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Almuhammadi GA, Alzughaibi RA, Ishqi RZ, Aboualkheir M, Allama AM. A Case Report of Primary Mediastinal Liposarcoma: A Rare Mediastinal Tumor. Cureus 2024; 16:e66293. [PMID: 39238675 PMCID: PMC11376471 DOI: 10.7759/cureus.66293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2024] [Indexed: 09/07/2024] Open
Abstract
Liposarcomas account for about 20% of all sarcomas among mesenchymal neoplasms. Myxomatous liposarcoma is a rare mediastinal tumor that seems the same as other lung disorders. The most common presenting symptoms are chest pain, dyspnea, and dysphagia. Most of the diagnostic findings are provided by radiological or postoperative histopathological tests. Surgery and chemotherapy, in some cases, are the basis of treatment. People with this condition have a higher probability of a favorable outcome if they receive an early diagnosis and treatment. We present a case of a 48-year-old male with primary mediastinal liposarcoma. The patient complained of chest pain and shortness of breath with a productive cough. Computed tomography (CT) showed a large right cystic mass on the right lower thoracic cavity. Surgery was done, and a histopathological examination of the surgical specimen confirmed the diagnosis.
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Affiliation(s)
| | | | - Raha Z Ishqi
- Collage of Medicine, Taibah University, Madinah, SAU
| | - Mervat Aboualkheir
- Department of Radiology and Medical Imaging, Taibah University, Madinah, SAU
| | - Amr M Allama
- Department of Thoracic Surgery, King Fahad General Hospital, Madinah, SAU
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2
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Rao J, Zhu Q, Yang X. Giant primary liposarcoma of the mediastinum: A case report and review of the literature. SAGE Open Med Case Rep 2023; 11:2050313X231206031. [PMID: 37860286 PMCID: PMC10583509 DOI: 10.1177/2050313x231206031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023] Open
Abstract
Liposarcoma is a carcinomatous mesenchymal tumor with various histologic features and is the most common soft tissue sarcoma originating in adipose tissue. Liposarcoma commonly occurs in the lower extremities and retroperitoneum but rarely in the mediastinum, specially extending into the thoracic cavity. We report a giant primary liposarcoma of the posterior mediastinum in a 63-year-old female who complained of cough, sputum, and pain in the right chest wall. A computed tomography scan of the chest showed a giant mass of 24 × 15 × 24 cm in the posterior mediastinum of the right thoracic cavity. After a thorough examination, no suspected lipomatous lesions were found elsewhere in the patient's body. The patient underwent a thoracotomy to remove the mediastinal mass through a right thoracic approach. Subsequently, hematoxylin-eosin staining revealed dedifferentiated liposarcoma (DDL), immunohistochemistry showed positive expression of cyclin-dependent kinase 4, and murine double minute 2 (MDM2), in addition, fluorescence in situ hybridization for the MDM2 gene was also positive, which suggested DDL. The patient was discharged without any complications, and no metastasis or recurrence was observed after 19 months of follow-up. To provide a reference for clinical diagnosis and treatment, we reviewed and discussed the literature on primary liposarcoma of the mediastinum.
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Affiliation(s)
- Jingjing Rao
- Department of Laboratory, Shiyan Maternal and Child Health Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
| | - Qingling Zhu
- Department of Internal Medicine, Yicheng Hospital of Traditional Chinese Medicine, Xiangyang, Hubei, P.R. China
| | - Xuejiao Yang
- Department of Laboratory, Shiyan Maternal and Child Health Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
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3
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Bokhari SA, Haseeb S, Baig MW, Qamar P, Bangash HH, Manzoor ZB, Khan HAB, Kaleem M, Munir S, Haseeb S. Myxomatous Liposarcoma of the Mediastinum: A Review of the Literature. Cureus 2022; 14:e28438. [PMID: 36176865 PMCID: PMC9512315 DOI: 10.7759/cureus.28438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/12/2022] Open
Abstract
Myxomatous liposarcoma is an extremely rare type of mediastinal tumour that manifests in a manner comparable to other lung pathologies. Chest pain, shortness of breath, and dysphagia are the common presenting complaints. Radiological examinations or postoperative histological examinations provide the majority of the diagnostic evidence. The cornerstone of therapy consists of surgery and sometimes chemotherapy. Those who are afflicted have a better chance of experiencing favourable outcomes if they receive a diagnosis and treatment quickly.
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Tuzzato G, Laranga R, Ostetto F, Bubbico E, Vara G, Bianchi G. Primary High-Grade Myxoid Liposarcoma of the Extremities: Prognostic Factors and Metastatic Pattern. Cancers (Basel) 2022; 14:cancers14112657. [PMID: 35681637 PMCID: PMC9179419 DOI: 10.3390/cancers14112657] [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: 03/27/2022] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: This retrospective study aimed to analyze the history and treatment outcomes of localized, high-grade MLS of the extremities. (2) Methods: We retrospectively reviewed 82 patients with primary high-grade MLS of the extremities. OS, LRFS, MFS, PRS, and DFS were analyzed. (3) Results: Five-year OS and LRS were 96% (95% CI: 86-98) and 94% (95% CI: 85-98), respectively. Statistical analysis indicated no risk factors for OS and LFRS. MFS was 77% (65-85) at 5-year follow-up. Size (p = 0.0337) was the only risk factor statistically significant for MFS (HR = 0.248, 95% CI: 0.07-0.84). Median PRS after distant metastasis was 34 months (range: 1-127 months). Five-year PRS was 79% (48-93). Overall, the 5-year DFS was 76% (65-85). (4) Conclusions: Patients with MLS were found to have a good prognosis. In high-grade deep-seated tumors, common risk factors for MLS do not correlate with survival. Tumor size appears to be the only predictor of long-term DSF and MSF.
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Affiliation(s)
- Gianmarco Tuzzato
- Unit of 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (G.T.); (F.O.); (E.B.); (G.B.)
| | - Roberta Laranga
- Unit of 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (G.T.); (F.O.); (E.B.); (G.B.)
- Correspondence:
| | - Federico Ostetto
- Unit of 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (G.T.); (F.O.); (E.B.); (G.B.)
| | - Elisa Bubbico
- Unit of 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (G.T.); (F.O.); (E.B.); (G.B.)
| | - Giulio Vara
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy;
| | - Giuseppe Bianchi
- Unit of 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (G.T.); (F.O.); (E.B.); (G.B.)
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5
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Tfayli Y, Baydoun A, Naja AS, Saghieh S. Management of myxoid liposarcoma of the extremity. Oncol Lett 2021; 22:596. [PMID: 34188698 PMCID: PMC8228380 DOI: 10.3892/ol.2021.12857] [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: 01/21/2021] [Accepted: 04/15/2021] [Indexed: 11/18/2022] Open
Abstract
Myxoid liposarcoma (MLPS) is the second most common type of LPS after the well differentiated LPS. MLPS is primarily localized to the extremities. The incidence of LPS is ~2 per million worldwide. MLPS accounts for ~30% of all LPS cases. MLPS is usually encountered in adults, but can also occur in younger individuals more than other types of LPS. MLPS can be divided into low- and high-grade subtypes, which present with differences in patient prognosis and outcome. Methods of tumor management include surgery, radiotherapy and chemotherapy; however, there is no unified treatment based on tumor characteristics alone. The present manuscript reviews the surgical management, radiotherapeutic and chemotherapeutic approaches reported in the literature for different types of MLPS in the extremities, as well as the post-treatment outcomes. In addition, the present review provides an evidence-based management plan for MLPS in the form of an organogram based on specific tumor and patient parameters.
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Affiliation(s)
- Yehia Tfayli
- Division of Orthopedic Surgery, Department of Surgery, American University of Beirut Medical Center, 11-0236 Beirut, Lebanon
| | - Ahmad Baydoun
- Department of Surgery, Saint George Hospital University Medical Center, University of Balamand, 11-0236 Beirut, Lebanon
| | - Ahmad Salaheddine Naja
- Division of Orthopedic Surgery, Department of Surgery, American University of Beirut Medical Center, 11-0236 Beirut, Lebanon
| | - Said Saghieh
- Division of Orthopedic Surgery, Department of Surgery, American University of Beirut Medical Center, 11-0236 Beirut, Lebanon
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Wang S, Zhou Y, Wang H, Ling J. Survival analysis and treatment strategies for limb liposarcoma patients with metastasis at presentation. Medicine (Baltimore) 2021; 100:e25296. [PMID: 33787618 PMCID: PMC8021344 DOI: 10.1097/md.0000000000025296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/05/2021] [Indexed: 01/04/2023] Open
Abstract
Limited data exist on patients with limb liposarcoma (LLS) with metastasis at presentation Moreover, the potential prognostic factors of this patient population are poorly documented because of its rarity. Therefore, we conducted this study to evaluate the clinicopathologic characteristics and prognostic factors for patients with metastatic LLS.All patients with LLS with metastasis at presentation from 1975 to 2016 were identified by using the Surveillance, Epidemiology, and End Results (SEER) database. The following clinical data were derived from this clinical database: age, sex, histologic grade, subtype, size of tumor, surgery, radiotherapy, chemotherapy, vital status, cause of death, and survival duration. The Kaplan-Meier method was performed to calculate median survival time and draw survivorship curves. Cox-proportional hazards regression model was used to reveal the statistical independence between various variables.The present study collected 184 cases from SEER database for survival analysis. Mean age was 57.8 years with 63.6% (n = 117) men. The 3-year overall survival (OS) and cancer-specific survival (CSS) rates of this population were 27.8% and 30.1%, respectively. Univariate analysis revealed that age, tumor grade, and surgery were significantly correlated with survival. Sex and tumor size did not reach significant predictor status of survival. Multivariate analysis revealed that age at diagnosis <60, low tumor grade, and local surgery were significantly correlated with improved OS and CSS.Patients with LLS with metastasis at diagnosis experienced quite poor prognosis. Currently, surgery for the primary tumor significantly prolonged the survival of those patients, whereas chemotherapy and radiotherapy need to be further confirmed.
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Affiliation(s)
- Shicheng Wang
- Department of Orthopedics, Ningbo No. 6 Hospital, Ningbo
| | - Yuanxi Zhou
- Department of Orthopedics, Health Community Group of Yuhuan Second People's Hospital, Yuhuan
| | - Haifeng Wang
- Department of Orthopedics, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Jing Ling
- Department of Orthopedics, Ningbo No. 6 Hospital, Ningbo
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Jeon HM, Lee JS, Kim SH, Yun KH, Park KH, Jeon MK, Lee YH, Yoon HI, Suh JS, Hur H, Kim KS, Kim S, Kim SH, Kim HS. Comprehensive Immuno-Molecular Profiles for Liposarcoma: Roles of Programmed Death Ligand 1, Microsatellite Instability, and PIK3CA. Oncology 2020; 98:817-826. [PMID: 32892196 DOI: 10.1159/000509004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Developing personalized strategies for cancer has shown good efficacies. METHODS We assessed the molecular targets programmed death ligand 1 (PD-L1), microsatellite instability (MSI), and PIK3CA. Seventy-four patients with liposarcomas who underwent curative resection were assessed for PD-L1 expression in the tumor and tumor-infiltrating lymphocytes (TILs), mismatch repair proteins (MLH1, PMS2, MSH2, and MSH6) by immunohistochemistry, MSI using polymerase chain reaction, and PIK3CA mutation/amplification using pyrosequencing and fluorescence in situ hybridization. RESULTS Seventeen (23%) cases were TIL+ (≥1 + expression) and associated with longer 5-year overall survival than those with TIL- tumors (84.4 vs. 60.8%, p = 0.007). Six (35.3%) PD-L1+ tumors were detected only in TIL+ cases, with none detected in tumor cells. Two well-differentiated liposarcomas showed MSI, one low and one high with concurrent loss of MLH1, MSH6, and PMS2. PIK3CA mutation was detected in 7 (9.5%) [exon 9 (n = 4) and exon 20 (n = 3)] and only 1 Q546K mutation was a PD-L1+ tumor. PIK3CA copy number gain was detected in 18 (24.4%) and was associated with TIL+ tumors (p = 0.045). CONCLUSIONS Our comprehensive immuno-molecular panel suggests that liposarcoma should be categorized based on the molecular genomic subtype for precision medicine.
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Affiliation(s)
- Hyae Min Jeon
- Pathology Center, Seegene Medical Foundation, Seoul, Republic of Korea
| | - Jae Seok Lee
- Department of Pathology, Sungkyunkwan University School of Medicine, Samsung Changwon Hospital, Changwon, Republic of Korea
| | - Soo Hee Kim
- Pathology Center, Seegene Medical Foundation, Seoul, Republic of Korea
| | - Kum-Hee Yun
- Yonsei Song-Dang Institute for Cancer Research, Yonsei University Health System, Seoul, Republic of Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyu Hyun Park
- Yonsei Song-Dang Institute for Cancer Research, Yonsei University Health System, Seoul, Republic of Korea
| | - Min Kyung Jeon
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Han Lee
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Suck Suh
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyuk Hur
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Sik Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sunghoon Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyun Kim
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo Song Kim
- Yonsei Song-Dang Institute for Cancer Research, Yonsei University Health System, Seoul, Republic of Korea, .,Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea,
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Iwamoto N, Matsuura Y, Ninomiya H, Ichinose J, Nakao M, Ishikawa Y, Okumura S, Mun M. An extremely rare case of rapidly growing mediastinal well-differentiated liposarcoma with a sclerosing variant: a case report. Surg Case Rep 2020; 6:158. [PMID: 32621145 PMCID: PMC7334334 DOI: 10.1186/s40792-020-00928-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/26/2020] [Indexed: 12/24/2022] Open
Abstract
Background Liposarcoma arising from the mediastinum is rare, accounting for less than 1% of mediastinal tumors. Furthermore, a rapidly growing well-differentiated liposarcoma is extremely rare. A well-differentiated liposarcoma is usually considered a low-grade malignancy. However, we present an extremely rare case of a sclerosing variant of well-differentiated liposarcoma that grew rapidly within a year. Case presentation A 77-year-old man with a giant mass in the left thoracic cavity was referred to our hospital. This mass measured about 10 cm and occupied the left-sided mediastinum on a chest radiography; however, there was no abnormal finding on the previous year’s chest radiography. Chest-enhanced computed tomography revealed a well-circumscribed 11-cm mass in the left-sided anterior mediastinum. Positron emission tomography showed accumulation of fluorodeoxyglucose uptake in this tumor (maximum standard uptake value = 3.3). The radiological findings of computed tomography and positron emission tomography indicated that this tumor was a benign or low-grade malignancy; therefore, the chest radiographic findings were difficult to explain. To explain this discrepancy and establish the diagnosis, tumor resection was performed via left posterolateral thoracotomy. Intraoperatively, the left phrenic nerve and pericardium were adhered tightly to the tumor, so we resected them. The tumor was well-circumscribed and fibrous; therefore, the initial diagnosis was solitary fibrous tumor. However, based on its histopathological and immunohistochemical patterns, the tumor was diagnosed as a sclerosing variant of well-differentiated liposarcoma. Five years postoperatively, the patient remains alive with no evidence of disease recurrence. Conclusions A well-differentiated liposarcoma is usually considered a low-grade malignancy. Nevertheless, the giant tumor in the present case appeared within 1 year. Thus, this was an extremely rare case of a sclerosing variant of well-differentiated liposarcoma with rapid growth.
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Affiliation(s)
- Naoya Iwamoto
- Department of Thoracic Surgical Oncology, the Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yosuke Matsuura
- Department of Thoracic Surgical Oncology, the Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Hironori Ninomiya
- Division of Pathology, the Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junji Ichinose
- Department of Thoracic Surgical Oncology, the Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masayuki Nakao
- Department of Thoracic Surgical Oncology, the Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yuichi Ishikawa
- Division of Pathology, the Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, the Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, the Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Horowitz J, Singhal M, Marrero D, Bashjawish F, Leto D, Winters M, Jeberaeel J. A Multi-Modality Treatment of Retroperitoneal De-Differentiated Liposarcoma. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e919245. [PMID: 32115569 PMCID: PMC7070895 DOI: 10.12659/ajcr.919245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Retroperitoneal sarcomas are rare tumors, only affecting 2 to 5 people per million population and accounting for 0.1% of all malignancies. Liposarcoma is the most common of all retroperitoneal sarcomas, responsible for approximately 20% of all sarcomas in adults. The most important prognostic factors are tumor grade, the presence of positive margins, tumor integrity, and degree of resection. CASE REPORT Our patient was a 73-year-old man with abdominal pain whose CT scan of the abdomen and pelvis demonstrated a 15×15 cm heterogeneous, left-sided intra-abdominal mass. He underwent resection of the retroperitoneal tumor, left colectomy, and left nephrectomy. Final pathology demonstrated a high-grade, de-differentiated liposarcoma with a rhabdosarcomatous component. The postoperative course was complicated by a small intra-abdominal abscess and abdominal dehiscence. a CT scan after surgery showed a residual tumor of the retroperitoneal posterior margin. Re-exploration to resect the residual tumor and repair the fascial dehiscence were performed. The patient underwent an initial chemotherapy regimen with doxorubicin, then moved to targeted therapy with Palbociclib, and is now on chemotherapy using Eribulin. CONCLUSIONS Achieving complete resection and the grade of the tumor at diagnosis are the 2 most important prognostic factors for patient survival in retroperitoneal liposarcoma, as survival rates are inversely proportional to the grade of the tumor. Even with the best resection attempts, there is always a risk of residual tumor cells within the tumor bed, which contribute to recurrence and need for additional surgical interventions. It is important to approach this disease process with a multidisciplinary team that includes surgical, medical, and radiation oncology to ensure the best survival outcomes. Retroperitoneal sarcoma recurrence and survival are directly related to the ability to achieve negative margins of resection, as well as the grade and size of the primary tumor. Adjuvant therapies that include radiation and immunotherapy may be effective in treating recurrent disease.
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Affiliation(s)
- Joel Horowitz
- Department of Oncological Surgery, Cape Fear Valley Hospital, Fayetteville, NC, USA
| | - Mayank Singhal
- Department of Internal Medicine, Cape Fear Valley Hospital, Fayetteville, NC, USA
| | - Dana Marrero
- Department of Internal Medicine, Cape Fear Valley Hospital, Fayetteville, NC, USA
| | - Fuad Bashjawish
- Department of Internal Medicine, Cape Fear Valley Hospital, Fayetteville, NC, USA
| | - Dezarae Leto
- Department of General Surgery, Cape Fear Valley Hospital, Fayetteville, NC, USA
| | - Maryselle Winters
- Department of General Surgery, Cape Fear Valley Hospital, Fayetteville, NC, USA
| | - Julian Jeberaeel
- Campbell School of Osteopathic Medicine, Cape Fear Valley Hospital, Fayetteville, NC, USA
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Lali BS, Kini H, Chakraborti S, Kini J, Suresh PK. Analysis of Dedifferentiated Liposarcomas Emphasizing the Diagnostic Dilemmas. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_129_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Introduction: Dedifferentiated liposarcoma (DDLPS) is defined as a progression of well-differentiated liposarcoma (WDLPS) to another nonlipogenic sarcoma. Since a variety of heterologous sarcomas can be encountered in dedifferentiation, clinical dilemmas arise. The present study analyzed the role of clinicopathologic and immunohistochemical (IHC) features in the diagnosis of DDLPS and its differentiation from mimics. Materials and Methods: A retrospective and prospective study was conducted wherein all cases of liposarcoma from 2012 to 2017 were reviewed. DDLPS cases were identified among pleomorphic lesions. Clinical and histopathological details for these cases were retrieved from medical records section and department archives. Histomorphology and immunohistochemistry (MDM2, S100, and Ki-67) were analyzed for these cases. Results: Among 37 cases of liposarcomas reviewed, DDLPS was diagnosed in 12 cases (32.4%). Mean age of the patients was 54.3 years with equal gender distribution (M:F =1:1.2). Two patients had recurrent tumors. Most were retroperitoneal (58.3%) with mean duration of symptoms being 8.7 months. Mean tumor dimension was 17.5 cm. High-grade dedifferentiated component was most common (83.3%) with only one case each (8.3%) of low-grade and homologous dedifferentiation. Undifferentiated pleomorphic sarcoma was the frequent nonlipogenic sarcoma. MDM2 overexpression was detected in 100%, focal S100 positivity seen in 66.6%, and mean Ki-67 labeling index was 24. Conclusion: DDLPS exhibits aggressive clinical behavior. Adequate sampling, correlation to clinical details, demonstration of transition from WDLPS to DDLPS aid in narrowing the differentials. Immunostaining with MDM2 helps in definite categorization and S100 highlights lipoblasts, when they are not easily identifiable. MDM2, CDK4, and p16 IHC panel is recommended in all cases and fluorescence in situ hybridization analysis where IHC is noncontributory.
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Affiliation(s)
- Bhagat Singh Lali
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Hema Kini
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Shrijeet Chakraborti
- Department of Cellular Pathology, Leighton Hospital, Mid Cheshire NHS Foundation Trust Hospitals, Crewe, England
| | - Jyoti Kini
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Pooja K Suresh
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
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11
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Zhang M, Zhang S, Shi H, Li W, Wei Z. Resection of a huge mediastinal well-differentiated liposarcoma involving left thoracic cavity. J Cardiothorac Surg 2019; 14:148. [PMID: 31387607 PMCID: PMC6683434 DOI: 10.1186/s13019-019-0965-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 07/16/2019] [Indexed: 11/18/2022] Open
Abstract
Background Mediastinal lipoma/liposarcoma is a rare tumor of the mediastinum. Case presentation This article reported one case of giant anterior superior mediastinum well-differentiated liposarcoma involving the left thoracic cavity with symptom of dysphagia. The mediastinum liposarcoma was completely resected through a left thoracotomy. Histologic examination and molecular pathological test clarified the diagnosis as well-differentiated mediastinal liposarcoma. There has been no evidence of recurrence during the 8 months follow-up. Conclusion Molecular pathological examination of the MDM2, CDK4 and p16 gene in tumors provides the diagnostic gold standard in distinguishing well-differentiated liposarcoma from lipoma. Complete surgical resection is the first-line treatment choice for mediastinal lipoma/ liposarcoma.
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Affiliation(s)
- Ming Zhang
- Department of Cardiothoracic Surgery, Shengzhou Renmin Hospital, Shaoxing, 312400, China
| | - Shaoqin Zhang
- Department of Cardiothoracic Surgery, Shengzhou Renmin Hospital, Shaoxing, 312400, China
| | - Hao Shi
- Department of Cardiothoracic Surgery, Shengzhou Renmin Hospital, Shaoxing, 312400, China
| | - Weidong Li
- Department of Cardiothoracic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China.
| | - Zhengliang Wei
- Department of Cardiothoracic Surgery, Shengzhou Renmin Hospital, Shaoxing, 312400, China.
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12
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Hashimoto S, Arai J, Nishimuta M, Matsumoto H, Fukuoka H, Muraoka M, Nakashima M, Yamaguchi H. Resection of liposarcoma of the greater omentum: A case report and literature review. Int J Surg Case Rep 2019; 61:20-25. [PMID: 31306901 PMCID: PMC6626973 DOI: 10.1016/j.ijscr.2019.06.067] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Liposarcoma usually occurs in the retroperitoneum and limbs. Liposarcoma of the greater omentum is rare, and most information of such liposarcomas has come from case reports. PRESENTATION OF CASE A 60-year-old woman was found to have an 8-cm intra-abdominal mass (suspected lipoma) by computed tomography. At the age of 63 years, she underwent a medical examination and a mass was palpated in the abdomen. Contrast-enhanced computed tomography and magnetic resonance imaging confirmed the presence of a huge intra-abdominal tumor with the omental artery passing through the mass. The tumor was simply resected. Histopathologically, the tumor was diagnosed as a well-differentiated liposarcoma, and the resection margin was microscopically negative. The patient had developed no recurrence or complications 9 months postoperatively. DISCUSSION Liposarcoma of the greater omentum is rare, and differentiation of liposarcoma from other tumors is challenging. Adjuvant therapy has not been established as an effective treatment, and radical (R0) resection of the tumor is recommended. Our case of liposarcoma of the greater omentum was surgically managed with good outcomes. CONCLUSION The diagnosis of liposarcoma with a lipomatous tumor is challenging, and resection should be considered for huge intra-abdominal lipomatous tumors.
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Affiliation(s)
- Shintaro Hashimoto
- Department of Surgery, Japan Community Health care Organization (JCHO), Isahaya General Hospital, Japan.
| | - Junichi Arai
- Department of Surgery, Japan Community Health care Organization (JCHO), Isahaya General Hospital, Japan.
| | - Masato Nishimuta
- Department of Surgery, Japan Community Health care Organization (JCHO), Isahaya General Hospital, Japan.
| | - Hirofumi Matsumoto
- Department of Surgery, Japan Community Health care Organization (JCHO), Isahaya General Hospital, Japan.
| | - Hidetoshi Fukuoka
- Department of Surgery, Japan Community Health care Organization (JCHO), Isahaya General Hospital, Japan.
| | - Masashi Muraoka
- Department of Surgery, Japan Community Health care Organization (JCHO), Isahaya General Hospital, Japan.
| | - Masahiro Nakashima
- Department of Pathology, Japan Community Health care Organization (JCHO), Isahaya General Hospital, Japan.
| | - Hiroyuki Yamaguchi
- Department of Surgery, Japan Community Health care Organization (JCHO), Isahaya General Hospital, Japan.
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Wu J, Qian S, Jin L. Prognostic factors of patients with extremity myxoid liposarcomas after surgery. J Orthop Surg Res 2019; 14:90. [PMID: 30922351 PMCID: PMC6438008 DOI: 10.1186/s13018-019-1120-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 03/06/2019] [Indexed: 12/22/2022] Open
Abstract
Background Extremity myxoid liposarcoma (MLS) is a rare soft tissue sarcoma in adults. We performed this study to define distinctive clinical features of extremity MLS by assessing prognostic factors. Methods Between 1973 and 2015, 1756 patients with extremity MLS who underwent surgical resection were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database of the US National Cancer Institute. Both overall survival (OS) and cancer-specific survival (CSS) were assessed using the Kaplan–Meier method (to obtain OS and CSS curves) and a Cox proportional hazards regression model. Results Of the 1756 patients with extremity MLS, the mean and median patient age at diagnosis were 47 and 45 years, respectively. More than half (n = 1027, 58.5%) of the patients were male. In terms of location, 10.5% tumors were located in the upper limbs and 89.5% in lower limbs. All patients received local surgery, and about half of the patients (57.2%) received radiation treatment. The 5- and 10-year OS rates of the entire cohort were 86.4% and 75.9%, respectively. The 5- and 10-year CSS rates were 90.5% and 85.2%, respectively. On multivariate analysis, older age, male gender, high tumor grade, and tumor size > 10 cm were found to be independent risk factors of both decreased OS and CSS. Year of diagnosis ≥ year 2000 was significantly associated with an increased CSS. In addition, radiation treatment failed to become an independent risk factor for either OS or CSS. Conclusion We identified age, gender, tumor grade, year of diagnosis, and tumor size as independent prognostic factors for OS and CSS in patients with extremity MLS.
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Affiliation(s)
- Jiaqi Wu
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310000, Zhejiang, People's Republic of China
| | - Shengjun Qian
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310000, Zhejiang, People's Republic of China
| | - Libin Jin
- Department of Orthopaedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310000, Zhejiang, People's Republic of China.
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14
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Luo P, Cai W, Yang L, Chen S, Wu Z, Chen Y, Zhang R, Shi Y, Yan W, Wang C. Prognostic significance of pretreatment lymphocyte/monocyte ratio in retroperitoneal liposarcoma patients after radical resection. Cancer Manag Res 2018; 10:4727-4734. [PMID: 30425569 PMCID: PMC6201845 DOI: 10.2147/cmar.s171602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The aim of this study was to evaluate the prognostic value of pretreatment inflammatory biomarkers in retroperitoneal liposarcoma (RPLS) patients after radical resection. Patients and methods One hundred patients with RPLS who underwent radical resection between September 2004 and October 2010 at Fudan University Shanghai Cancer Center were included in this study. Laboratory tests of peripheral blood were sampled before surgery. The optimal cutoff values of systemic inflammatory markers were defined by receiver-operating curve analyses. Curves of disease-free survival (DFS) and overall survival (OS) were obtained by the Kaplan-Meier method. Cox proportional hazards regression modeling was used to perform univariate and multivariate analyses. Results The median follow-up time was 53 months. The median DFS and OS were 27 and 86 months, respectively. On the basis of the optimal cutoff value of 3, 24 patients were classified into low lymphocyte/monocyte ratio (LMR) group and 76 patients into high LMR group. In univariate analysis, low LMR group had significantly shorter DFS (P<0.001) and OS (P<0.001) compared to high LMR group. In multivariate analysis, low LMR was demonstrated as an independent negative prognostic factor for both DFS (HR=2.854, 95% CI=1.392-5.851, P=0.004) and OS (HR=3.897, 95% CI=1.681-9.033, P=0.002). Conclusion Pretreatment LMR is a useful prognostic marker in RPLS patients after radical resection.
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Affiliation(s)
- Peng Luo
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Weiluo Cai
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Lingge Yang
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Shiqi Chen
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Zhiqiang Wu
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Yong Chen
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Ruming Zhang
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Yingqiang Shi
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Wangjun Yan
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Chunmeng Wang
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
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15
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Luo P, Cai W, Yang L, Wu Z, Chen Y, Zhang R, Yan W, Shi Y, Wang C. Retroperitoneal dedifferentiated liposarcoma: Analysis of 61 cases from a large institution. J Cancer 2018; 9:3831-3838. [PMID: 30410585 PMCID: PMC6218781 DOI: 10.7150/jca.25715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 07/20/2018] [Indexed: 01/13/2023] Open
Abstract
Background: To describe the clinical features of retroperitoneal dedifferentiated liposarcoma (RP DDLS) and further evaluate the prognostic factors. Methods: The clinicopathological variables and treatment strategies of 61 RP DDLS patients who underwent surgical resections at a single institution between September 2005 and September 2016 were reviewed. Kaplan-Meier and Cox regression methods were conducted for survival analyses. Results: The average patients' age was 52 years (range, 27-81), and there was almost no gender predilection (30 males vs. 31 females). 51 (83.6%) patients got gross tumor resections (R0/R1 resection), and the median tumor size was 19 cm (range, 4.3-50 cm). 39(63.9%) patients were with intermediate-grade sarcoma and 22(36.1%) were with high-grade sarcoma. The median intraoperative blood loss was 400 ml (range, 50-2700ml). 19 (31.1%) patients presented multifocal diseases. Tumors were removed intactly in 42 (68.9%) patients. In order to obtain gross tumor resections, 33 (54.1%) of the patients underwent excisions of at least one adjacent organ, of which kidney (n=21, 63.6%) was the most common one. 6 (9.8%) patients developed distant metastases during follow-up. The overall 5-year progression-free survival (PFS) rate was 3.7%, with the median PFS of 19 months. The 5-year overall survival (OS) rate was 43.5%, with the median OS of 58 months. Updating to November 2017, 30 (49.2%) patients remained alive. The median follow-up time was 49 months. Multivariate analysis using Cox proportional hazards model revealed that tumor grade, blood loss, resection extent, and tumor integrity were independently associated with OS (p=0.032, p=0.018, p=0.020, p=0.005, respectively). Tumor grade, tumor integrity and multifocality were significant predictors for PFS (p=0.013, p=0.080, p=0.009, p=0.028, respectively). Conclusion: Intermediate-grade histology, intraoperative blood loss < 400 ml, complete tumor resection, and tumor integrity were independently associated with better OS. Intermediate-grade histology, tumor integrity and unifocal disease independently predicted favorable PFS.
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Affiliation(s)
- Peng Luo
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weiluo Cai
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lingge Yang
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhiqiang Wu
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yong Chen
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ruming Zhang
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wangjun Yan
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yingqiang Shi
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chunmeng Wang
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Abstract
RATIONALE Liposarcoma is a cancerous mesenchymal tumor and the most common soft-tissue sarcoma that starts in the adipose tissue. Liposarcoma is commonly found in lower extremities and retroperitoneum, but rarely occurs in the mediastinum. PATIENT CONCERNS A 63-year-old male was referred to our clinic with a 6-month history of chronic cough and dyspnea. DIAGNOSE Chest x-rays demonstrated a large mass occupying the left hemithorax. Contrast-enhanced computed tomography (CT) revealed a large mass in the anterior mediastinum, which caused the extrinsic compression of the main and left pulmonary artery and the right shift of mediastinum. Diagnosis of liposarcoma was confirmed by microscopic examination and immunohistochemistry analysis. INTERVENTIONS The patient underwent a thoracotomy for resection of the mediastinal lesion via left thoracic approach. OUTCOMES The patient discharged without any complications and has been continuing to follow up in clinic without any complaints. LESSONS The primary mediastinal liposarcoma is rare, and we recommend that the liposarcoma should be considered in the differential diagnosis of a patient presenting with a mediastinal mass.
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Affiliation(s)
- Yu-Shang Yang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan
- Department of Thoracic Surgery, Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Cheng-Yun Bai
- Department of Thoracic Surgery, Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Zhong-Cheng Li
- Department of Thoracic Surgery, Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Wen-Jun Li
- Department of Thoracic Surgery, Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Yong Li
- Department of Thoracic Surgery, Affiliated Hospital of Qinghai University, Xining, Qinghai, China
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17
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Willburger JCF, Kettelhack C, Fuchs B, Schaefer DJ, Osinga R. Giant myxoid liposarcoma of the gluteal region: case report of patient caused delay of surgical treatment and review of the literature. J Surg Case Rep 2018; 2018:rjy265. [PMID: 30310650 PMCID: PMC6174623 DOI: 10.1093/jscr/rjy265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/05/2018] [Accepted: 09/18/2018] [Indexed: 11/21/2022] Open
Abstract
Although adult soft tissue sarcoma is a rare disease, it needs individual treatment by an experienced, interdisciplinary team. We present an exceptional case of a 36-year-old woman suffering from a giant intermediate grade myxoid liposarcoma of the left buttock. She had been seen 4 years earlier but refused to undergo any treatment by then. Now suffering from a foul, ulcerating and superinfected tumor she agreed to surgical treatment. Despite delay, treatment could be performed according to the most up to date sarcoma guidelines which are discussed, including a brief review of the literature.
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Affiliation(s)
- Johanna C F Willburger
- Department of General Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Christoph Kettelhack
- Department of General Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Bruno Fuchs
- Center for Bone and Soft Tissue Sarcoma UZH, University of Zürich, Forchstrasse 340, CH-8008 Zürich, Switzerland
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Rik Osinga
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
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18
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Salduz A, Alpan B, Valiyev N, Özmen E, İribaş A, Ağaoğlu F, Bayram A, Bilgiç B, Özger H. Neoadjuvant radiotherapy for myxoid liposarcomas: Oncologic outcomes and histopathologic correlations. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:355-361. [PMID: 28869066 PMCID: PMC6197565 DOI: 10.1016/j.aott.2017.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 12/30/2016] [Accepted: 01/31/2017] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the histopathological features of primary extremity myxoid liposarcoma before and after neoadjuvant radiation therapy, and to evaluate the oncological outcomes of the patients. METHODS The study included 23 patients (16 men and 7 women with a mean age of 43 (24-69) years) with primary myxoid liposarcoma of the extremities, who were treated between January 1998 and December 2015. Inclusion criteria were histopathological confirmation of the diagnosis with both the initial biopsy and the resection specimen, and having undergone neoadjuvant radiotherapy. Demographic, clinical and histopathological data were evaluated. RESULTS Over a mean follow-up time of 55.2 (8-139) months, 5 patients (21.7%) died secondary to disease progression, leaving 18 patients (78.3%) still alive at the time of last follow-up. Only one patient (4%) experienced local recurrence and six (26%) patients developed distant metastases. Disease-free survival at 5 and 10 years were 66%; whereas, overall patient survival at 5 and 10 years were 78.1% and 71.0%, respectively. Tumor size (>15 cm) and presence of metastasis were significantly associated with increased overall mortality. On histopathology, necrosis was present in 12/23 resection specimens. Hyalinization/fibrosis and residual viable tumor was present in all specimens. Adipocytic maturation/cytodifferentiation was seen in 8/23 patients. CONCLUSION Neoadjuvant radiotherapy was effective for myxoid liposarcomas histopathologically, although these histopathological features did not affect the patients' oncological outcomes. Favorable oncological outcomes were obtained with neoadjuvant radiotherapy, surgical resection and chemotherapy. LEVEL OF EVIDENCE Level IV, therapeutic study.
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19
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Edagawa M, Haratake N, Shimamatsu S, Toyozawa R, Nosaki K, Hirai F, Yamaguchi M, Taguchi K, Kaneko K, Seto T, Takenoyama M, Ichinose Y. Surgical resection of a well-differentiated inflammatory liposarcoma of the middle mediastinum: a case report. J Thorac Dis 2017; 9:E689-E693. [PMID: 28932587 DOI: 10.21037/jtd.2017.07.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Liposarcomas are the most common type of mesenchymal neoplasm in soft tissue sarcomas. Although they frequently develop at the lower limbs or retroperitoneum, cases arising from the mediastinum are rare. Furthermore, the incidence of the inflammatory subtype of well-differentiated liposarcoma is known to be low. We experienced a case of a middle mediastinal liposarcoma in a 68-year-old woman. The tumor, which was completely resected, was 92 mm in diameter. The tumor consisted of two different imaging components that showed different growth and which were diagnosed as the lipoma-like subtype and inflammatory subtype of well-differentiated liposarcoma. To the best of our knowledge, this is the first report of a well-differentiated inflammatory liposarcoma arising from the middle mediastinum.
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Affiliation(s)
- Makoto Edagawa
- Department of Thoracic Oncology, Institute for Clinical Research, National Kyushu Cancer Center, Fukuoka, Japan
| | - Naoki Haratake
- Department of Thoracic Oncology, Institute for Clinical Research, National Kyushu Cancer Center, Fukuoka, Japan
| | - Shinichiro Shimamatsu
- Department of Thoracic Oncology, Institute for Clinical Research, National Kyushu Cancer Center, Fukuoka, Japan
| | - Ryo Toyozawa
- Department of Thoracic Oncology, Institute for Clinical Research, National Kyushu Cancer Center, Fukuoka, Japan
| | - Kaname Nosaki
- Department of Thoracic Oncology, Institute for Clinical Research, National Kyushu Cancer Center, Fukuoka, Japan
| | - Fumihiko Hirai
- Department of Thoracic Oncology, Institute for Clinical Research, National Kyushu Cancer Center, Fukuoka, Japan
| | - Masafumi Yamaguchi
- Department of Thoracic Oncology, Institute for Clinical Research, National Kyushu Cancer Center, Fukuoka, Japan
| | - Kenichi Taguchi
- Cancer Pathology Laboratory, Institute for Clinical Research, National Kyushu Cancer Center, Fukuoka, Japan
| | - Koichiro Kaneko
- PET Imaging Diagnostic Center, Fukuoka Central General Medical Examination Center, Fukuoka, Japan
| | - Takashi Seto
- Department of Thoracic Oncology, Institute for Clinical Research, National Kyushu Cancer Center, Fukuoka, Japan
| | - Mitsuhiro Takenoyama
- Department of Thoracic Oncology, Institute for Clinical Research, National Kyushu Cancer Center, Fukuoka, Japan
| | - Yukito Ichinose
- Department of Thoracic Oncology, Institute for Clinical Research, National Kyushu Cancer Center, Fukuoka, Japan
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20
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Prognostic factors and outcome of Liposarcoma patients: a retrospective evaluation over 15 years. BMC Cancer 2017; 17:410. [PMID: 28606068 PMCID: PMC5469180 DOI: 10.1186/s12885-017-3398-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 06/01/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Soft tissue sarcomas are rare entities with over 50 histological subtypes. Liposarcoma (LS) is the most common neoplasm in this group; it is a complex neoplasm that is divided into different histological subtypes. Different therapy options, such as surgical resection, radiation, and chemotherapy, are available. Depending on the subtype, location, status of the resection margins and metastatic status, different therapy options are used. Therefore, the aim of this study was to determine the prognostic factors influencing the survival of patients affected by LS with consideration for the grading, histological subtype, state of the resection margin, size, location, metastases and local recurrence in a retrospective, single-centre analysis over 15 years. METHODS We included 133 patients (male/female = 67/66) in this study. We recorded the histologic subtype, grade, TNM classification, localization, biopsy technique, tumour margins, number of operations, complications, radiation and dose, chemotherapy, survival, recrudescence, metastases and follow-up. Survivorship analysis was performed. RESULTS We detected 56 (43%; 95%-CI 34.6-51.6%) atypical LS cases, 21 (16.2%; 95%-CI 9.8-22.5) dedifferentiated LS cases, 40 (30.8%; 95%-CI 22.8-38.7) myxoid LS cases and 12 (9.2%; 95%-CI 4.3-14.2) pleomorphic LS cases. G1 was the most common grade, which was followed by G3. Negative margins (R0) were detected in 67 cases (53.6%; 95%-CI 44.9-62.3) after surgical resection. Local recurrence was detected in 23.6% of cases. The presence of metastases and dedifferentiated LS subtype as well as negative margins, grade and tumour size are significant prognostic factors of the survival rates (p < 0.015). CONCLUSION Grading, LS subtype, negative margins after surgery, metastases and tumour size are independently associated with disease-specific survival, and patients with local recurrence had lower survival rates. We hope our investigation may facilitate a further prospective study and clinical decision-making in LS.
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21
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Nieder C, Norum J, Hintz M, Grosu AL. Short Survival Time after Palliative whole Brain Radiotherapy: Can We Predict Potential Overtreatment by Use of a Nomogram? J Cancer 2017; 8:1525-1529. [PMID: 28775771 PMCID: PMC5535707 DOI: 10.7150/jca.18600] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/04/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Many patients with brain metastases undergoing whole brain radiotherapy (WBRT) have very limited survival. The purpose of this study was to validate a nomogram derived from a large American database and to examine its ability to better predict short survival (cut-off 2 months) than previous models. MATERIAL AND METHODS This retrospective study included 254 European patients treated with primary WBRT. In addition, an exploratory analysis of patients managed with best supportive care (BSC) was performed too. RESULTS Median survival after WBRT was 3.0 months. The median nomogram point sum was 122 (range 31-212). The nomogram-predicted median survival for a patient with 122 points is 3.3 months. Despite the nomogram's ability to stratify the patients into different prognostic groups, the survival curves of patients with intermediate point sum in the range of 90-139 points were largely superimposable. The poorest prognostic group with ≥180 points had a median and maximum survival of 1.8 and 4.6 months, respectively. Among these 18 patients (7%) 9 survived for less than and 9 for more than 2 months. Comparable survival outcomes were observed after BSC in a smaller group of 8 patients with ≥180 points. CONCLUSIONS Because of several differences between the original and validation findings, the nomogram should be examined in additional large databases. Its ability to predict poor survival is promising and possibly comparable to our previously published models. The final goal of developing a validated model that allows poor prognosis patients to safely forego WBRT without compromising survival or quality of life requires further research efforts.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, 8092 Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, 9037 Tromsø, Norway
| | - Jan Norum
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, 9037 Tromsø, Norway.,Northern Norway Regional Health Authority trust, 8038 Bodø, Norway
| | - Mandy Hintz
- Department of Radiation Oncology, University Hospital Freiburg, 79106 Freiburg, Germany
| | - Anca L Grosu
- Department of Radiation Oncology, University Hospital Freiburg, 79106 Freiburg, Germany.,German Cancer Consortium (DKTK), Freiburg, and German Cancer Research Centre (DKFZ), D-69121 Heidelberg, Germany
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22
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Patel RB, Li T, Liao Z, Jaldeepbhai JA, Perera HAPNV, Muthukuda SK, Dhirubhai DH, Singh V, Du X, Yang J. Recent translational research into targeted therapy for liposarcoma. Stem Cell Investig 2017; 4:21. [PMID: 28447036 DOI: 10.21037/sci.2017.02.09] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/19/2017] [Indexed: 12/18/2022]
Abstract
Liposarcomas (LPS) are among the most common soft tissue sarcomas, originating from adipocytes. Treatment for LPS typically involves surgical resection and radiation therapy, while the use of conventional cytotoxic chemotherapy for unresectable or metastatic LPS remains controversial. This review summarizes the results of recent translational research and trials of novel therapies targeting various genetic and molecular aberrations in different subtypes of LPS. Genetic aberrations such as the 12q13-15 amplicon, genetic amplification of MDM2, CDK4, TOP2A, PTK7, and CHEK1, point mutations in CTNNB1, CDH1, FBXW7, and EPHA1, as the fusion of FUS-DDIT3/EWSR1-DDIT3 are involved in the pathogenesis LPS and represent potential therapeutic candidates. Tyrosine kinase inhibitors targeting MET, AXL, IGF1R, EGFR, VEGFR2, PDGFR-β and Aurora kinase are effective in certain types of LPS. Abnormalities in the PI3K/Akt signaling pathway deregulation of C/EBP-α and its partner PPAR-γ, and the interaction between calreticulin (CRT) and CD47 are also promising therapeutic targets. These promising new approaches may help to supplement existing treatments for LPS.
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Affiliation(s)
- Rashi Bharat Patel
- International Medical School, Tianjin Medical University, Tianjin 300061, China.,Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Ting Li
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Zhichao Liao
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Jivani Aakash Jaldeepbhai
- International Medical School, Tianjin Medical University, Tianjin 300061, China.,Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - H A Pavanika N V Perera
- International Medical School, Tianjin Medical University, Tianjin 300061, China.,Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Sujani Kaushalya Muthukuda
- International Medical School, Tianjin Medical University, Tianjin 300061, China.,Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Dholiya Hardeep Dhirubhai
- International Medical School, Tianjin Medical University, Tianjin 300061, China.,Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Vaibhav Singh
- International Medical School, Tianjin Medical University, Tianjin 300061, China.,Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
| | - Xiaoling Du
- Department of Diagnostics, Tianjin Medical University, Tianjin 300061, China
| | - Jilong Yang
- International Medical School, Tianjin Medical University, Tianjin 300061, China.,Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
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