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Gingell L, Sharrak A, Hawes K, Schlatter M. Lipoblastoma-Related Volvulus in a Nine-Year-Old Female. Cureus 2024; 16:e62430. [PMID: 39011190 PMCID: PMC11249053 DOI: 10.7759/cureus.62430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2024] [Indexed: 07/17/2024] Open
Abstract
Lipoblastomas are benign neoplasms that arise from embryonal adipocytes. They predominantly impact the pediatric population, with most cases occurring in the first few years of life. These tumors typically present as a soft, palpable, painless mass and tend to involve the mesenchymal tissues of the extremities and trunk. Intraabdominal involvement and intraabdominal complications secondary to lipoblastoma are incredibly rare. Here, we present the case of a nine-year-old female who presented to the emergency department (ED) with one week of intermittent lower abdominal pain. The CT abdomen/pelvis demonstrated a well-circumscribed hypodense omental mass measuring 10.1 cm x 4.7 cm x 13.4 cm with minimal mass effect or bowel displacement. At that time, the patient's abdomen was soft without tenderness, distention, or rigidity. Her initial laboratory studies and vital signs were within normal limits. She was evaluated by pediatric surgery, who, given her clinical stability, planned for an anticipated elective resection. Thirteen days after her initial ED visit, the patient returned to the ED with nausea, vomiting, and diffuse abdominal pain. Repeat CT abdomen/pelvis revealed shifting of the omental mass from the left hemi-abdomen to the right hemi-abdomen with associated mesenteric 'swirl sign' and dilated loops of small bowel consistent with small bowel obstruction. Given the patient's CT findings and signs of peritonitis on a physical exam, she was emergently taken to the operating room, where the mass along with 20 cm of small bowel intimately associated with the mass was resected. The proximal end of the involved bowel was found to be twisted and necrotic, consistent with volvulus. A specimen was sent for cytogenetics and found to be positive for FLAG1, ultimately revealing a diagnosis of lipoblastoma. The majority of lipoblastoma development is underpinned by gene rearrangements in the zinc-finger transcription factor PLAG1. Although benign, these tumors can exhibit rapid proliferation and have high recurrence rates. Patients should be monitored long-term with ultrasound (US) or MRI following surgery to assess for recurrence.
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Affiliation(s)
- Luke Gingell
- Medicine, Michigan State University College of Human Medicine, Grand Rapids, USA
| | - Aryana Sharrak
- General Surgery, Michigan State University College of Human Medicine, Grand Rapids, USA
| | - Kristen Hawes
- General Surgery, Michigan State University College of Human Medicine, Grand Rapids, USA
| | - Marc Schlatter
- Pediatric Surgery, Michigan State University College of Human Medicine, Grand Rapids, USA
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2
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Cardoen L, Nicolas N, Le Gaudu V, Gauthier A, Carton M, Berrebi D, Cyrta J, Collignon C, Cordero C, Pierron G, Pannier S, Philippe-Chomette P, Orbach D, Brisse HJ. Fat-Containing Soft Tissue Tumors in Children, Adolescents, and Young Adults: Which Require Biopsy? Cancers (Basel) 2023; 15:3228. [PMID: 37370837 DOI: 10.3390/cancers15123228] [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: 06/02/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE To confirm the overall benignity of fat-containing soft tissue tumors (STT) on a pediatric cohort and to define the clinical and imaging features that warrant a biopsy. METHODS A retrospective monocentric study was conducted on patients aged less than 25 years consecutively referred for fat-containing STT to our Comprehensive Cancer Center between 1998 and 2022. Tumor imaging characteristics at diagnosis (US, CT, or MRI) were correlated with pathology. RESULTS The database extraction identified 63 fat-containing tumors with clinical, histologic, and imaging data available for review. In total, 58 (92%) were benign tumors: 36 lipoblastomas and lipomas, 12 fibrous hamartomas of infancy (FHI), 5 lipofibromatosis, 2 lipomas arborescens, 2 lipomatosis and 1 spindle-cell lipoma. Five patients (8%) were diagnosed with liposarcoma. Factors significantly correlated with malignancy were age >10 years old (p < 0.001), having a cancer-predisposing condition (p < 0.001), a percentage of fat <25% (p = 0.002), and a presence of myxoid zones (p < 0.001) on imaging. CONCLUSION Most fat-containing STT in children may be classified as benign tumors based on clinics and imaging. The indication for biopsy could be limited to patients aged 10 years or more with either a cancer-predisposing condition or imaging features demonstrating either a low-fat component (<25%) or the presence of myxoid zones.
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Affiliation(s)
| | - Nayla Nicolas
- Department of Imaging, Institut Curie, 75005 Paris, France
| | | | - Arnaud Gauthier
- Department of Pathology, Institut Curie, 75005 Paris, France
| | - Matthieu Carton
- Department of Biostatistics, Institut Curie, 75005 Paris, France
| | - Dominique Berrebi
- Department of Pathology, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades, 75015 Paris, France
| | - Joanna Cyrta
- Department of Pathology, Institut Curie, 75005 Paris, France
| | - Charlotte Collignon
- SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, PSL University, 75005 Paris, France
| | - Camille Cordero
- SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, PSL University, 75005 Paris, France
| | - Gaëlle Pierron
- Department of Somatic Genetics, Institut Curie, 75005 Paris, France
| | - Stéphanie Pannier
- Paediatric Orthopaedic Service, Assistance Publique des Hôpitaux de Paris, Université Paris Cité, Hôpital Necker, 75015 Paris, France
| | - Pascale Philippe-Chomette
- Department of Pediatric Surgery, Assistance Publique des Hôpitaux de Paris, Hôpital Robert Debré, 75019 Paris, France
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, PSL University, 75005 Paris, France
| | - Hervé J Brisse
- Department of Imaging, Institut Curie, 75005 Paris, France
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Saga M, Yamaura A, Miyagawa T. Lipoblastomatosis Extended into the Lumbar Spinal Canal in a Child: A Case Report. Pediatr Neurosurg 2023; 58:168-172. [PMID: 37315552 DOI: 10.1159/000531548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 05/26/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Lipoblastoma and lipoblastomatosis are rare benign mesenchymal adipose tumors that originate from embryonic white adipocytes and occur most commonly in infancy and early childhood. Lipoblastomas occur in the extremities and trunk, including the retroperitoneum and peritoneal cavity. Therefore, infiltration into the spinal canal has rarely been reported. CASE PRESENTATION A 4-year-old girl presented to our clinic because of difficulty sitting on the floor with her legs straight. She also complained of enuresis and constipation for the past 6 months with persistent headaches and back pain evoked by body anteflexion. A magnetic resonance imaging revealed a massive lesion of the psoas major muscle, retroperitoneal, and subcutaneous spaces, extending into the spinal epidural space between L2 and S1. The patient underwent surgery which resulted in gross total removal of the tumor from the spinal canal. The mass was yellowish, soft, lobulated, fatty, and easily removed from the surrounding structures. Pathology confirmed the diagnosis of lipoblastoma. The postoperative course was uneventful, and the patient was discharged without any signs of neurological deficit. CONCLUSION We herein discuss a rare case of lipoblastoma extending into the spinal canal, resulting in neurological symptoms. Although this tumor is benign with no potential for metastasis, it is prone to local recurrence. Therefore, close postoperative observation should be performed.
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Affiliation(s)
- Marina Saga
- Department of Pediatric Neurosurgery, Matsudo City General Hospital, Chiba, Japan
| | - Akira Yamaura
- Department of Pediatric Neurosurgery, Matsudo City General Hospital, Chiba, Japan
| | - Tadashi Miyagawa
- Department of Pediatric Neurosurgery, Matsudo City General Hospital, Chiba, Japan
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Muacevic A, Adler JR. A Giant Compressive Mesenteric Lipoblastoma Initially Suspected to Be Abdominal Malignancy: A Report of a Rare Case in a Nine-Month-Old Infant. Cureus 2023; 15:e33799. [PMID: 36660240 PMCID: PMC9845517 DOI: 10.7759/cureus.33799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 01/21/2023] Open
Abstract
Lipoblastoma is a rare benign soft tissue neoplasm rising from embryonic white adipose tissue known as lipoblast that keeps proliferating during the postnatal period. Although lipoblastomas are benign, they often grow rapidly. Most lipoblastomas are asymptomatic at presentation; they can present as a growing painless palpable mass and progressive symptoms of various organ compression depending on localization. A giant mesenteric lipoblastoma is a rare case with only a few cases reported. An infant with large intraabdominal masses may present preoperative diagnostic difficulties. Differential diagnoses are broad and may include sarcomas, germ-cell tumors, lipomas, lymphomas, hepatoblastomas, Wilm's tumors, and neuroblastomas. Thorough clinical, radiological, and pathological investigations are ultimately required to obtain a definitive diagnosis. Regardless of location, the treatment of choice for lipoblastoma is complete surgical resection. All patients should be followed up for a minimum of five years We report a rare case of a giant compressive mesenteric lipoblastoma that was initially suspected as abdominal malignancy in a nine-month-old infant. As physicians, we must always consider the underlying cause as well as the malignant or benign nature of a growing mass to treat the patient appropriately.
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AlObaid B, Alzahrani NA, Shokor N, Alshammari K. Myxoid pleomorphic liposarcoma of the falciform ligament: a rare case report. J Surg Case Rep 2022; 2022:rjac531. [PMID: 36518639 PMCID: PMC9731610 DOI: 10.1093/jscr/rjac531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/28/2022] [Indexed: 08/30/2023] Open
Abstract
Liposarcomas are a group of malignancies that mainly affect adults. Myxoid pleomorphic liposarcoma (MPL) is a newly added subtype of liposarcomas [1]. It is extremely rare and mostly affects infants and children, and it has a predilection for the mediastinum. We report a case of a 58-years-old female with MPL originating from the falciform ligament who presented initially with vague abdominal pain. MPLs have an aggressive pathology and high metastasis and recurrence potential.
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Affiliation(s)
- Bashayer AlObaid
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nayef A Alzahrani
- Department of Surgery, National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Department of Surgery, St George Hospital & University of New South Wales, Sydney, New South Wales, Australia
| | - Nada Shokor
- King Abdulaziz Medical Center, Department of Pathology and Laboratory Medicine, Riyadh, Saudi Arabia
| | - Kanan Alshammari
- King Abdulaziz Medical Center, Department of Oncology, Riyadh, Saudi Arabia
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6
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Chitikela S, Bhagel V, Barwad A, Ahmed S, Rastogi S. Diagnosis of pleomorphic myxoid liposarcoma: Does it provoke germline testing for Li-Fraumeni syndrome? Pediatr Blood Cancer 2022; 69:e29766. [PMID: 35652567 DOI: 10.1002/pbc.29766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Sindhura Chitikela
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Bhagel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Barwad
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Shamim Ahmed
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Rastogi
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
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7
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Zhang W, Zhang S, Yang Z, Zhang Y, Wang Z. Lipoblastoma in one adult and 35 pediatric patients: Retrospective analysis of 36 cases. Exp Ther Med 2022; 25:11. [PMID: 36561624 PMCID: PMC9748941 DOI: 10.3892/etm.2022.11710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Lipoblastoma is a rare benign mesenchymal neoplasm that typically occurs at various sites in infants and children but may also occur in adults. Thus, differential diagnoses are often performed. To understand this tumor type, the present study described clinicopathological features, diagnosis and differential diagnosis of different morphological lipoblastomas. A single-institution retrospective review of 36 lipoblastoma cases diagnosed between 2015 and 2021 was performed. Formalin-fixed paraffin-embedded tissue was used for S-100, CD34, P16 and desmin immunohistochemistry analysis, along with rapid fluorescence in situ hybridization (FISH) detection with pleiomorphic adenoma gene 1 (PLAG1). The 36 cases included 14 females and 22 males [age range, 7 days to 33 years (median, 16.5 years); 28 patients were aged ≤3 years] and the tumors were located in the trunk (n=16), limbs (n=12), head and neck (n=6), and perineum (n=2). Histologically, lipoblastomas were divided into classic (n=15), lipoma-like (n=13) and myxoid (n=8) subtypes. They comprised lobules of mature adipose tissue of varying size and a fine capillary network surrounded by mucinous stroma. Single- or multivesicular lipoblasts positive for S-100 (29/36, 81%) were observed, with occasional mature adipocytes. Peripheral vessels and cytoplasm of primitive mesenchymal cells were diffusely positive for CD34 (36/36, 100%), whereas primitive mesenchymal cells and striated muscle tissue were positive for desmin (26/36, 72%). Most tumor cells were negative while only few were positive for P16 (8/36, 22%). FISH revealed PLAG1 breakage and rearrangement in 24/32 (75%) patients. In total, 28 patients were followed up post-operatively (range, 2-84 months; median, 41 months; 3 patients relapsed and 8 were lost to follow-up). In conclusion, diagnosis of a typical lipoblastoma is not difficult and PLAG1 breakage detection is key for the diagnosis.
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Affiliation(s)
- Wenchuan Zhang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Shuwan Zhang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Zixin Yang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Ying Zhang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Zhe Wang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China,Correspondence to: Professor Zhe Wang, Department of Pathology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning 110004, P.R. China
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8
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Myxolipoma of hand in a child: case report of a rare tumor. J Ultrasound 2022; 26:295-300. [PMID: 36152213 PMCID: PMC10063741 DOI: 10.1007/s40477-022-00727-7] [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: 07/27/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022] Open
Abstract
Lipomatous tumors account for less than 10% of tumors in the pediatric population. Myxolipomas (a subset of lipoma characterised by mature adipose tissue and abundant mucoid substance) are found to be even rarer. There are a few case reports in different body parts like heart, kidney, oral cavity, epiglottis, cervical and mediastinal regions. However, there are no case reports on the involvement of the hands in any age group. High resolution ultrasound is the imaging modality of choice for the initial evaluation of superficial soft tissue tumors, their site, nature and extent. In conjunction with clinical findings and age of presentation, it helps in narrowing down the differential diagnosis and planning the management. Hyperechoic fatty tumors in the pediatric hand are mostly benign and includes lipomas, lipoblastomas and fibrous hamartomas of infancy as the main differentials. A definitive diagnosis is based on a histo-pathological and molecular cytogenetic examination. This article presents a never before reported case of a rare, large, myxolipoma of the hand in a 22-month-old boy.
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9
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Lipoblastoma of the extremities. J Plast Reconstr Aesthet Surg 2022; 75:3761-3767. [DOI: 10.1016/j.bjps.2022.06.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 04/26/2022] [Accepted: 06/05/2022] [Indexed: 11/21/2022]
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10
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11
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Update of Pediatric Lipomatous Lesions: A Clinicopathological, Immunohistochemical and Molecular Overview. J Clin Med 2022; 11:jcm11071938. [PMID: 35407546 PMCID: PMC8999862 DOI: 10.3390/jcm11071938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/25/2022] [Accepted: 03/30/2022] [Indexed: 01/27/2023] Open
Abstract
Lipomatous neoplasms are a rare entity in the pediatric population, comprising less than 10% of soft tissue tumors in the first two decades of life. Some characteristics of pediatric adipocytic tumors are analogous to their adult counterparts, some pediatric lipomatous lesions however harbor unique features. In recent years, there have been significant advances in the understanding of the pathogenesis and hence in the classification and treatment of pediatric adipocytic tumors. This literature-based article will provide a review of the presently known clinicopathological, immunohistochemical and molecular features of pediatric lipomatous lesions.
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12
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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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13
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Rodriguez JD, Selleck AM, Abdel Razek AAK, Huang BY. Update on MR Imaging of Soft Tissue Tumors of Head and Neck. Magn Reson Imaging Clin N Am 2021; 30:151-198. [PMID: 34802577 DOI: 10.1016/j.mric.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article reviews soft tissue tumors of the head and neck following the 2020 revision of WHO Classification of Soft Tissue and Bone Tumours. Common soft tissue tumors in the head and neck and tumors are discussed, along with newly added entities to the classification system. Salient clinical and imaging features that may allow for improved diagnostic accuracy or to narrow the imaging differential diagnosis are covered. Advanced imaging techniques are discussed, with a focus on diffusion-weighted and dynamic contrast imaging and their potential to help characterize soft tissue tumors and aid in distinguishing malignant from benign tumors.
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Affiliation(s)
- Justin D Rodriguez
- Department of Radiology, Duke University, 2301 Erwin Rd, Durham, NC 27705, USA
| | - A Morgan Selleck
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina Hospitals, 170 Manning Drive, CB 7070, Physicians Office Building, Rm G190A, Chapel Hill, NC 27599, USA
| | | | - Benjamin Y Huang
- Department of Radiology, UNC School of Medicine, 101 Manning Drive, CB#7510, Chapel Hill, NC 27599, USA.
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14
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Gerhard-Hartmann E, Vokuhl C, Roth S, Steinmüller T, Rosenfeldt M, Zamò A, Rosenwald A, Appenzeller S, Ernestus K, Maurus K. The histological and molecular spectrum of lipoblastoma: A case series with identification of three novel gene fusions by targeted RNA-sequencing. Pathol Res Pract 2021; 226:153591. [PMID: 34455363 DOI: 10.1016/j.prp.2021.153591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/14/2021] [Indexed: 12/14/2022]
Abstract
Lipoblastoma is a rare benign mesenchymal neoplasm that typically occurs in infancy but may also occur in older age groups and various locations. Thus, there are often numerous clinical differential diagnoses. Moreover, lipoblastomas can show a broad histologic spectrum, which can hamper the correct diagnosis, particularly in small biopsies. At the genomic level, lipoblastomas are characterized by chromosomal fusions involving the PLAG1 gene. We investigated 11 lipoblastoma samples from 10 pediatric patients (age range five months to 12 years), including one patient with local recurrence, in view of their histopathological features, and performed targeted RNA sequencing. We found a broad histological spectrum with some tumors with prominent myxoid changes, but also tumors composed mainly of mature adipocytic cells, and classified the cases according to the literature as classic (mixed), maturing, or myxoid subtype. By targeted RNA sequencing analysis, we identified characteristic PLAG1 rearrangements in 70% of the investigated cases. Moreover, these analyses revealed three novel gene fusions, two affecting the PLAG1 gene and one involving HMGA2. Besides, we performed PLAG1 immunohistochemistry and identified positive cells, typically immature adipocytic cells and spindle cells, at various numbers in all cases. However, in the maturing areas, only very sparsely positive cells were found, limiting the value of the PLAG1 immunohistochemistry as an adjunct in the diagnosis of lipoblastoma, particularly for the maturing subtype and small biopsies. The presented case series confirms the broad morphological spectrum of lipoblastoma described in the literature and underlines the value of modern molecular diagnostic approaches as a supportive diagnostic tool in challenging cases and for gaining further insights into the molecular basis of this rare mesenchymal tumor.
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Affiliation(s)
- Elena Gerhard-Hartmann
- Institute of Pathology, University of Würzburg, Würzburg, Germany; Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Würzburg, Germany.
| | - Christian Vokuhl
- Section of Pediatric Pathology, Department of Pathology, University Hospital Bonn, Bonn, Germany
| | - Sabine Roth
- Institute of Pathology, University of Würzburg, Würzburg, Germany; Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Würzburg, Germany
| | - Tabea Steinmüller
- Institute of Pathology, University of Würzburg, Würzburg, Germany; Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Würzburg, Germany
| | - Mathias Rosenfeldt
- Institute of Pathology, University of Würzburg, Würzburg, Germany; Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Würzburg, Germany
| | - Alberto Zamò
- Institute of Pathology, University of Würzburg, Würzburg, Germany; Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Würzburg, Germany
| | - Andreas Rosenwald
- Institute of Pathology, University of Würzburg, Würzburg, Germany; Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Würzburg, Germany
| | - Silke Appenzeller
- Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Würzburg, Germany
| | - Karen Ernestus
- Institute of Pathology, University of Würzburg, Würzburg, Germany; Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Würzburg, Germany
| | - Katja Maurus
- Institute of Pathology, University of Würzburg, Würzburg, Germany; Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Würzburg, Germany
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15
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McRae JJLH, Hashmi A, Radulescu A, Carter CS, Khan FA. Lipoblastomas and liposarcomas in paediatric patients: A case series. J Int Med Res 2021; 49:300060520981362. [PMID: 33730887 PMCID: PMC8166409 DOI: 10.1177/0300060520981362] [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] [Indexed: 11/17/2022] Open
Abstract
Lipoblastomas and liposarcomas are rare causes of soft tissue masses in paediatric patients. In this retrospective clinical case series we identified 11 patients from our paediatric database (10 with a lipoblastoma and one with a liposarcoma) who had attended our hospital between 1998 and 2019. The median age of patients with lipoblastoma was 29 months. All lipoblastoma cases were managed with surgical excision and histological examination. The 18-year old patient with liposarcoma presented with a metastatic and unresectable tumour that was unresponsive to chemotherapy and radiation. Our experience demonstrates the importance of differentiating the type of soft tissue mass in children.
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Affiliation(s)
| | - Asra Hashmi
- School of Medicine, Loma Linda University, Loma Linda, CA, USA.,Department of Plastic Surgery, Loma Linda University, Loma Linda, CA, USA
| | - Andrei Radulescu
- School of Medicine, Loma Linda University, Loma Linda, CA, USA.,Division of Paediatric Surgery, Department of Surgery, Loma Linda University, Loma Linda, CA, USA
| | - Cody S Carter
- School of Medicine, Loma Linda University, Loma Linda, CA, USA.,Division of Paediatric Surgery, Department of Surgery, Loma Linda University, Loma Linda, CA, USA
| | - Faraz A Khan
- School of Medicine, Loma Linda University, Loma Linda, CA, USA.,Division of Paediatric Surgery, Department of Surgery, Loma Linda University, Loma Linda, CA, USA
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16
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Staging and Classification of Primary Musculoskeletal Bone and Soft Tissue Tumors Based on the 2020 WHO Update, From the AJR Special Series on Cancer Staging. AJR Am J Roentgenol 2021; 217:1038-1052. [PMID: 33852362 DOI: 10.2214/ajr.21.25658] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Staging of primary musculoskeletal bone and soft tissue tumors is most commonly performed using the AJCC and the Enneking or Musculoskeletal Tumor Society (MSTS) staging systems. Radiologic imaging is integral in achieving adequate musculoskeletal neoplastic staging by defining lesion extent and identifying regional lymph node involvement and distant metastatic disease. Additional important features in surgical planning, though not distinct components of the staging systems, include cortical involvement, joint invasion, and neurovascular encasement; these features are optimally evaluated by MRI. In 2020, the WHO updated the classification of primary musculoskeletal tumors of soft tissue and bone. The update reflects the continued explosion in identification of novel gene alterations in many bone and soft tissue neoplasms. This has resulted in newly designated lesions, reclassification of lesion categories, and improved specificity of diagnosis. While radiologists do not need to have a comprehensive knowledge of the pathologic details, a broad working understanding of the most recent update is important to aid accurate and timely diagnosis given that histologic grading is a component of all staging systems. By approaching primary musculoskeletal neoplasms through a multidisciplinary approach with colleagues in pathology, orthopedic oncology, radiation oncology, and medical oncology, radiologists may promote improved diagnosis, treatment, and outcomes.
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17
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Gerhard-Hartmann E, Wiegering V, Benoit C, Meyer T, Rosenwald A, Maurus K, Ernestus K. A large retroperitoneal lipoblastoma as an incidental finding: a case report. BMC Pediatr 2021; 21:159. [PMID: 33814013 PMCID: PMC8019505 DOI: 10.1186/s12887-021-02628-w] [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: 12/10/2020] [Accepted: 03/24/2021] [Indexed: 12/12/2022] Open
Abstract
Background Lipoblastoma is a rare benign mesenchymal neoplasm of infancy that most commonly occurs on the extremities and trunk but can arise at variable sites of the body. Retroperitoneal lipoblastomas are particularly rare but can grow to enormous size, and preoperative diagnosis is difficult with diverse, mostly malignant differential diagnoses that would lead to aggressive therapy. Since lipoblastoma is a benign tumor that has an excellent prognosis after resection, correct diagnosis is crucial. Case presentation A case of a large retroperitoneal tumor of a 24-month old infant that was clinically suspicious of a malignant tumor is presented. Due to proximity to the right kidney, clinically most probably a nephroblastoma or clear cell sarcoma of the kidney was suspected. Radiological findings were ambiguous. Therefore, the mass was biopsied, and histology revealed an adipocytic lesion. Although mostly composed of mature adipocytes, in view of the age of the patient, the differential diagnosis of a (maturing) lipoblastoma was raised, which was supported by molecular analysis demonstrating a HAS2-PLAG1 fusion. The tumor was completely resected, and further histopathological workup led to the final diagnosis of a 13 cm large retroperitoneal maturing lipoblastoma. The child recovered promptly from surgery and showed no evidence of recurrence so far. Conclusion Although rare, lipoblastoma should be included in the differential diagnoses of retroperitoneal tumors in infants and children, and molecular diagnostic approaches could be a helpful diagnostic adjunct in challenging cases.
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Affiliation(s)
- Elena Gerhard-Hartmann
- Department of Pathology, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany. .,Comprehensive Cancer Center Mainfranken, Würzburg, Germany.
| | | | - Clemens Benoit
- Division of Pediatric Radiology, University Department of Radiology, Würzburg, Germany
| | - Thomas Meyer
- Division of Pediatric Surgery, University Medical Center ZOM, Würzburg, Germany
| | - Andreas Rosenwald
- Department of Pathology, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - Katja Maurus
- Department of Pathology, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - Karen Ernestus
- Department of Pathology, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken, Würzburg, Germany
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18
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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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19
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Choi JH, Ro JY. The 2020 WHO Classification of Tumors of Soft Tissue: Selected Changes and New Entities. Adv Anat Pathol 2021; 28:44-58. [PMID: 32960834 DOI: 10.1097/pap.0000000000000284] [Citation(s) in RCA: 186] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Soft tissue tumors are a relatively rare and diagnostically challenging group of neoplasms that can have varying lines of differentiation. Accurate diagnosis is important for appropriate treatment and prognostication. In the 8 years since the publication of the 4th Edition of World Health Organization (WHO) classification of soft tissue tumors, significant advances have been made in our understanding of soft tissue tumor molecular biology and diagnostic criteria. The 5th Edition of the 2020 WHO classification of tumors of soft tissue and bone incorporated these changes. Classification of tumors, in general, but particularly in soft tissue tumors, is increasingly based on the molecular characteristics of tumor types. Understanding tumor molecular genetics improves diagnostic accuracy for tumors that have been difficult to classify on the basis of morphology alone, or that have overlapping morphologic features. In many large hospitals in the United States and Europe, molecular tests on soft tissue tumors are a routine part of diagnosis. Therefore, surgical pathologists should be familiar with newly emerging molecular genetic techniques in clinical settings. In the near future, molecular tests, particularly in soft tissue tumor diagnosis, will become as routine during diagnosis as immunohistochemistry is currently. This new edition provides an updated classification scheme and essential diagnostic criteria for soft tissue tumors. Newly recognized entities and subtypes of existing tumor types, several reclassified tumors, and newly defined molecular and genetic data have been incorporated. Herein, we summarize the updates in the WHO 5th Edition, focusing on major changes in each category of soft tissue tumor, and the newly described tumor entities and subtypes.
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Affiliation(s)
- Joon Hyuk Choi
- Department of Pathology, Yeungnam University College of Medicine, Daegu, South Korea
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX
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20
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Lopez-Nunez O, Alaggio R, Ranganathan S, Schmitt L, John I, Church AJ, Picarsic J. New molecular insights into the pathogenesis of lipoblastomas: clinicopathologic, immunohistochemical, and molecular analysis in pediatric cases. Hum Pathol 2020; 104:30-41. [PMID: 32692992 DOI: 10.1016/j.humpath.2020.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022]
Abstract
Lipoblastomas can occasionally require further molecular confirmation when occurring outside of the usual age groups or demonstrating unusual morphology. We reviewed 28 lipoblastomas with 16 controls. Lipoblastomas were subdivided into myxoid (n = 7), classic (n = 9), or lipoma-like (n = 12) subtypes. PLAG1 immunohistochemistry, PLAG1 fluorescence in situ hybridization (FISH), and targeted RNA sequencing were performed on formalin-fixed paraffin-embedded tissue. Karyotypes were available in a subset of lipoblastomas (n = 9). Gene rearrangements were identified in 17/25 (68%) lipoblastomas, including PLAG1 (15/25, 60%) and HMGA2 (2/25, 8%). Five novel fusion partners (DDX6, KLF10, and KANSL1L with PLAG1 and EP400 and FGD6 with HMGA2) were found. PLAG1 immunohistochemistry was positive (nuclear, moderate/strong) in myxoid and classic subtypes lipoblastomas with preferential expression in mesenchymal cells within myxoid stroma and fibrous septa and negative in all controls. When comparing PLAG1 immunohistochemistry with molecular testing (FISH and/or RNA sequencing and/or karyotype), concordant results were noted in 13/25 (52%) cases, increasing to 15/25 (60%) after slight adjustment of the PLAG1 FISH positive threshold. In myxoid and classic lipoblastomas, PLAG1 immunohistochemistry seems to be a better surrogate marker for PLAG1 rearrangement, as compared with lipoma-like subtypes. In lipoma-like subtypes, targeted RNA sequencing appears to detect PLAG1 fusions better than FISH and immunohistochemistry. The preferential expression of PLAG1 in the mesenchymal and fibroblast-like cells deserves further investigation as the putative cell of origin in lipoblastoma.
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Affiliation(s)
- Oscar Lopez-Nunez
- Department of Pathology and Laboratory Medicine, UPMC, Pittsburgh, PA, 15213, USA; Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Rita Alaggio
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA; Department of Pathology, Bambino Gesù Children's Hospital, IRCCS, Rome, 00165, Italy
| | - Sarangarajan Ranganathan
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA; Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Lori Schmitt
- Division of Pediatric Pathology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, 15224, USA
| | - Ivy John
- Department of Pathology and Laboratory Medicine, UPMC, Pittsburgh, PA, 15213, USA; Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Alanna J Church
- Department of Pathology, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Jennifer Picarsic
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA; Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.
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21
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Kukull BJ, Khalighi MA, Gundle KR, Hansford BG, Corless CL, Davis JL. Low-grade Osteosarcomatous Dedifferentiation of an Atypical Lipomatous Tumor in a Pediatric Patient. Pediatr Dev Pathol 2020; 23:240-246. [PMID: 31739757 DOI: 10.1177/1093526619889130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atypical and malignant lipomatous tumors are infrequent in the pediatric population. Within this uncommon cohort, the morphologically and genetically related spectrum of atypical lipomatous tumor/well-differentiated liposarcoma/dedifferentiated liposarcoma (ALT/WDL/DDLS) is markedly rare. Their shared characteristic molecular aberration is a genomic amplicon of a region of chromosome 12q, including the oncogenes MDM2 and CDK4. We present an unusual case of a pediatric patient with an ALT, with recurrence after 2 years in the form of a bone-forming mass, radiologically and pathologically mimicking parosteal osteosarcoma, a tumor also molecularly characterized by amplification of MDM2 and CDK4. However, with ample histologic sampling, a single focus of lipogenic differentiation was identified, thus representing the first near complete low-grade osteosarcomatous dedififferentation reported within ALT/WDL/DDLS and the first ever in pediatric patient. The case serves a reminder of a diagnosis differential and pitfalls within MDM2-amplified tumors.
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Affiliation(s)
- Benjamin J Kukull
- Department of Pathology, Oregon Health & Science University, Portland, Oregon
| | - Mazdak A Khalighi
- Department of Pathology, Oregon Health & Science University, Portland, Oregon
| | - Kenneth R Gundle
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon.,Operative Care Division, Portland VA Medical Center, Portland, Oregon
| | - Barry G Hansford
- Department of Radiology, Oregon Health & Science University, Portland, Oregon
| | - Christopher L Corless
- Department of Pathology, Oregon Health & Science University, Portland, Oregon.,Knight Cancer Institute, Portland, Oregon
| | - Jessica L Davis
- Department of Pathology, Oregon Health & Science University, Portland, Oregon
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22
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Özşen M, Yalçınkaya U, Yazıcı Z, Sarısözen MB. Lipomatous Tumors in Pediatric Patients: A Retrospective Analysis of 50 cases. Turk Patoloji Derg 2020; 36:1-10. [PMID: 31282548 PMCID: PMC10512668 DOI: 10.5146/tjpath.2019.01464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/01/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Although lipomatous tumors are the most common type of mesenchymal tumors in adults, they account for less than 10% of all soft tissue lesions in pediatric patients. In this descriptive study, we aim to present our series of pediatric lipomatous tumors consisting of lipoma, neural fibrolipoma, lipoblastoma, atypical lipomatous tumor, myxoid liposarcoma and pleomorphic liposarcoma, and to evaluate the clinicopathological characteristics of these tumors in reference to the literature. MATERIAL AND METHOD In this study, pediatric lipomatous tumor cases diagnosed between 2002 and 2018 were screened from pathological archives and retrospectively evaluated. RESULTS A total of 50 cases were diagnosed with lipomatous tumor within the mentioned period. Of the total cases, 24 were female (48%) and 26 were male (52%), with age distribution ranging from 1 to 204 months. Histopathological examination revealed lipoma in 26 cases (52%), lipoblastoma in 19 (38%), atypical lipomatous tumor in 2 (4%), myxoid liposarcoma in 2 (4%), and pleomorphic liposarcoma in 1 case (2%). CONCLUSION Although lipomatous tumors are the most common type of mesenchymal tumors; they rarely occur in children. Since there is a limited number of studies on pediatric lipomatous tumors in the literature, there is insufficient data on the prevalence and incidence of these tumors. These tumors may slowly enlarge to greater sizes, especially those localized in deep tissues, and may cause various clinical symptoms by compressing surrounding tissues. Local recurrences may occur, even after total excision, and require close monitoring.
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Affiliation(s)
- Mine Özşen
- Department of Pathology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Ulviye Yalçınkaya
- Department of Pathology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Zeynep Yazıcı
- Department of Radiology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Mehmet Bartu Sarısözen
- Department of Orthopedics and Traumatology, Uludag University Faculty of Medicine, Bursa, Turkey
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23
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Squillaro AI, Chow MD, Arias F, Sadimin ET, Lee YH. A Giant Childhood Mesenteric Lipoblastoma With Extensive Maturation. Front Pediatr 2020; 8:404. [PMID: 32793530 PMCID: PMC7393439 DOI: 10.3389/fped.2020.00404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/12/2020] [Indexed: 12/11/2022] Open
Abstract
Abdominal lipoblastomas are uncommon soft tissue tumors in children and rarely arise from the mesentery. Due to intraabdominal location and slow growth, these masses can go unnoticed for long periods of time and often found on surgical exploration. We present a case of a 12-year-old male with years of abdominal distension accompanied by new onset early satiety that was found to have an intra-abdominal mass. He underwent an exploratory laparotomy revealing a large 33 x 27 x 15 cm rubbery mesenteric mass displacing the entire intra-abdominal contents, connected by a single vascular pedicle and encasing a loop of small intestine. The mass was resected and the patient did well without signs of recurrence. Histology confirmed the presence of mature adipocytes but on further cytogenetic analysis, a translocation between chromosomes 2 and 8 at the 12q arm was detected, which is often associated with lipoblastomas. This case represents the one of the largest mesenteric lipoblastomas that matured extensively to lipoma-like histology at the time of surgical resection.
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Affiliation(s)
- Anthony I Squillaro
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Monica D Chow
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Fernando Arias
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Evita T Sadimin
- Department of Pathology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Yi-Horng Lee
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States.,Division of Pediatric Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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24
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Zhou J, Li X, Cai Y, Wang L, Yang SD. Undifferentiated myxoid lipoblastoma with PLAG1 gene rearrangement in infant. Pathol Res Pract 2019; 216:152765. [PMID: 31796335 DOI: 10.1016/j.prp.2019.152765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/13/2019] [Accepted: 11/25/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To analyze the clinicopathologic feature, diagnosis and differential diagnosis of undifferentiated myxoid lipoblastoma in infant. METHODS The study included 2 cases of undifferentiated myxoid lipoblastoma in infant according to the molecular genetic diagnosis. The relevant clinicopathologic feature was investigated. RESULTS We describe 2 cases of undifferentiated myxoid lipoblastoma in infant. The both large circumscribed masses are located in deep soft tissue. Unlike most lipoblastoma, lobulated appearance was not obvious in one case and completely absent in another. The both cases presented prominent myxoid change with a plexiform vascular pattern. There were some spindle-shaped or stellate mesenchymal cells, while no any mature adipocytes. The initial suggestion of case 1 was myxoid liposarcoma, and case 2 was aggressive angiomyxoma. However, few S-100 positive lipoblasts suggested the origin of the tumor. FISH analysis using a PLAG1 break apart probe confirmed a PLAG1 rearrangment. The final diagnosis was undifferentiated myxoid lipoblastoma. CONCLUSIONS The undifferentiated myxoid lipoblastoma is a very rare tumor in infant. Histologically, prominent myxoid change, a plexiform vascular pattern and lacking of mature adipocytes make it indistinguishable from myxoid liposarcoma, PMMTI and aggressive angiomyxoma. The S-100 positive lipoblasts and genetic rearrangement of PLAG1 helps in confirming the diagnosis. Even if there were no mature adipocytes, myxoid lipoblastoma was still a diagnosis that can not be ignored in myxoid tumors in children.
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Affiliation(s)
- Jing Zhou
- Department of Pathology, Wuxi People'S Hospital Affiliated with Nanjing Medical University, Wuxi, 214023, China.
| | - Xia Li
- Department of Pathology, Wuxi People'S Hospital Affiliated with Nanjing Medical University, Wuxi, 214023, China.
| | - Ying Cai
- Department of Pathology, Wuxi People'S Hospital Affiliated with Nanjing Medical University, Wuxi, 214023, China.
| | - Lu Wang
- Department of Pathology, Wuxi People'S Hospital Affiliated with Nanjing Medical University, Wuxi, 214023, China.
| | - Shu-Dong Yang
- Department of Pathology, Wuxi People'S Hospital Affiliated with Nanjing Medical University, Wuxi, 214023, China.
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25
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Olaya-C M, Franco JA, Messa OA. Symptomatic and lethal congenital primary cardiac rhabdomyoma. CASE REPORTS IN PERINATAL MEDICINE 2019. [DOI: 10.1515/crpm-2019-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Congenital tumors, including mesenchymal rhabdomyoma, are highly infrequent. The combination of a congenital tumor and rhabdomyoma is rarer yet, even more so when primary origin is in the heart.
Case presentation
We present a case of fetal hydrops fetalis, wherein the post-mortem exam revealed a cardiac tumor more than twice the size of the heart itself; histological study confirmed primary rhabdomyoma involving the left ventricle.
Conclusion
It is essential to keep in mind that fetal tumors should always be differentiated from malformations; in fetuses tissue immaturity must be taken into account for categorization; despite benign labeling, they can be lethal.
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Affiliation(s)
- Mercedes Olaya-C
- Pontificia Universidad Javeriana , Department of Pathology , Bogota , Colombia
- Hospital Universitario San Ignacio , Department of Pathology , Bogota , Colombia
| | - Jorge Andres Franco
- Pontificia Universidad Javeriana , Department of Morphology , Bogota , Colombia
| | - Oscar Alberto Messa
- Pontificia Universidad Javeriana , Department of Pathology , Bogota , Colombia
- Hospital Universitario San Ignacio , Department of Pathology , Bogota , Colombia
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26
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Zare SY, Leivo M, Fadare O. Recurrent Pleomorphic Myxoid Liposarcoma in a Patient With Li-Fraumeni Syndrome. Int J Surg Pathol 2019; 28:225-228. [DOI: 10.1177/1066896919878804] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pleomorphic myxoid liposarcoma is an extremely rare, clinically aggressive subtype of liposarcoma that has been primarily reported in young patients. In this article, we report a case of a pleomorphic myxoid liposarcoma that presented as a second primary neoplasm in a 34-year-old man with history of primary mediastinal large B-cell lymphoma. During the clinical workup, the patient was diagnosed with a germline TP53 gene mutation and Li-Fraumeni syndrome. The tumor, a 2.9 × 2.3 × 2.0 cm well-demarcated and solid mass, was centered in the anterior chest wall soft tissue. Histologically, most of the tumor displayed abundantly myxoid stroma, low cellularity of mostly bland spindle cells, delicate branching capillaries, and lipoblasts; these areas transitioned to small areas whose features were reminiscent of pleomorphic liposarcoma. As assessed by fluorescence in situ hybridization, the tumor showed no DDIT3 ( CHOP) (12q13) rearrangements or MDM2 gene amplification. Clinically, the tumor progressed with multiple recurrences and metastasis to the humerus bone. To our knowledge, this is the first case of pleomorphic myxoid liposarcoma diagnosed in an adult with Li-Fraumeni syndrome.
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Affiliation(s)
| | - Mariah Leivo
- University of California San Diego, La Jolla, CA, USA
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27
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Creytens D. What's new in adipocytic neoplasia? Virchows Arch 2019; 476:29-39. [PMID: 31501988 DOI: 10.1007/s00428-019-02652-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/27/2019] [Accepted: 08/13/2019] [Indexed: 01/04/2023]
Abstract
Adipocytic tumors are frequently encountered in routine practice, and while the vast majority represent commonly encountered tumor types (e.g., benign lipoma), the heterogeneity and rarity of other adipocytic neoplasms can pose diagnostic challenges. Atypical and malignant adipocytic tumors account for approximately 20% of all sarcomas. The 2013 World Health Organization (WHO) classification of soft tissue and bone tumors recognizes four major liposarcoma subtypes, characterized by distinct clinical behavior, distinctive morphologies, as well as unique genetic findings: atypical lipomatous tumor/well-differentiated liposarcoma, dedifferentiated liposarcoma, myxoid liposarcoma, and pleomorphic liposarcoma. Since the publication of the 2013 WHO classification of soft tissue and bone tumors, the most notable change in the category of adipocytic tumors has been made in the clinicopathologic and molecular characterization of the heterogeneous but distinct group of "atypical low-grade adipocytic neoplasms with spindle cell features," for which the term atypical spindle cell/pleomorphic lipomatous tumor has been proposed. Another substantive change in the group of adipocytic tumors is the introduction of pleomorphic myxoid liposarcoma (myxoid pleomorphic liposarcoma) as an apparently novel subtype of aggressive liposarcoma, especially occurring in children and young adults with a predilection for the mediastinum. This review will further focus upon the diagnostic criteria of these novel emerging entities in the group of adipocytic tumors.
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Affiliation(s)
- David Creytens
- Department of Pathology, Ghent University and Ghent University Hospital, C. Heymanslaan 10,, B-9000, Ghent, Belgium.
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28
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Francom CR, Leoniak SM, Lovell MA, Herrmann BW. Head and neck pleomorphic myxoid liposarcoma in a child with Li-Fraumeni syndrome. Int J Pediatr Otorhinolaryngol 2019; 123:191-194. [PMID: 31129458 DOI: 10.1016/j.ijporl.2019.05.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Pleomorphic myxoid liposarcoma is a rare and aggressive cancer seen in the pediatric population that has been previously associated with hereditable cancer disorders like Li Fraumeni syndrome. We present a case report and review of the relevant literature. CASE PRESENTATION Pleomorphic myxoid liposarcoma presenting as a second primary tumor in a child with a strong family history for cancer led to diagnosis of Li-Fraumeni syndrome, which is associated with TP53 tumor suppressor gene inactivation. MANAGEMENT AND OUTCOME The tumor was fully excised, but postoperative radiation was deferred to limit future radiation-induced tumorgenesis. DISCUSSION Pleomorphic myxoid liposarcoma is rare but aggressive, and should prompt caregivers to test for potential hereditable cancer disorders. Li-Fraumeni syndrome is associated with early onset neoplasia and development of recurrent primary tumors. Its presence affects treatment decisions and methods of surveillance. Chemoradiation should be used judiciously in this population.
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Affiliation(s)
- Christian R Francom
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA
| | - Steven M Leoniak
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA
| | - Mark A Lovell
- Department of Pathology and Laboratory Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brian W Herrmann
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA.
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29
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Fanna M, Rougemont AL, Arni D, Toso C, Anooshiravani-Dumont M, Wildhaber BE. Giant Intrahepatic Lipoblastoma in a Child. J Pediatr 2019; 210:235-236.e1. [PMID: 30955788 DOI: 10.1016/j.jpeds.2019.02.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/22/2019] [Accepted: 02/26/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Martina Fanna
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Anne-Laure Rougemont
- Division of Clinical Pathology, Geneva University Hospitals, Geneva, Switzerland
| | - Delphine Arni
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Christian Toso
- Division of Visceral Surgery, Geneva University Hospitals, Geneva, Switzerland
| | | | - Barbara E Wildhaber
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, Geneva University Hospitals, Geneva, Switzerland
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30
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Asmandar S, Ranganathan S, Ramirez R, Chamond O, Coulomb A, Boudjemaa S. Myxoid Lipoblastoma and Mimickers on Fine-Needle Biopsy in a Child. Pediatr Dev Pathol 2019; 22:157-160. [PMID: 30322346 DOI: 10.1177/1093526618805894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Image-guided percutaneous core needle biopsy is a standard and safe procedure for the diagnosis of both solid and hematological malignancies in children. Despite recent improvements, nondiagnosis biopsies persist. Lipoblastoma is a benign adipocytic tumor composed of embryonal fat admixed with mature adipocytes and occurring before the age of 1 year in one-third of cases. Lipoblastoma is usually easily diagnosed, but in some cases, diagnosis may be difficult on percutaneous biopsies, when the lipoblastic component is not well represented or when the tumor contains a prominent myxoid component mimicking other myxoid tumors. We report here a case of lipoblastoma with a predominant myxoid component and discuss differential diagnosis of myxoid lesions of infancy. In such cases, pathologic examination enhanced by adjunct techniques, such as immunohistochemistry and cytogenetic or molecular genetic studies, is needed to achieve accurate diagnosis, particularly on fine-needle biopsies.
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Affiliation(s)
- Safaa Asmandar
- 1 Service d'Anatomie et de Cytologie Pathologiques, Hôpital d'Enfants Armand Trousseau, Université Pierre et Marie Curie, Paris, France
| | | | - Rodrigo Ramirez
- 1 Service d'Anatomie et de Cytologie Pathologiques, Hôpital d'Enfants Armand Trousseau, Université Pierre et Marie Curie, Paris, France
| | - Olivier Chamond
- 3 Service de Chirurgie Viscérale, Hôpital d'Enfants Armand Trousseau, Université Pierre et Marie Curie, Paris, France
| | - Aurore Coulomb
- 1 Service d'Anatomie et de Cytologie Pathologiques, Hôpital d'Enfants Armand Trousseau, Université Pierre et Marie Curie, Paris, France
| | - Sabah Boudjemaa
- 1 Service d'Anatomie et de Cytologie Pathologiques, Hôpital d'Enfants Armand Trousseau, Université Pierre et Marie Curie, Paris, France
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31
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Abstract
Adipocytic neoplasms in the pediatric population demonstrate a different histologic spectrum and frequency than in adults. The vast majority of these tumors are benign, with lipoma being the most common entity. The identification of signature cytogenetic and molecular alterations for certain lesions, such as PLAG1 gene rearrangement in lipoblastoma and FUS-DDIT3 fusion in myxoid liposarcoma, has been helpful in approaching these neoplasms and aiding in confirming the diagnosis. Furthermore, it is important for pathologists to recognize that adipocytic neoplasms may be associated with different syndromes with potential impact in managing such patients. This review provides a summary of the clinical pictures, histologic characteristics, molecular alterations, differential diagnoses, and syndromic associations of the commonly encountered fatty tumors in children.
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Affiliation(s)
- Juan Putra
- Paediatric Pathologist, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, 555 University Ave Rm. 3119, Toronto, ON M5G 1X8, Canada.
| | - Alyaa Al-Ibraheemi
- Department of Pathology, Children's Hospital Boston and Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States.
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32
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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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33
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Brundler MA, Kurek KC, Patel K, Jester I. Submucosal Colonic Lipoblastoma Presenting With Colo-colonic Intussusception in an Infant. Pediatr Dev Pathol 2018; 21:401-405. [PMID: 28420321 DOI: 10.1177/1093526617705271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Lipoblastoma is a benign adipose tumor typically presenting in infancy in superficial soft tissues of extremities. Intestinal complications secondary to intraabdominal or retroperitoneal involvement are exceedingly rare. We describe a unique case of a primary intestinal lipoblastoma arising from the submucosa of the transverse colon in an otherwise healthy 18-month-old boy. He presented with a history of reducible rectal prolapse, rectal bleeding, and episodic abdominal pain and was initially treated for constipation. Imaging identified a short colo-colonic intussusception, confirmed at laparotomy, and a fatty mass thought to arise from the mesentery. Pathological examination of the resected transverse colon revealed a submucosal tumor composed of a mixture of mature adipose tissue, foci of myxoid mesenchymal tissue with desmin positive, HMGA2 negative spindle cells, and scattered lipoblasts, characteristic of lipoblastoma. Lipoblastoma should be considered as a potential albeit rare cause of intussusception in young children, where a pathologic lead point is infrequently identified.
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Affiliation(s)
- Marie-Anne Brundler
- 1 Department of Histopathology, Birmingham Children's Hospital, Birmingham, UK.,2 Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,3 Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kyle C Kurek
- 2 Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kamlesh Patel
- 4 Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Ingo Jester
- 4 Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, UK
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34
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Abstract
This overview of mesenchymal tumors presenting in the skin and/or subcutis in children brings together the range of neoplasms and hamartomas which are seen in this age-group. It is not surprising from the perspective of the pediatric or general surgical pathologist that vascular anomalies, including true neoplasms and vascular malformations, are the common phenotypic category. Since there is considerable morphologic overlap among these lesions, clinicopathologic correlation may be more important than for many of the other mesenchymal tumors. The skin and subcutis are the most common sites of clinical presentation for the infantile myofibroma which is the most common of fibrous mesenchymal tumors in children. Several of the other mesenchymal tumors are more common adults-like dermatofibrosarcoma protuberans, but nonetheless have an important presence in children, even as a congenital neoplasm. A lipomatous tumor in a young child should be considered as a possible manifestation of an overgrowth syndrome.
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Affiliation(s)
- Louis P Dehner
- 1 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital, Washington University Medical Center, St. Louis, Missouri.,2 Dermatopathology Center and Division of Dermatology, Washington University Medical Center, St. Louis, Missouri
| | - Alejandro A Gru
- 3 Department of Pathology, University of Virginia, Charlottesville, Virginia.,4 Department of Dermatology, University of Virginia, Charlottesville, Virginia
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35
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Fine-needle aspiration of lipoblastoma: Cytological, molecular, and clinical features. Cancer Cytopathol 2017; 125:934-939. [DOI: 10.1002/cncy.21916] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/21/2017] [Accepted: 07/31/2017] [Indexed: 12/17/2022]
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36
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Sinclair TJ, Thorson CM, Alvarez E, Tan S, Spunt SL, Chao SD. Pleomorphic myxoid liposarcoma in an adolescent with Li-Fraumeni syndrome. Pediatr Surg Int 2017; 33:631-635. [PMID: 28160093 DOI: 10.1007/s00383-017-4063-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2017] [Indexed: 11/24/2022]
Abstract
We present the case of a 15-year-old female with a right perineal mass that was found to be pleomorphic myxoid liposarcoma, a recently recognized, rare subtype of liposarcoma. The patient had a strong family history of malignancy and genetic screening revealed a pathogenic TP53 mutation consistent with Li-Fraumeni syndrome.
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Affiliation(s)
- Tiffany J Sinclair
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive Rm H3691, Stanford, CA, 94306, USA
| | - Chad M Thorson
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Alway Building M116, MC: 5733, Stanford, CA, 94305, USA
| | - Elysia Alvarez
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Stanford, USA
| | - Serena Tan
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive Rm L235, Stanford, CA, 94305, USA
| | - Sheri L Spunt
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Stanford, USA
| | - Stephanie D Chao
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Alway Building M116, MC: 5733, Stanford, CA, 94305, USA.
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37
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Sheybani EF, Eutsler EP, Navarro OM. Fat-containing soft-tissue masses in children. Pediatr Radiol 2016; 46:1760-1773. [PMID: 27866258 DOI: 10.1007/s00247-016-3690-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 06/28/2016] [Accepted: 08/12/2016] [Indexed: 12/27/2022]
Abstract
The diagnosis of soft-tissue masses in children can be difficult because of the frequently nonspecific clinical and imaging characteristics of these lesions. However key findings on imaging can aid in diagnosis. The identification of macroscopic fat within a soft-tissue mass narrows the differential diagnosis considerably and suggests a high likelihood of a benign etiology in children. Fat can be difficult to detect with sonography because of the variable appearance of fat using this modality. Fat is easier to recognize using MRI, particularly with the aid of fat-suppression techniques. Although a large portion of fat-containing masses in children are adipocytic tumors, a variety of other tumors and mass-like conditions that contain fat should be considered by the radiologist confronted with a fat-containing mass in a child. In this article we review the sonographic and MRI findings in the most relevant fat-containing soft-tissue masses in the pediatric age group, including adipocytic tumors (lipoma, angiolipoma, lipomatosis, lipoblastoma, lipomatosis of nerve, and liposarcoma); fibroblastic/myofibroblastic tumors (fibrous hamartoma of infancy and lipofibromatosis); vascular anomalies (involuting hemangioma, intramuscular capillary hemangioma, phosphate and tensin homologue (PTEN) hamartoma of soft tissue, fibro-adipose vascular anomaly), and other miscellaneous entities, such as fat necrosis and epigastric hernia.
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Affiliation(s)
- Elizabeth F Sheybani
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.,Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric P Eutsler
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Oscar M Navarro
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada. .,Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
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38
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Hofvander J, Jo VY, Ghanei I, Gisselsson D, Mårtensson E, Mertens F. Comprehensive genetic analysis of a paediatric pleomorphic myxoid liposarcoma reveals near-haploidization and loss of theRB1gene. Histopathology 2016; 69:141-147. [DOI: 10.1111/his.12913] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Jakob Hofvander
- Department of Clinical Genetics; University and Regional Laboratories; Skåne University Hospital; Lund University; Lund Sweden
| | - Vickie Y Jo
- Department of Pathology; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Iman Ghanei
- Department of Orthopedics; Skåne University Hospital; Lund University; Lund Sweden
| | - David Gisselsson
- Department of Clinical Genetics; University and Regional Laboratories; Skåne University Hospital; Lund University; Lund Sweden
| | - Emma Mårtensson
- Department of Clinical Genetics; University and Regional Laboratories; Skåne University Hospital; Lund University; Lund Sweden
| | - Fredrik Mertens
- Department of Clinical Genetics; University and Regional Laboratories; Skåne University Hospital; Lund University; Lund Sweden
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39
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Owens C, Young A, Loukopoulos P, Hilbert B. Lipoma of the long digital extensor tendon sheath in a horse. EQUINE VET EDUC 2015. [DOI: 10.1111/eve.12528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- C. Owens
- Veterinary Clinical Centre and Veterinary Diagnostic Laboratory; School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga New South Wales Australia
| | - A. Young
- University Veterinary Teaching Hospital; Faculty of Veterinary Science; University of Sydney; Camden New South Wales Australia
| | - P. Loukopoulos
- Veterinary Clinical Centre and Veterinary Diagnostic Laboratory; School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga New South Wales Australia
| | - B. Hilbert
- Veterinary Clinical Centre and Veterinary Diagnostic Laboratory; School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga New South Wales Australia
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40
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Undifferentiated myxoid lipoblastoma with PLAG1-HAS2 fusion in an infant; morphologically mimicking primitive myxoid mesenchymal tumor of infancy (PMMTI)--diagnostic importance of cytogenetic and molecular testing and literature review. Cancer Genet 2015; 209:21-9. [PMID: 26701195 DOI: 10.1016/j.cancergen.2015.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 02/07/2023]
Abstract
Lipoblastoma is a benign myxoid neoplasm arising in young children that typically demonstrates adipose differentiation. It is often morphologically indistinguishable from primitive myxoid mesenchymal tumor of infancy (PMMTI), which is characterized by a well-circumscribed myxoid mass with a proliferation of primitive mesenchymal cells with mild cytologic atypia. PMMTI occurs in the first year of life and is known to have locally aggressive behavior. No specific genetic rearrangements have been reported to date. In contrast, the presence of PLAG1 (Pleomorphic Adenoma Gene 1) rearrangement is diagnostic for lipoblastoma. We hereby demonstrate the combined application of multiple approaches to tackle the diagnostic challenges of a rapidly growing neck tumor in a 3-month-old female. An incisional tumor biopsy had features of an undifferentiated, myxoid mesenchymal neoplasm mimicking PMMTI. However, tumor cells showed diffuse nuclear expression by immunohistochemical (IHC) stain. Conventional cytogenetic and fluorescence in situ hybridization (FISH) analyses as well as next generation sequencing (NGS) demonstrated evidence of PLAG1 rearrangement, confirming the diagnosis of lipoblastoma. This experience warrants that undifferentiated myxoid lipoblastoma can mimic PMMTI, and the combination of cytogenetic and molecular approaches is essential to distinguish these two myxoid neoplasms. Literature on lipoblastomas with relevant molecular and cytogenetic findings is summarized. Our case is the first lipoblastoma diagnosed with a PLAG1 fusion defined by NGS technology.
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41
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42
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Wobser M, Ernestus K, Hamm H. Pädiatrische Dermatohistopathologie - Histologie von Dermatosen im Neugeborenen- und Säuglingsalter. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12651_suppl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marion Wobser
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie; Universitätsklinikum Würzburg
| | - Karen Ernestus
- Institut für Pathologie; Julius-Maximilians-Universität Würzburg
| | - Henning Hamm
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie; Universitätsklinikum Würzburg
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43
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Wobser M, Ernestus K, Hamm H. Pediatric dermatohistopathology--histopathology of skin diseases in newborns and infants. J Dtsch Dermatol Ges 2015; 13:535-48. [PMID: 26018366 DOI: 10.1111/ddg.12651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2015] [Indexed: 12/22/2022]
Abstract
While neonatal skin physiology has been thoroughly examined using non-invasive techniques in recent years, only few systematic studies and review articles addressing the histopathology of neonatal skin have been published thus far. In most cases, histopathological findings of dermatoses in neonatal skin do not significantly differ from those seen in adult skin. Nevertheless, a comprehensive knowledge of embryonic and fetal skin development as well as the microanatomical structure of neonatal skin can contribute to a better understanding of various dermatoses of infancy. In the first part of this review article, we present the histopathological features of such skin diseases, which, though generally rare, almost exclusively appear during the first weeks of life due to distinctive structural and functional features of neonatal skin. The second part is dedicated to classic dermatoses of infancy and their histopathological features.
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Affiliation(s)
- Marion Wobser
- Department of Dermatology, Venereology, and Allergology, Würzburg University Hospital
| | - Karen Ernestus
- Institute of Pathology, Julius Maximilian University Würzburg
| | - Henning Hamm
- Department of Dermatology, Venereology, and Allergology, Würzburg University Hospital
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44
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Shinkai T, Masumoto K, Ono K, Yano E, Kobayashi C, Fukushima T, Sumazaki R, Satomi K, Noguchi M. A case of unusual histology of infantile lipoblastoma confirmed by PLAG1 rearrangement. Surg Case Rep 2015; 1:42. [PMID: 26943407 PMCID: PMC4747941 DOI: 10.1186/s40792-015-0042-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/05/2015] [Indexed: 12/28/2022] Open
Abstract
Lipoblastoma, a relatively rare benign adipose neoplasm, predominantly affects children younger than 3 years of age. We herein report the case of a 7-month-old girl with an unusual myxomatous histology of lipoblastoma. A rapidly growing mass was detected in the subcutaneous area of the left buttock. Histologically, the tumor consisted of abundant myxoid stroma exhibiting cellular atypia and a high mitotic activity. Although the histological findings were unusual, the tumor was diagnosed as a lipoblastoma according to both PLAG1 immunohistochemistry and the presence of PLAG1 rearrangement on fluorescence in situ hybridization.
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Affiliation(s)
- Toko Shinkai
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Kouji Masumoto
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Kentaro Ono
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Eri Yano
- Department of Pediatrics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Chie Kobayashi
- Department of Pediatrics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Takashi Fukushima
- Department of Pediatrics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Ryo Sumazaki
- Department of Pediatrics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Kaishi Satomi
- Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Masayuki Noguchi
- Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
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45
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Langhans L, Frevert SC, Andersen M. Lipomatous tumours of the face in infants: diagnosis and treatment. J Plast Surg Hand Surg 2015; 49:260-264. [DOI: 10.3109/2000656x.2015.1034725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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46
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Pio L, Torre M, Romanini Catalan MV, Granata C, Avanzini S, Buffa P, Sementa AR. Diffuse lipomatosis of the chest wall: report of a neonatal case. Ann Thorac Surg 2015; 99:326-8. [PMID: 25555958 DOI: 10.1016/j.athoracsur.2014.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 01/31/2014] [Accepted: 02/04/2014] [Indexed: 11/28/2022]
Abstract
Diffuse lipomatosis is a very rare condition, the nature of which, neoplastic or hamartomatous, has not yet been defined. We report the case of a small child with a right thoracic lesion of neonatal onset and extremely rapid growth, who successfully underwent complete surgical resection. The differential diagnoses and proper surgical treatment are discussed.
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Affiliation(s)
- Luca Pio
- Pediatric Surgery Department, Istituto Giannina Gaslini, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genova, Italy.
| | - Michele Torre
- Pediatric Surgery Department, Istituto Giannina Gaslini, Genova, Italy
| | | | - Claudio Granata
- Department of Radiology, Istituto Giannina Gaslini, Genova, Italy
| | - Stefano Avanzini
- Pediatric Surgery Department, Istituto Giannina Gaslini, Genova, Italy
| | - Piero Buffa
- Pediatric Surgery Department, Istituto Giannina Gaslini, Genova, Italy
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47
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Creytens D, van Gorp J, Ferdinande L, Van Roy N, Libbrecht L. Array-based comparative genomic hybridization analysis of a pleomorphic myxoid liposarcoma. J Clin Pathol 2014; 67:834-5. [PMID: 24970901 DOI: 10.1136/jclinpath-2014-202420] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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48
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Abstract
Constipation is a common cause of pediatric abdominal pain seen in pediatric emergency departments (EDs). We present the case of an 11-year-old boy with a 4-month history of chronic constipation and abdominal pain who presented to the children's ED. He was found to have a large abdominal mass that was determined to be a myxoid liposarcoma. An extensive review of the medical literature did not reveal any previous cases of this type of tumor presenting to the ED as chronic constipation.
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49
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A 22-month-old male child with a painless arm mass presenting to the emergency department. Pediatr Emerg Care 2014; 30:221-3. [PMID: 24589816 DOI: 10.1097/pec.0000000000000116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Abstract
Lipoblastoma is a rare benign neoplasm found exclusively in the pediatric population that can occur anywhere in the body, most commonly seen in the extremities but also found in the face. We report an 8-month-old female subject who presented with multifocal soft tissue masses of the face. The diagnosis of lipoblastoma was made in 2 separate locations after surgical resection. Subsequent surgery was performed at the cheek site in an attempt to remove further mass, resulting in discovery of 2 other discrete tumors found to be lipoblastomas. Although the literature reports recurrence rates ranging from 14% to 27%, to our knowledge, aside from a case of Proteus syndrome, there are no known reports of multiple lipoblastomas in the literature. Presentation of the case, review of pertinent literature, and consideration of congenital infiltrative lipomatosis of the face follow.
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