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Fine needle aspiration biopsy of well-differentiated liposarcoma of the neck in a young female. A case report.

BACKGROUND: Well-differentiated liposarcomas are low grade, nonmetastasizing, malignant neoplasms composed primarily of mature adipose tissue. They are uncommon in the head and neck. CASE: A 24-year-old female presented to the ears, nose and throat clinic for evaluation of a recent, rapidly growing neck mass on the right side. Fine needle aspiration (FNA) biopsy of the mass showed that the smears had fragments of connective tissue with a mixture of mature-appearing fat traversed by bands of fibrous collagen and vessels. Nuclei within the fat and fibrous bands were mildly irregular, hyperchromatic and enlarged, with one or two small nucleoli. Infrequently present but readily identified, lipoblasts were scattered throughout the aspirate smears. A diagnosis of "atypical lipomatous neoplasm" was rendered. Subsequently, the mass was surgically removed. On histologic examination, the tumor was a well-differentiated liposarcoma. CONCLUSION: FNA biopsy of well-differentiated liposarcomas in the head and neck can present difficulties in the classification and diagnosis of this neoplasm.

Adult↗

Electron microscopy in the diagnosis of liposarcoma and fibrosarcoma of the larynx.

Electron microscopy (EM) was useful in establishing the final diagnosis in specific instances of liposarcoma and fibrosarcoma of the larynx. In the first case light microscopy revealed cells that met the histologic criteria of a low grade liposarcoma; EM revealed cells that displayed a varied ultrastructural differentiation; thus the tumor was classified as a mixed mesenchymal tumor rather than liposarcoma per se. In the second case, pathologic evaluation indicated a grade 2 fibrosarcoma. EM revealed malignant mesenchymal cells that closely recapitulated normal fibroblasts (no epithelial differentiation was present). This kind of information enables more accurate determination of the source of the primary lesion than results of light microcsopy alone.

Diagnosis, Differential↗

Liposarcoma of the colon: a case report.

A 52-year-old woman presented with abdominal pain and hematochezia. A colonoscopy showed a polypoid mass in the descending colon. A left hemicolectomy revealed a well-differentiated liposarcoma forming a polypoid intraluminal mass and an ill-defined nodule in the adjacent mesocolon. She remained well 2 years later. A review of the literature revealed only 2 reported cases of colonic liposarcoma, 1 of the myxoid type, and the other of the pleomorphic type. Two other possible cases of well-differentiated liposarcoma of the colon were uncovered from the literature.

Abdominal Pain↗

Well-differentiated liposarcoma of the epiglottis.

Liposarcomas of the larynx are very rare. A review of the English literature revealed only 28 published reports of tumours in this anatomical location. Diagnosis requires a high index of suspicion and careful histologic analysis. We present a case of a well-differentiated liposarcoma of the epiglottis, the tenth reported case at this laryngeal subsite. Initial biopsy specimens showed histological characteristics of a liposarcoma, which facilitated provision of optimal surgical treatment after careful analysis of published literature.

Epiglottis↗

Liposarcoma of the retropharyngeal space.

Liposarcoma is a common soft tissue malignancy that occurs infrequently in the head and neck. Liposarcoma of the retropharynx is exceptionally rare, only four cases being described in the literature. We present a case in which retropharyngeal liposarcoma occurred in a patient who had had multiple previous subcutaneous lipomas excised. This paper explores this very unusual presentation and discusses the difficulties in the diagnosis and management of this rare tumour.

Acute Disease↗

Paraffinoma in anterior abdominal wall mimicking liposarcoma.

Paraffinoma of breast is a recognized complication of paraffin injection for breast augmentation. Liquid paraffin can extend along fascial planes to involve adjacent tissues. A rare case of paraffinoma in anterior abdominal wall, which was misdiagnosed as a soft tissue liposarcoma before surgical excision, is reported. It was heterogeneous with marked posterior acoustic shadowing and small peripheral cysts on ultrasound. On MRI, it had ill-defined margins and was heterogeneous in signal intensity. Small round components which were hypointense on all sequences were demonstrated. There is significant overlapping of imaging features between paraffinoma and soft tissue liposarcoma. Histological differentiation from well-differentiated liposarcoma may also be difficult. A detailed clinical history of previous paraffin injection for breast augmentation is very important for correct interpretation of imaging and histopathological findings.

Abdominal Wall↗

Lipoma and liposarcoma of the parotid gland: high-resolution preoperative imaging diagnosis.

Over the past 7 years, nine fatty tumors within the parotid gland have been managed (eight lipomas, one liposarcoma). High-resolution computed tomography examination was carried out in all cases; with correct preoperative diagnosis recorded each time. The computed tomography imaging characteristics of lipoma, liposarcoma, and the differential diagnosis from other fat density lesions, such as a fatty infiltration, appear quite specific. The liposarcoma and six of the lipomas were resected at formal parotidectomy with facial nerve preservation. Two patients with small intraglandular lipomas have elected to undergo long-term clinical and imaging observation. Our experience indicates that high-resolution, soft-tissue imaging with computed tomography and magnetic resonance imaging permits consistent preoperative fatty tumor diagnosis. This imaging input facilitates rational treatment decision-making.

Absorptiometry, Photon↗

Liposarcoma in adult limbs treated by limb-sparing surgery and adjuvant radiotherapy.

Between December 1995 and March 2003, 38 adult patients with intermediate or high-grade liposarcoma in a limb were treated by limb-sparing surgery and post-operative radiotherapy. The ten-year local recurrence-free survival was 83%, the ten-year metastasis-free survival 61%, the ten-year disease-free survival 51% and the ten-year overall survival 67%. Analysis of failure and success showed no association with the age of the patients, gender, the location of the primary tumour, the type of liposarcoma and the quality of resection. Our results indicate that liposarcoma may recur even ten years after the end of definitive therapy and may spread to unexpected sites as for soft-tissue sarcoma.

Adolescent↗

Liposarcoma of the posterior mediastinum in a child.

Liposarcoma is rare in children and rarely occurs in the posterior mediastinum in any age group. A massive intrathoracic tumor in a 17-year-old young man was a diagnostic dilemma; preoperative radiographic evaluation and biopsy led us to believe it was a teratoma. At operation, a poorly differentiated myxoid liposarcoma originating from the posterior mediastinum was found and excised. To our knowledge, this is the first liposarcoma of the posterior mediastinum reported in a patient less than 18 years old.

Adolescent↗

Myxoid liposarcoma of the supraclavicular fossa.

Liposarcomas generally originate most often in the extremities or retroperitoneum, less frequently in the head and neck, and rarely in the thorax. We describe a particularly rare presentation of myxoid liposarcoma originating in the supraclavicular fossa. The mass was resected and has not recurred. We searched our pathology database for other soft-tissue tumors of the supraclavicular fossa and found no other case of sarcoma originating in this site. In addition, we performed a literature review of thoracic and neck liposarcomas to identify similar cases and discuss their clinical course.

Aged↗

Renal liposarcoma.

INTRODUCTION: Liposarcoma is a malignant mesenchymal tumor frequently located in retroperitoneum, and rarely presenting an isolated lesion in kidney. CASE REPORT: Female, Caucasian, 49-year old patient, with family history of renal polycystic disease, was selected for organ donation. During preoperative examinations a renal pleomorphic liposarcoma was detected. She was treated with radical nephrectomy and remains asymptomatic, without evidences of recurrence in control ecographic examinations after a 4-year follow-up. COMMENTS: Renal liposarcoma is a rare tumor. We report one case incidentally diagnosed during a routine pre-transplantation assessment in renal donor.

Female↗

Combination chemotherapy in retroperitoneal poorly differentiated myxoid liposarcoma: a report of a case.

We describe a case of a 47-year-old man with retroperitoneal poorly differentiated myxoid liposarcoma. The retroperitoneal invasion of the sarcoma caused hydroureter-nephrosis, rectal stenosis and also exaggerated steroid induced diabetes mellitus. A remarkable regression was achieved by systemic combination of chemotherapy with prednisolone, cyclophosphamide, vincristine sulfate and actinomycin D. This combination chemotherapy is worth trying if a patient has inoperable liposarcoma. It can also be used to reduce local recurrence rate after surgical or radiation therapy, or both, against liposarcoma.

Antineoplastic Agents↗

A well-differentiated liposarcoma co-existent with leiomyoma.

BACKGROUND: The coexistence of a well-differentiated liposarcoma (atypical lipomatous tumor) and benign smooth muscle component in a single soft tissue neoplasm is extremely rare. CASE REPORT: Histologic and immunohistochemical characteristics of tumor, which represented the recurrence of a retroperitoneal atypical lipoma in a 50-year-old female patient are presented in this paper. The tumor represented the recurrence of a retroperitoneal atypical lipoma. Lipomatous component consisted of a mixture of lipoma-like and sclerosing variant of well-differentiated liposarcoma. Characteristically, the heterologous smooth muscle differentiation was manifested as a macroscopically visible nodular growth in the form of a leiomyoma within the adipocytic component. It consisted of intersecting fascicles of spindle cells, which lacked mitoses and significant atypia, and were immunopositive for smooth muscle markers. CONCLUSION: This case of well-differentiated liposarcoma with benign smooth muscle is the first reported tumor of retroperitoneal localization. It is also the first one to exhibit the heterologous smooth muscle component as a distinct leiomyoma.

Female↗

Liposarcomas in dogs: 56 cases (1989-2000).

OBJECTIVE: To determine the biological behavior of liposarcomas in dogs and identify clinical signs, the effect of treatment on survival time, and potential prognostic factors. DESIGN: Retrospective study. ANIMALS: 56 dogs with histologically confirmed liposarcoma. PROCEDURE: Information was obtained on signalment, tumor size, location of the tumor, stage of disease, remission duration, overall survival time, cause of death, type of surgery (incisional biopsy, marginal excision, or wide excision), and any additional treatments given. RESULTS: Surgery consisted of incisional biopsy in 6 dogs, marginal excision in 34, and wide excision in 16. Twenty-five dogs had histologic evidence of tumor cells at the surgical margins and 28 did not (status of the margins was unknown in 3 dogs). Twelve of 43 dogs had local recurrence. Median survival time was 694 days, and the only factor significantly associated with survival time was type of surgery performed. Median survival times were 1,188, 649, and 183 days, respectively, for dogs that underwent wide excision, marginal excision, and incisional biopsy. Factors that were not found to be significantly associated with survival time included tumor size, status of the margins, tumor location, and histologic subtype. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that in dogs, liposarcomas are locally invasive neoplasms that rarely metastasize and occur primarily in appendicular or axial locations and that wide excision is preferred to marginal excision when feasible.

Animals↗

A case of multifocal liposarcoma?

A 53-year-old man presented with a grade 2 liposarcoma in his left thigh and grade III liposarcomas in the mediastinum and omentum. Later, a grade 2 tumor was discovered in the musculature of his right thigh. In addition to recurrences, he developed lesions that were considered metastatic. He died 3 years later of multiple lesions. The case may represent a multifocal liposarcoma, which has been previously reported in only 35 cases.

Abdominal Neoplasms↗

[Telomere lengths and telomerase activity in liposarcomas].

We measured telomerase activity in 36 malignant and seven benign lipomatous neoplasias from 34 patients to assess the role of telomerase in the development of liposarcoma. The sensitive PCR-based telomerase assay (telomeric repeat amplification protocol-TRAP) was applied. We correlated telomerase activity with the shortening or elongation of telomeric repeat fragment length (TRF), measured by using hybridization with a telomere specific oligonucleotide probe. Telomerase activity was demonstrated in 69% of malignant tumors. This information may be helpful in distinguishing benign tumors from malignant neoplasias. Telomerase expression, however, seems to be characteristic of poorly differentiated liposarcomas. Telomerase activity was not correlated with age at the time of diagnosis or with sex. We observed that telomerase expressing tumors had higher proliferation indices than neoplasias lacking telomerase. Telomerase activity was observed in all eight recurrences, suggesting a close association of telomerase with the biologic behavior of liposarcomas. Therefore, we assume that telomerase plays a key role in the establishment and progression of lipomatous tumors.

Humans↗

Liposarcoma: a review of current diagnosis and management.

Liposarcoma is an uncommon sarcoma. Its presentation can be deceptive, varying from innocuous to frank malignancy. Liposarcoma behaves differently from other sarcomas. This article highlights the key prognostic factors of liposarcoma, based on current literature, and suggests a plan of management.

Female↗

Liposarcoma of the hypopharynx. A case report and review of the literature.

A new case of well differentiated hypopharyngeal liposarcoma is reported. The author reviews the literature about the clinical and histologic features of these tumors. From the 93 head and neck liposarcomas reported 13 are located in the hypopharynx. The mean age of presentation is 61 years and males are largely predominant. Etiology is still unknown. Tumor size does not seem to affect the prognosis. Usually patients do not present with cervical lymph node metastasis nor distant metastasis. Histologic diagnosis according to Enzinger and Weis's classification could be difficult especially to distinguish between lipoma and well differentiated liposarcoma. The main prognostic factor is histologic grade but early recognition combined with a complete surgical excision can result in a decreased local recurrence rate and high survival rate. Low grade tumors often recur locally but distant metastases are rare. From the 8 well differentiated tumors reviewed 6 presented a local recurrence 2 months to 20 years after surgery but only 1 patient died without disease. High grade tumors are much more aggressive locally and metastasize frequently. Radiotherapy and chemotherapy are proposed in selected cases without evidence to be of value.

Humans↗