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M S A, K C, Bhargavan RV, Somanathan T, Subhadradevi L. An overview on liposarcoma subtypes: Genetic alterations and recent advances in therapeutic strategies. J Mol Histol 2024; 55:227-240. [PMID: 38696048 DOI: 10.1007/s10735-024-10195-4] [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: 07/24/2023] [Accepted: 04/18/2024] [Indexed: 05/21/2024]
Abstract
Liposarcoma (LPS) is a rare malignancy of adipocytic differentiation. According to World Health Organization classification, LPS comprises of four principle subtypes Atypical lipomatous tumor/Well-differentiated liposarcoma (ATL/WDLPS), Dedifferentiated liposarcoma (WDLPS), Myxoid liposarcoma (MLPS), and Pleomorphic liposarcoma (PLPS). Each subtype can develop at any location and shows distinct clinical behavior and treatment sensitivity. ATL/ WDLPS subtype has a higher incidence rate, low recurrence, and is insensitive to radiation and chemotherapy. DDLPS is the focal progression of WDLPS, which is aggressive and highly metastasizing. MLPS is sensitive to radiation and chemotherapy, with a higher recurrence rate and metastasis. PLPS subtype is highly metastasizing, has a poor prognosis, and exhibiting higher recurrence rate. Initial histological analysis provides information for the characterization of LPS subtypes', further molecular and genetic analysis provides certain subtype specifications, such as gene amplifications and gene fusions. Such molecular genetic alterations will be useful as therapeutic targets in various cancers, including the LPS subtypes. A wide range of novel therapeutic agents based on genetic alterations that aim to target LPS subtypes specifically are under investigation. This review summarizes the LPS subtype classification, their molecular genetic characteristics, and the implications of genetic alterations in therapeutics.
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Affiliation(s)
- Anju M S
- Division of Cancer Research, Regional Cancer Centre (Research Centre, University of Kerala), Thiruvananthapuram, Kerala, 695011, India
| | - Chandramohan K
- Division of Surgical Oncology, Regional Cancer Centre (Research Centre, University of Kerala), Thiruvananthapuram, Kerala, 695011, India
| | - Rexeena V Bhargavan
- Division of Surgical Oncology, Regional Cancer Centre (Research Centre, University of Kerala), Thiruvananthapuram, Kerala, 695011, India
| | - Thara Somanathan
- Division of Pathology, Regional Cancer Centre (Research Centre, University of Kerala), Thiruvananthapuram, Kerala, 695011, India
| | - Lakshmi Subhadradevi
- Division of Cancer Research, Regional Cancer Centre (Research Centre, University of Kerala), Thiruvananthapuram, Kerala, 695011, India.
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Assi T, Ngo C, Faron M, Verret B, Lévy A, Honoré C, Hénon C, Le Péchoux C, Bahleda R, Le Cesne A. Systemic Therapy in Advanced Pleomorphic Liposarcoma: a Comprehensive Review. Curr Treat Options Oncol 2023; 24:1598-1613. [PMID: 37843627 DOI: 10.1007/s11864-023-01139-3] [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] [Accepted: 09/24/2023] [Indexed: 10/17/2023]
Abstract
OPINION STATEMENT The therapeutic approach of pleomorphic liposarcoma (PLPS), a rare high-grade subgroup of soft tissue sarcoma, is commonly extrapolated from the management of other LPS subtypes. Only published retrospective data on PLPS currently serve as a guide for oncologists without clear recommendations or specific guidelines. In the advanced setting, specific systemic therapy such as eribulin and trabectedin showed promising activity in comparison to conventional therapy (doxorubicin- and gemcitabine-based protocols), which currently remains the current standard of care at initial stages of the disease. The better understanding of soft tissue sarcoma (STS) pathophysiology and disease course has led to the development of adapted clinical trial designs for rare STS histotypes with specific treatment approach.
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Affiliation(s)
- Tarek Assi
- Sarcoma Unit, Department of Cancer Medicine, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, Villejuif, France.
| | - Carine Ngo
- Sarcoma Unit, Department of Cancer Medicine, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, Villejuif, France
| | - Matthieu Faron
- Sarcoma Unit, Department of Cancer Medicine, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, Villejuif, France
- Oncostat U1018, Inserm, Université Paris-Saclay, Equipe Labellisée Ligue Contre le Cancer, Villejuif, France
| | - Benjamin Verret
- Sarcoma Unit, Department of Cancer Medicine, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, Villejuif, France
| | - Antonin Lévy
- Sarcoma Unit, Department of Cancer Medicine, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, Villejuif, France
| | - Charles Honoré
- Sarcoma Unit, Department of Cancer Medicine, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, Villejuif, France
| | - Clémence Hénon
- Sarcoma Unit, Department of Cancer Medicine, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, Villejuif, France
| | - Cécile Le Péchoux
- Sarcoma Unit, Department of Cancer Medicine, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, Villejuif, France
| | - Rastilav Bahleda
- Sarcoma Unit, Department of Cancer Medicine, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, Villejuif, France
| | - Axel Le Cesne
- Sarcoma Unit, Department of Cancer Medicine, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, Villejuif, France
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Al-Attar M, Jnawali A, Yang M. Rare Pleomorphic Liposarcoma Presented as Jejunal Obstruction. Case Rep Pathol 2023; 2023:8040232. [PMID: 37409099 PMCID: PMC10319459 DOI: 10.1155/2023/8040232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 07/07/2023] Open
Abstract
Pleomorphic liposarcoma (PLS) is typically found in the lower and upper extremities. PLS arising in the gastrointestinal (GI) tract is extremely rare. Here, we reported a case of a 71-year-old female with a history of rectal adenocarcinoma presenting with small bowel obstruction. Small bowel resection was performed and revealed a 7.8 cm transmural mass in the jejunum. Histology reviewed a heterogenous epithelioid malignant tumor with intracytoplasmic fatty droplets scalloping the nucleus consistent with lipoblasts in some cells and others with numerous PAS/diastase+intracytoplasmic eosinophilic globules. Scattered multinucleated giant cells were also present. Mitotic count was up to 80/10 HPFs including some bizarre mitotic figures, and Ki67 proliferation index was approximately 60%. Immunohistochemistry demonstrated that the malignant cells were negative for pancytokeratin, CD117, DOG1, SMA, desmin, MyoD1, ERG1, CD34, CD31, SOX10, Melan A, and S100. INI1 was retained. Beta-catenin showed normal membranous staining. P53 was diffusely positive suggestive of mutant phenotype. Fluorescence in situ hybridization (FISH) assay was negative for MDM2 amplification and DDIT3 rearrangement. The overall morphologic and immunohistochemical features supported a diagnosis of high-grade pleomorphic liposarcoma. Diagnosis of PLS can be challenging due to its rarity in GI tract and lack of specific biomarkers, and histomorphology with identification of lipoblasts remains the gold standard.
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Affiliation(s)
- Mohammad Al-Attar
- University of Massachusetts Memorial Health Care, UMass Chan Medical School, Worcester, MA 01605, USA
| | - Anup Jnawali
- University of Massachusetts Memorial Health Care, UMass Chan Medical School, Worcester, MA 01605, USA
| | - Michelle Yang
- University of Massachusetts Memorial Health Care, UMass Chan Medical School, Worcester, MA 01605, USA
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Gjorgova Gjeorgjievski S, Thway K, Dermawan JK, John I, Fisher C, Rubin BP, Jenkins S, Thangaiah JJ, Folpe AL, Fritchie KJ. Pleomorphic Liposarcoma: A Series of 120 Cases With Emphasis on Morphologic Variants. Am J Surg Pathol 2022; 46:1700-1705. [PMID: 36006773 DOI: 10.1097/pas.0000000000001962] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pleomorphic liposarcoma (PLPS) is a highly aggressive sarcoma comprising variable numbers of pleomorphic lipoblasts mixed with undifferentiated pleomorphic sarcoma (UPS)-like areas. Morphologic variants, such as myxofibrosarcoma-like or epithelioid, may cause diagnostic confusion, especially on a core biopsy, but there are few data on the prognostic significance of these features. A total of 120 PLPS biopsies and resection specimens were reviewed and catalogued based on the presence of myxofibrosarcoma-like, UPS-like, and epithelioid foci, in 10% increments. The clinical parameters were collected. Cases occurred in 75 males and 45 females, ranging from 8 to 98 years (median, 62.5 y). Cases arose in the extremities (n=72), trunk (n=32), head/neck (n=10), bone (n=4), mediastinum (n=1), or viscera (colon polyp, n=1). Of those with known depth (n=81), 40 were intramuscular, 34 were subcutaneous, and 7 arose in the dermis. Their sizes ranged from 1 to 24.5 cm (median, 7 cm). Of the patients with ≥1 month of follow-up (n=70), 5 had recurrence and 15 had metastasis. The 5-year overall survival and event-free survival rates were 66.2% and 63.1%, respectively. Tumors ≥5 cm had inferior overall survival compared with tumors <5 cm. The presence of epithelioid areas was also statistically significant in terms of poorer overall survival and event-free survival, while tumors with ≥50% undifferentiated pleomorphic-like areas had better overall survival. There was a trend towards poorer outcomes in tumors with necrosis (≥1%). PLPS is an aggressive adipocytic malignancy that is most commonly present in the extremities of older adults. The morphologic features of these tumors are diverse, and they may be mistaken for UPS or myxofibrosarcoma, carcinoma, and melanomas, particularly on biopsies. Tumor size, necrosis, and epithelioid morphology are associated with adverse prognosis.
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Affiliation(s)
- Sandra Gjorgova Gjeorgjievski
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Khin Thway
- Sarcoma Unit, The Royal Marsden Hospital, London
| | - Josephine K Dermawan
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Ivy John
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA
| | - Cyril Fisher
- Department of Musculoskeletal Pathology, University Hospitals Birmingham, Birmingham UK
| | - Brian P Rubin
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | | | | | - Andrew L Folpe
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Karen J Fritchie
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
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Drabent P, Fraitag S. Malignant Superficial Mesenchymal Tumors in Children. Cancers (Basel) 2022; 14:cancers14092160. [PMID: 35565289 PMCID: PMC9104419 DOI: 10.3390/cancers14092160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/12/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022] Open
Abstract
Malignant superficial mesenchymal tumors are a very diverse group of neoplasms with few clinical and radiological discriminatory factors. Hence, some of these cancers are rarely suspected based on clinical and radiological grounds, others may be easily misdiagnosed, and the histological analysis of a biopsy or resection is central in the diagnostic process. In children, the age at presentation is a major element of the differential diagnosis. Some tumors have a very distinct epidemiology, while others may be seen at any age. More recently, the advances in molecular biology have greatly improved the diagnosis of mesenchymal tumors and new entities are still being described. In the present review, we provide an overview of the diversity of malignant superficial mesenchymal tumors in children, including new and/or rare entities. We discuss the important diagnostic features, be they clinical, histological, or molecular. Special attention was given to the genetic features of these tumors, particularly when they were helpful for the diagnosis or treatment.
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Affiliation(s)
- Philippe Drabent
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, 75015 Paris, France;
- Faculté de Médecine, Université de Paris, 75005 Paris, France
| | - Sylvie Fraitag
- Department of Pathology, Necker-Enfants Malades Hospital, APHP, 75015 Paris, France;
- Faculté de Médecine, Université de Paris, 75005 Paris, France
- Correspondence:
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Hsu JY, Seligson ND, Hays JL, Miles WO, Chen JL. Clinical Utility of CDK4/6 Inhibitors in Sarcoma: Successes and Future Challenges. JCO Precis Oncol 2022; 6:e2100211. [PMID: 35108033 PMCID: PMC8820917 DOI: 10.1200/po.21.00211] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/08/2021] [Accepted: 12/17/2021] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Soft tissue and bone sarcomas are rare malignancies that exhibit significant pathologic and molecular heterogeneity. Deregulation of the CDKN2A-CCND-CDK4/6-retinoblastoma 1 (Rb) pathway is frequently observed in about 25% of unselected sarcomas and is pathognomonic for specific sarcoma subtypes. This genomic specificity has fueled the clinical evaluation of selective CDK4/6 inhibitors in sarcomas. Here, we highlight successes, opportunities, and future challenges for using CDK4/6 inhibitors to treat sarcoma. MATERIALS AND METHODS This review summarizes the current evidence for the use of CDK4/6 inhibitors in sarcoma while identifying molecular rationale and predictive biomarkers that provide the foundation for targeting the CDK4/6 pathway in sarcoma. A systematic review was performed of articles indexed in the PubMed database and the National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov). For each sarcoma subtype, we discuss the preclinical rationale, case reports, and available clinical trials data. RESULTS Despite promising clinical outcomes in a subset of sarcomas, resistance to CDK4/6 inhibitors results in highly heterogeneous clinical outcomes. Current clinical data support the use of CDK4/6 inhibitors in subsets of sarcoma primarily driven by CDK4/6 deregulation. When dysregulation of the Rb pathway is a secondary driver of sarcoma, combination therapy with CDK4/6 inhibition may be an option. Developing strategies to identify responders and the mechanisms that drive resistance is important to maximize the clinical utility of these drugs in patients with sarcoma. Potential biomarkers that indicate CDK4/6 inhibitor sensitivity in sarcoma include CDK4, CCND, CCNE, RB1, E2F1, and CDKN2A. CONCLUSION CDK4/6 inhibitors represent a major breakthrough for targeted cancer treatment. CDK4/6 inhibitor use in sarcoma has led to limited, but significant, early clinical success. Targeted future clinical research will be key to unlocking the potential of CDK4/6 inhibition in sarcoma.
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Affiliation(s)
- Jocelyn Y. Hsu
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Nathan D. Seligson
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH
- Department of Pharmacotherapy and Translational Research, University of Florida, Jacksonville, FL
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Nemours Children's Specialty Care, Jacksonville, FL
| | - John L. Hays
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| | - Wayne O. Miles
- Department of Molecular Genetics, The Ohio State University, Columbus, OH
| | - James L. Chen
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH
- Division of Bioinformatics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH
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Primary Cutaneous Alveolar Rhabdomyosarcoma in an Elderly Adult: A Rare Potential Mimic of Merkel Cell Carcinoma. Am J Dermatopathol 2022; 44:218-222. [PMID: 34991098 DOI: 10.1097/dad.0000000000002124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Rhabdomyosarcoma (RMS) rarely arises as a primary skin tumor. It is also very rare in older adults, especially the alveolar type. We report an 80-year-old White woman who presented with a painful, erythematous, raised lesion (2 × 3.5 cm) above the left knee that was fixed within the skin, yet mobile about underlying soft tissue. A punch biopsy showed monotonous malignant round blue cells involving the dermis. Immunostains showed diffuse expression of CD56, focal chromogranin, focal dot-like pancytokeratin, CK7, and neurofilament, but negative for synaptophysin, CK20, SOX-10, MUM-1, CD43, TTF-1, and CD99. A CK20-negative variant of Merkel cell carcinoma was initially favored, but given the unusual immunophenotype and the presence of cellular dyscohesion, desmin and myogenin stains were performed, both of which were diffusely positive. Molecular testing revealed rearrangement of PAX3 and FOXO1 loci, confirming the diagnosis of alveolar RMS. PET/CT showed a probable 1.9-cm left inguinal lymph node metastasis; no internal or deep soft tissue primary tumor mass was identified, supporting a true primary cutaneous origin. Alveolar RMS may express keratins and neuroendocrine markers, making it easy to confuse with Merkel cell carcinoma on those exceptionally rare instances, when it arises in the skin of older adults.
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Thway K. What’s new in adipocytic neoplasia? Histopathology 2021; 80:76-97. [DOI: 10.1111/his.14548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Khin Thway
- Sarcoma Unit Royal Marsden Hospital London UK
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Primary Cutaneous Atypical Spindle Cell Lipomatous Tumor. Case Rep Pathol 2021; 2021:4082289. [PMID: 34790420 PMCID: PMC8592773 DOI: 10.1155/2021/4082289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022] Open
Abstract
This report documents an exophytic, pedunculated nodule in a 74-year-old man that upon histopathological examination revealed an atypical spindle cell/pleomorphic lipomatous tumor (ASPLT) confined to the papillary and reticular dermis, representing the fourth documented case within the skin. Despite the overt pleomorphic changes present histologically, the patient is free of metastasis or recurrence five years after surgery.
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Local Recurrence Rates of Skin Tumors After Resection With Complete Circumferential Peripheral and Deep Margin Assessment-Identification of High-Risk Entities. Dermatol Surg 2021; 47:e31-e36. [PMID: 33565775 DOI: 10.1097/dss.0000000000002431] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The local recurrence rates of malignant skin tumors after micrographic controlled surgery using complete circumferential peripheral and deep margin assessment (CCPDMA) are reported to be low. However, in daily practice, tumor entities with a significantly higher recurrence rate are found. OBJECTIVE The aim of the investigation was to identify these high-risk tumors to develop approaches for risk stratification. PATIENTS AND METHODS We included different malignant tumors that were surgically treated and examined with CCPDMA using paraffin sections and H&E staining. Re-excisions were performed until the tumor was completely removed. RESULTS Ninety-nine thousand three hundred seventy-two tumors were included in the study; the follow-up period was 4 years (median). Eight tumor entities were identified as high-risk entities, showing a significantly higher local recurrence rate of over 20%: desmoplastic squamous cell carcinoma, desmoplastic melanoma, Merkel cell carcinoma, microcystic adnexal carcinoma, pleomorphic sarcoma, liposarcoma as well as angiosarcoma, and extramammary Paget's disease. CONCLUSION Complete circumferential peripheral and deep margin assessment allows complete control of the resection margins and enables skin-sparing resections with low recurrence rates for basal cell carcinomas, nondesmoplastic squamous cell carcinomas, lentiginous melanomas, and dermatofibrosarcoma protuberans. However, other tumors show significantly higher recurrence rates and therefore need to be classified as high-risk tumors.
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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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Wan L, Tu C, Qi L, Li Z. Survivorship and prognostic factors for pleomorphic liposarcoma: a population-based study. J Orthop Surg Res 2021; 16:175. [PMID: 33663547 PMCID: PMC7931523 DOI: 10.1186/s13018-021-02327-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/24/2021] [Indexed: 02/03/2023] Open
Abstract
Background Pleomorphic liposarcoma is the least common but most aggressive subtype of liposarcoma. Very few studies have presented data on pleomorphic liposarcoma specifically, often including a limited number of cases and short-term follow-up. As a result, the survivorship and prognostic characteristics of this tumor remain incompletely identified. Study design and setting Cross-sectional analysis of the Surveillance Epidemiology and End Results database (1996–2015). Results Overall survival for the entire series was 54% (95% confidence interval [CI], 49–58%) and 40% (95% CI, 35–45%) at 5 and 10 years, respectively. Disease-specific survival for the entire series was 60% (95% CI, 56–65%) and 53% (95% CI, 48–58%) at 5 and 10 years, respectively. Patients who survived 10 years or more were more likely to die of events unrelated to pleomorphic liposarcoma. Univariate and multivariate analysis demonstrated that not receiving cancer-directed surgery was an independent poor prognostic factor. Older age (≥ 65 years old) was associated with worse overall survival but not disease-specific survival. Tumor stage and radiotherapy showed different impact on survival depending on tumor size. In comparison to localized staged tumors, regional stage only predicts poor survival in patients with tumor size less than 5 cm, while distant stage is an independent worse prognosis factor. Radiotherapy only benefits patients with tumor size larger than 10 cm. These results were confirmed in competing risk analysis. Conclusion Survival rates of patients with pleomorphic liposarcoma has not changed over the past 20 years. Patients with distant stage have poor prognosis; regional stage indicates worse survival in patients with tumor size less than 5 cm. Receiving surgery could prolong the survival, while radiotherapy only benefits patients with large tumor size (> 10 cm). Older age is associated with poor overall survival but not disease-specific survival. Routine patient surveillance following initial diagnosis should at least be 10 years for pleomorphic liposarcoma. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02327-3.
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Affiliation(s)
- Lu Wan
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, 139 Renming Road, Changsha, 410011, Hunan, People's Republic of China.,Vaccine and Immunotherapy Center, Infectious Diseases Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA.,Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, 139 Renming Road, Changsha, 410011, Hunan, People's Republic of China
| | - Chao Tu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, 139 Renming Road, Changsha, 410011, Hunan, People's Republic of China.,Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, 139 Renming Road, Changsha, 410011, Hunan, People's Republic of China
| | - Lin Qi
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, 139 Renming Road, Changsha, 410011, Hunan, People's Republic of China.,Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, 139 Renming Road, Changsha, 410011, Hunan, People's Republic of China
| | - Zhihong Li
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, 139 Renming Road, Changsha, 410011, Hunan, People's Republic of China. .,Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, 139 Renming Road, Changsha, 410011, Hunan, People's Republic of China.
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Tamkus S, Gusho CA, Colman MW, Miller I, Gitelis S, Blank AT. A single institutional experience treating adipocytic tumors: incidence, disease-related outcomes, and the clinical significance of MDM2 analysis. Orthop Rev (Pavia) 2020; 12:8818. [PMID: 33312490 PMCID: PMC7726827 DOI: 10.4081/or.2020.8818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/16/2020] [Indexed: 11/23/2022] Open
Abstract
Adipocytic tumors exist either as a benign or malignant form. The benign variant, lipoma, is composed of normal fat tissue. Lipomas typically develop from superficial fat cells beneath the skin or mucous membranes. Liposarcoma, the malignant counterpart, often develops in deeper tissues and is the most commonly diagnosed Soft Tissue Sarcoma (STS), comprising at least 20% of adult STS. However, malignant tumors of fatty origin exist as a spectrum of diagnoses, each carrying a unique risk of recurrence, metastasis, and longterm survival. The World Health Organization classifies liposarcomas into five categories: i) Atypical Lipomatous Tumors/Well Differentiated (ALT/WD); Ii) Dedifferentiated (ALT/DD); Iii) Myxoid; Iv) Round cell; and v) Pleomorphic. Lipomatous tumors often exhibit different immunohistochemical patterns. Benign lipomas are distinguished by the absence of Murine Double-Minute 2 (MDM2) amplification. Similarly, ALT/WD, classically defined as a low-grade and locally aggressive tumor, demonstrates consistent patterns of MDM2 amplification. Some studies suggest 10% of ALT/WD progress to the highgrade DD form, with others report a dedifferentiation rate of as high as 20% for primary ALT/WD based on location. The ALT/DD subtype is aggressive and has a high capacity to metastasize. While the mechanism of pathogenesis of ALT/DD metastasis is unknown, previous studies suggest that increased MDM2 amplification may play a role. This study sought to evaluate a single institutional experience treating the entire spectrum of lipomatous tumors and describe utilization patterns of MDM2 testing. The group hypothesized: i) Atypical Lipomatous Tumors (ALT), which include ALT/DD and ALT/WD, would exhibit a higher rate of local recurrence than lipomas with no significantly increased incidence of metastases; and ii) at least 50% of our MDM2 testing of ALT would prove positive for the MDM2 overamplification. This study retrospectively reviewed 105 cases (66 lipomas, 27 ALTs, 12 liposarcomas) of patients who underwent lipomatous tumor excision at our institution from 2013 to 2017. Twenty-five tumors (6 lipomas, 18 ALT, 1 liposarcoma) were tested for MDM2 amplification. Three of the tested tumors recurred (2 ALT, 1 liposarcoma), and each exhibited MDM2 overamplification. Five tumors (5 liposarcoma) developed late metastases. These data suggest that although ALT is associated with a higher rate of local recurrence, metastases are quite rare. Additionally, the data demonstrate a high rate of positive MDM2 testing (76%) based on clinical and imaging characteristics of the tumors.
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Affiliation(s)
- Saule Tamkus
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center; and Midwest Orthopedics at Rush, Chicago, IL
| | - Charles A Gusho
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center; and Midwest Orthopedics at Rush, Chicago, IL
| | - Matthew W Colman
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center; and Midwest Orthopedics at Rush, Chicago, IL
| | - Ira Miller
- Department of Pathology, Rush University Medical Center at Rush, Chicago, IL, USA
| | - Steven Gitelis
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center; and Midwest Orthopedics at Rush, Chicago, IL
| | - Alan T Blank
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center; and Midwest Orthopedics at Rush, Chicago, IL
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Creytens D. Purely intradermal atypical spindle cell/pleomorphic lipomatous tumor. J Cutan Pathol 2020; 48:601-602. [PMID: 32352578 DOI: 10.1111/cup.13731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 04/04/2020] [Accepted: 04/24/2020] [Indexed: 12/25/2022]
Affiliation(s)
- David Creytens
- Department of Pathology, Ghent University and Ghent University Hospital, Ghent, Belgium
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15
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Berg SH, Massoud CM, Jackson-Cook C, Boikos SA, Smith SC, Mochel MC. A Reappraisal of Superficial Pleomorphic Liposarcoma. Am J Clin Pathol 2020; 154:353-361. [PMID: 32525520 DOI: 10.1093/ajcp/aqaa045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Superficial pleomorphic liposarcoma (PL) has a favorable prognosis compared to deeply seated PL. Given developments in the classification of lipomatous neoplasms, we reappraised a series of cases. METHODS Retrospective clinicopathologic evaluation and genome-wide single-nucleotide polymorphism (SNP) microarray studies were performed for cases previously designated superficial PL. RESULTS Four cases were identified (age, 48-70 years). Two were dermally confined, whereas two were superficial subcutaneous; no recurrences or metastases were reported. Tumors demonstrated pleomorphic spindled morphology with variable cellularity. Multivacuolated atypical lipoblasts were focal in 3 and abundant in 1. Dermal tumors demonstrated atypical cells within sclerotic collagen. Genome-wide SNP microarray studies revealed consistent gains and losses, including losses at the 13q14.2 locus encompassing RB1 and DLEU2 and deletion/disruption of the TP53 locus. Although subcutaneous examples showed genomic changes similar to deep PL, the dermal examples showed fewer genetic alterations, including changes reported in the spectrum of atypical spindle cell/pleomorphic lipomatous tumors (ASPLT). All lacked MDM2 amplification. CONCLUSIONS Careful integration of histologic and genetic features may improve classification of lipomatous neoplasms with atypia, allowing reclassification of some superficial PL as ASPLT.
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Affiliation(s)
| | | | - Colleen Jackson-Cook
- Department of Pathology, Virginia Commonwealth University Health System, Richmond
- Department of Human and Molecular Genetics, Virginia Commonwealth University Health System, Richmond
| | - Sosipatros Alexander Boikos
- Department of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University Health System, Richmond
| | | | - Mark Cameron Mochel
- Department of Pathology, Virginia Commonwealth University Health System, Richmond
- Department of Dermatology, Virginia Commonwealth University Health System, Richmond
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16
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Shon W, Billings SD. Soft Tissue Special Issue: Selected Topics in the Pathology of Adipocytic Tumors. Head Neck Pathol 2020; 14:1-11. [PMID: 31950475 PMCID: PMC7021849 DOI: 10.1007/s12105-019-01112-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/02/2019] [Indexed: 12/11/2022]
Abstract
Our understanding of adipocytic tumors classification and diagnosis continues to evolve. We present a brief review and updated summary of selected adipocytic tumors involving the head and neck region. For the practicing pathologist, knowledge of these established and emerging entities is critical for the correct pathologic diagnosis and treatment of the patient.
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Affiliation(s)
- Wonwoo Shon
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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17
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Chambers M, Badin DJ, Sriharan AA, Linos KD. Expanding the differential of cutaneous epithelioid tumors: A case of dedifferentiated liposarcoma with epithelioid features involving the skin, with review of the literature. J Cutan Pathol 2020; 47:554-560. [PMID: 31995237 DOI: 10.1111/cup.13650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 11/30/2022]
Abstract
Liposarcomas are categorized into four distinct histopathological subtypes: atypical lipomatous tumors (ALT)/well-differentiated liposarcoma (WDL), dedifferentiated, myxoid, and pleomorphic. Dedifferentiated liposarcomas account for approximately 18% of all liposarcomas, characteristically arising in the deep soft tissue. They are reported to have lower rates of metastasis compared to other pleomorphic sarcomas.1 -3 The classic histopathologic appearance is ALT/WDL admixed or juxtaposed with a predominantly nonlipogenic sarcoma. Epithelioid features are rare, appearing in as few as 3% of tumors, and have not previously been reported in a superficial location. Herein, we present a 57-year-old male with intradermal and subcutaneous metastasis of his known deep dedifferentiated liposarcoma with epithelioid features. By H&E the tumor featured cords and sheets of crowded, plump, epithelioid cells with thick nuclear membranes and prominent nucleoli, which raised a broad differential including carcinoma and melanoma. By immunohistochemistry the tumor was diffusely positive for MDM2 and CDK4, on the other hand stains for Sox10, Melan A, MITF, CKAE1/3, desmin, and S100 protein were negative. This case serves as an opportunity to raise awareness of this rare morphological subtype, which can involve the skin and mimic epithelial and melanocytic malignancies. It can be a potential diagnostic pitfall, especially if metastases are the first presentation.
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Affiliation(s)
- Meagan Chambers
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Dylan J Badin
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Aravindhan A Sriharan
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.,Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Konstantinos D Linos
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.,Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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18
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Suarez-Kelly LP, Baldi GG, Gronchi A. Pharmacotherapy for liposarcoma: current state of the art and emerging systemic treatments. Expert Opin Pharmacother 2019; 20:1503-1515. [PMID: 31136210 DOI: 10.1080/14656566.2019.1618271] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introduction: Liposarcomas are a heterogeneous group of soft tissue tumors that arise from adipose tissue and are one of the most common soft tissue sarcomas found in adults. Liposarcomas are subclassified into four subtypes with distinct histologic and biologic features that influence their treatment and management. Areas covered: This manuscript reviews the key clinicopathologic and cytogenic characteristics of the liposarcoma histologic subtypes and summarizes the results of recent clinical trials, treatment options, and future directions in the pharmacotherapy for the management of liposarcoma. Expert opinion: Despite significant advancements in the management of this disease, the treatment of liposarcoma continues to be a challenge. Surgical resection remains the mainstay of treatment for localized disease; however, use of systemic therapies in conjunction with surgery may be considered in patients where tumor shrinkage could reduce surgical morbidity and in patients with high-risk of micrometastatic disease. Anthracycline-based chemotherapy regimens remain the standard first-line treatment for unresectable/metastatic liposarcoma. Trabectedin and eribulin are currently the two most promising and evidenced-based second-line treatment options for liposarcomas. However, multiple clinical trials dedicated to patients with liposarcoma evaluating novel targeted agents are ongoing. Every effort should be made to enroll patients with liposarcoma into histotype-specific clinical trials.
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Affiliation(s)
- Lorena P Suarez-Kelly
- Complex General Surgical Oncology Fellow, The Ohio State University , Columbus , OH , USA
| | - Giacomo G Baldi
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato , Prato , Italy.,Adult mesenchymal and Rare Tumor Unit, Department of Cancer Medicine, Fondazione IRCCS-Istituto Nazionale dei Tumori , Milan , Italy
| | - Alessandro Gronchi
- Sarcoma Service of the Department of Surgery, Fondazione IRCCS-Istituto Nazionale dei Tumori , Milan , Italy
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19
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Ryan MP, Woolridge KF, Sedrak M, Berlingeri-Ramos AC, Group AR. A rare variant of extraskeletal osteosarcoma presenting as a clinically benign subcutaneous neoplasm. J Cutan Pathol 2019; 46:546-549. [PMID: 30972791 DOI: 10.1111/cup.13474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/24/2019] [Accepted: 03/04/2019] [Indexed: 11/27/2022]
Abstract
Extraskeletal osteosarcoma (ESOS) is a rare variant of osteosarcoma that arises without attachment to the underlying skeleton. These cancers are typically found embedded in deeper tissues, most commonly the muscle or fascia, and are rarely found within the skin or subcutis. Most tumors are large in size upon initial presentation, and carry a poor prognosis. We discuss the case of a 48-year-old Caucasian woman who presented to a dermatology clinic with an asymptomatic, small, mobile, subcutaneous mass that appeared clinically benign. After elective removal and histopathologic examination, the patient was diagnosed with ESOS. ESOS presenting in this manner is exceedingly rare, and this case highlights the importance of sending all excised specimens, even those with a benign presentation, for pathologic examination.
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Affiliation(s)
- Michael P Ryan
- School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Katelyn F Woolridge
- Department of Dermatology, University of Texas Medical Branch, Galveston, Texas
| | | | | | - Ashley R Group
- Department of Dermatology, University of Texas Medical Branch, Galveston, Texas
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20
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Puls F, Pillay N, Fagman H, Palin-Masreliez A, Amary F, Hansson M, Kindblom LG, McCulloch TA, Meligonis G, Muc R, Rissler P, Sumathi VP, Tirabosco R, Hofvander J, Magnusson L, Nilsson J, Flanagan AM, Mertens F. PRDM10-rearranged Soft Tissue Tumor: A Clinicopathologic Study of 9 Cases. Am J Surg Pathol 2019; 43:504-513. [PMID: 30570551 DOI: 10.1097/pas.0000000000001207] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gene fusion transcripts containing PRDM10 were recently identified in low-grade undifferentiated pleomorphic sarcomas (UPS). Here, we describe the morphologic and clinical features of 9 such tumors from 5 men and 4 women (age: 20 to 61 y). Three cases had previously been diagnosed as UPS, 3 as superficial CD34-positive fibroblastic tumor (SCD34FT), 2 as pleomorphic liposarcoma, and 1 as pleomorphic hyalinizing angiectatic tumor. The tumors were located in the superficial and deep soft tissues of the thigh/knee region (4 cases), shoulder (2 cases), foot, trunk, and perineum (1 case each) ranging in size from 1 to 6 cm. All showed poorly defined cellular fascicles of pleomorphic cells within a fibrous stroma with frequent myxoid change and a prominent inflammatory infiltrate. All displayed highly pleomorphic nuclear features, but a low mitotic count. Most tumors were well circumscribed. One of 9 tumors recurred locally, but none metastasized. Immunohistochemically, all were CD34 and showed nuclear positivity for PRDM10; focal positivity for cytokeratins was seen in 5/6 cases. PRDM10 immunoreactivity was evaluated in 50 soft tissue tumors that could mimic PRDM10-rearranged tumors, including 4 cases exhibiting histologic features within the spectrum of SCD34FT. Except for 2/6 pleomorphic liposarcomas and 1/4 myxofibrosarcomas, other tumors did not show nuclear positivity but displayed weak to moderate cytoplasmic immunoreactivity. In conclusion, PRDM10-rearranged soft tissue tumor is characterized by pleomorphic morphology and a low mitotic count. Its morphologic spectrum overlaps with SCD34FT. Clinical features of this small series suggest an indolent behavior, justifying its distinction from UPS and other sarcomas.
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Affiliation(s)
- Florian Puls
- Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg
| | - Nischalan Pillay
- Department of Cellular and Molecular Pathology, Royal National Orthopaedic Hospital NHS Trust, Stanmore
- Research Department of Pathology, University College London Cancer Institute, London
| | - Henrik Fagman
- Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg
| | - Anne Palin-Masreliez
- Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg
| | - Fernanda Amary
- Department of Cellular and Molecular Pathology, Royal National Orthopaedic Hospital NHS Trust, Stanmore
| | - Magnus Hansson
- Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg
| | - Lars-Gunnar Kindblom
- Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg
| | - Tom A McCulloch
- Department of Histopathology, Nottingham City Hospital, Nottingham
| | | | - Ronald Muc
- Department of Histopathology, Heartlands Hospital, Birmingham
| | - Pehr Rissler
- Department of Clinical Genetics and Pathology, University and Regional Laboratories, Skåne University Hospital, Lund University
| | - Vaiyapuri P Sumathi
- Department of Musculoskeletal Pathology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Roberto Tirabosco
- Department of Cellular and Molecular Pathology, Royal National Orthopaedic Hospital NHS Trust, Stanmore
| | - Jakob Hofvander
- Department of Clinical Genetics, Lund University, Lund, Sweden
| | - Linda Magnusson
- Department of Clinical Genetics, Lund University, Lund, Sweden
| | - Jenny Nilsson
- Department of Clinical Genetics, Lund University, Lund, Sweden
| | - Adrienne M Flanagan
- Department of Cellular and Molecular Pathology, Royal National Orthopaedic Hospital NHS Trust, Stanmore
- Research Department of Pathology, University College London Cancer Institute, London
| | - Fredrik Mertens
- Department of Clinical Genetics and Pathology, University and Regional Laboratories, Skåne University Hospital, Lund University
- Department of Clinical Genetics, Lund University, Lund, Sweden
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Abstract
Pleomorphic liposarcoma is the least common but most aggressive subtype of liposarcoma. Tumors most commonly arise in the deep soft tissues of the extremities in adult patients. Pleomorphic liposarcoma has no specific immunohistochemical or molecular genetic features, and the presence of lipoblasts remains the sole diagnostic criterion. Diagnostic challenges include the identification of lipoblasts, which are often scarce or focal, and the distinction from other pleomorphic sarcomas, including dedifferentiated liposarcoma with homologous lipoblastic differentiation. This review provides an updated overview of the clinicopathologic features of pleomorphic liposarcoma, with discussion of its morphologic variants, differential diagnosis, and the role of small biopsy samples.
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Affiliation(s)
- William J Anderson
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States
| | - Vickie Y Jo
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States.
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22
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Abstract
Myxoid adipocytic tumors encompass a broad heterogeneous group of benign and malignant adipocytic tumors, which are typically myxoid (e.g. myxoid liposarcoma, lipoblastoma and lipoblastoma-like tumor of the vulva) or may occasionally appear predominantly myxoid (e.g. pleomorphic liposarcoma, atypical lipomatous tumor, dedifferentiated liposarcoma, chondroid lipoma, spindle cell/pleomorphic lipoma, atypical spindle cell lipomatous tumor and atypical pleomorphic lipomatous tumor). There have been significant advances in recent years in classification and understanding the pathogenesis of adipocytic tumors, based on the correlation of histologic, immunohistochemical, and cytogenetic/molecular findings. Despite these advances, the morphologic diagnosis and accurate classification of a myxoid adipocytic tumor can be challenging due to major morphologic overlap between myxoid adipocytic and non-adipocytic tumors. This article will provide a review on the currently known morphological, immunohistochemical and molecular features of myxoid adipocytic tumors and their differential diagnosis.
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Affiliation(s)
- David Creytens
- Department of Pathology, Ghent University and Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; CRIG, Cancer Research Institute Ghent, Ghent University and Ghent University Hospital, Ghent, Belgium.
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23
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Martelosso A, Bitencourt P, Lima RB, D'Acri AM, Martins C, Lupi O, Basilio-de-Oliveira RP. Giant primary pleomorphic dermal liposarcoma. J Cutan Pathol 2017; 44:724-725. [DOI: 10.1111/cup.12963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 04/19/2017] [Accepted: 05/08/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Andresa Martelosso
- Gaffree & Guinle University Hospital; Federal University of the State of Rio de Janeiro (UNIRIO); Rio de Janeiro Brazil
| | - Priscila Bitencourt
- Gaffree & Guinle University Hospital; Federal University of the State of Rio de Janeiro (UNIRIO); Rio de Janeiro Brazil
| | - Ricardo Barbosa Lima
- Gaffree & Guinle University Hospital; Federal University of the State of Rio de Janeiro (UNIRIO); Rio de Janeiro Brazil
| | - Antonio Macedo D'Acri
- Gaffree & Guinle University Hospital; Federal University of the State of Rio de Janeiro (UNIRIO); Rio de Janeiro Brazil
| | - Carlos Martins
- Gaffree & Guinle University Hospital; Federal University of the State of Rio de Janeiro (UNIRIO); Rio de Janeiro Brazil
| | - Omar Lupi
- Gaffree & Guinle University Hospital; Federal University of the State of Rio de Janeiro (UNIRIO); Rio de Janeiro Brazil
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24
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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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25
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Ramírez-Bellver JL, López J, Macías E, Alegría-Landa V, Gimeno I, Pérez-Plaza A, Kutzner H, Requena L. Primary dermal pleomorphic liposarcoma: utility of adipophilin and MDM2/CDK4 immunostainings. J Cutan Pathol 2016; 44:283-288. [PMID: 27778364 DOI: 10.1111/cup.12850] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 10/06/2016] [Accepted: 10/18/2016] [Indexed: 11/28/2022]
Abstract
Liposarcoma, usually arises in deep soft tissues and pleomorphic liposarcoma (PL), is the rarest histopathologic variant. However, 15 cases of entirely dermal PL have been reported. We describe a case of a 79-year-old man who developed a rapidly growing nodule on his thorax. Excisional biopsy was performed and immunohistochemical studies were carried. The lesion was a well-circumscribed dermal nodule composed of multivacuolated pleomorphic lipoblasts and atypical mitotic figures. Neoplastic cells expressed CD10 and resulted negative S100 protein, Melan-A, MITF-1, AE1/AE3, CD4, CD68 (PGM1), retinoblastoma gene family protein, pericentrine and lysozyme. Adipophilin stain showed the lipid contents in the cytoplasm of the neoplastic cells. MDM2 and CDK4 resulted both negative. A diagnosis of primary dermal PL was made. This case shows the utility of adipophilin immunostaining to prove the lipid contents in neoplastic cells, which has the advantage of using formalin-fixed paraffin-embedded tissue and making needless frozen sections and ultrastructural studies to show these findings. Negative MDM2/CDK4 staining in our case argues against the possibility of dedifferentiated liposarcoma and further supports the diagnosis of true PL.
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Affiliation(s)
| | - Joaquín López
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Elena Macías
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | | | - Ignacio Gimeno
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Alejandra Pérez-Plaza
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Heinz Kutzner
- Department of Dermatology, Dermatopathologie Friedrichshafen, Friedrichshafen, Germany
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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26
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De Vita A, Mercatali L, Recine F, Pieri F, Riva N, Bongiovanni A, Liverani C, Spadazzi C, Miserocchi G, Amadori D, Ibrahim T. Current classification, treatment options, and new perspectives in the management of adipocytic sarcomas. Onco Targets Ther 2016; 9:6233-6246. [PMID: 27785071 PMCID: PMC5067014 DOI: 10.2147/ott.s112580] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Sarcomas are a heterogeneous group of mesenchymal tumors arising from soft tissue or bone, with an uncertain etiology and difficult classification. Soft tissue sarcomas (STSs) account for around 1% of all adult cancers. Till date, more than 50 histologic subtypes have been identified. Adipocyte sarcoma or liposarcoma (LPS) is one of the most common STS subtypes, accounting for 15% of all sarcomas, with an incidence of 24% of all extremity STSs and 45% of all retroperitoneal STSs. The new World Health Organization classification system has divided LPS into four different subgroups: atypical lipomatous tumor/well-differentiated LPS, dedifferentiated LPS, myxoid LPS, and pleomorphic LPS. These lesions can develop at any location and exhibit different aggressive potentials reflecting their morphologic diversity and clinical behavior. Patients affected by LPS should be managed in specialized multidisciplinary cancer centers. Whereas surgical resection is the mainstay of treatment for localized disease, the benefits of adjuvant and neoadjuvant chemotherapy are still unclear. Systemic treatment, particularly chemotherapy, is still limited in metastatic disease. Despite the efforts toward a better understanding of the biology of LPS, the outcome of advanced and metastatic patients remains poor. The advent of targeted therapies may lead to an improvement of treatment options and clinical outcomes. A larger patient enrollment into translational and clinical studies will help increase the knowledge of the biological behavior of LPSs, test new drugs, and introduce new methodological studies, that is, on treatment response.
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Affiliation(s)
- Alessandro De Vita
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC
| | - Laura Mercatali
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC
| | - Federica Recine
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC
| | - Federica Pieri
- Pathology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Nada Riva
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC
| | - Alberto Bongiovanni
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC
| | - Chiara Liverani
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC
| | - Chiara Spadazzi
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC
| | - Giacomo Miserocchi
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC
| | - Dino Amadori
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC
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27
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Zou Y, Billings SD. Myxoid cutaneous tumors: a review. J Cutan Pathol 2016; 43:903-18. [DOI: 10.1111/cup.12749] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 02/16/2016] [Accepted: 04/05/2016] [Indexed: 01/16/2023]
Affiliation(s)
- Youran Zou
- Department of PathologyCleveland Clinic Cleveland OH USA
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Cesinaro AM, Mataca E, Gambini C, Kutzner H. An unusual presentation of dermatofibrosarcoma protuberans with pleomorphic sarcomatous transformation: potential pitfall and diagnostic strategy. J Cutan Pathol 2016; 43:589-593. [DOI: 10.1111/cup.12688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/09/2015] [Accepted: 10/13/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Anna Maria Cesinaro
- Department of Anatomic Pathology; Azienda Ospedaliero-Universitaria; Modena Italy
| | - Ema Mataca
- Department of Anatomic Pathology; Azienda Ospedaliero-Universitaria; Modena Italy
| | - Claudio Gambini
- Department of Anatomic Pathology; Clinica Montallegro; Genua Italy
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Yu J, Sokumbi O. Cutaneous metastasis of pleomorphic liposarcoma to the scalp: an elusive diagnosis. J Cutan Pathol 2016; 43:526-530. [PMID: 26968423 DOI: 10.1111/cup.12692] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/24/2015] [Accepted: 11/02/2015] [Indexed: 12/17/2022]
Abstract
Liposarcomas are one of the most common sarcomas arising in the extremities of the elderly. Various subtypes of liposarcomas include well-differentiated liposarcomas, dedifferentiated liposarcomas, myxoid liposarcomas and pleomorphic liposarcomas. Pleomorphic liposarcomas are the rarest subtype and have the highest malignant potential compared with the other subtypes of liposarcomas. Metastases to internal organs are common but cutaneous metastasis is very rare with only few cases in the literature. We present a patient with a known diagnosis of stage IV metastatic liposarcoma who presented to our clinic with a rapidly growing nodule on the scalp. A biopsy showed a high-grade poorly differentiated spindled cell neoplasm sparing the epidermis with scattered lipoblasts. Immunostaining for S100, SOX10, and MNF-116 were negative. To further characterize the neoplasm, immunostaining with MDM-2 was performed and was also found to be negative. The histologic appearance, immunohistochemical staining, and clinical history support a diagnosis of metastatic pleomorphic liposarcoma to the scalp. The diagnosis of pleomorphic liposarcoma is challenging. It is often difficult to differentiate from myxofibrosarcoma or other high-grade pleomorphic sarcomas based on histology alone. However, the presence of bizarre lipoblasts and negative MDM-2 staining can be helpful clues to differentiate this neoplasm from histologic mimics.
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Affiliation(s)
- JiaDe Yu
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Olayemi Sokumbi
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
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Winchester DS, Gardner KH, Lehman JS, Otley CC. Superficial liposarcoma: A retrospective review of 13 cases. J Am Acad Dermatol 2016; 74:391-3. [DOI: 10.1016/j.jaad.2015.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/06/2015] [Accepted: 08/09/2015] [Indexed: 11/24/2022]
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Buehler D, Marburger TB, Billings SD. Primary subcutaneous myxoid liposarcoma: a clinicopathologic review of three cases with molecular confirmation and discussion of the differential diagnosis. J Cutan Pathol 2014; 41:907-15. [DOI: 10.1111/cup.12428] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 06/10/2014] [Accepted: 06/15/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Darya Buehler
- Department of Pathology; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - Trent B. Marburger
- Department of Pathology; Cleveland Clinic; Cleveland OH USA
- Department of Dermatology; Cleveland Clinic; Cleveland OH USA
| | - Steven D. Billings
- Department of Pathology; Cleveland Clinic; Cleveland OH USA
- Department of Dermatology; Cleveland Clinic; Cleveland OH USA
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Wang L, Ren W, Zhou X, Sheng W, Wang J. Pleomorphic liposarcoma: a clinicopathological, immunohistochemical and molecular cytogenetic study of 32 additional cases. Pathol Int 2014; 63:523-31. [PMID: 24274714 DOI: 10.1111/pin.12104] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 09/28/2013] [Indexed: 11/27/2022]
Abstract
The purpose of this study is to report the author's experience with 32 cases of pleomorphic liposarcoma to further broaden the clinicopathological spectrum. The tumours occurred equally in males and females with ages ranging from 11 to 83 years (median, 56 years). Tumour site included the extremities (17 cases), abdomen/retroperitoneum (4 cases), internal organs (5 cases), thoracic cavity/mediastinum (2 cases), orbit, neck, groin and scrotum (1 case each). The diagnostic pleomorphic lipoblasts were identified in 31 primary tumours and one recurrent tumor but varied widely in proportion between cases or different areas of the same tumor. Four tumors contained sheets or focal aggregates of lipoblasts with epithelioid morphology. The nonlipogenic component in 26 cases had an appearance of undifferentiated pleomorphic sarcoma, whereas in six cases it was consistent with intermediate to high grade myxofibrosarcoma. The pleormorphic and epithelioid lipoblasts displayed variable expression of S100 protein. There was no signal of amplified MDM2 gene in 10 cases tested by fluorescence in situ hybridization. This study further illustrates that pleomorphic liposarcoma is a distinctive entity with no relationship to either well differentiated liposarcoma or dedifferentiated liposarcoma. Albeit very rare, pleomorphic liposarcoma can occur in teenaged patients and internal organs.
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Affiliation(s)
- Lei Wang
- Department of Pathology, Cancer Hospital, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Lokka S, Scheel AH, Dango S, Schmitz K, Hesterberg R, Rüschoff J, Schildhaus HU. Challenging dedifferentiated liposarcoma identified by MDM2-amplification, a report of two cases. BMC Clin Pathol 2014; 14:36. [PMID: 25126005 PMCID: PMC4132276 DOI: 10.1186/1472-6890-14-36] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 07/16/2014] [Indexed: 11/20/2022] Open
Abstract
Background Liposarcoma is the most frequent soft tissue sarcoma. Well differentiated liposarcoma may progress into dedifferentiated liposarcoma with pleomorphic histology. A minority additionally features myogenic, osteo- or chondrosarcomatous heterologous differentiation. Genomic amplification of the Mouse double minute 2 homolog (MDM2) locus is characteristic for well differentiated and dedifferentiated liposarcomas. Detection of MDM2 amplification may supplement histopathology and aid to distinguish liposarcoma from other soft tissue neoplasia. Case presentation Here we present two cases of dedifferentiated liposarcoma with challenging presentation. Case 1 features a myogenic component. As the tumour infiltrated the abdominal muscles and showed immunohistochemical expression of myogenic proteins, rhabdomyosarcoma had to be ruled out. Case 2 has an osteosarcomatous component resembling extraosseous osteosarcoma. The MDM2 status was determined in both cases and helped making the correct diagnosis. Overexpression of MDM2 and co-overexpression of Cyclin-dependent kinase 4 is demonstrated by immunohistochemistry. The underlying MDM2 amplification is shown by fluorescence in situ hybridisation. Since low grade osteosarcoma may also harbour MDM2 amplification it is emphasised that the amplification has to be present in the lipomatous parts of the tumour to distinguish liposarcoma from extraosseous osteosarcoma. Conclusions The two cases exemplify challenges in the diagnoses of dedifferentiated liposarcoma. Liposarcoma often has pleomorphic histology and additionally may feature heterologous components that mimic other soft tissue neoplasms. Amplification of MDM2 is characteristic for well differentiated and dedifferentiated liposarcomas. Determination of the MDM2 status by in situ hybridisation may assist histopathology and help to rule out differential diagnoses.
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Affiliation(s)
- Suvi Lokka
- Institute of Pathology Nordhessen, Germaniastr. 7, 34119 Kassel, Germany
| | - Andreas H Scheel
- Institute of Pathology Nordhessen, Germaniastr. 7, 34119 Kassel, Germany.,Department of Pathology, University Medical Centre Göttingen, Robert-Koch-Str. 38, 37077 Göttingen, Germany
| | - Sebastian Dango
- Rotes Kreuz Krankenhaus, Department of Surgery, Hansteinstrasse 29, 34121 Kassel, Germany.,Department of General, Visceral, and Paediatric Surgery, University Medical Centre Göttingen, Robert-Koch-Str. 38, 37077 Göttingen, Germany
| | - Katja Schmitz
- Department of Pathology, University Medical Centre Göttingen, Robert-Koch-Str. 38, 37077 Göttingen, Germany
| | - Rudolf Hesterberg
- Rotes Kreuz Krankenhaus, Department of Surgery, Hansteinstrasse 29, 34121 Kassel, Germany
| | - Josef Rüschoff
- Institute of Pathology Nordhessen, Germaniastr. 7, 34119 Kassel, Germany
| | - Hans-Ulrich Schildhaus
- Department of Pathology, University Medical Centre Göttingen, Robert-Koch-Str. 38, 37077 Göttingen, Germany
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Dodd LG, Sara Jiang X, Rao K, Bui MM. Pleomorphic liposarcoma: a cytologic study of five cases. Diagn Cytopathol 2014; 43:138-43. [PMID: 24652822 DOI: 10.1002/dc.23148] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 02/21/2014] [Accepted: 02/24/2014] [Indexed: 11/06/2022]
Abstract
Pleomorphic liposarcoma represents one of the rarest variants of liposarcoma. It has a poor prognosis and unlike other variants of liposarcoma, lacks a molecular or genetic signature. Histologic studies of pleomorphic liposarcoma have defined this lesion as a high grade sarcoma, which contains a variable number of lipoblasts. We describe the cytologic features of five cases of pleomorphic liposarcoma, all of which had histologic confirmation. We consistently identified numerous lipoblasts as well as micro and macrovesicular fat vacuoles in the background of cellular, pleomorphic sarcomatoid neoplasms. The appearance of the aspirates differs substantially form other variants of liposarcoma.
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Affiliation(s)
- Leslie G Dodd
- Department of Pathology, University of North Carolina at Chapel Hill, North Carolina
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Abstract
The study of sarcoma pathology is a rapidly evolving field. The continued refinement of classic diagnostic techniques in conjunction with the molecular diagnostics has resulted in an abundance of data regarding this diverse and rare group of tumors. We anticipate that cutting edge technology including next generation sequencing will continue to further our understanding of saromagenesis and enable more precise classification and diagnosis of sarcomas in the future.
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Wagner JM, Lee KS, Rosas H, Kliewer MA. Accuracy of sonographic diagnosis of superficial masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1443-1450. [PMID: 23887955 DOI: 10.7863/ultra.32.8.1443] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The purpose of this study was to retrospectively review the diagnostic accuracy of sonography in the evaluation of superficial masses with surgical and histologic findings as the reference standard. METHODS Institutional Review Board approval was obtained, informed consent was waived, and Health Insurance Portability and Accountability Act compliance was maintained. Seventy-two superficial masses in 62 patients were examined sonographically by a single radiologist (reader 1) and subsequently underwent surgical therapy. Three radiologists experienced in sonography, blinded to the original interpretation and surgical findings, retrospectively and independently reviewed the sonographic images and assigned the cases to 1 of 14 diagnostic categories. For all lesions, the rendered diagnosis was compared with the reference standard to determine concordance. For the specific diagnosis of lipoma, sensitivity, specificity, and accuracy were assessed for all readers individually and collectively. RESULTS Surgery and histolopathologic analysis yielded 39 lipomas, 6 hernias, 4 foreign bodies, 4 hemangiomas, and 19 other nonlipomatous lesions, including 1 malignancy. The rendered diagnosis was concordant with the reference standard in 93% of cases for reader 1 and in 89% of cases for all readers. The sensitivity, specificity, and accuracy for the diagnosis of lipoma were 92%, 100%, and 96% for reader 1 and 96%, 97%, and 96% for all readers. CONCLUSIONS Sonography has high accuracy in the evaluation of superficial masses, particularly lipomas.
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Affiliation(s)
- Jason M Wagner
- Department of Radiology, University of Wisconsin, Madison, Wisconsin USA.
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Al-Zaid T, Wang WL, Lopez-Terrada D, Lev D, Hornick JL, Hafeez Diwan A, Fletcher CDM, Lazar AJ. Pleomorphic fibroma and dermal atypical lipomatous tumor: are they related? J Cutan Pathol 2013; 40:379-84. [DOI: 10.1111/cup.12095] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 01/06/2013] [Accepted: 01/13/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Tariq Al-Zaid
- Department of Pathology; The University of Texas MD Anderson Cancer Center; Houston; TX; USA
| | - Wei-Lien Wang
- Department of Pathology; The University of Texas MD Anderson Cancer Center; Houston; TX; USA
| | | | | | - Jason L. Hornick
- Department of Pathology; Brigham and Women's Hospital and Harvard Medical School; Boston; MA; USA
| | - A. Hafeez Diwan
- Department of Pathology; Baylor College of Medicine; Houston; TX; USA
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Combined cutaneous sarcoma: pleomorphic liposarcoma and conventional osteosarcoma-the so-called malignant mesenchymoma. Case Rep Pathol 2012; 2012:749898. [PMID: 23082265 PMCID: PMC3469087 DOI: 10.1155/2012/749898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 09/09/2012] [Indexed: 11/23/2022] Open
Abstract
Malignant mesenchymoma is combined soft tissue tumors of mesenchymal origin. Cutaneous combined sarcomas are exceedingly rare. We report the case of an 81-year-old woman who presented a left cutaneous mass. She underwent a wide local excision. Histopathological and immunohistochemical studies were consistent with the diagnosis of combined pleomorphic liposarcoma and conventional osteosarcoma (malignant mesenchymoma). Although it is extremely rare, this case suggests that combined sarcoma should be considered in the differential diagnosis of undifferentiated pleomorphic neoplasms.
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