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Devaraja K, Aggarwal S, Pillai S, Singh BMK. Large atypical lipomatous tumour of the neck with mediastinal extension managed by transcervical excision. BMJ Case Rep 2024; 17:e258292. [PMID: 38789269 DOI: 10.1136/bcr-2023-258292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024] Open
Abstract
Tumours of adipose tissue origin are relatively rare in the head and neck. Here, we report a case of an unfamiliar lipomatous lesion that involved the neck and mediastinum. A nil-comorbid man in his 40s presented with a slowly progressive anterior neck swelling of 3 years, which was diagnosed as lipoma by histopathological sampling. Computed tomography demonstrated the lesion to be involving parapharyngeal and retropharyngeal spaces with mediastinal extension. The lesion was removed by the transcervical approach. The final histology of the excised specimen, with immunohistochemistry for mouse double minute 2 (MDM2) and p16, suggested an atypical lipomatous tumour (ALT). This report accentuates the occurrence of this rare neoplasm in the neck, which often mimics lipoma clinically. Although radiology can demonstrate suggestive features, histology with MDM2 and/or p16 positivity can confirm the diagnosis of ALT as against the lipoma. A successful transcervical excision, despite the deeper extension of the lesion between the critical structures of the neck and mediastinum, demonstrates the non-infiltrating nature of the tumour.
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Affiliation(s)
- K Devaraja
- Division of Head and Neck Surgery, Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India
| | - Shruti Aggarwal
- Division of Head and Neck Surgery, Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India
| | - Suresh Pillai
- Division of Head and Neck Surgery, Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India
| | - Brij Mohan Kumar Singh
- Department of Pathology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India
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2
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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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Li L, Yue P, Du Q, Zhang H, Song Y. MDM2 FISH testing criteria in adipose tissue tumors with mature adipocytic morphology - A resection case-based study. Pathol Res Pract 2024; 253:155039. [PMID: 38134838 DOI: 10.1016/j.prp.2023.155039] [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: 07/19/2023] [Revised: 12/02/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
The current criteria for utilizing MDM2 Fluorescence In Situ Hybridization (FISH) in adipose-derived tumors were first introduced in 2015 and have been widely adopted. However, these criteria may fail to identify some atypical lipomatous tumors / well-differentiated liposarcoma (ALT/WDL) with mature adipocytic morphology in clinical practice, possibly due to the fact that the existing criteria are primarily based on biopsy cases. Hence, a criterion based on resection cases is needed. In this study, we included 87 adipose tissue tumors with mature adipocytic morphology which were first resected, as well as 9 consultation cases and 25 recurrent resection cases. The final diagnosis was based on MDM2 amplification status. Among the 87 first-time resection cohort, MDM2 FISH amplification was observed in only 2 (5%) of the 39 superficial cases. Marginal infiltration was significantly different in both the MDM2 FISH negative and positive groups (p < 0.05). Of the 37 intramuscular tumors, 17 (46%) showed MDM2 FISH amplification. The MDM2 amplification positive group had a larger tumor size than MDM2 amplification negative group (p = 0.042). Tumors of larger size (≥11 cm) were highly correlated with MDM2 amplification (p = 0.003), but still, 35.3% of the MDM2 amplification-positive cases had tumor sizes less than 11 cm. Eight (66.7%) out of twelve retroperitoneal/ pelvic cases were MDM2 FISH positive. Among the 25 recurrent cases, twenty (80%) of them had MDM2 FISH amplification. In conclusion, we recommend MDM2 FISH for: 1. superficial cases with marginal infiltration based on adequate margin sampling; 2. all intramuscular tumors, retroperitoneal/pelvic tumors and recurrent tumors, both in resection cases and biopsy cases.
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Affiliation(s)
- Lihong Li
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Pinli Yue
- State Key Lab of Molecular Oncology, Laboratory of Cell and Molecular Biology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qiang Du
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hongtu Zhang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Yan Song
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
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Lu Y, Chen X, Zeng W, Hua P, Shen Y, Qiu Y, He X, Zhang H. COL1A1::PDGFB fusion uterine sarcoma with a TERT promoter mutation. Genes Chromosomes Cancer 2024; 63:e23210. [PMID: 37870859 DOI: 10.1002/gcc.23210] [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: 07/01/2023] [Revised: 09/29/2023] [Accepted: 10/15/2023] [Indexed: 10/24/2023] Open
Abstract
COL1A1::PDGFB fusion uterine sarcoma is a rare uterine mesenchymal tumor with some clinicopathological features that overlap with those of soft tissue dermatofibrosarcoma protuberans. However, the varied clinicopathologic and genetic characteristics have not been fully revealed, which may be a potential pitfall for diagnosis. Here, we present a case of COL1A1::PDGFB fusion-positive uterine sarcoma in a 49-years-old female. Histologically, the tumor from the initial marginal excision predominantly exhibited high-grade fibrosarcomatous and myxofibrosarcoma-like appearances, while a low-grade focal area displaying storiform growth was identified in the residual tumor after subsequently extended resection. Immunohistochemically, the high-grade components mainly exhibited focal positivity for CD34 and mutated-type p53 immunoreactivity, whereas the low-grade component showed diffuse positivity for CD34 and wild-type p53 staining. The COL1A1::PDGFB fusion was confirmed by fluorescence in situ hybridization and next-generation sequencing. In addition, the TERT-124 C > T mutation was further identified in this lesion's fibrosarcomatous and classic storiform components. To the best of our knowledge, this is the first described case of COL1A1::PDGFB fusion uterine sarcoma with a TERT promoter mutation, which might be a novel genetic finding associated with tumorigenesis of this rare tumor.
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Affiliation(s)
- Yang Lu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Xinyi Chen
- Department of Pathology, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao, China
| | - Wenjing Zeng
- Department of Pathology, Longchang People's Hospital, Sichuan, China
| | - Ping Hua
- Department of Pathology, Chengdu Women's and Children's Center Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yangmei Shen
- Department of pathology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yan Qiu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin He
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongying Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
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Sivarajah G, Snow H, Wilkinson MJ, Strauss DC, Smith MJ, Hayes AJ. Low local recurrence rates following marginal surgical resection of non-coelomic Atypical Lipomatous Tumours/Well-differentiated Liposarcomas. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107301. [PMID: 38041960 DOI: 10.1016/j.ejso.2023.107301] [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: 07/14/2023] [Revised: 11/09/2023] [Accepted: 11/22/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION High rates of local recurrence (LR) have been reported following resection of extremity Atypical lipomatous tumours/Well-differentiated liposarcomas (ALTs). This retrospective study of patients who underwent resection of primary deep extremity and trunk ALTs at a specialist sarcoma centre aims to assess morbidity and factors associated with low local recurrence rates (LRR). METHODS To review a homogeneous cohort of patients with low-grade disease, tumours with known high-risk histological features were excluded. Prognostic variables potentially influencing local recurrence (LR) (age, size, site, margin status, and histological findings) were analysed. Endpoints were LR, distant recurrence (DR) and local disease-free survival (LDFS). RESULTS 127 patients were identified, with median follow-up of 54 months (0-235). Median tumour size was 17.5 cm (5-36). 85 % occurred in the lower limb. 93.7 % underwent marginal resection. No patients received radiotherapy. Median hospital stay was 3 days (0-16). 7.9 % returned to theatre for evacuation of haematoma or infected seroma and 18.1 % had outpatient seroma aspiration. Surgical margins were R0/R1 in 93.7 % of patients and R2 in 6.3 % with a LR rate of 8.4 % and 75 % respectively at median time of 54 months. One- and 5-year LDFS was 100 % and 88.4 %, respectively. DR rate was 0.8 % (1/127) this patient had pleomorphic liposarcomatous transformation on recurrence and subsequently developed distant metastases. No patients died of disease. CONCLUSION Function-preserving marginal resection of non-coelomic ALTs has low morbidity, low LR and extremely low rates of distant relapse. Patients with lower limb ALT were found to have significantly lower LR, which may impact follow-up protocols.
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Affiliation(s)
- Gausihi Sivarajah
- Sarcoma and Melanoma Unit, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, Fulham Rd, London, SW3 6JJ, United Kingdom
| | - Hayden Snow
- Sarcoma and Melanoma Unit, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, Fulham Rd, London, SW3 6JJ, United Kingdom
| | - Michelle J Wilkinson
- Sarcoma and Melanoma Unit, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, Fulham Rd, London, SW3 6JJ, United Kingdom.
| | - Dirk C Strauss
- Sarcoma and Melanoma Unit, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, Fulham Rd, London, SW3 6JJ, United Kingdom
| | - Myles Jf Smith
- Sarcoma and Melanoma Unit, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, Fulham Rd, London, SW3 6JJ, United Kingdom
| | - Andrew J Hayes
- Sarcoma and Melanoma Unit, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, Fulham Rd, London, SW3 6JJ, United Kingdom
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Cui J, Peng R, Zhang Y, Lu Y, He X, Chen M, Zhang H. Case Report: Primary low-grade dedifferentiated liposarcoma of the urinary bladder with molecular confirmation. Front Oncol 2023; 13:1221027. [PMID: 37881487 PMCID: PMC10597670 DOI: 10.3389/fonc.2023.1221027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/18/2023] [Indexed: 10/27/2023] Open
Abstract
Liposarcomas originating in the urinary bladder are extremely rare. Only six cases of bladder liposarcoma have been reported, and all have been described as myxoid liposarcomas. Notably, none of the patients underwent molecular testing. Here, we report a dedifferentiated liposarcoma (DDL) that occurred in the urinary bladder, primarily in a 69-year-old Chinese woman, with infrequent low-grade dedifferentiation. Computed tomography (CT) revealed an ill-defined solid mass in the anterior bladder wall. The patient underwent a partial bladder resection. Histologically, the tumor cells with mild-to-moderate nuclear atypia were arranged in fascicular and storiform patterns, mimicking a low-grade fibroblastic tumor. In addition, scattered small foci of typical lipoma-like well-differentiated components were identified. Immunohistochemically, the tumor tested positivity for MDM2, CDK4, and p16. Fluorescence in situ hybridization revealed MDM2 gene amplification in the neoplastic cells. Whole-exome sequencing showed that this tumor also harbored CDK4, TSPAN31, and JUN amplification. At the latest follow-up (85 months after surgery), the patient was alive, with no evidence of disease. To the best of our knowledge, this is the first example of a molecularly confirmed primary bladder liposarcoma and the first case of DDL at this site.
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Affiliation(s)
| | | | | | | | | | | | - Hongying Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
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7
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Gitto S, Interlenghi M, Cuocolo R, Salvatore C, Giannetta V, Badalyan J, Gallazzi E, Spinelli MS, Gallazzi M, Serpi F, Messina C, Albano D, Annovazzi A, Anelli V, Baldi J, Aliprandi A, Armiraglio E, Parafioriti A, Daolio PA, Luzzati A, Biagini R, Castiglioni I, Sconfienza LM. MRI radiomics-based machine learning for classification of deep-seated lipoma and atypical lipomatous tumor of the extremities. LA RADIOLOGIA MEDICA 2023:10.1007/s11547-023-01657-y. [PMID: 37335422 DOI: 10.1007/s11547-023-01657-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/26/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE To determine diagnostic performance of MRI radiomics-based machine learning for classification of deep-seated lipoma and atypical lipomatous tumor (ALT) of the extremities. MATERIAL AND METHODS This retrospective study was performed at three tertiary sarcoma centers and included 150 patients with surgically treated and histology-proven lesions. The training-validation cohort consisted of 114 patients from centers 1 and 2 (n = 64 lipoma, n = 50 ALT). The external test cohort consisted of 36 patients from center 3 (n = 24 lipoma, n = 12 ALT). 3D segmentation was manually performed on T1- and T2-weighted MRI. After extraction and selection of radiomic features, three machine learning classifiers were trained and validated using nested fivefold cross-validation. The best-performing classifier according to previous analysis was evaluated and compared to an experienced musculoskeletal radiologist in the external test cohort. RESULTS Eight features passed feature selection and were incorporated into the machine learning models. After training and validation (74% ROC-AUC), the best-performing classifier (Random Forest) showed 92% sensitivity and 33% specificity in the external test cohort with no statistical difference compared to the radiologist (p = 0.474). CONCLUSION MRI radiomics-based machine learning may classify deep-seated lipoma and ALT of the extremities with high sensitivity and negative predictive value, thus potentially serving as a non-invasive screening tool to reduce unnecessary referral to tertiary tumor centers.
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Affiliation(s)
- Salvatore Gitto
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | - Renato Cuocolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
- Augmented Reality for Health Monitoring Laboratory (ARHeMLab), Department of Electrical Engineering and Information Technology, University of Naples "Federico II", Naples, Italy
| | - Christian Salvatore
- DeepTrace Technologies, Milan, Italy
- Department of Science, Technology and Society, University School for Advanced Studies IUSS Pavia, Pavia, Italy
| | - Vincenzo Giannetta
- Diagnostic and Interventional Radiology Department, IRCCS Ospedale San Raffaele-Turro, Università Vita-Salute San Raffaele, Milan, Italy
| | - Julietta Badalyan
- Scuola di Specializzazione in Statistica Sanitaria e Biometria, Università Degli Studi Di Milano, Milan, Italy
| | - Enrico Gallazzi
- UOC Patologia Vertebrale e Scoliosi, ASST Gaetano Pini - CTO, Milan, Italy
| | | | - Mauro Gallazzi
- UOC Radiodiagnostica, ASST Gaetano Pini - CTO, Milan, Italy
| | - Francesca Serpi
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | - Alessio Annovazzi
- Nuclear Medicine Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Vincenzo Anelli
- Radiology and Diagnostic Imaging Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Jacopo Baldi
- Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | | | | | | | | | - Roberto Biagini
- Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Isabella Castiglioni
- Department of Physics, Università degli Studi di Milano-Bicocca, Milan, Italy
- Institute of Biomedical Imaging and Physiology, Consiglio Nazionale Delle Ricerche, Segrate, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
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Watson S, Gruel N, Le Loarer F. New developments in the pathology and molecular biology of retroperitoneal sarcomas. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1053-1060. [PMID: 35151525 DOI: 10.1016/j.ejso.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/22/2022] [Accepted: 02/02/2022] [Indexed: 02/07/2023]
Abstract
Retroperitoneal sarcomas (RPS) refer to a heterogeneous group of malignancies of mesenchymal origin developing from retroperitoneal tissues and vessels. The most frequent RPS are well differentiated/dedifferentiated liposarcomas and leiomyosarcomas, but other rare histological subtypes can be observed. Over the last decade, significant advances have been made in the pathological and molecular characterization of sarcomas. These advances have led to major changes in their diagnostic management as well as in the development of new therapeutic strategies based on tumor biology and microenvironment. This review describes the current knowledge and recent findings in the pathology and molecular biology of the most frequent RPS subtypes.
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Affiliation(s)
- Sarah Watson
- INSERM U830, Équipe Labellisée Ligue Nationale Contre le Cancer, Diversity and Plasticity of Childhood Tumors Lab, PSL Research University, Institut Curie Research Center, Paris, France; Department of Medical Oncology, Institut Curie Hospital, Paris, France.
| | - Nadege Gruel
- INSERM U830, Équipe Labellisée Ligue Nationale Contre le Cancer, Diversity and Plasticity of Childhood Tumors Lab, PSL Research University, Institut Curie Research Center, Paris, France; Department of Translational Research, PSL Research University, Institut Curie Research Center, Paris, France
| | - François Le Loarer
- Department of Pathology, Institut Bergonie, Bordeaux, France; INSERM U1218, Unité ACTION, Institut Bergonie, Bordeaux, France; University of Bordeaux, Talence, France
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Foreman SC, Llorián-Salvador O, David DE, Rösner VKN, Rischewski JF, Feuerriegel GC, Kramp DW, Luiken I, Lohse AK, Kiefer J, Mogler C, Knebel C, Jung M, Andrade-Navarro MA, Rost B, Combs SE, Makowski MR, Woertler K, Peeken JC, Gersing AS. Development and Evaluation of MR-Based Radiogenomic Models to Differentiate Atypical Lipomatous Tumors from Lipomas. Cancers (Basel) 2023; 15:cancers15072150. [PMID: 37046811 PMCID: PMC10093205 DOI: 10.3390/cancers15072150] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/10/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023] Open
Abstract
Background: The aim of this study was to develop and validate radiogenomic models to predict the MDM2 gene amplification status and differentiate between ALTs and lipomas on preoperative MR images. Methods: MR images were obtained in 257 patients diagnosed with ALTs (n = 65) or lipomas (n = 192) using histology and the MDM2 gene analysis as a reference standard. The protocols included T2-, T1-, and fat-suppressed contrast-enhanced T1-weighted sequences. Additionally, 50 patients were obtained from a different hospital for external testing. Radiomic features were selected using mRMR. Using repeated nested cross-validation, the machine-learning models were trained on radiomic features and demographic information. For comparison, the external test set was evaluated by three radiology residents and one attending radiologist. Results: A LASSO classifier trained on radiomic features from all sequences performed best, with an AUC of 0.88, 70% sensitivity, 81% specificity, and 76% accuracy. In comparison, the radiology residents achieved 60–70% accuracy, 55–80% sensitivity, and 63–77% specificity, while the attending radiologist achieved 90% accuracy, 96% sensitivity, and 87% specificity. Conclusion: A radiogenomic model combining features from multiple MR sequences showed the best performance in predicting the MDM2 gene amplification status. The model showed a higher accuracy compared to the radiology residents, though lower compared to the attending radiologist.
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Affiliation(s)
- Sarah C. Foreman
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Oscar Llorián-Salvador
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
- Department of Informatics, Bioinformatics and Computational Biology—i12, Technische Universität München, Boltzmannstr. 3, 85748 Munich, Germany
- Institute of Organismic and Molecular Evolution, Johannes Gutenberg University Mainz, Hanns-Dieter-Hüsch-Weg 15, 55128 Mainz, Germany
| | - Diana E. David
- Department of Informatics, Bioinformatics and Computational Biology—i12, Technische Universität München, Boltzmannstr. 3, 85748 Munich, Germany
| | - Verena K. N. Rösner
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Jon F. Rischewski
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany
| | - Georg C. Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Daniel W. Kramp
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Ina Luiken
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Ann-Kathrin Lohse
- Department of Radiology, University Hospital Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany
| | - Jurij Kiefer
- Department of Plastic Surgery, University Hospital Freiburg, University of Freiburg, Hugstetterstraße 55, 79106 Freiburg im Breisgau, Germany
| | - Carolin Mogler
- Institute of Pathology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Carolin Knebel
- Department of Orthopedics and Sport Orthopedics, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Matthias Jung
- Department of Radiology, University Hospital Freiburg, University of Freiburg, Hugstetterstraße 55, 79106 Freiburg im Breisgau, Germany
| | - Miguel A. Andrade-Navarro
- Institute of Organismic and Molecular Evolution, Johannes Gutenberg University Mainz, Hanns-Dieter-Hüsch-Weg 15, 55128 Mainz, Germany
| | - Burkhard Rost
- Department of Informatics, Bioinformatics and Computational Biology—i12, Technische Universität München, Boltzmannstr. 3, 85748 Munich, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Marcus R. Makowski
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Jan C. Peeken
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Umwelt und Gesundheit, Institute of Radiation Medicine Neuherberg, 85764 Munich, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, 69120 Heidelberg, Germany
| | - Alexandra S. Gersing
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany
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Chen C, He X, Chen M, Du T, Qin W, Jing W, Zhang H. Diagnostic value of MDM2 RNA in situ hybridization for low-grade osteosarcoma: Consistency comparison of RNA in situ hybridization, fluorescence in situ hybridization, and immunohistochemistry. Virchows Arch 2023:10.1007/s00428-023-03530-9. [PMID: 36977943 DOI: 10.1007/s00428-023-03530-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/18/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
Detection of MDM2 gene amplification via fluorescence in situ hybridization (FISH) and MDM2 overexpression by immunohistochemistry (IHC) have been utilized for the diagnosis of low-grade osteosarcoma (LGOS). The aim of this study was to evaluate the diagnostic value of MDM2 RNA in situ hybridization (RNA-ISH) and compare this assay with MDM2 FISH and IHC in distinguishing LGOS from its histologic mimics. MDM2 RNA-ISH, FISH and IHC were performed on nondecalcified samples of 23 LGOSs and 52 control cases. Twenty (20/21, 95.2%) LGOSs were MDM2-amplified, and two cases failed in FISH. All control cases were MDM2-nonamplified. All 20 MDM2-amplified LGOSs and one MDM2-nonamplified LGOS harboring TP53 mutation and RB1 deletion showed positivity for RNA-ISH. Fifty of the 52 (96.2%) control cases were negative for RNA-ISH. The diagnostic sensitivity and specificity of MDM2 RNA-ISH were 100.0% and 96.2%, respectively. Nineteen of the 23 LGOSs were evaluated by MDM2 RNA-ISH and FISH in decalcified samples simultaneously. All decalcified LGOSs failed in FISH and most samples (18/19) were no staining in RNA-ISH. Fifteen (15/20, 75%) MDM2-amplified LGOSs were positive for IHC and 96.2% (50/52) of control cases were negative. The sensitivity of RNA-ISH (100%) was higher than that of IHC (75%). In conclusion, MDM2 RNA-ISH has great value for the diagnosis of LGOS, with excellent consistency with FISH and better sensitivity than IHC. Acid decalcification still has an adverse impact on RNA. Some MDM2-nonamplified tumors may show positivity for MDM2 RNA-ISH, which needs to be analyzed comprehensively in combination with clinicopathological features.
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Affiliation(s)
- Chen Chen
- Department of Pathology, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041, Sichuan, China
| | - Xin He
- Department of Pathology, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041, Sichuan, China
| | - Min Chen
- Department of Pathology, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041, Sichuan, China
| | - Tianhai Du
- Department of Pathology, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041, Sichuan, China
| | - Weiji Qin
- Department of Pathology, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041, Sichuan, China
| | - Wenyi Jing
- Department of Pathology, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041, Sichuan, China
| | - Hongying Zhang
- Department of Pathology, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu, 610041, Sichuan, China.
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Choi JH, Ro JY. The Recent Advances in Molecular Diagnosis of Soft Tissue Tumors. Int J Mol Sci 2023; 24:ijms24065934. [PMID: 36983010 PMCID: PMC10051446 DOI: 10.3390/ijms24065934] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
Soft tissue tumors are rare mesenchymal tumors with divergent differentiation. The diagnosis of soft tissue tumors is challenging for pathologists owing to the diversity of tumor types and histological overlap among the tumor entities. Present-day understanding of the molecular pathogenesis of soft tissue tumors has rapidly increased with the development of molecular genetic techniques (e.g., next-generation sequencing). Additionally, immunohistochemical markers that serve as surrogate markers for recurrent translocations in soft tissue tumors have been developed. This review aims to provide an update on recently described molecular findings and relevant novel immunohistochemical markers in selected soft tissue tumors.
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Affiliation(s)
- Joon Hyuk Choi
- Department of Pathology, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Namgu, Daegu 42415, Republic of Korea
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College, Cornell University, Houston, TX 77030, USA
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12
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Evaluation of Classic and Quantitative Imaging Features in the Differentiation of Benign and Atypical Lipomatous Soft Tissue Tumors Using a Standardized Multiparametric MRI Protocol: A Prospective Single-Centre Study in 45 Patients. Curr Oncol 2023; 30:3315-3328. [PMID: 36975465 PMCID: PMC10047222 DOI: 10.3390/curroncol30030252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/24/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
Background: Discrimination between benign and atypical lipomatous tumors (ALT) is important due to potential local complications and recurrence of ALT but can be difficult due to the often-similar imaging appearance. Using a standardized MRI protocol, this study aimed to rank established and quantitative MRI features by diagnostic value in the differentiation of benign and atypical lipomatous tumors and to develop a robust scoring system. Methods: Patients with clinical or sonographic suspicion of a lipomatous tumor were prospectively and consecutively enrolled from 2015 to 2019 after ethic review board approval. Histology was confirmed for all ALT and 85% of the benign cases. Twenty-one demographic and morphologic and twenty-three quantitative features were extracted from a standardized MRI protocol (T1/T2-proton-density-weighting, turbo-inversion recovery magnitude, T2* multi-echo gradient-echo imaging, qDIXON-Vibe fat-quantification, T1 relaxometry, T1 mapping, diffusion-weighted and post-contrast sequences). A ranking of these features was generated through a Bayes network analysis with gain-ratio feature evaluation. Results: Forty-five patients were included in the analysis (mean age, 61.2 ± 14.2 years, 27 women [60.0%]). The highest-ranked ALT predictors were septation thickness (gain ratio merit [GRM] 0.623 ± 0.025, p = 0.0055), intra- and peritumoral STIR signal discrepancy (GRM 0.458 ± 0.046, p < 0.0001), orthogonal diameter (GRM 0.554 ± 0.188, p = 0.0013), contrast enhancement (GRM 0.235 ± 0.015, p = 0.0010) and maximum diameter (GRM 0.221 ± 0.075, p = 0.0009). The quantitative features did not provide a significant discriminatory value. The highest-ranked predictors were used to generate a five-tiered score for the identification of ALTs (correct classification rate 95.7% at a cut-off of three positive items, sensitivity 100.0%, specificity 94.9%, likelihood ratio 19.5). Conclusions: Several single MRI features have a substantial diagnostic value in the identification of ALT, yet a multiparametric approach by a simple combination algorithm may support radiologists in the identification of lipomatous tumors in need for further histological assessment.
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Zhang Z, Lu Y, Shi C, Chen M, He X, Zhang H. Pediatric dermatofibrosarcoma protuberans: A clinicopathologic and genetic analysis of 66 cases in the largest institution in Southwest China. Front Oncol 2023; 13:1017154. [PMID: 36776313 PMCID: PMC9916051 DOI: 10.3389/fonc.2023.1017154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/02/2023] [Indexed: 01/28/2023] Open
Abstract
Background Dermatofibrosarcoma protuberans (DFSP) is an uncommon cutaneous tumor in children. Most published articles are sporadic or small series and lack systematically molecular analyses. The aim of our study is to better understand the clinicopathologic and genetic features of these rare lesions. Methods All patients diagnosed with DFSP aged ≤ 18 years were retrospectively reviewed from January 2006 to May 2022. Results A total of 66 cases (32 male and 34 female patients) were identified, with ages ranging from 0.3 to 18 years (median, 13 years). Tumor locations predominantly occurred on the trunk (38/66, 57.6%), followed by the extremities (20/66, 30.3%) and head/neck (8/66, 12.1%). Histological findings revealed classic (41/66, 62.1%), myxoid (4/66, 6.1%), pigmented (6/66, 9.1%), plaque-like (3/66, 4.5%), giant cell fibroblastoma (GCF; 6/66, 9.1%), and fibrosarcomatous (6/66, 9.1%) variants of DFSP. Immunochemistry revealed minority tumors (9/66, 13.6%) showing patchy or negative staining for CD34. Fluorescence in situ hybridization (FISH) indicated that 49 of 53 tested cases including all detected biopsy specimens (11/11) contained COL1A1-PDGFB fusion, in which the average copy number gain of COL1A1-PDGFB was 0.68. There were four cases negative for COL1A1-PDGFB rearrangement, one of which was found to harbor a novel COL3A1-PDGFB fusion by next-generation sequencing (NGS). Treatment for 63 patients comprised 40 marginal excisions and 23 wide local excisions (WLEs), including 1 with imatinib therapy. Follow-up information was available on 49 patients with a duration of 12-161 months (median, 60 months). Fourteen patients developed tumor recurrence, all with initial marginal excisions. The others survived with no evidence of disease. Conclusions This study of pediatric DFSP indicates certain discrepancies in clinicopathologic characteristics between children and adults. The majority of pediatric DFSPs contain COL1A1-PDGFB fusion, the same as their adult counterparts. The COL3A1-PDGFB chimerism might be associated with the special morphology of GCF, which needs further investigation. FISH is valuable in biopsy tissues and cases with atypical CD34 immunostaining, while supplementary NGS could be helpful to identify the cytogenetically cryptic DFSP. Overall, an urgent accurate diagnosis is needed to formulate an optimal therapeutic strategy in the pediatric population.
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Affiliation(s)
- Zhang Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Lu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Changle Shi
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Min Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin He
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongying Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
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14
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Farshid G, Otto S, Collis M, Napper S, Nicola M. Silver In Situ Hybridization for the Rapid Assessment of MDM2 Amplification in Soft Tissue and Bone Tumors. Validation Based on an Audit of 192 Consecutive Cases Evaluated by Silver In Situ Hybridization and Fluorescence In Situ Hybridization. Appl Immunohistochem Mol Morphol 2023; 31:101-106. [PMID: 36692149 DOI: 10.1097/pai.0000000000001098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 12/07/2022] [Indexed: 01/25/2023]
Abstract
The discovery of almost invariable mouse double minute 2 (MDM2) amplification among atypical lipomatous tumors (ALT)/well-differentiated liposarcoma and dedifferentiated liposarcoma is incorporated into the contemporary diagnostic workup of fatty lesions. MDM2 amplifications are also found frequently in intimal sarcomas and in low-grade osteogenic sarcoma. At present, fluorescence in situ hybridization (FISH) is the reference test for MDM2 assessment. We are interested in evaluating silver in situ hybridization (SISH) for this purpose. Between October 2016 and May 2020, in 192 consecutive cases requiring MDM2 FISH, SISH was also performed concurrently, including 77 (40.1%) core biopsies and 115 (58.9%) surgical specimens. The mean patient age was 61.0 years. SISH results were available overnight or within 48 hours if repeat testing was required. FISH results were available within 2 to 5 weeks. The cost of SISH was one third of FISH. FISH demonstrated MDM2 amplification in 44 cases (23.6%), was negative in 144 cases (74.4%) and nondiagnostic in 4 decalcified cases (2.0%). SISH showed MDM2 amplification in 33 cases (17.2%), no amplification in 119 cases (62.0%), and indeterminate results because of poor signal in 40 (20.8%) cases. All 33 (100%) SISH-amplified tumors and 113 of 119 (95.0%) nonamplified results were confirmed by FISH. There were no clear differences in the performance of SISH on NCB versus surgical specimens. The overall performance indices of SISH are sensitivity 75%, specificity 78.5%, positive predictive value 100%, and negative predictive value 95.8%. FISH is not required when SISH is clearly amplified. This is clinically useful and improves efficiency. Nonamplified SISH results provide early indications of the likely FISH findings, but there is a 4.2% chance of FISH being positive. At present, the main drawback of SISH is the high rate of nondiagnostic tests. Optimization of SISH signal detection to reduce the proportion of indeterminate results is our current focus.
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Affiliation(s)
- Gelareh Farshid
- Surgical Pathology, SA Pathology at the Royal Adelaide Hospital, BreastScreen SA, Discipline of Medicine, Adelaide University
| | - Sophia Otto
- Surgical Pathology, SA Pathology at the Royal Adelaide Hospital
| | - Maria Collis
- Surgical Pathology, SA Pathology at the Royal Adelaide Hospital
| | - Setha Napper
- Surgical Pathology, SA Pathology at the Royal Adelaide Hospital
| | - Mario Nicola
- Genetic and Molecular Pathology, SA Pathology at Frome Road, South Australia
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15
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Xie Y, Jing W, Zhao W, Peng R, Chen M, Lan T, Peng H, He X, Chen H, Zhang Z, Zhang H. Primary intrathoracic liposarcomas: A clinicopathologic and molecular study of 43 cases in one of the largest medical centers of China. Front Oncol 2022; 12:949962. [PMID: 36059611 PMCID: PMC9432863 DOI: 10.3389/fonc.2022.949962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/27/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Primary intrathoracic liposarcoma is extremely rare, and most published series lack genetic analyses. The aim of our study is to better understand the clinicopathologic and genetic features of these rare lesions. Materials and methods Forty-three primary intrathoracic liposarcomas were identified and most cases were analyzed by systematic genetic studies, including fluorescence in situ hybridization (FISH), whole-exome sequencing (WES), and Sanger sequencing. Results This series included 27 males and 16 females (ratios, 1.68:1) aged 24-73 years (median, 53 years). Tumors mainly occurred in the mediastinum (n=23, 53.5%), followed by pleural cavity (n=16, 37.2%) and lung (n=4, 9.3%). The study included 21 well-differentiated liposarcomas (WDLs), 19 dedifferentiated liposarcomas (DDLs), 2 myxoid pleomorphic liposarcomas (MPLs) and 1 pleomorphic liposarcoma (PL), without identification of myxoid liposarcoma. FISH analysis identified MDM2 amplification in 17 of 18 WDLs (94.4%) and all DDLs (16/16, 100.0%). The MDM2-nonamplified WDL was CDK4-nonamplified but FRS2-amplified. WES and Sanger sequencing found somatic TP53 mutation in the 2 MPLs. Follow-up information was available for 33 of 38 cases (86.8%). Thirteen patients (39.4%) showed no evidence of disease, 10 patients (30.3%) were alive with disease, and 8 patients (24.2%) died of disease. Fourteen cases developed recurrence and 1 with metastasis. Conclusions WDL/DDL was the overwhelming subtype in this location, followed by MPL and PL. Analysis of the FRS2 gene, in combination with MDM2 and other genes of 12q13-15, may more precisely characterize WDL/DDLs. MPL is the most fatal subtype of this site. Further studies are needed to explore the role of TP53 in the pathogenesis of MPL.
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Affiliation(s)
- You Xie
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Wenyi Jing
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Zhao
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Ran Peng
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Min Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Lan
- Department of Pathology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Cancer Hospital Affiliate to School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Heng Peng
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin He
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Huijiao Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhang Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongying Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Hongying Zhang,
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16
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Yee EJ, Stewart CL, Clay MR, McCarter MM. Lipoma and Its Doppelganger: The Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma. Surg Clin North Am 2022; 102:637-656. [PMID: 35952693 DOI: 10.1016/j.suc.2022.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Lipomatous tumors are among the most common soft tissue lesions encountered by the general surgeon. Shared history and clinical presentation make differentiation between benign lipomas and low-grade liposarcomas a diagnostic dilemma. This article reviews the epidemiology, clinical history, diagnostic workup, management, natural history, and surveillance of benign lipomas and atypical lipomatous tumors/well-differentiated liposarcomas. Although it is important that aggressive, potentially malignant atypical lipomatous tumors and liposarcomas be managed in a multidisciplinary, preferably high-volume setting, it is equally as important for the nonspecialist general surgeon to be familiar with lipoma and its doppelganger-the well-differentiated liposarcoma.
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Affiliation(s)
- Elliott J Yee
- Department of Surgery, University of Colorado, 12605 East 16th Avenue, Aurora, CO 80045, USA.
| | - Camille L Stewart
- Department of Surgery, University of Colorado, 12605 East 16th Avenue, Aurora, CO 80045, USA
| | - Michael R Clay
- Department of Pathology, Univeristy of Colorado, 12605 East 16th Avenue, Aurora, CO 80045, USA
| | - Martin M McCarter
- Department of Surgery, University of Colorado, 12605 East 16th Avenue, Aurora, CO 80045, USA
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17
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Wilcock DM, McMurtry V, Coleman JF, Kim JT, Khalili P, Deftereos G, Albertson D, Gulbahce EH, Liu T, Sirohi D. Histopathological Correlation of Chromosome 12 Polysomy by Fluorescence in Situ Hybridization in Adipocytic Neoplasms. Int J Surg Pathol 2022; 30:734-742. [PMID: 35261272 DOI: 10.1177/10668969221085289] [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: 10/18/2022]
Abstract
Background: Identification of MDM2 amplification by fluorescence in situ hybridization is an important diagnostic tool for evaluation of adipocytic neoplasms. Rarely, neoplasms can show increased copies of MDM2 and CEP12 probes (polysomy) without amplification (MDM2/CEP12 ratio <2.0). While noted in the literature, this finding has not been the focus of any study to date. Methods: Consecutive cases were retrospectively screened for increased copies of MDM2 and CEP12 and were classified as: high polysomy (ratio<2.0, CEP12≥10.0), low polysomy (ratio<2.0, but >0.5, CEP12≥4.0 but <9.9), and CEP12 amplification (ratio≤0.5, CEP12 > 4.0). H&E slides were classified by a pathologist into diagnostic categories based on morphology without knowledge of MDM2 amplification result. Correlations between chromosome 12 polysomy and histological features in the same region of the tumor were investigated. Results: There were 19 (0.7%) high polysomy, 52 (2.0%) low polysomy and 3 (0.1%) CEP12 amplification cases identified in the 2541 cases screened. While low polysomy was seen across benign and malignant adipocytic tumors and other sarcomas, high level polysomy was primarily seen in liposarcomas, both atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDLPS) and dedifferentiated liposarcoma (DDLPS). No lipomas were high polysomy. Conclusion: Polysomy is an uncommon, but distinct, finding in adipocytic neoplasms found across the spectrum of benign to malignant with little insight into the pathophysiology or prognosis. While low polysomy is also observed in benign adipocytic neoplasms, high polysomy is almost always seen in malignant adipocytic neoplasms and is uncommon in benign adipocytic neoplasms.
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Affiliation(s)
- Diane M Wilcock
- The Institute for Experimental Pathology® , ARUP Laboratories, Salt Lake City, UT
| | - Valarie McMurtry
- The Institute for Experimental Pathology® , ARUP Laboratories, Salt Lake City, UT.,14434University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Joshua F Coleman
- The Institute for Experimental Pathology® , ARUP Laboratories, Salt Lake City, UT.,14434University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Jong Taek Kim
- The Institute for Experimental Pathology® , ARUP Laboratories, Salt Lake City, UT.,14434University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Parisa Khalili
- The Institute for Experimental Pathology® , ARUP Laboratories, Salt Lake City, UT.,14434University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Georgios Deftereos
- The Institute for Experimental Pathology® , ARUP Laboratories, Salt Lake City, UT.,14434University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Daniel Albertson
- The Institute for Experimental Pathology® , ARUP Laboratories, Salt Lake City, UT.,14434University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Evin H Gulbahce
- The Institute for Experimental Pathology® , ARUP Laboratories, Salt Lake City, UT.,14434University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Ting Liu
- The Institute for Experimental Pathology® , ARUP Laboratories, Salt Lake City, UT.,14434University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Deepika Sirohi
- The Institute for Experimental Pathology® , ARUP Laboratories, Salt Lake City, UT.,14434University of Utah and ARUP Laboratories, Salt Lake City, UT
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Lu Y, Li T, Chen M, Peng H, Du T, Qiu Y, Zhang H. Coamplification of 12q15 and 12p13 and homozygous CDKN2A/2B deletion: synergistic role of fibrosarcomatous transformation in dermatofibrosarcoma protuberans with a cryptic COL1A1-PDGFB fusion. Virchows Arch 2022; 481:313-319. [PMID: 35171326 DOI: 10.1007/s00428-022-03297-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 02/05/2023]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is characterized by collagen type I alpha 1 chain-platelet-derived growth factor B chain (COL1A1-PDGFB) fusion. We present a case of fibrosarcomatous DFSP with lung metastasis in a 53-year-old man. Histologically, the primary and metastatic tumors were composed of high-grade fibrosarcomatous component with varying myxoid changes, while only a small focus of the classic DFSP element was identified in the primary lesion. No evidence of COL1A1-PDGFB fusion was identified by routine fluorescence in situ hybridization (FISH). Subsequent next-generation sequencing and COL1A1 break-apart FISH identified the fusion. In addition, coamplification of 12q15 and 12p13, along with CDKN2A/2B deletion, was confirmed to be limited to the fibrosarcomatous component. The current case is a novel FS-DFSP with cryptic COL1A1-PDGFB fusion. This is the first published example of DFSP harboring coamplification of 12q and 12p sequences. More importantly, the genetic aberrations restricted to the fibrosarcomatous component indicated a synergistic role of higher-grade progression.
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Affiliation(s)
- Yang Lu
- Department of Pathology, West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, China
| | - Tao Li
- Department of Pathology, Pujiang County People's Hospital, Chengdu, China
| | - Min Chen
- Department of Pathology, West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, China
| | - Heng Peng
- Department of Pathology, West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, China
| | - Tianhai Du
- Department of Pathology, West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, China
| | - Yan Qiu
- Department of Pathology, West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, China
| | - Hongying Zhang
- Department of Pathology, West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, China.
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Expression of FRS2 in atypical lipomatous tumor/well-differentiated liposarcoma and dedifferentiated liposarcoma: an immunohistochemical analysis of 182 cases with genetic data. Diagn Pathol 2021; 16:96. [PMID: 34696768 PMCID: PMC8543942 DOI: 10.1186/s13000-021-01161-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 10/06/2021] [Indexed: 02/08/2023] Open
Abstract
Background The fibroblast growth factor receptor substrate 2 (FRS2) gene is located close to MDM2 and CDK4 within the 12q13-15 chromosomal region. FRS2 gene was recently found to be consistently amplified in atypical lipomatous tumor (ALT)/well-differentiated liposarcoma (WDL) and dedifferentiated liposarcoma (DDL), suggesting the detection of FRS2 amplification could be a diagnostic tool for ALT/WDL/DDLs. However, the expression of FRS2 protein and diagnostic value of FRS2 immunohistochemistry (IHC) has not been evaluated in a large cohort of ALT/WDL/DDLs. Methods A SNOMED search of hospital surgical pathology files from January 2007 to July 2020 identified 182 ALT/WDL/DDLs with available materials. FRS2 fluorescence in situ hybridization (FISH) and IHC were performed on 182 ALT/WDL/DDLs and 64 control samples. The expression of FRS2 was also compared with that of classic immunomarkers (MDM2 and CDK4) of this tumor entity. Results This study included 91 ALT/WDLs and 91 DDLs. The FISH results showed 172 of 182 (94.5%) cases were FRS2-amplified, and 10 cases were FRS2-nonamplified. Immunostaining results showed 171 (94.0%) ALT/WDL/DDLs were positive for FRS2 and 11 cases (6.0%) were FRS2-immunonegative. In 172 FRS2-amplified cases, 166 (96.5%) were FRS2-immunopositive, and 6 (3.5%) were negative. Among 10 FRS2-nonamplified ALT/WDL/DDL cases, 5 cases were FRS2-immunonegative, and 5 tumors displayed 1+ staining for this marker. In 64 control cases, none of them exhibited FRS2 amplification. Forty-seven (73.5%) control cases were negative for FRS2 immunostaining, while 17 cases (26.5%) were FRS2-immunopositive. Fifteen of these false positive samples (15/17, 88.2%) showed 1+ positivity and only 2 cases (2/17, 11.8%) displayed 2+ positivity. In ALT/WDL/DDLs, the sensitivity of FRS2 immunostaining was slightly lower than MDM2 (FRS2 vs. MDM2: 94.0% vs 100.0%) and CDK4 (FRS2 vs. CDK4: 94.0% vs 97.0%). However, the specificity of FRS2 (73.5%) was slightly higher than that of MDM2 (67.8%) and CDK4 (64.4%). Conclusion This study indicated that FRS2 IHC had relatively good consistency with FRS2 FISH, suggesting that FRS2 immunostaining could be utilized as an additional screening tool for the diagnosis of ALT/WDL/DDL. It must be emphasized that MDM2/CDK4/FRS2 especially MDM2 FISH remains the gold standard and the most recommended method to diagnose this entity.
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20
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The Utility of Chest Imaging for Surveillance of Atypical Lipomatous Tumors. Sarcoma 2021; 2021:4740924. [PMID: 34671190 PMCID: PMC8523289 DOI: 10.1155/2021/4740924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background Unlike other soft tissue sarcomas, atypical lipomatous tumors (ALTs) are thought to have a low propensity for metastasis. Despite this, a standard of care for pulmonary metastasis (PM) surveillance has not been established. This study aimed to evaluate the utility of chest imaging for PM surveillance following ALT excision. Methods This was a multi-institution, retrospective review of all patients with primary ALTs of the extremities or superficial torso who underwent excision between 2006 and 2018. Minimum follow-up was two years. Long-term survival was evaluated using the Kaplan-Meier method. Results 190 patients with ALT were included. Average age was 61.7 years and average follow-up was 58.6 months (24 to 180 months). MDM2 testing was positive in 88 patients (46.3%), and 102 (53.7%) did not receive MDM2 testing. 188 patients (98.9%) had marginal excision, and 127 (66.8%) had marginal or positive margins. Patients received an average of 0.9 CT scans and 1.3 chest radiographs over the surveillance period. 10-year metastasis-free survival was 100%, with no documented deaths from disease. Conclusions This study suggests that chest imaging does not have a significant role in PM surveillance following ALT excision, but advanced local imaging and chest surveillance may be considered in cases of local recurrence or concern for dedifferentiation.
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21
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Vargas AC, Joy C, Cheah AL, Jones M, Bonar F, Brookwell R, Garrone B, Talbot J, Harraway J, Gill AJ, Maclean FM. Lessons learnt from MDM2 fluorescence in-situ hybridisation analysis of 439 mature lipomatous lesions with an emphasis on atypical lipomatous tumour/well-differentiated liposarcoma lacking cytological atypia. Histopathology 2021; 80:369-380. [PMID: 34523152 DOI: 10.1111/his.14558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/30/2021] [Accepted: 09/04/2021] [Indexed: 11/30/2022]
Abstract
AIMS Amplification of the murine double minute-2 (MDM2) gene, which is usually detected with fluorescence in-situ hybridisation (FISH), is the key driving event for atypical lipomatous tumours (ALTs)/well-differentiated liposarcomas (WDLs). We sought to determine the concordance between the histopathological findings and MDM2 FISH in the diagnosis of ALT/WDL, and to identify the histological features of MDM2-amplified tumours lacking classic atypia. METHODS AND RESULTS We performed a retrospective analysis of all mature lipomatous lesions subjected to MDM2 FISH analysis at our institution. MDM2 FISH analysis was performed on 439 mature lipomatous lesions: 364 (82.9%) were negative and 75 (17%) were positive. In 17 of 75 (22.6%) ALTs/WDLs, cytological atypia was not identified on initial histological assessment, thus favouring lipoma. On review, these cases shared common histological features, consisting of a very low number of relatively small stromal cells within the tumour lobules, with mildly coarse chromatin and oval nuclei, admixed with unremarkable adipocytes in a tumour background devoid of fibroconnective septa, areas of fibrosis, or blood vessels. These cells matched the cells in which FISH showed MDM2 amplification. In contrast, 13 cases (3.5%) regarded as suspicious for ALT/WDL on the basis of histology lacked MDM2 amplification and were reclassified following the FISH findings. CONCLUSIONS We conclude that a subset of lipoma-like ALTs/WDLs are not associated with any of the features typically described in ALT/WDL. Our study also showed that tumours >100 mm are more likely to be ALT/WDL; however, a history of recurrence or concerning clinical/radiological features was not significantly associated with classification as ALT/WDL.
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Affiliation(s)
- Ana Cristina Vargas
- Department of Anatomical Pathology, Sonic Healthcare-Douglass Hanly Moir Pathology, Macquarie Park, Australia.,Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Joy
- Department of Cytogenetics, Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
| | - Alison L Cheah
- Department of Anatomical Pathology, Sonic Healthcare-Douglass Hanly Moir Pathology, Macquarie Park, Australia
| | - Martin Jones
- Department of Anatomical Pathology, Sonic Healthcare-Douglass Hanly Moir Pathology, Macquarie Park, Australia
| | - Fiona Bonar
- Department of Anatomical Pathology, Sonic Healthcare-Douglass Hanly Moir Pathology, Macquarie Park, Australia
| | - Ross Brookwell
- Department of Cytogenetics, Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
| | - Bernadette Garrone
- Department of Cytogenetics, Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
| | - Joel Talbot
- Department of Anatomical Pathology, Sonic Healthcare-Douglass Hanly Moir Pathology, Macquarie Park, Australia
| | - James Harraway
- Department of Cytogenetics, Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Anatomical Pathology, NSW Health Pathology, Royal North Shore Hospital, Sydney, Australia
| | - Fiona M Maclean
- Department of Anatomical Pathology, Sonic Healthcare-Douglass Hanly Moir Pathology, Macquarie Park, Australia.,Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, Australia.,Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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22
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Liposarcoma in children and young adults: a clinicopathologic and molecular study of 23 cases in one of the largest institutions of China. Virchows Arch 2021; 479:537-549. [PMID: 33738541 DOI: 10.1007/s00428-021-03076-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/19/2021] [Accepted: 03/07/2021] [Indexed: 02/05/2023]
Abstract
The incidence of pediatric liposarcoma is rare and most published cases lack systematic genetic analyses. We present clinicopathologic and genetic features of 23 liposarcomas aged <22 years. The study cohort comprised 10 males and 13 females (M:F=1:1.3) aged 11-21 years (median 17 years). The tumors predominantly occurred at the extremities (16/23; 69.6%), followed by the head/neck (2/23; 8.7%), chest (2/23; 8.7%), waist (2/23, 8.7%), and retroperitoneum (1/23; 4.3%). The tumor subtypes were sixteen myxoid liposarcoma (ML), one well-differentiated liposarcoma (WDL), two dedifferentiated liposarcoma (DDL), one pleomorphic liposarcoma (PL), and three myxoid pleomorphic liposarcoma (MPL) cases. Fluorescence in situ hybridization analysis identified MDM2/CDK4 amplification in all WDL/DDL cases (3/3; 100%) and DDIT3 rearrangement in all ML cases (13/13; 100%). Whole-exome sequencing indicated that one PL case and one MPL case exhibited RB1 loss. The two tested MPL cases had TP53 mutation and one of them harbored a TP53 germline mutation. Follow-up information was available for 20 patients (20/23; 87.0%) with a median follow-up duration of 42.5 months (range, 13-120 months). Three patients exhibited tumor progression (3/20;15.0%). Seventeen patients (17/20; 85.0%) survived with no evidence of disease. One MPL case (1/20; 5.0%) died of the disease. In conclusion, despite some overlaps, the occurrence, distribution of subtype, and prognosis of liposarcoma are overall different in children and adults. Most MLs and ALT/WDL/DDLs showed similar genetic aberrations with adult counterparts. Molecular features of MPL overlapped with those of conventional PL. The genetic characteristics including Tp53 status of MPL need further investigation.
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23
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Vílchez-Oya F, Salman-Monte TC, Monfort J. Hip Pain Secondary to Intermuscular Lipoma. REUMATOLOGIA CLINICA 2021; 17:175-177. [PMID: 31445871 DOI: 10.1016/j.reuma.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/12/2019] [Accepted: 07/03/2019] [Indexed: 06/10/2023]
Affiliation(s)
| | | | - Jordi Monfort
- Servicio de Reumatología, Parc de Salut Mar/Hospital del Mar, Barcelona, España
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24
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Pouedras M, Briand S, Crenn V, Cassagnau E, Gouin F. Non image-guided core needle biopsies can be used safely to improve diagnostic efficiency for soft tissue tumors. Surg Oncol 2021; 37:101518. [PMID: 33434767 DOI: 10.1016/j.suronc.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/11/2020] [Accepted: 12/27/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Front-line biopsy remains the rule in the management of soft tissue mass syndromes. Although open biopsy has long been considered the gold standard, it has recently been shown that a percutaneous biopsy is associated with a reduction in the rate of complications and cost, while maintaining high diagnostic accuracy. Though there is much literature regarding the diagnostic accuracy of image-guided and open biopsies for soft tissue tumors, the accuracy of percutaneous non image-guided biopsies has not been well documented. The objective of this study was to compare the failure rate of non image-guided biopsies, image-guided biopsies and open biopsies for the diagnosis of soft tissue tumors. We also attempted to identify the failure risk factors for non image-guided biopsies and we compared the diagnostic delay of the three types of biopsy. MATERIALS AND METHODS This was a continuous, single-center retrospective study. We reviewed the results from 337 patients managed with a biopsy (percutaneous or open) for a soft tissue tumor, all carried out in our center between January 2010 and December 2015. Biopsy technique was chosen by the treating orthopedic surgeon, according to the clinical and radiological characteristics of the mass. 141 patients (41.8%) had a non-image-guided biopsy as the first-line diagnostic procedure, 81 (24.0%) had an image-guided biopsy, and 115 (34.1%) an open biopsy. Diagnostic failure was defined either by a non-contributory biopsy, the need for repeat biopsy, or a major histological discordance obtained from the resected tumor piece. The risk factors studied were tumor characteristics, patient' characteristics and sampling modalities. Diagnostic delay was defined as the period between the day of the first external consultation at the hospital and the day of the notification of the diagnosis by the physician. RESULTS We obtained a failure rate of 9.9% (14 patients) for non image-guided biopsies. Eleven were non-contributive and three were considered as errors of diagnosis. The failure rate for image-guided biopsies was 18.5% (15 patients), with no significant difference compared with non image-guided biopsies. The open biopsies were associated with a failure rate of 6.9% (eight patients). We found no failure risk factors for non image-guided biopsies. Diagnostic delay was significantly shorter for non image-guided biopsies (p = 0.001). CONCLUSION When performed in a referral center by the patient's surgeon, a non-image-guided core needle biopsy is a safe procedure which ensures equivalent diagnostic accuracy for soft tissue tumors, while reducing the diagnostic delay.
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Affiliation(s)
- Marie Pouedras
- Orthopedics and Trauma Department, University Hospital of Nantes, 1, place Alexis Ricordeau, 44093, Nantes Cedex 1, France.
| | - Sylvain Briand
- Orthopedic and Traumatology Surgery Department, Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris, Paris-Sud University ORSAY, 78 Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France.
| | - Vincent Crenn
- Orthopedics and Trauma Department, University Hospital of Nantes, 1, place Alexis Ricordeau, 44093, Nantes Cedex 1, France; Inserm UMR 1238, Bone sarcomas and Remodeling of Calcified Tissues, France.
| | - Elisabeth Cassagnau
- Department of Pathology, University Hospital of Nantes, 1, place Alexis Ricordeau, 44093, Nantes Cedex 1, France.
| | - François Gouin
- Centre Léon Bérard, Department of Surgery, Lyon, France; Inserm U1238, Bone Sarcomas and Remodeling of Calcified Tissue, France.
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25
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Nardo L, Abdelhafez YG, Acquafredda F, Schirò S, Wong AL, Sarohia D, Maroldi R, Darrow MA, Guindani M, Lee S, Zhang M, Moawad AW, Elsayes KM, Badawi RD, Link TM. Qualitative evaluation of MRI features of lipoma and atypical lipomatous tumor: results from a multicenter study. Skeletal Radiol 2020; 49:1005-1014. [PMID: 31965239 DOI: 10.1007/s00256-020-03372-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/25/2019] [Accepted: 01/01/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The objectives of the study are (1) to distinguish lipoma (L) from atypical lipomatous tumor (ALT) using MRI qualitative features, (2) to assess the value of contrast enhancement, and (3) to evaluate the reproducibility and confidence level of radiological readings. MATERIALS AND METHODS Patients with pathologically proven L or ALT, who underwent MRI within 3 months from surgical excision were included in this retrospective multicenter international study. Two radiologists independently reviewed MRI centrally. Impressions were recorded as L or ALT. A third radiologist was consulted for discordant readings. The two radiologists re-read all non-contrast sequences; impression was recorded; then post-contrast images were reviewed and any changes were recorded. RESULTS A total of 246 patients (135 females; median age, 59 years) were included. ALT was histopathologically confirmed in 70/246 patients. In multivariable analysis, in addition to the lesion size, deep location, proximal lower limb lesions, demonstrating incomplete fat suppression, or increased architectural complexity were the independent predictive features of ALT; but not the contrast enhancement. Post-contrast MRI changed the impression in a total of 5 studies (3 for R1 and 4 for R2; 2 studies are common); all of them were incorrectly changed from Ls to ALTs. Overall, inter-reader kappa agreement was 0.42 (95% CI 0.39-0.56). Discordance between the two readers was statistically significant for both pathologically proven L (p < 0.001) and ALT (p = 0.003). CONCLUSION Most qualitative MR imaging features can help distinguish ALTs from BLs. However, contrast enhancement may be limited and occasionally misleading. Substantial discordance on MRI readings exists between radiologists with a relatively high false positive and negative rates.
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Affiliation(s)
- Lorenzo Nardo
- Department of Radiology, University of California Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA.
| | - Yasser G Abdelhafez
- Department of Radiology, University of California Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
| | | | - Silvia Schirò
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.,Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Andrew L Wong
- Department of Radiology, University of California Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
| | - Dani Sarohia
- Department of Radiology, University of California Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
| | - Roberto Maroldi
- Scienze Radiologiche, Università degli Studi di Brescia, Brescia, Italy
| | - Morgan A Darrow
- Pathology and Laboratory Medicine, University of California Davis, Sacramento, CA, USA
| | - Michele Guindani
- Department of Statistics, University of California, Irvine, CA, USA
| | - Sonia Lee
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Michelle Zhang
- Department of Diagnostic Radiology, McGill University Health Center, Montreal, Canada
| | - Ahmed W Moawad
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ramsey D Badawi
- Department of Radiology, University of California Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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Donners R, Krieg AH, Baumhoer D, Boll DT, Harder D. Quantitative signal intensity ratios to distinguish between subfascial lipoma and atypical lipomatous tumor/well-differentiated liposarcoma using short-tau inversion recovery (STIR) MRI. Diagn Interv Imaging 2020; 101:383-390. [PMID: 32107197 DOI: 10.1016/j.diii.2020.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/24/2020] [Accepted: 01/30/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To establish simple quantitative variables at short-tau inversion recovery (STIR) magnetic resonance imaging (MRI) to identify lipomas with high specificity in patients with indeterminate subfascial lipomatous tumors. MATERIALS AND METHODS The MRI examinations of 26 patients (14 men, 12 women; mean age 63±12.5 [SD] years; range: 40-84years) with histopathologically proven subfascial atypical lipomatous tumors/well-differentiated liposarcomas (ALT/WDLs) and those of 68 patients (32 men, 36 women; mean age, 56±13.5 [SD] years; range: 21-83years) with lipomas were retrospectively reviewed. Ratios derived from region of interest based signal intensity (SI) measurements of tumors and adjacent fat on STIR images were calculated and maximum tumor diameters were noted. Diagnostic parameter capabilities were assessed using ROC curve analysis. Interreader agreement was evaluated by calculation of intraclass correlation coefficients (ICC). RESULTS Using a cut-off value of 1.18, STIR-SI ratios allowed discriminating between lipoma and ALT/WDL (AUC=0.88; P<0.001) yielding 93% specificity (95% CI: 77-99%) and 74% sensitivity (95% CI: 61-84%) for the diagnosis of lipoma. Interreader agreement was excellent (ICC=0.93). A significant difference in maximum tumor diameter was found between ALT/WDLs (mean: 18.1±6.0 [SD] cm; range: 5.6-33.1cm) and lipomas (mean: 9.7±5.0 [SD] cm; range: 2.9-29.1cm) (P<0.001). Using a cut-off of 11cm, maximum tumor diameter allowed discriminating between lipoma and ALT/WDLs with 92% specificity (95% CI: 75-99%) and 69% sensitivity (95% CI: 57-80%). The combination of a STIR-SI ratio<1.4 and maximum tumor diameter<11cm yielded 100% specificity (95% CI: 87-100%) and 65% sensitivity (95% CI: 54-77%) for the diagnosis of lipoma. CONCLUSION The combination of STIR-SI ratio and maximum diameter allows discriminating between lipoma and ALT/WDL in initially indeterminate lipomatous tumors.
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Affiliation(s)
- R Donners
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - A H Krieg
- Bone and Soft tissue Sarcoma Center, University Basel (KWUB), University Childrens Hospital (UKBB), 4031 Basel, Switzerland
| | - D Baumhoer
- Bone Tumor Reference Center at the Institute of Pathology, University Hospital and University of Basel, 4031 Basel, Switzerland
| | - D T Boll
- Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - D Harder
- Department of Radiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
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Atypical Lipomatous Tumors: Does Our Inconsistent Terminology Have Patient Repercussions? Results of a Meta-Analysis. Am J Clin Oncol 2020; 42:487-492. [PMID: 30932920 DOI: 10.1097/coc.0000000000000540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Misnaming low-grade lipomatous tumors poses a clinical and medicolegal challenge, potentially subjecting patients to expensive and unnecessary surgeries. The terms atypical lipomatous tumor (ALT) and "well-differentiated" liposarcoma (WDL) have been used interchangeably in pathology reports, scholarly works and consensus recommendations, creating vagaries between low-virulence extremity tumors and retroperitoneal disease with metastatic potential. METHODS A systematic review was performed on all studies that reported on the local recurrence rate and metastasis of ALTs and WDLs in living human subjects. Local recurrence and metastases were compared using Fisher's Exact Test. RESULTS In total, 20 studies evaluated ALTs (n=936), whereas 13 studied WDLs (n=626). Mean follow-up was 6.6±2.0 years (median, 7.0 y). No metastatic disease was observed among ALTs, whereas 15 patients with WDLs (2.7%, P<0.0001) had metastases. The local recurrence rate of ALTs was significantly lower than WDLs after both marginal (15.1%, 141/936 vs. 46.0%, 288/626, P<0.0001) and wide excisions (3.3%, 2/59 in ALT vs. 17.4%, 19/109, P=0.007). CONCLUSIONS ALT should be reserved for extremity lesions meeting appropriate histopathologic criteria that represent nonmetastatic disease, reducing over-diagnosis, over-treatment, and patient risk.
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28
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MDM2 RNA In Situ Hybridization for the Diagnosis of Atypical Lipomatous Tumor: A Study Evaluating DNA, RNA, and Protein Expression. Am J Surg Pathol 2020; 43:446-454. [PMID: 30520819 DOI: 10.1097/pas.0000000000001199] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The distinction of atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) from its benign counterpart, lipoma, may represent a challenge. MDM2 DNA amplification is used as the gold standard as MDM2 immunohistochemistry lacks specificity and sensitivity. Herein, we investigate the diagnostic utility of MDM2 RNA in situ hybridization (RNA-ISH) and compare the test with MDM2 immunohistochemistry and MDM2 DNA fluorescence in situ hybridization (FISH) in benign and malignant lipomatous neoplasms. We evaluated 109 neoplasms including 27 lipomas, 25 spindle cell lipomas, 32 ALTs/WDLs, and 25 dedifferentiated liposarcomas (DDL). The validation cohort included 14 lipoma-like neoplasms that lacked unequivocal features of ALT/WDL and in which MDM2 immunohistochemistry was either equivocal, negative or falsely positive. Immunohistochemistry, automated RNA-ISH and DNA-FISH for MDM2 were performed. Tumors with diffuse nuclear staining or >50 dots per cell on RNA-ISH were considered positive. All lipomas and lipoma variants were negative for RNA-ISH while all ALTs/WDLs and DDLs were positive. Eighty percent (24/30) and 92% (22/24) of ALTs/WDLs and DDLs were positive for MDM2 immunohistochemistry. Lipomas and its variants were negative for MDM2 amplification; 92% and 100% of ALTs/WDLs and DDLs showed MDM2 DNA amplification. The mean percentage of ALT/WDL tumor cells showing MDM2 RNA-ISH positivity was 73% compared with 24% on MDM2 immunohistochemistry. RNA-ISH correctly classified all 10 ALTs/WDLs and all 4 lipomas in the validation cohort. The performance of MDM2 RNA-ISH and MDM2 DNA-FISH are equivalent. MDM2 RNA-ISH can be of diagnostic value in histologically challenging lipomatous neoplasms. The automated MDM2 RNA-ISH assay should allow for more widespread use of MDM2 testing and for a more sensitive and specific diagnosis of ALT/WDL.
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Presman B, Jauffred SF, Kornø MR, Petersen MM. Low Recurrence Rate and Risk of Distant Metastases following Marginal Surgery of Intramuscular Lipoma and Atypical Lipomatous Tumors of the Extremities and Trunk Wall. Med Princ Pract 2020; 29:203-210. [PMID: 31550705 PMCID: PMC7315139 DOI: 10.1159/000503621] [Citation(s) in RCA: 3] [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] [Received: 04/28/2019] [Accepted: 09/24/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The purpose of the present study was to determine the local recurrence rate, risk of dedifferentiation, and distant metastasis after surgical excision of intramuscular lipomas (IML) and atypical lipomatous tumors (ALT). SUBJECTS AND METHODS We retrospectively assessed all IML and ALT surgically removed from the extremities or trunk wall in our clinic between 1997 and 2006. Data from 141 patients with IML and 35 patients with ALT were extracted from the National Pathology Registry and patient files. RESULTS IML and ALT recurred in 10 and 6 tumors, respectively. No metastases were observed in either group. The 5- and 10-year local recurrence-free survival rates were 97.1% (94.3-99.9) and 94.8% (CI: 91.1-98.6) for IML and 84.6% (CI: 72.1-97.1) and 81.1% (CI: 67.6-94.8) for ALT, respectively. ALT were found to dedifferentiate in 2/35 cases. CONCLUSION Both IML and ALT showed a low recurrence rate when removed surgically from the extremities or trunk wall with intended marginal resection. No distant metastases were observed in any of the groups. It, therefore, seems safe to treat these tumors with marginal resection.
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Affiliation(s)
- Benjamin Presman
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sune Frederik Jauffred
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Maj Raundrup Kornø
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Michael Mørk Petersen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,
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30
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Liposarcoma of the left hemithorax and implications of MDM2. JOURNAL OF RADIOTHERAPY IN PRACTICE 2019. [DOI: 10.1017/s1460396919000372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Use of molecular information to guide clinical management of thoracic liposarcoma following resection.Case presentation:We present a case of a large liposarcoma of the left hemithorax. Initial biopsy consistent with lipoma however following resection pathology showed well-differentiated liposarcoma. Clinical data and molecular information including MDM2 from the tumour were employed in decision making regarding subsequent adjuvant radiation therapy versus close observation.Conclusion:Improved molecular characterisation has increased the precision of histological diagnoses and prediction of outcomes for many cancers. These may continue to help guide and strengthen clinical decision making and recommendations as they pertain to adjuvant therapy versus observation in the case of this patient.
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31
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Waters R, Horvai A, Greipp P, John I, Demicco EG, Dickson BC, Tanas MR, Larsen BT, Ud Din N, Creytens DH, Bahrami A, Doyle LA, Jo VY, Al-Ibraheemi A, Thway K, Jenkins SM, Siontis B, Folpe A, Fritchie K. Atypical lipomatous tumour/well-differentiated liposarcoma and de-differentiated liposarcoma in patients aged ≤ 40 years: a study of 116 patients. Histopathology 2019; 75:833-842. [PMID: 31471922 DOI: 10.1111/his.13957] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/23/2019] [Indexed: 11/30/2022]
Abstract
AIMS Limited data exist on atypical lipomatous tumour (ALT)/well-differentiated liposarcoma (WDL) and de-differentiated liposarcoma (DDLPS) in children and young adults. METHODS AND RESULTS Cases of ALT/WDL/DDLPS arising in patients aged ≤ 40 years were collected from multiple institutional and consultation archives. A total of 116 cases of ALT/WDL (75) and DDLPS (41) were identified, representing fewer than 5% of these tumours seen at our institutions during this time-period. The patients (59 male/57 female) ranged in age from 8 to 40 years. Sites included deep central (abdomen/retroperitoneum/pelvis/groin) (n = 60), extremity (n = 42), trunk (n = 5), head/neck (n = 8) and mediastinum (n = 1). De-differentiated patterns included: high-grade pleomorphic sarcoma, myxofibrosarcoma-like, heterologous rhabdomyoblastic differentiation, low-grade spindle cell sarcoma and homologous lipoblastic differentiation. Forty-one patients experienced a local recurrence and 11 patients with DDLPS developed metastasis. ALT arising in the extremities had lower recurrence rates than deep central WDL (5-year recurrence-free survival 88.9% versus 59.0%; P = 0.002), while patients with deep central DDLPS experienced significantly more adverse events compared to WDL at this site (5-year event-free survival 11.9% versus 59.0%) (P < 0.0001). Seven (of eight) head/neck tumours had follow-up available; five recurred, and one patient (DDLPS) with recurrence also experienced a metastasis. The single mediastinal tumour (DDLPS) recurred and metastasised. CONCLUSION ALT/WDL and DDLPS occurring in patients aged ≤ 40 years is rare, but exhibits similar morphological features to its counterparts in older adults, including potential for heterologous and homologous de-differentiation in the latter. Although case numbers are limited, tumours arising in the head and neck exhibit high rates of adverse events, suggesting that classification as WDL rather than ALT is more appropriate.
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Affiliation(s)
- Rebecca Waters
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Andrew Horvai
- Department of Anatomic Pathology, University of California, San Francisco, CA, USA
| | - Patricia Greipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ivy John
- Department of Anatomic Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth G Demicco
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Brendan C Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Munir R Tanas
- Department of Pathology, University of Iowa, Iowa City, IA, USA
| | - Brandon T Larsen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, USA
| | - Nasir Ud Din
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - David H Creytens
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Armita Bahrami
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Leona A Doyle
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Vickie Y Jo
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Khin Thway
- Sarcoma Unit, Royal Marsden Hospital, London, UK
| | | | | | - Andrew Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Karen Fritchie
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Cairncross L, Snow HA, Strauss DC, Smith MJF, Sjokvist O, Messiou C, Thway K, Hayes AJ. Diagnostic performance of MRI and histology in assessment of deep lipomatous tumours. Br J Surg 2019; 106:1794-1799. [PMID: 31502664 DOI: 10.1002/bjs.11309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/07/2019] [Accepted: 06/11/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Deep lipomatous tumours can be benign lipomas or intermediate/locally recurring atypical lipomatous tumours (ALTs). Differentiating between these two entities clinically and radiologically is difficult. The aims of this study were to report a series of deep lipomatous tumours, comparing the clinical, radiological and pathological features of ALTs and lipomas; and to predict the likelihood of a lipomatous tumour being ALT based on anatomical site and MRI characteristics. METHODS This was a retrospective review of patients with deep lipomatous tumours presenting over 6 years to a tertiary sarcoma centre, with preoperative MRI, and preoperative or postoperative histology including MDM2 gene analysis. Sensitivity, specificity, predictive values and accuracy in diagnosing ALT were calculated for MRI and histopathological features. RESULTS Some 248 patients were included; 81 (32·7 per cent) had a final diagnosis of ALT. ALTs were larger than lipomas (median 19 versus 10 cm; P < 0·001); there was no ALT smaller than 5 cm. A tumour presenting in the lower limb was more likely to be an ALT than a lesion at any other site (48·4 versus 13·5 per cent; P < 0·001). In patients with lipomatous tumours at sites other than the lower limbs, MRI had a negative predictive value of 95 per cent for excluding ALT. CONCLUSION Despite concern, most deep lipomatous tumours (nearly 70 per cent) are benign lipomas. Certain features imply that tumours are almost never ALT: smaller than 5 cm or located outside the lower limb with no suspicious characteristics on MRI. Tumours with these features might safely and confidently be managed outside tertiary sarcoma centres.
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Affiliation(s)
- L Cairncross
- Department of Academic Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK
| | - H A Snow
- Department of Academic Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK
| | - D C Strauss
- Department of Academic Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK
| | - M J F Smith
- Department of Academic Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK
| | - O Sjokvist
- Department of Academic Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK
| | - C Messiou
- Department of Radiology, Royal Marsden Hospital, London, UK
| | - K Thway
- Department of Pathology, Royal Marsden Hospital, London, UK
| | - A J Hayes
- Department of Academic Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK
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Cheng Y, Ko AT, Huang JH, Lee BC, Yang RS, Liang CW, Tai HC, Cheng NC. Developing a clinical scoring system to differentiate deep-seated atypical lipomatous tumor from lipoma of soft tissue. Asian J Surg 2019; 42:832-838. [DOI: 10.1016/j.asjsur.2018.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/13/2018] [Accepted: 12/24/2018] [Indexed: 02/07/2023] Open
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Knebel C, Neumann J, Schwaiger BJ, Karampinos DC, Pfeiffer D, Specht K, Lenze U, von Eisenhart-Rothe R, Rummeny EJ, Woertler K, Gersing AS. Differentiating atypical lipomatous tumors from lipomas with magnetic resonance imaging: a comparison with MDM2 gene amplification status. BMC Cancer 2019; 19:309. [PMID: 30943944 PMCID: PMC6448188 DOI: 10.1186/s12885-019-5524-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/26/2019] [Indexed: 02/07/2023] Open
Abstract
Background To evaluate the diagnostic value of MR imaging for the differentiation of lipomas and atypical lipomatous tumors (ALT) in comparison with histology and MDM2 amplification status. Methods Patients with well-differentiated lipomatous tumors (n = 113), of which 66 were diagnosed as lipoma (mean age 53 years (range, 13–82); 47% women) and 47 as atypical lipomatous tumor (ALT; mean age 60 years (range, 28–88); 64% women), were included into this study using histology and MDM2 amplification status by fluorescence in situ hybridization (FISH) as standard of reference. Preoperative MR images were retrospectively assessed by two radiologists for the following imaging features: maximum tumor diameter (mm) as well as the affected compartment (intramuscular, intermuscular or subcutaneous), septa (absent, thin (< 2 mm) or thick septa (> 2 mm) with nodular components); contrast enhancing areas within the lipomatous tumor (< 1/3 of the tumor volume, > 1/3 of the tumor volume); Results Of the 47 patients with ALT, 40 (85.1%) presented thick septa (> 2 mm) and this finding significantly increased the likelihood of ALT (OR 6.24, 95% CI 3.36–11.59; P < 0.001). The likelihood of ALT was increased if the tumor exceeded a maximum diameter of 130.0 mm (OR 2.74, 95% CI 1.82–4.11, P < 0.001). The presence of contrast enhancement in lipomatous tumors significantly increased the likelihood of ALT (Odds ratio (OR) 2.95, 95% confidence interval (CI) 2.01–4.31; P < 0.001). Of the lipomas, 21.1% were located subcutaneously, 63.6% intramuscularly and 15.2% intermuscularly. On the other hand, none of the ALTs were located subcutaneously, the majority was located intermuscularly (87.3%) and a small number of ALTs was located intramuscularly (12.7%). Conclusions Our results suggest that using specific morphological MR imaging characteristics (maximum tumor diameter, thick septa and contrast enhancement) and the information on the localization of the lipomatous tumor, a high sensitivity and substantial specificity can be achieved for the diagnosis of lipomas and ALTs.
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Affiliation(s)
- Carolin Knebel
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Jan Neumann
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Dimitris C Karampinos
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Daniela Pfeiffer
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Katja Specht
- Institute of Pathology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Ulrich Lenze
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Ernst J Rummeny
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Alexandra S Gersing
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
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[Mass of adipose tissue: Inflammation, pseudo-tumour and tumour: The cornelian fan: Case No. 4]. Ann Pathol 2019; 39:202-206. [PMID: 30824320 DOI: 10.1016/j.annpat.2019.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 01/25/2019] [Indexed: 11/23/2022]
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Abstract
Adipocytic neoplasms include a diversity of both benign tumors (lipomas) and malignancies (liposarcomas), and each tumor type is characterized by its own unique molecular alterations driving tumorigenesis. Work over the past 30 years has established the diagnostic utility of several of these characteristic molecular alterations (e.g. MDM2 amplification in well- and dedifferentiated liposarcoma, FUS/EWSR1-DDIT3 gene fusions in myxoid liposarcoma, RB1 loss in spindle cell/pleomorphic lipoma). More recent studies have focused on additional molecular alterations which may have therapeutic or prognostic impact. This review will summarize several of the important molecular findings in adipocytic tumors that have been described over the past 10 years.
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Affiliation(s)
- Elizabeth G Demicco
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
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Caliò A, Brunelli M, Segala D, Pedron S, Doglioni C, Argani P, Martignoni G. VEGFA amplification/increased gene copy number and VEGFA mRNA expression in renal cell carcinoma with TFEB gene alterations. Mod Pathol 2019; 32:258-268. [PMID: 30206412 DOI: 10.1038/s41379-018-0128-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/21/2018] [Accepted: 07/28/2018] [Indexed: 12/20/2022]
Abstract
Amplification of vascular endothelial growth factor A (VEGFA) has been recently reported in TFEB-amplified renal cell carcinomas regardless the level of TFEB amplification. We sought to determine VEGFA amplification by fluorescent in situ hybridization (FISH) and VEGFA mRNA expression by in situ hybridization (RNAscope 2.5) in a series of 10 renal cell carcinomas with TFEB gene alterations, either amplification and/or rearrangement (t(6;11) renal cell carcinoma). TFEB gene rearrangement was demonstrated in eight cases, whereas the remaining two cases showed a high level of TFEB (> 10 copies of fluorescent signals) gene amplification without evidence of rearrangement. Among the eight t(6;11) renal cell carcinomas (TFEB-rearranged cases), one case displayed a high level of TFEB gene amplification and two showed increased TFEB gene copy number (3-4 copies of fluorescent signals). Those three cases behaved aggressively. By FISH, VEGFA was amplified in all three cases with TFEB amplification and increased VEGFA gene copy number was observed in the two aggressive cases t(6;11) renal cell carcinomas with an overlapping increased number of TFEB fluorescent signals. Overall, VEGFA mRNA expression was observed in 8 of 10 cases (80%); of these 8 cases, 3 cases showed high-level TFEB amplification, one case showed TFEB rearrangement with increased TFEB gene copy number, whereas four showed TFEB gene rearrangement without increased copy number. In summary, VEGFA amplification/increased gene copy number and VEGFA mRNA expression occur in TFEB-amplified renal cell carcinoma, but also in a subset of t(6;11) renal cell carcinoma demonstrating aggressive behavior, and in unamplified conventional t(6;11) renal cell carcinoma suggesting VEGFA as potential therapeutic target in these neoplasms even in the absence of TFEB amplification. We finally propose that all the renal tumors showing morphological characteristics suggesting t(6;11) renal cell carcinoma and all unclassified renal cell carcinomas, either high grade or low grade, should immunohistochemically be evaluated for cathepsin K and/or Melan-A and if one of them is positive, tested for TFEB gene alteration and VEGFA gene amplification.
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Affiliation(s)
- Anna Caliò
- Department of Diagnostic and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Diagnostic and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Diego Segala
- Department of Pathology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Serena Pedron
- Department of Diagnostic and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | | | - Pedram Argani
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Guido Martignoni
- Department of Diagnostic and Public Health, Section of Pathology, University of Verona, Verona, Italy. .,Department of Pathology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy.
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Abstract
Lipomatous soft-tissue tumors are the most common neoplasms encountered by physicians. They range from benign lipomas to high-grade liposarcomas. Unplanned excisions of sarcomas are commonly due to the presumptive diagnosis of lipoma and can be avoided by understanding their diagnostic magnetic resonance imaging appearance. Magnetic resonance images should be obtained for all soft-tissue masses that are deep to fascia or those >5 cm in subcutaneous tissue. Atypical lipomatous tumors present as large deep fatty masses and have a propensity for local recurrence and a small risk of malignant transformation. Well-differentiated liposarcomas are histologically identical to atypical lipomatous tumors but have a markedly worse prognosis secondary to their anatomic location. Masses that lack isointense signal to subcutaneous fat on MRI may represent a sarcoma and require a biopsy before definitive treatment. Large deep lipomatous masses and liposarcomas should be sent to a sarcoma referral center for definitive treatment.
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40
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Abstract
Soft tissue neoplasms are diagnostically challenging, although many advances in ancillary testing now enable accurate classification of fine-needle aspiration biopsies by detection of characteristic immunophenotypes (including protein correlates of molecular alterations) and molecular features. Although there are many useful diagnostic immunohistochemical markers and molecular assays, their diagnostic utility relies on correlation with clinical and morphologic features, judicious application, and appropriate interpretation because no single test is perfectly sensitive or specific. This review discusses applications of ancillary testing for commonly encountered soft tissue neoplasms in cytopathologic practice in the context of a pattern-based approach.
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Affiliation(s)
- Vickie Y Jo
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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42
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Chebib I, Jo VY. Application of ancillary studies in soft tissue cytology using a pattern‐based approach. Cancer Cytopathol 2018; 126 Suppl 8:691-710. [DOI: 10.1002/cncy.22030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Ivan Chebib
- James Homer Wright Pathology Laboratories Massachusetts General Hospital Boston Massachusetts
- Harvard Medical School Boston Massachusetts
| | - Vickie Y. Jo
- Department of Pathology Brigham and Women’s Hospital Boston Massachusetts
- Harvard Medical School Boston Massachusetts
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43
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Vargas AC, Selinger C, Satgunaseelan L, Cooper WA, Gupta R, Stalley P, Brown W, Soper J, Schatz J, Boyle R, Thomas DM, Tattersall MH, Bhadri V, Maclean F, Bonar SF, Scolyer RA, Karim RZ, McCarthy SW, Mahar A, O'Toole SA. FISH analysis of selected soft tissue tumors: Diagnostic experience in a tertiary center. Asia Pac J Clin Oncol 2018; 15:38-47. [DOI: 10.1111/ajco.12980] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 03/29/2018] [Indexed: 12/20/2022]
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44
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Perrier L, Rascle P, Morelle M, Toulmonde M, Ranchere Vince D, Le Cesne A, Terrier P, Neuville A, Meeus P, Farsi F, Ducimetière F, Blay JY, Ray Coquard I, Coindre JM. The cost-saving effect of centralized histological reviews with soft tissue and visceral sarcomas, GIST, and desmoid tumors: The experiences of the pathologists of the French Sarcoma Group. PLoS One 2018; 13:e0193330. [PMID: 29621244 PMCID: PMC5886412 DOI: 10.1371/journal.pone.0193330] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 02/08/2018] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE This study examined the types of discordance occurring in the diagnosis of soft tissue and visceral sarcomas, gastrointestinal stromal tumors (GIST), and desmoid tumors, as well as the economic impact of diagnostic discrepancies. METHODS We carried out a retrospective, multicenter analysis using prospectively implemented databases performed on a cohort of patients within the French RRePS network in 2010. Diagnoses were deemed to be discordant based on the 2013 World Health Organization (WHO) classification. Predictive factors of discordant diagnoses were explored. A decision tree was used to assess the expected costs of two strategies of disease management: one based on revised diagnoses after centralized histological review (option 1), the other on diagnoses without centralized review (option 2). Both were defined based on the patient and the disease characteristics, according to national or international guidelines. The time horizon was 12 months and the perspective of the French National Health Insurance (NHI) was retained. Costs were expressed in Euros for 2013. Sensitivity analyses were performed using low and high scenarios that included ± 20% estimates for cost. RESULTS A total of 2,425 patients were included. Three hundred forty-one patients (14%) had received discordant diagnoses. These discordances were determined to mainly be benign tumors diagnosed as sarcomas (n = 124), or non-sarcoma malignant tumors diagnosed as sarcomas (n = 77). The probability of discordance was higher for a final diagnosis of desmoid tumors when compared to liposarcomas (odds ratio = 5.1; 95%CI [2.6-10.4]). The expected costs per patient for the base-case analysis (low- and high-case scenarios) amounted to €8,791 (€7,033 and €10,549, respectively) for option 1 and €8,904 (€7,057 and €10,750, respectively) for option 2. CONCLUSIONS Our findings highlight misdiagnoses of sarcomas, which were found to most often be confused with benign tumors. Centralized histological reviews are likely to provide cost-savings for the French NHI.
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Affiliation(s)
- Lionel Perrier
- University of Lyon, Léon Bérard Cancer Centre, GATE L-SE UMR 5824, Lyon, France.,Direction of Clinical Research and Innovation, DRCI, Léon Bérard Cancer Centre, Lyon, France
| | - Pauline Rascle
- Direction of Clinical Research and Innovation, DRCI, Léon Bérard Cancer Centre, Lyon, France
| | - Magali Morelle
- University of Lyon, Léon Bérard Cancer Centre, GATE L-SE UMR 5824, Lyon, France.,Direction of Clinical Research and Innovation, DRCI, Léon Bérard Cancer Centre, Lyon, France
| | - Maud Toulmonde
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | | | - Axel Le Cesne
- Department of Medecine, Institut Gustave Roussy, Villejuif, France
| | | | - Agnès Neuville
- Department of Anatomopathology, Institut Bergonié, Bordeaux, France
| | - Pierre Meeus
- Department of Surgery, Cancer Centre Léon Bérard, Lyon, France
| | - Fadila Farsi
- Réseau Espace Santé Cancer Rhône-Alpes, Lyon, France
| | | | - Jean-Yves Blay
- Department of Medicine, Cancer Centre Léon Bérard, Lyon, France
| | - Isabelle Ray Coquard
- Santé-Individu-société EA-INSERM 4129, Cancer centre Léon Bérard, Lyon, France.,Department of Medicine, Cancer Centre Léon Bérard, Lyon, France
| | - Jean-Michel Coindre
- Department of Anatomopathology, Institut Bergonié, Bordeaux, France.,University Victor Ségalen, Bordeaux, France
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Jing W, Lan T, Chen H, Zhang Z, Chen M, Peng R, He X, Zhang H. Amplification of FRS2 in atypical lipomatous tumour/well-differentiated liposarcoma and de-differentiated liposarcoma: a clinicopathological and genetic study of 146 cases. Histopathology 2018; 72:1145-1155. [PMID: 29368794 DOI: 10.1111/his.13473] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/18/2018] [Indexed: 02/05/2023]
Abstract
AIMS The aim of this study was to evaluate the frequency of FRS2 amplification and its relationship with the clinicopathological features of atypical lipomatous tumour (ALT)/well-differentiated liposarcoma (WDL)/de-differentiated liposarcoma (DDL). METHODS AND RESULTS FRS2 and MDM2 fluorescence in-situ hybridisation (FISH) was performed on 146 tumours (70 ALT/WDLs and 76 DDLs). One hundred and eight control samples were included for FRS2 analysis. FRS2 amplification was detected in 136 of 146 (93.2%) ALT/WDL/DDLs, including 63 ALT/WDLs and 73 DDLs. A higher FRS2/CEP12 ratio was observed in DDLs than in ALT/WDLs (P = 0.0005). The FRS2/CEP12 ratio of peripheral tumours was lower than that of central tumours (P = 0.00004). All the ALT/WDL/DDLs showed MDM2 amplification (100%). The MDM2+ /FRS2- series included seven ALT/WDLs and three DDLs. Four of seven (57.1%) MDM2+ /FRS2- ALT/WDLs occurred in peripheral sites, slightly higher than the percentage of MDM2+ /FRS2+ ALT/WDLs (28 of 63, 44.4%). All the three MDM2+ /FRS2- DDLs (100%) were peripheral tumours, a much higher proportion than that of MDM2+ /FRS2+ DDLs (10 of 73, 13.7%). A high percentage of homologous pleomorphic liposarcoma-like DDLs (two of three) were observed in the MDM2+ /FRS2- group. In the control group all the parosteal osteosarcomas (five of five, 100%) were FRS2 amplified, whereas the remaining 103 samples were FRS2 non-amplified. CONCLUSIONS These findings suggest that FRS2 is amplified consistently in ALT/WDL/DDLs and offer another avenue for the investigation of the biology of this tumour group. MDM2+ /FRS2- cases seem to be associated with certain clinicopathological features, and further investigation is needed.
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Affiliation(s)
- Wenyi Jing
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Lan
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Huijiao Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhang Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Min Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Ran Peng
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin He
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongying Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
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Coran A, Ortolan P, Attar S, Alberioli E, Perissinotto E, Tosi AL, Montesco MC, Rossi CR, Tropea S, Rastrelli M, Stramare R. Magnetic Resonance Imaging Assessment of Lipomatous Soft-tissue Tumors. ACTA ACUST UNITED AC 2018; 31:387-395. [PMID: 28438867 DOI: 10.21873/invivo.11071] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/03/2017] [Accepted: 04/04/2017] [Indexed: 01/13/2023]
Abstract
AIM To establish the accuracy of magnetic resonance imaging (MRI) in distinguishing between benign and malignant lipomatous tumors; to evaluate the reproducibility of the MRI interpretation assessing the agreement between judgments of two radiologists with the same experience in soft-tissue sarcomas; to identify an association among MRI findings (size, depth, septa, nodules, signal homogeneity) and nature of the lesion. MATERIALS AND METHODS A total of 54 patients (28 men and 26 women), with a mean age of 56 (range=27-84) were included years. All subjects followed-up by the Multidisciplinary Sarcoma Group. The following MRI findings were judged in a blind study by two radiologists: size, localization, septa, nodules and signal homogeneity. A diagnostic indication was then given from among lipoma, atypical lipomatous tumour (ALT) and liposarcoma. Accuracy in distinguishing between benign and malignant lesions, and between lipoma and ALT (Fisher's exact test), inter-operator agreement (Cohen's kappa), association of MRI findings and malignancy of the lesion (Fisher's exact test and odds ratio) were evaluated. RESULTS The inter-operator agreement was complete (100%). The agreement between diagnostic hypothesis and histological diagnosis was statistically significant (p<0.05). Among the radiological findings taken into account, only septa and signal homogeneity were significantly associated with the malignancy of the lesion (p<0.05). CONCLUSION MRI could be helpful in distinguishing lipomatous tumors, allowing biopsy to be avoided in some cases (negative predictive value=100%).
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Affiliation(s)
- Alessandro Coran
- Department of Radiology and Medical Physics, Oncologic Radiology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Paolo Ortolan
- Department of Medicine, Radiology Unit, University of Padova, Padua, Italy
| | - Shady Attar
- Department of Medicine, Radiology Unit, University of Padova, Padua, Italy
| | - Enrico Alberioli
- Department of Medicine, Radiology Unit, University of Padova, Padua, Italy
| | - Egle Perissinotto
- Department of Biostatistics, Public Health Unit, University of Padova, Padua, Italy
| | - Anna Lisa Tosi
- Department of General Health Services, Pathology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Maria Cristina Montesco
- Department of General Health Services, Pathology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Carlo Riccardo Rossi
- Department of Surgical Oncology, Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Saveria Tropea
- Department of Surgical Oncology, Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Marco Rastrelli
- Department of Surgical Oncology, Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Roberto Stramare
- Department of Medicine, Radiology Unit, University of Padova, Padua, Italy
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Younan Y, Martinez A, Reimer N, Edgar M, Gonzalez F, Umpierrez M, Subhawong T, Singer AD. Combined classical spindle cell/pleomorphic lipoma spectrum imaging and clinical data. Skeletal Radiol 2018; 47:51-59. [PMID: 28823067 DOI: 10.1007/s00256-017-2751-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/10/2017] [Accepted: 08/01/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Compile the largest study to date on the imaging and clinical features of the classic spindle cell/pleomorphic lipoma spectrum and suggest this diagnosis be included in the differential for benign and malignant macroscopic fat-containing soft tissue masses regardless of the mass location or patient demographics. MATERIALS AND METHODS An institutional search was performed to identify all available classic-type spindle cell/pleomorphic lipomas with available demographic and imaging data. Images and reports were analyzed by one MSK-trained radiologist and radiographic, anatomic and clinical data were recorded. Additionally, a literature search was performed to identify studies describing the spindle cell lipoma spectrum imaging features and were combined with institutional data. RESULTS Forty-two institutional cases were identified, 37 of which had MRIs performed among which 21 had images available (T1- and T2-weighted pulse sequences) for review while the remainder had outside reports detailing the mass imaging features. There was a mean age of 57 with 79% of cases occurring in males. Contrary to prior reports, 57% of masses were subcutaneous, and the neck and back region accounted for 26% of cases. When the institutional cases were combined with available data in the literature, there was a new sample size of 91 masses, 74 of which had MRI and/or CT data. Eighty-seven percent of masses were heterogeneous, 51% were composed of less than 75% fat, 65% were in the back, neck or shoulder region, 27% of masses were deep and 91% demonstrated enhancement. Eighty-two percent of patients were males with a mean age of 58 at excision. CONCLUSION Imaging features, patient demographics and tumor location alone are not enough to differentiate tumors of the spindle cell lipoma spectrum from other macroscopic fat-containing benign and malignant tumors, and these entities should be included in the same imaging differential diagnosis.
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Affiliation(s)
- Yara Younan
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Anthony Martinez
- Department of Pathology, Emory University Hospital, Atlanta, GA, USA
| | - Nickolas Reimer
- Department of Orthopedic Surgery, Emory University Hospital, Atlanta, GA, USA
| | - Mark Edgar
- Department of Pathology, Emory University Hospital, Atlanta, GA, USA
| | - Felix Gonzalez
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Monica Umpierrez
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Ty Subhawong
- Department of Radiology, University of Miami, Miami, FL, USA
| | - Adam D Singer
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA.
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Joseph M, Hamilton EC, Hayes-Jordan A, Huh WW, Austin MT. The impact of racial/ethnic disparities on survival for children and adolescents with extremity sarcomas: A population-based study. J Pediatr Surg 2017; 53:S0022-3468(17)30656-5. [PMID: 29132798 DOI: 10.1016/j.jpedsurg.2017.10.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 10/05/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to determine whether racial/ethnic disparities exist in disease presentation, treatment, and survival among children and adolescents with extremity sarcoma. METHODS The Surveillance, Epidemiology, and End Results (SEER) data were analyzed for patients <20years old with soft-tissue extremity sarcomas from 1973 to 2013. Multivariate logistic regression was performed to determine the association between race/ethnicity and disease stage at presentation and likelihood of surgical resection. Overall survival (OS) was evaluated using hazard ratios with 95% confidence intervals. RESULTS 1261 cases were identified: 650 (52%) non-Hispanic whites (NHW), 313 (25%) Hispanics, 182 (14%) non-Hispanic blacks (NHB), and 116 (9%) other race/ethnicity. Logistic regression results showed that Hispanics and NHB were 51% and 44%, respectively, less likely to undergo surgical resection compared to NHW (OR=0.49, 95% CI: 0.30-0.80; OR=0.56, 95% CI: 0.32-0.98, respectively). Factors associated with failure to undergo surgical resection included histology, lower extremity site, tumor size, and distant metastases. OS based on race/ethnicity significantly differed using the log-rank test, with NHB having the worst survival (p<0.05). CONCLUSIONS We conclude that NHB, Hispanics, and other race/ethnicity were less likely to undergo surgical resection for extremity sarcoma. Further work is needed to better characterize and eliminate disparities in the management and outcomes of children with extremity sarcomas. TYPE OF STUDY Prognosis study. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Michael Joseph
- Department of Pediatric Surgery, McGovern Medical School, Houston, TX; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School, Houston, TX
| | - Emma C Hamilton
- Department of Pediatric Surgery, McGovern Medical School, Houston, TX; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School, Houston, TX
| | - Andrea Hayes-Jordan
- Department of Pediatric Surgery, McGovern Medical School, Houston, TX; Division of Pediatrics, Children's Cancer Hospital at the University of Texas M.D. Anderson Cancer Center, Houston, TX; Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Winston W Huh
- Division of Pediatrics, Children's Cancer Hospital at the University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Mary T Austin
- Department of Pediatric Surgery, McGovern Medical School, Houston, TX; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School, Houston, TX; Division of Pediatrics, Children's Cancer Hospital at the University of Texas M.D. Anderson Cancer Center, Houston, TX; Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
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Correlation of Classic and Molecular Cytogenetic Alterations in Soft-Tissue Sarcomas: Analysis of 46 Tumors With Emphasis on Adipocytic Tumors and Synovial Sarcoma. Appl Immunohistochem Mol Morphol 2017; 25:168-177. [DOI: 10.1097/pai.0000000000000294] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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