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Ciongariu AM, Țăpoi DA, Dumitru AV, Bejenariu A, Marin A, Costache M. Pleomorphic Liposarcoma Unraveled: Investigating Histopathological and Immunohistochemical Markers for Tailored Diagnosis and Therapeutic Innovations. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:950. [PMID: 38929567 PMCID: PMC11205576 DOI: 10.3390/medicina60060950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/01/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
Liposarcomas are some of the most challenging soft tissue tumors and are subclassified into multiple subtypes with special histologic and molecular features. The peculiarities of each histopathological subtype influence the clinical behavior, management, and treatment of these neoplasms. For instance, well-differentiated liposarcomas are common soft tissue malignancies and usually display a favorable outcome. On the other hand, pleomorphic liposarcoma is the rarest, yet the most aggressive subtype of liposarcoma. This histopathological diagnosis may be challenging due to the scarce available data and because pleomorphic liposarcomas can mimic other pleomorphic sarcomas or other neoplasms of dissimilar differentiation. Nevertheless, the correct diagnosis of pleomorphic liposarcoma is of utmost importance as such patients are prone to develop local recurrences and metastases. Treatment usually consists of surgical excision along with radiotherapy and follow-up of the patients. Therefore, this review aims to assess the complex clinical, histological, and immunohistochemical features of liposarcomas in order to establish how these characteristics influence the management and prognosis of the patients, emphasizing the particularities of pleomorphic liposarcoma.
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Affiliation(s)
- Ana-Maria Ciongariu
- Department of Pathology, “Carol Davila’’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.C.); (D.-A.Ț.); (M.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania;
| | - Dana-Antonia Țăpoi
- Department of Pathology, “Carol Davila’’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.C.); (D.-A.Ț.); (M.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania;
| | - Adrian-Vasile Dumitru
- Department of Pathology, “Carol Davila’’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.C.); (D.-A.Ț.); (M.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania;
| | - Adrian Bejenariu
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania;
| | - Andrei Marin
- Department of Plastic Surgery, “Carol Davila’’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Mariana Costache
- Department of Pathology, “Carol Davila’’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.C.); (D.-A.Ț.); (M.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania;
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McCollum KJ, Al-Rohil RN. Application of immunohistochemical studies in diagnosing emerging superficial mesenchymal neoplasms. Semin Diagn Pathol 2023:S0740-2570(23)00043-6. [PMID: 37120348 DOI: 10.1053/j.semdp.2023.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
Molecular diagnostics, with the subsequent development of novel immunohistochemical markers, continues to advance and expand the field of soft tissue pathology. As such, the ever-evolving molecular diagnostic landscape will continue to shape and refine our understanding and classification of neoplasms. This article reviews the current literature on various tumors of mesenchymal origin, including fibroblastic/fibrohistiocytic, adipocytic, vascular, and tumors of uncertain origin. We aim to give the reader a detailed understanding and pragmatic approach to various new and established immunohistochemical stains in diagnosing these neoplasms and also discuss various pitfalls with significant repercussions.
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Affiliation(s)
- Kasey J McCollum
- Department of Pathology, Duke University Hospital, United States
| | - Rami N Al-Rohil
- Department of Pathology, Duke University Hospital, United States; Department of Dermatology, Duke University Hospital, United States.
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Kawaguchi M, Kato H, Kobayashi K, Miyazaki T, Nagano A, Noda Y, Hyodo F, Matsuo M. Differences in MRI findings of superficial spindle cell lipoma and atypical lipomatous tumor/well-differentiated liposarcoma. Br J Radiol 2023; 96:20220743. [PMID: 36607278 PMCID: PMC9975377 DOI: 10.1259/bjr.20220743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the efficacy of using MRI findings to differentiate superficial spindle cell lipomas (SCLs) from atypical lipomatous tumor/well-differentiated liposarcomas (ALT/WDLs). METHODS This study included 12 patients with histopathologically proven superficial SCLs and 11 with ALT/WDLs. MRI findings for both pathologies were retrospectively reviewed and compared between the two pathologies. RESULTS The neck, upper back, and shoulder regions were more frequent locations of SCLs than of ALT/WDLs (100% vs 55%, p < 0.05), whereas no significant differences were observed in age and sex. The median maximum diameter of the lesion was smaller in SCLs than in ALT/WDLs (44 mm [interquartile range (IQR): 35-63] vs 102 mm [IQR: 86-119], p < 0.05). On T 1 weighted images, non-fatty area was more frequently observed in SCLs than in ALT/WDLs (73% vs 25%, p < 0.05), and the median rate of non-fatty area was larger in SCLs than in ALT/WDLs (7.5% [IQR: 1.0-53] vs 0% [IQR: 0-0.2], p < 0.05). On fat-suppressed T 2 weighted images, a solid hyperintense area was more frequently observed in SCLs than in ALT/WDLs (83% vs 27%, p < 0.05). CONCLUSION The maximum diameter, non-fatty area on T 1 weighted images, and solid hyperintense area on fat-suppressed T 2 weighted images were useful imaging features for differentiating superficial SCLs from ALT/WDLs. ADVANCES IN KNOWLEDGE In superficial lipomatous tumors, small tumor size and non-fatty solid area were valuable findings for diagnosing SCLs.
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Affiliation(s)
| | - Hiroki Kato
- Department of Radiology, Gifu University, Gifu, Japan
| | | | | | - Akihito Nagano
- Department of Orthopedic Surgery, Gifu University, Gifu, Japan
| | | | - Fuminori Hyodo
- Department of Radiology, Frontier Science for Imaging, Gifu University, Gifu, Japan
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Ballhause TM, Weiss S, Reiter A, Frosch KH, Luebke AM, Bannas P, Schlickewei CW, Priemel MH. Can homogeneous, lipomatous tumors be primarily resected without biopsy? A retrospective analysis of 240 tumors. World J Surg Oncol 2022; 20:184. [PMID: 35676721 PMCID: PMC9178814 DOI: 10.1186/s12957-022-02665-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND According to guidelines, every soft tissue tumor (STT) larger than 3 cm should be biopsied before definitive resection. Advances in magnetic resonance imaging (MRI) improve the possibility to give a provisional diagnosis of the tumor's entity. Can lipomas and atypical lipomatous tumors (ALTs) of the extremities therefore be primarily marginally resected based on interpretation of MR images without a previous biopsy?. METHODS In this retrospective, single-center study, 240 patients with the suspicion of a lipomatous tumor in MRI and surgical treatment in our institution between 2011 and 2020 were included. MR imaging was performed before surgery. All resected specimens underwent histopathological analysis. RESULTS The collective comprised 142 tumors that were suspected as lipoma or ALT by the radiologist and underwent primary marginal resection (PMR). One case had myxoid liposarcoma that was underestimated on MRI and needed radical follow-up resection. One-hundred forty-one patients were cured after PMR. Ninety-eight patients were biopsied initially and in 93 cases resected afterwards according to the necessary oncological margins. CONCLUSION In our institution, PMR is performed if a lipoma or ALT is suspected on MR imaging. Our treatment method and the diagnostic algorithm are presented. Primary resection spares patients from one surgical procedure, but a slight risk for underestimation of the tumor remains.
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Affiliation(s)
- Tobias M Ballhause
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Sebastian Weiss
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alonja Reiter
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Trauma Surgery, Orthopedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Andreas M Luebke
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten W Schlickewei
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias H Priemel
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Epigenetics of Cutaneous Sarcoma. Int J Mol Sci 2021; 23:ijms23010422. [PMID: 35008848 PMCID: PMC8745302 DOI: 10.3390/ijms23010422] [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] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/25/2021] [Accepted: 12/28/2021] [Indexed: 12/13/2022] Open
Abstract
Epigenetic changes influence various physiological and pathological conditions in the human body. Recent advances in epigenetic studies of the skin have led to an appreciation of the importance of epigenetic modifications in skin diseases. Cutaneous sarcomas are intractable skin cancers, and there are no curative therapeutic options for the advanced forms of cutaneous sarcomas. In this review, we discuss the detailed molecular effects of epigenetic modifications on skin sarcomas, such as dermatofibrosarcoma protuberans, angiosarcoma, Kaposi's sarcoma, leiomyosarcoma, and liposarcoma. We also discuss the application of epigenetic-targeted therapy for skin sarcomas.
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Lemaitre M, Chevalier B, Jannin A, Bourry J, Espiard S, Vantyghem MC. Multiple symmetric and multiple familial lipomatosis. Presse Med 2021; 50:104077. [PMID: 34687914 DOI: 10.1016/j.lpm.2021.104077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/20/2021] [Accepted: 10/12/2021] [Indexed: 01/18/2023] Open
Abstract
Lipomas are the most common soft tissue tumors and are malignant in only 1% of cases. Lipomatosis is defined as the presence of multiple benign lipomas on the body, without lipoatrophy. Their impact on quality of life is significant. Different entities have been described such as symmetrical multiple lipomatosis (MSL), also called Madelung's disease and familial multiple lipomatosis (FML). MSL occurs preferentially in men (but also women) who are alcohol abuser. There are different subtypes of the disease, the most classic of which affects the upper body and the nuchal region with a buffalo hump appearance. A metabolic component with obesity is frequent. In contrast to Dercum's disease, there is no pain. SAOS, complications of the metabolic syndrome and of alcohol abuse including cancers, may be associated and should be screened. FML has been little described in the literature since Brodie's first report in 1846. FML occurs preferentially in the third decade but equally in women and men. Its autosomal dominant component is classically accepted with variable penetrance within the same family. Association with naevi, angiomas, polyneuropathies and with gastrointestinal comorbidities has been reported. Interestingly, and in contrast with most lipodystrophy disorders, the patients show an insulin sensitivity profile. A better understanding of the underlying pathophysiological mechanisms would open up avenues on therapeutic research, since treatments are only symptomatic to date.
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Affiliation(s)
- Madleen Lemaitre
- CHU Lille, Endocrinology, Diabetology and Metabolism, F-59000 Lille, France; Univ. Lille, F-59000 Lille, France.
| | - Benjamin Chevalier
- CHU Lille, Endocrinology, Diabetology and Metabolism, F-59000 Lille, France; Univ. Lille, F-59000 Lille, France
| | - Arnaud Jannin
- CHU Lille, Endocrinology, Diabetology and Metabolism, F-59000 Lille, France; Univ. Lille, F-59000 Lille, France
| | - Julien Bourry
- CHU Lille, Endocrinology, Diabetology and Metabolism, F-59000 Lille, France; Univ. Lille, F-59000 Lille, France
| | - Stéphanie Espiard
- CHU Lille, Endocrinology, Diabetology and Metabolism, F-59000 Lille, France; Inserm U1190, F-59000 Lille, France; Univ. Lille, F-59000 Lille, France
| | - Marie-Christine Vantyghem
- CHU Lille, Endocrinology, Diabetology and Metabolism, F-59000 Lille, France; Inserm U1190, F-59000 Lille, France; Univ. Lille, F-59000 Lille, France.
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Rare Forms of Lipomatosis: Dercum's Disease and Roch-Leri Mesosomatous Lipomatosis. J Clin Med 2021; 10:jcm10061292. [PMID: 33800991 PMCID: PMC8003963 DOI: 10.3390/jcm10061292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/16/2021] [Accepted: 03/15/2021] [Indexed: 12/13/2022] Open
Abstract
In contrast to obesity, which is very frequent, lipomatosis and lipodystrophy syndromes are rare diseases of adipose tissue. Lipodystrophy syndromes are characterized by metabolic abnormalities associated with partial or generalized lipoatrophy. Lipomatosis is defined by the presence of several body lipomas without lipoatrophy. Dercum’s disease (DD) and Roch-Leri mesosomatous lipomatosis (RLML) are rare and poorly characterized forms of lipomatosis. They have raised little clinical interest despite the non-negligible consequences of DD on quality of life. The main clinical presentation of these diseases includes multiple lipomas, which are painful in DD (in contrast to RLML). The two diseases are frequently associated with obesity and metabolic syndrome, with hypertension, diabetes, or dyslipidemia. The long-term course of the diseases remains poorly described. DD affects mainly women, whereas RLML mostly affects men. In both diseases lipomas are found on the back and thighs, as well as on the abdomen in DD and the forearms in RLML. The painful lipomas tend to recur after surgery in DD (in contrast to RLML). Most cases are sporadic. No specific treatment has been identified, as the pathophysiology remains unknown. Nevertheless, low-grade fat inflammation and specific abnormalities such as hyperbasophilia deserve further investigation. The aim of this review is to analyze the available literature on the topic.
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Mashima E, Sawada Y, Nakamura M. Recent Advancement in Atypical Lipomatous Tumor Research. Int J Mol Sci 2021; 22:994. [PMID: 33498189 PMCID: PMC7863944 DOI: 10.3390/ijms22030994] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 02/07/2023] Open
Abstract
After Evans and colleagues identified the lipomatous tumor with a well-differentiated liposarcoma in a subcutaneous location or within a muscle layer, namely, atypical lipomatous tumor (ALT), this malignancy has been investigated to clarify the characteristics of clinical behavior and genomic changes. As one of the important issues for clinicians, it is a hot topic of how to distinguish ALT from benign lipoma in the clinical aspect. Recent studies revealed novel findings to clarify the risk factor for the diagnosis of ALT and molecular targets for the treatment of ALT. Clinical characteristics of superficial-type ALT well reflect the subcutaneous location of the tumor and are slightly different compared to deep-type ALT, such as tumor size. In addition, there has been a recent discovery of novel findings in ALT-related genes, namely, HMG2A (high mobility group protein 2a), YEATS4 (YEATS domain containing 4), and CPM (Carboxypeptidase M). Recent updates on treatment for advanced ALT are well developed including immunotherapy and conducting clinical trials. Finally, this review introduces one of the hot topics of ALT research focused on epigenetic changes: their attention in recent updates on clinical characteristics and the novel discovery of related genes, treatment, and epigenetic modifications in atypical lipomatous tumors.
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Affiliation(s)
| | - Yu Sawada
- Department of Dermatology, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-Ku, Kitakyushu, Fukuoka 807-8555, Japan; (E.M.); (M.N.)
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