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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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Chen T, Roelofs KA, Baugh S, Esfandiari M, Rootman DB. Orbital Liposarcoma: A Surveillance, Epidemiology and End Results Database Study. Ophthalmic Plast Reconstr Surg 2024; 40:93-98. [PMID: 37695202 DOI: 10.1097/iop.0000000000002516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
PURPOSE Orbital liposarcoma is a challenging tumor to treat due to its rarity and high rate of local recurrence, and the role of radiotherapy and chemotherapy remain unclear. Analysis of big data may improve our overall understanding of orbital disease and role of adjuvant therapies. METHODS Data were extracted from the Surveillance, Epidemiology and End Results (SEER) Research Plus database from 1975 to 2017. All patients with a diagnosis of liposarcoma (ICD-O3 codes 8850-8858, 8869-8862, 8870, 8880, 8881) were included. Cases were divided into 4 groups by primary site: orbit, retroperitoneum, soft tissue, and other. RESULTS A total of 16,958 patients were included. Patients with orbital involvement were younger and more likely to be female ( p < 0.05). Among orbital lesions, myxoid liposarcoma was the most common histologic subtype (6/19; 31.6%) followed by well differentiated (5/19; 26.3%). This differed from the distribution of histologic subtypes encountered elsewhere, for which well-differentiated liposarcoma was the most common (retroperitoneum 979/3,136; 31%, soft tissue 3,493/11,671; 30%, and other sites 497/2,132; 23%, p < 0.05). Dedifferentiated histologic subtype was the second most common subtype found in the retroperitoneum (946/3,136; 30%), whereas it was less common in the orbit (2/19; 11%) and soft tissue (1,396/11,671; 12%) ( p < 0.001). Patients with orbital liposarcoma had similar disease-specific mortality compared with soft-tissue location ( p = 0.825) and lower disease-specific mortality compared with retroperitoneal location ( p < 0.001). When all locations were combined, patients with well-differentiated liposarcoma had the lowest disease-specific mortality. CONCLUSIONS Patients with orbital liposarcoma tend to be younger, female, and have a better prognosis than those with retroperitoneal disease, likely due to the lower incidence of dedifferentiated histologic subtype.
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Affiliation(s)
- Teresa Chen
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
| | - Samuel Baugh
- Department of Statistics, University of California, Los Angeles, California, U.S.A
| | - Mahtash Esfandiari
- Department of Statistics, University of California, Los Angeles, California, U.S.A
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A
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Ciongariu AM, Dumitru AV, Cîrstoiu C, Crețu B, Sajin M, Țăpoi DA, Ciobănoiu AD, Bejenariu A, Marin A, Costache M. The Conundrum of Dedifferentiation in a Liposarcoma at a Peculiar Location: A Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050967. [PMID: 37241198 DOI: 10.3390/medicina59050967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 04/30/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
Dedifferentiated liposarcoma of the deep soft tissue of the lower extremities is an infrequent finding. Myxoid liposarcoma is considered the most common soft tissue neoplasia arising in this anatomic region. Divergent differentiation usually occurs within well-differentiated liposarcoma and is exceedingly rare in a myxoid liposarcoma. We report a 32-year-old man who developed a dedifferentiated liposarcoma of the thigh on the background of a pre-existing myxoid liposarcoma. The gross examination of the surgical specimen showed a 11/7/2 cm tumour mass with solid tan-grey areas and focal myxoid degeneration. The microscopic examination revealed a malignant lipogenic proliferation, containing round cells with hyperchromatic nuclei and atypical lipoblasts, confined to the basophilic stroma with a myxoid aspect. Abrupt transition towards a hypercellular, non-lipogenic area consisting of highly pleomorphic spindle cells with atypical mitotic figures was also noted. Immunohistochemical staining was performed. Tumour cells in the lipogenic area were intensely positive for S100 and p16, and CD34 staining highlighted an arborizing capillary network. The dedifferentiated tumour areas showed positive MDM2 and CDK4 staining within neoplastic cells, with the Ki 67 proliferation marker expressed in approximately 10% of the cells. Wild-type TP53 protein expression pattern was documented. Thus, the diagnosis of a dedifferentiated liposarcoma was established. This paper aims to provide further knowledge about liposarcomas with divergent differentiation at peculiar locations, emphasizing the importance of histopathologic examination and immunohistochemical analysis for establishing the diagnosis and assessing the therapeutic response and prognosis of this condition.
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Affiliation(s)
- Ana-Maria Ciongariu
- Pathology Department, University Emergency Hospital, 050098 Bucharest, Romania
- Morphology Department, Faculty of Medicine "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adrian-Vasile Dumitru
- Pathology Department, University Emergency Hospital, 050098 Bucharest, Romania
- Morphology Department, Faculty of Medicine "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Cătălin Cîrstoiu
- Morphology Department, Faculty of Medicine "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Orthopedic Surgery and Traumatology Department, University Emergency Hospital, 050098 Bucharest, Romania
| | - Bogdan Crețu
- Morphology Department, Faculty of Medicine "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Orthopedic Surgery and Traumatology Department, University Emergency Hospital, 050098 Bucharest, Romania
| | - Maria Sajin
- Pathology Department, University Emergency Hospital, 050098 Bucharest, Romania
- Morphology Department, Faculty of Medicine "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Dana-Antonia Țăpoi
- Pathology Department, University Emergency Hospital, 050098 Bucharest, Romania
- Morphology Department, Faculty of Medicine "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Aminia-Diana Ciobănoiu
- Pathology Department, University Emergency Hospital, 050098 Bucharest, Romania
- Morphology Department, Faculty of Medicine "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adrian Bejenariu
- Pathology Department, University Emergency Hospital, 050098 Bucharest, Romania
| | - Andrei Marin
- Pathology Department, University Emergency Hospital, 050098 Bucharest, Romania
- Morphology Department, Faculty of Medicine "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Plastic Surgery Department, Faculty of Medicine "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mariana Costache
- Pathology Department, University Emergency Hospital, 050098 Bucharest, Romania
- Morphology Department, Faculty of Medicine "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Ulloa-Padilla JP, Rubio RH, Zhou S, Carrasco J, Watson A, Jiang W, Cooper K, Morgenstern K, Milman T. Atypical Spindle Cell and Pleomorphic Lipomatous Tumor of the Ocular Adnexa: Two Cases of a Rare Entity. Ophthalmic Plast Reconstr Surg 2023; 39:e44-e49. [PMID: 36700863 DOI: 10.1097/iop.0000000000002305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Atypical spindle cell and pleomorphic lipomatous tumor (ASCPLT) is a rare lipomatous neoplasm that was recently introduced into the World Health Organization Classification of Soft Tissue and Bone tumors as a distinct entity. ASCPLT has potential for local recurrence but does not metastasize. This biologic behavior separates ASCPLT from its morphologic mimics. Ocular adnexal ASCPLT has not been previously reported. Described herein are two patients with ASCPLT. The subcutaneous orbital rim lesion featured markedly pleomorphic spindle and multinucleated cells. The eyelid lesion was dominated by atypical spindle cells in a background of mature adipocytes. Both neoplasms demonstrated infiltrative margins, rare mitotic figures, immunoreactivity for CD34 and loss of Rb1, and the absence of MDM2 amplification by fluorescence in situ hybridization. Recognition of ASCPLT in the differential of ocular adnexal neoplasms may lead to a re-evaluation of morphologically similar tumors, which may have varied biologic behavior and warrant a different management approach.
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Affiliation(s)
- Jan P Ulloa-Padilla
- Department of Ophthalmic Plastic and Reconstructive Surgery, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, U.S.A
| | | | - Siwei Zhou
- Department of Ophthalmic Plastic and Reconstructive Surgery, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Jacqueline Carrasco
- Department of Ophthalmic Plastic and Reconstructive Surgery, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Alison Watson
- Department of Ophthalmic Plastic and Reconstructive Surgery, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Wei Jiang
- Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Kumarasen Cooper
- Department of Pathology and Laboratory Medicine at the Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, U.S.A
| | - Kenneth Morgenstern
- Department of Ophthalmic Plastic and Reconstructive Surgery, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Tatyana Milman
- Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, U.S.A
- Department of Pathology and Laboratory Medicine at the Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, U.S.A
- Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, U.S.A
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Wang P. Editorial for "Differentiation Between Lipomas and Atypical Lipomatous Tumors of the Extremities Using Radiomics". J Magn Reson Imaging 2022; 56:1755-1756. [PMID: 35319805 DOI: 10.1002/jmri.28169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 01/04/2023] Open
Affiliation(s)
- Ping Wang
- Neuroimaging Innovation Center, Barrow Neurological Institute, Phoenix, Arizona, USA
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Recurrent primary orbital well-differentiated liposarcoma /atypical lipomatous tumor: A rare case report with six-year follow-up. Am J Ophthalmol Case Rep 2022; 27:101602. [PMID: 35711172 PMCID: PMC9194691 DOI: 10.1016/j.ajoc.2022.101602] [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: 02/17/2022] [Revised: 05/13/2022] [Accepted: 05/26/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose We report a case with over 6 years of follow-up for well-differentiated liposarcoma or atypical lipomatous tumor (WDL/ALT). Observations Over a 6-year time course, a patient with a recurrent right orbital mass was biopsied/debulked four times. It was not until the fourth biopsy that a diagnosis of WDL/ALT was obtained. Throughout the time course, the patient maintained good vision and there has been no evidence of dedifferentiation or metastasis thus far. Conclusions The diagnosis of WDL/ALT sound be considered in the cases of a recurrent orbit mass when pathology continually shows nonspecific fibrofatty tissue with chronic inflammatory changes.
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Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma of the Orbit: Three Cases and Review of the Literature. Ophthalmic Plast Reconstr Surg 2021; 37:S134-S140. [PMID: 32991496 DOI: 10.1097/iop.0000000000001804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The authors present 3 patients from this retrospective case series to review the clinical findings, imaging, pathology, and treatment of orbital atypical lipomatous tumor/well-differentiated liposarcoma. Pathology of biopsy specimens ranged from spindle cell proliferations mimicking neurofibroma to proliferations of well-differentiated adipocytes. Immunohistochemical stains were positive for murine double minute 2 in 1 case, and fluorescent in situ hybridization showed amplification of murine double minute 2 in 2 cases. Treatments ranged from serial debulking, proton beam irradiation, and exenteration. None of the patients developed metastases. A literature review supported the low-grade nature of this lesion. Orbital atypical lipomatous tumor/well-differentiated liposarcoma is a low-grade, indolent liposarcoma that may be locally invasive. The histologic diagnosis is enhanced with immunohistochemical staining for murine double minute 2 and fluorescent in situ hybridization analysis for amplification of murine double minute 2. Although treatment may vary according to the individual, conservative therapies may be attempted prior to radical surgery.
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