposarcoma (n=3), dedifferentiated liposarcoma (n=3)). The tumors ranged from 5.2 to 19.5 cm and arose predominantly in the cervical esophagus. All consisted chiefly of mature adipose tissue, with a variable component of fibrous septa. In all cases, close inspection of these fibrous septa showed them to contain an increased number of slightly enlarged spindled cells with irregular, hyperchromatic nuclei, similar to those seen in some well-differentiated liposarcomas. Three cases, all previously classified as dedifferentiated liposarcoma, showed in addition solid zones of non-lipogenic spindle cell sarcoma. By fluorescence in situ hybridization (FISH), all cases showed MDM2 amplification, confirming diagnoses as well-differentiated (N=10) and dedifferentiated (N=3) liposarcoma. Clinical follow-up (8 cases, range 22-156 months, median 33 months) showed 3 patients with local recurrences (1 well-differentiated and 2 dedifferentiated liposarcomas), 1 patient with liver metastases (dedifferentiated liposarcoma) and 2 deaths from disease (both dedifferentiated liposarcomas). These results suggest that the great majority of large, polypoid, fat-containing masses of the esophagus represent well and dedifferentiated liposarcoma, rather than 'giant fibrovascular polyps.' We suggest that the diagnosis of 'giant fibrovascular polyp' should be made with great caution in the esophagus, and only after careful morphological study and MDM2 FISH has excluded the possibility of liposarcoma.
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Ioanidis KE, MacNeil SD, Tay KY, Wehrli B. An atypical lipomatous tumor mimicking a giant fibrovascular polyp of the hypopharynx: A case report. Medicine (Baltimore) 2017; 96:e6927. [PMID: 29068974 PMCID: PMC5671807 DOI: 10.1097/md.0000000000006927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Giant fibrovascular polyps (GFVPs) found in the hypopharynx are exceedingly rare. These are benign tumors which are identified by CT or MRI and usually treated based on symptoms. Even more rarely, pathology may identify one of these masses as an atypical lipomatous tumor (ALT). This paper will present a case of an ALT of the hypopharynx that was originally classified as a GFVP, highlighting the difficulty in distinguishing between them and the importance of making the correct diagnosis. PATIENT CONCERNS An 84-year-old man presented to the emergency department with a 6-month history of a pedunculated hypopharyngeal growth, dysphagia, and intermittent dyspnea. DIAGNOSES The mass was characterized as a GFVP by barium swallow and MRI. INTERVENTIONS The hypopharyngeal mass was resected for obstructive symptoms and to confirm the diagnosis. Final pathology found the mass to be more consistent with an atypical lipomatous tumor (ALT). OUTCOMES The patient's dysphagia and dyspnea resolved. He was free of recurrence at 22 months postoperative. LESSONS Both GFVPs and ALTs are very rarely found in the hypopharynx but can be easily misclassified as one another. Imaging is useful to initially characterize the mass, but to definitively differentiate between them, pathological analysis is necessary. Although they are rare, it is important to consider both possibilities on the differential for hypopharyngeal masses. Further, accurate analysis is essential to distinguish between them because their definitive management and follow-up is different.
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Affiliation(s)
| | | | | | - Bret Wehrli
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Rare Giant Pedunculated Liposarcoma of the Hypopharynx: Case Report and Review of Literature. J Gastrointest Cancer 2017; 47:449-453. [PMID: 26449226 DOI: 10.1007/s12029-015-9767-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Liposarcoma is considered the most common soft tissue sarcoma in adults. It represents approximately 20 % of all mesenchymal malignancies, and most frequently it involves the retroperitoneum, trunk, and extremities. Hypopharyngeal localization of liposarcoma is extremely rare. METHODS We report a new rare case of giant pedunculated liposarcoma arising from the left antero-lateral wall of the hypopharyngeal-esophageal junction, and we present a complete review of the literature. RESULTS An 81-year-old man presented with a 5-month history of dysphagia and 30-kg weight loss, due to a giant pedunculated liposarcoma of the hypopharynx, which is resected with cervical approach. CT scan imaging revealed a 25-cm-long pedunculated heterogeneous mass with fat-like density originating from the anterior wall of hypopharyngeal-esophageal junction protruding into the lumen. The polypoid mass was identified as well as the stalk, and it was completely delivered through the cervical incision. Histopatological examination showed a dedifferentiated liposarcoma, without positive or close margins. No further chemoradiation therapy was performed due to the patient's age, comorbidities, negative margins, and absence of distant metastases. Dysphagia solved 1 month after surgery. No evidence of tumor recurrence was seen in the 12 months following surgery. CONCLUSIONS When base of the tumor is located in hypopharynx or cervical portion of the esophagus, and tumor is not aggressive, cervical approach is better, irrespective of the tumor size, except for cases in which an endoscopic approach is feasible.
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Riva G, Sensini M, Corvino A, Garzaro M, Pecorari G. Liposarcoma of Hypopharynx and Esophagus: a Unique Entity? J Gastrointest Cancer 2017; 47:135-42. [PMID: 26875081 DOI: 10.1007/s12029-016-9808-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Liposarcoma is the most common soft tissue sarcoma in adults. It represents approximately 20 % of all mesenchymal malignancies. It most frequently involves retroperitoneum, trunk, and extremities. Hypopharyngeal and esophageal localization of liposarcoma is extremely rare. METHODS We performed a systematic review of literature and reported 26 and 33 cases of hypopharyngeal and esophageal liposarcoma. We analyzed natural history, imaging features, histology, treatment, and prognosis, with a specific focus to similarities and differences between tumors of hypopharynx and esophagus. RESULTS Hypopharyngeal and esophageal liposarcomas have more similarities than differences. Incidence has a peak at 6th and 7th decades. The diagnostic procedures are barium swallow, endoscopic examination, and CT/MR imaging. Well-differentiated liposarcoma represents the most frequent histological subtype. Surgical excision is the main treatment. Endoscopic resection can be useful for pedunculated tumors of hypopharynx and cervical esophagus. Differences between hypopharyngeal and esophageal liposarcoma are represented by local recurrence rate (greater for hypopharyngeal tumors), number of giant tumors, and time to recurrence (greater for esophageal tumors). Finally, liposarcomas of distal esophagus need more extended approaches. CONCLUSIONS Liposarcomas of hypopharynx and cervical esophagus could be considered a unique pathological entity, with similar features and treatment options. Survival rate is dependent on histological type and location. Local recurrence is common, especially for hypopharyngeal liposarcoma, while the risk of lymph node or distant metastasis is very low. Patients should undergo regular examinations to rule out local recurrence, also for a long time, especially for esophageal tumors.
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Affiliation(s)
- Giuseppe Riva
- 1st ENT Division, Surgical Sciences Department, University of Turin, Via Genova 3, 10126, Turin, Italy.
| | - Matteo Sensini
- 1st ENT Division, Surgical Sciences Department, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Andrea Corvino
- 1st ENT Division, Surgical Sciences Department, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Massimiliano Garzaro
- 1st ENT Division, Surgical Sciences Department, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Giancarlo Pecorari
- 1st ENT Division, Surgical Sciences Department, University of Turin, Via Genova 3, 10126, Turin, Italy
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Dowli A, Mattar A, Mashimo H, Huang Q, Cohen D, Fisichella PM, Lebenthal A. A pedunculated giant esophageal liposarcoma: a case report and literature review. J Gastrointest Surg 2014; 18:2208-13. [PMID: 25190025 DOI: 10.1007/s11605-014-2628-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 08/04/2014] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The majority of esophageal tumors arise from the mucosal layer; only 5 % are of mesenchymal origins. Of the latter, barely 0.5 % are liposarcomas. We present a case of an esophageal liposarcoma with a review of the literature. CASE REPORT A 64-year-old male was referred with 5 years of progressive dysphagia. Preoperative evaluation initially suggested a leiomyoma. The polypoid lesion was then resected through a cervical esophagotomy, once endoscopic resection proved to be not feasible. The definitive pathologic diagnosis confirmed a well-differentiated liposarcoma. LITERATURE REVIEW Esophageal liposarcomas are very rare and only 40 such cases have been reported in the literature. Most patients were male (80 %), the median age was 62 years (range 38-83 years), and the most common symptom was dysphagia (85 %). Only in two cases was a liposarcoma detected on preoperative biopsy. The most common histological subtype was well-differentiated liposarcoma. Overall, 77.5 % of the patients were successfully treated with surgery, 20 % endoscopically, and 2.5 % were ablated with CO2 laser. CONCLUSION Esophageal liposarcoma is an extremely rare tumor. The majority of patients are males; dysphagia is the most common initial symptom, and preoperative biopsy is unreliable. Because these tumors are pedunculated, well-circumscribed, and well-differentiated, they can be safely resected locally. All patients need long-term follow-up as this disease can recur many decades after treatment.
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Affiliation(s)
- A Dowli
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston VA Health Care System, Harvard Medical School, Boston, MA, USA
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