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Gross JM, Perret R, Coindre JM, Le Loarer F, Michal M, Michal M, Miettinen M, McCabe CE, Nair AA, Swanson AA, Thangaiah JJ, Torres-Mora J, Bonadio A, Voltaggio L, Epstein JI, Gupta S, Folpe AL, Schoolmeester JK. Lipoblastoma-Like Tumor and Fibrosarcoma-Like Lipomatous Neoplasm Represent the Same Entity: A Clinicopathologic and Molecular Genetic Study of 23 Cases Occurring in Both Men and Women at Diverse Locations. Mod Pathol 2023; 36:100246. [PMID: 37307874 PMCID: PMC10530403 DOI: 10.1016/j.modpat.2023.100246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/14/2023]
Abstract
Lipoblastoma-like tumor (LLT) is a benign soft tissue tumor demonstrating mixed morphologic features of lipoblastoma, myxoid liposarcoma, and spindle cell lipoma but lacking genetic alterations associated with those tumors. LLT was originally thought to be specific to the vulva but has since been reported in the paratesticular region. The morphologic features of LLT overlap with those of "fibrosarcoma-like lipomatous neoplasm" (FLLN), a rare, indolent adipocytic neoplasm considered by some to form part of the spectrum of atypical spindle cell and pleomorphic lipomatous tumor. We compared the morphologic, immunohistochemical, and genetic features of 23 tumors previously classified as LLT (n = 17) and FLLN (n = 6). The 23 tumors occurred in 13 women and 10 men (mean age, 42 years; range, 17 to 80 years). Eighteen (78%) cases arose in the inguinogenital region, whereas 5 tumors (22%) involved noninguinogenital soft tissue, including the flank (n = 1), shoulder (n = 1), foot (n = 1), forearm (n = 1), and chest wall (n = 1). Microscopically, the tumors were lobulated and septated, with variably collagenized fibromyxoid stroma, prominent thin-walled vessels, scattered univacuolated or bivacuolated lipoblasts, and a minor component of mature adipose tissue. Using immunohistochemistry, 5 tumors (42%) showed complete RB1 loss, with partial loss in 7 cases (58%). RNA sequencing, chromosomal microarray, and DNA next-generation sequencing study results were negative for significant alterations. There were no clinical, morphologic, immunohistochemical, or molecular genetic differences between cases previously classified as LLT or FLLN. Clinical follow-up (11 patients [48%]; range, 2-276 months; mean, 48.2 months) showed all patients were alive without disease, and only one patient had experienced a single local recurrence. We conclude that LLT and FLLN represent the same entity, for which "LLT" seems most appropriate. LLT may occur in either sex and any superficial soft tissue location. Careful morphologic study and appropriate ancillary testing should allow for the distinction of LLT from its potential mimics.
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Affiliation(s)
- John M Gross
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Raul Perret
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France; Bordeaux Institute of Oncology, Université de Bordeaux, Institut Bergonié, Bordeaux, France
| | - Jean Michel Coindre
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France; Bordeaux Institute of Oncology, Université de Bordeaux, Institut Bergonié, Bordeaux, France; University of Bordeaux, Talence, France
| | - Francois Le Loarer
- Department of Biopathology, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France; Bordeaux Institute of Oncology, Université de Bordeaux, Institut Bergonié, Bordeaux, France; University of Bordeaux, Talence, France
| | - Michael Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Michal Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Markku Miettinen
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Chantal E McCabe
- Department of Quantitative Health Sciences, Division of Computational Biology, Mayo Clinic, Rochester, Minnesota
| | - Asha A Nair
- Department of Quantitative Health Sciences, Division of Computational Biology, Mayo Clinic, Rochester, Minnesota
| | - Amy A Swanson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Judith J Thangaiah
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Jorge Torres-Mora
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Angelo Bonadio
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Lysandra Voltaggio
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jonathan I Epstein
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Aldawood Z, Al-Ibraheemi A. Lipoblastoma Arising in the Head and Neck: A Clinicopathologic Analysis of 20 Cases. Head Neck Pathol 2023; 17:768-774. [PMID: 37486535 PMCID: PMC10514009 DOI: 10.1007/s12105-023-01575-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/08/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Lipoblastomas (LPBs) are benign adipocytic neoplasms believed to recapitulate the development of embryonal fat. METHODS We investigated the clinicopathologic and immunohistochemical features of 20 lipoblastomas arising in the head and neck in 18 patients. RESULTS Patients included 6 males and 12 females (1:2 ratio) with age at diagnosis ranging from 4 months to 28 years. Tumors occurred more commonly in the neck (12, 66.7%) and less commonly in the forehead, scalp, and tongue (2, 11.1%). Tumor size ranged from 1.4 to 6.0 cm (median 5.0 cm). Two patients, a 4-month-old female and 3-year-old male, had local recurrence of neck tumors at 4 months and 3 years after excision, respectively. Microscopically, tumors had a lobulated growth pattern and consisted of adipocytes at varying stages of differentiation. In addition to the classical histologic features, lipoma-like and myxoid variants constituted 45% of cases. Metaplastic elements, including brown fat and cartilage, were identified in two cases. CONCLUSIONS LPBs arising in the head and neck region are not uncommon and occurred at a rate of 9% in our cohort. They should be kept in the differential diagnosis when a fatty tumor is encountered in an older child or occurring at an unusual location.
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Affiliation(s)
- Zahra Aldawood
- Department of Biomedical Dental Science, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam, Saudi Arabia
| | - Alyaa Al-Ibraheemi
- Department of Pathology, Children's Hospital Boston and Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
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Thway K. What’s new in adipocytic neoplasia? Histopathology 2021; 80:76-97. [DOI: 10.1111/his.14548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Khin Thway
- Sarcoma Unit Royal Marsden Hospital London UK
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4
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Chiang S. Recent advances in smooth muscle tumors with PGR and PLAG1 gene fusions and myofibroblastic uterine neoplasms. Genes Chromosomes Cancer 2020; 60:138-146. [PMID: 33230916 DOI: 10.1002/gcc.22920] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/12/2020] [Indexed: 12/11/2022] Open
Abstract
Uterine epithelioid and myxoid leiomyosarcomas and inflammatory myofibroblastic tumors are rare mesenchymal neoplasms. Next-generation sequencing recently detected novel PGR fusions in uterine epithelioid leiomyosarcomas that demonstrate characteristic rhabdoid and spindled morphology. PLAG1 gene fusions have also been identified in a subset of myxoid leiomyosarcomas and are associated with PLAG1 overexpression. ALK rearrangements underpin the vast majority of uterine inflammatory myofibroblastic tumors, which demonstrate morphologic, and immunohistochemical features similar to those of inflammatory myofibroblastic tumors elsewhere. This review summarizes the morphologic, immunophenotypic, and molecular genetic features of PGR fusion-positive epithelioid leiomyosarcoma, PLAG1 fusion-positive myxoid leiomyosarcoma, and inflammatory myofibroblastic tumors of the uterus.
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Affiliation(s)
- Sarah Chiang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Lopez-Nunez O, Alaggio R, Ranganathan S, Schmitt L, John I, Church AJ, Picarsic J. New molecular insights into the pathogenesis of lipoblastomas: clinicopathologic, immunohistochemical, and molecular analysis in pediatric cases. Hum Pathol 2020; 104:30-41. [PMID: 32692992 DOI: 10.1016/j.humpath.2020.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022]
Abstract
Lipoblastomas can occasionally require further molecular confirmation when occurring outside of the usual age groups or demonstrating unusual morphology. We reviewed 28 lipoblastomas with 16 controls. Lipoblastomas were subdivided into myxoid (n = 7), classic (n = 9), or lipoma-like (n = 12) subtypes. PLAG1 immunohistochemistry, PLAG1 fluorescence in situ hybridization (FISH), and targeted RNA sequencing were performed on formalin-fixed paraffin-embedded tissue. Karyotypes were available in a subset of lipoblastomas (n = 9). Gene rearrangements were identified in 17/25 (68%) lipoblastomas, including PLAG1 (15/25, 60%) and HMGA2 (2/25, 8%). Five novel fusion partners (DDX6, KLF10, and KANSL1L with PLAG1 and EP400 and FGD6 with HMGA2) were found. PLAG1 immunohistochemistry was positive (nuclear, moderate/strong) in myxoid and classic subtypes lipoblastomas with preferential expression in mesenchymal cells within myxoid stroma and fibrous septa and negative in all controls. When comparing PLAG1 immunohistochemistry with molecular testing (FISH and/or RNA sequencing and/or karyotype), concordant results were noted in 13/25 (52%) cases, increasing to 15/25 (60%) after slight adjustment of the PLAG1 FISH positive threshold. In myxoid and classic lipoblastomas, PLAG1 immunohistochemistry seems to be a better surrogate marker for PLAG1 rearrangement, as compared with lipoma-like subtypes. In lipoma-like subtypes, targeted RNA sequencing appears to detect PLAG1 fusions better than FISH and immunohistochemistry. The preferential expression of PLAG1 in the mesenchymal and fibroblast-like cells deserves further investigation as the putative cell of origin in lipoblastoma.
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Affiliation(s)
- Oscar Lopez-Nunez
- Department of Pathology and Laboratory Medicine, UPMC, Pittsburgh, PA, 15213, USA; Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Rita Alaggio
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA; Department of Pathology, Bambino Gesù Children's Hospital, IRCCS, Rome, 00165, Italy
| | - Sarangarajan Ranganathan
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA; Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Lori Schmitt
- Division of Pediatric Pathology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, 15224, USA
| | - Ivy John
- Department of Pathology and Laboratory Medicine, UPMC, Pittsburgh, PA, 15213, USA; Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Alanna J Church
- Department of Pathology, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Jennifer Picarsic
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA; Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.
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Novel PLAG1 Gene Rearrangement Distinguishes a Subset of Uterine Myxoid Leiomyosarcoma From Other Uterine Myxoid Mesenchymal Tumors. Am J Surg Pathol 2020; 43:382-388. [PMID: 30489320 DOI: 10.1097/pas.0000000000001196] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Genetic alterations in uterine myxoid leiomyosarcoma are unknown. We investigate the clinicopathologic features of 19 uterine tumors previously diagnosed as myxoid leiomyosarcomas in which tumoral RNA was subjected to targeted RNA sequencing. PLAG1, BCOR, BCORL1, HMGA2, and ALK break-apart fluorescence in situ hybridization (FISH) and BCOR, PLAG1, and ALK immunohistochemistry were performed in cases which failed or lacked fusions by sequencing. The diagnosis of myxoid leiomyosarcoma was confirmed in 15 cases after exclusion of 4 tumors with BCOR and ALK rearrangements. These 15 patients presented at a median age of 50 years with stage I (3), II (2), III (2), and IV (1) tumors, respectively; stage was unknown in 7 cases. Tumor size ranged from 10 to 24 cm. Matrix was myxoid in all tumors and also eosinophilic in 2. Cells were spindled, epithelioid, and both in 10, 2, and 3 tumors and showed mild, moderate, and severe nuclear atypia in 3, 8, and 4 tumors, respectively. Mitotic index ranged from <1 to 14/10 HPF, while tumor necrosis was present in 6 (40%). Novel TRPS1-PLAG1 or RAD51B-PLAG1 fusions were detected by sequencing in 4 tumors, 3 of which were also confirmed by FISH. Diffuse PLAG1 expression was seen in 7 tumors, including 4 with PLAG1 rearrangement. No morphologic differences were seen among PLAG1 fusion-positive and fusion-negative tumors. No PLAG1, HMGA2, ALK, BCOR, or BCORL1 rearrangements were detected by FISH in 11 tumors. On the basis of sequencing and FISH results, PLAG1 rearrangements resulting in PLAG1 expression underpin ~25% of myxoid leiomyosarcomas and may serve as a useful diagnostic biomarker. Immunohistochemistry, targeted RNA sequencing, and/or FISH may distinguish myxoid leiomyosarcoma from its morphologic mimics.
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Nitta Y, Miyachi M, Tomida A, Sugimoto Y, Nakagawa N, Yoshida H, Ouchi K, Tsuchiya K, Iehara T, Konishi E, Umeda K, Okamoto T, Hosoi H. Identification of a novel BOC-PLAG1 fusion gene in a case of lipoblastoma. Biochem Biophys Res Commun 2019; 512:49-52. [DOI: 10.1016/j.bbrc.2019.02.154] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 02/28/2019] [Indexed: 11/24/2022]
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Abstract
Myxoid adipocytic tumors encompass a broad heterogeneous group of benign and malignant adipocytic tumors, which are typically myxoid (e.g. myxoid liposarcoma, lipoblastoma and lipoblastoma-like tumor of the vulva) or may occasionally appear predominantly myxoid (e.g. pleomorphic liposarcoma, atypical lipomatous tumor, dedifferentiated liposarcoma, chondroid lipoma, spindle cell/pleomorphic lipoma, atypical spindle cell lipomatous tumor and atypical pleomorphic lipomatous tumor). There have been significant advances in recent years in classification and understanding the pathogenesis of adipocytic tumors, based on the correlation of histologic, immunohistochemical, and cytogenetic/molecular findings. Despite these advances, the morphologic diagnosis and accurate classification of a myxoid adipocytic tumor can be challenging due to major morphologic overlap between myxoid adipocytic and non-adipocytic tumors. This article will provide a review on the currently known morphological, immunohistochemical and molecular features of myxoid adipocytic tumors and their differential diagnosis.
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Affiliation(s)
- David Creytens
- Department of Pathology, Ghent University and Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; CRIG, Cancer Research Institute Ghent, Ghent University and Ghent University Hospital, Ghent, Belgium.
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9
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Lipoblastoma-like tumor of the vulva: a clinicopathologic, immunohistochemical, fluorescence in situ hybridization and genomic copy number profiling study of seven cases. Mod Pathol 2018; 31:1862-1868. [PMID: 29976943 DOI: 10.1038/s41379-018-0102-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/28/2018] [Accepted: 05/28/2018] [Indexed: 11/09/2022]
Abstract
Lipoblastoma-like tumor of the vulva was first described as a benign mesenchymal neoplasm of adipocytic differentiation having features of lipoblastoma, myxoid liposarcoma, and spindle cell lipoma. Prior studies of lipoblastoma-like tumor have evaluated PLAG1, HMGA2, and RB1 immunohistochemistry and DDIT3 rearrangement status, with results supporting its distinction from lipoblastoma and myxoid liposarcoma. However, absent RB1 expression was reported in a majority of tested cases, suggesting that lipoblastoma-like tumor may have underlying 13q alterations and be related to RB1-deleted soft tissue tumors. To further understand the molecular genetics of lipoblastoma-like tumor, we examined 7 cases by RB1 immunohistochemistry, DDIT3 and PLAG1 break apart FISH probes, RB1 enumeration FISH probe, and genomic copy number analysis by microarray. Patient age ranged from 21 to 56 years (median 35 years). Clinical follow up was available for 5 patients (71%) ranging 3-264 months (median 74 months). Microscopically, lipoblastoma-like tumor formed large lobules separated by thin and/or thick bands of fibrous tissue and had a prominent network of thin-walled vessels. Each tumor was predominantly composed of spindle cells and lipoblasts with variable quantities of mature adipocytes. RB1 immunohistochemistry exhibited a heterogeneous or "mosaic" pattern of weak and negative nuclear expression in all seven cases. DDIT3 and PLAG1 FISH were negative in each case. No evidence of RB1 regional gain or loss was identified by FISH. Genomic copy number analysis by chromosomal microarray showed a normal diploid profile in six tumors (86%). One tumor had copy number abnormalities consisting of an 11.9 megabase deletion from 1p13.3 to 1p11.2 and monosomy 14. Although lipoblastoma-like tumor has features of lipoblastoma, myxoid liposarcoma, and spindle cell lipoma, it is genetically different from these tumors. Furthermore, lipoblastoma-like tumor does not appear to have structural abnormalities of 13q resulting in deletion of RB1.
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10
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Hashimoto S, Kikuta K, Sekita T, Nakayama R, Takayama S, Sasaki A, Kameyama K, Nakamura M, Matsumoto M, Morioka H. A giant popliteal lipoblastoma in a 23-month-old girl: a case report. J Med Case Rep 2017; 11:338. [PMID: 29202860 PMCID: PMC5716229 DOI: 10.1186/s13256-017-1513-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 11/19/2017] [Indexed: 11/20/2022] Open
Abstract
Background Lipoblastomas are rare benign tumors that arise from embryonic white fat and almost always occur in babies and children. Here, we report a case of a giant popliteal lipoblastoma in a 23-month-old Japanese girl that was successfully treated via complete resection. Case presentation Our patient was a 23-month-old Japanese girl. At 6 months of age, she presented at a nearby hospital with a mass on the popliteal side of her lower right leg. She had no symptoms and was diagnosed as having a benign adipose tumor via magnetic resonance imaging. The mass gradually increased in size, and she was referred to our hospital at 1 year and 11 months of age. A physical examination and radiology revealed a localized mass 13 × 10 × 7 cm in size in the aforementioned area that restricted knee movement and caused proximal tibia deformity. Magnetic resonance imaging showed a giant circumscribed subcutaneous mass with multiple partitions that was hyperintense on T1-weighted and T2-weighted images but not fat-saturated on T2-weighted images. Based on these findings, she was diagnosed as having a lipoblastoma. Because the mass surrounded her popliteal artery and vein and part of the popliteal nerve, surgical resection was considered risky, and we opted to simply observe her. However, owing to rapid growth of the mass and the worsening of symptoms, she underwent complete resection at 2 years and 6 months of age. A histological examination confirmed the diagnosis of a lipoblastoma. She was discharged from our hospital 3 days after surgery with no symptoms. She could walk without pain at the 6-month follow-up, and no local recurrence was observed. Conclusions We successfully treated a giant popliteal lipoblastoma without complications by performing a total resection. Our report provides evidence that lipoblastomas should be considered for surgical resection when they progress or symptoms appear.
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Affiliation(s)
- Shogo Hashimoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, 160-8582, Tokyo, Japan
| | - Kazutaka Kikuta
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, 160-8582, Tokyo, Japan.
| | - Tetsuya Sekita
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, 160-8582, Tokyo, Japan
| | - Robert Nakayama
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, 160-8582, Tokyo, Japan
| | - Shinichiro Takayama
- Department of Orthopaedic Surgery, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, 157-8535, Tokyo, Japan
| | - Aya Sasaki
- Department of Pathology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, 160-8582, Tokyo, Japan
| | - Kaori Kameyama
- Department of Pathology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, 160-8582, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, 160-8582, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, 160-8582, Tokyo, Japan
| | - Hideo Morioka
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, 160-8582, Tokyo, Japan.,Department of Orthopaedic Surgery, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, 157-8535, Tokyo, Japan
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Fine-needle aspiration of lipoblastoma: Cytological, molecular, and clinical features. Cancer Cytopathol 2017; 125:934-939. [DOI: 10.1002/cncy.21916] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/21/2017] [Accepted: 07/31/2017] [Indexed: 12/17/2022]
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12
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Undifferentiated myxoid lipoblastoma with PLAG1-HAS2 fusion in an infant; morphologically mimicking primitive myxoid mesenchymal tumor of infancy (PMMTI)--diagnostic importance of cytogenetic and molecular testing and literature review. Cancer Genet 2015; 209:21-9. [PMID: 26701195 DOI: 10.1016/j.cancergen.2015.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 02/07/2023]
Abstract
Lipoblastoma is a benign myxoid neoplasm arising in young children that typically demonstrates adipose differentiation. It is often morphologically indistinguishable from primitive myxoid mesenchymal tumor of infancy (PMMTI), which is characterized by a well-circumscribed myxoid mass with a proliferation of primitive mesenchymal cells with mild cytologic atypia. PMMTI occurs in the first year of life and is known to have locally aggressive behavior. No specific genetic rearrangements have been reported to date. In contrast, the presence of PLAG1 (Pleomorphic Adenoma Gene 1) rearrangement is diagnostic for lipoblastoma. We hereby demonstrate the combined application of multiple approaches to tackle the diagnostic challenges of a rapidly growing neck tumor in a 3-month-old female. An incisional tumor biopsy had features of an undifferentiated, myxoid mesenchymal neoplasm mimicking PMMTI. However, tumor cells showed diffuse nuclear expression by immunohistochemical (IHC) stain. Conventional cytogenetic and fluorescence in situ hybridization (FISH) analyses as well as next generation sequencing (NGS) demonstrated evidence of PLAG1 rearrangement, confirming the diagnosis of lipoblastoma. This experience warrants that undifferentiated myxoid lipoblastoma can mimic PMMTI, and the combination of cytogenetic and molecular approaches is essential to distinguish these two myxoid neoplasms. Literature on lipoblastomas with relevant molecular and cytogenetic findings is summarized. Our case is the first lipoblastoma diagnosed with a PLAG1 fusion defined by NGS technology.
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Al-Mubarak G, Bryant AS, Crawford JH, Dukes CM, Kelly DR, Young DW, Cleveland DC. Surgical and Anesthetic Management of a Mediastinal Fatty Tumor: Lipoblastoma. Ann Thorac Surg 2015; 100:e97-8. [PMID: 26522578 DOI: 10.1016/j.athoracsur.2015.04.103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 04/20/2015] [Accepted: 04/23/2015] [Indexed: 11/18/2022]
Abstract
Lipoblastoma is a rare fatty tumor that is diagnosed almost exclusively in children. Presentation often consists of respiratory symptoms; chest computed tomography shows a hypodense, low, attenuated mediastinal mass. Surgical approach and anesthetic management are dependent on the location of the tumor and the degree of airway compression; in most cases, a thoracotomy is performed, although a sternotomy is used in selected cases. Final diagnosis can be confirmed using molecular genetic analysis; a genetic hallmark of lipoblastoma is the rearrangement of chromosomal region 8q12 and the PLAG1 gene. Tumor recurrence is rare when a complete resection is performed.
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Affiliation(s)
- Ghada Al-Mubarak
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ayesha S Bryant
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Jack H Crawford
- Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christopher M Dukes
- Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - David R Kelly
- Department of Pathology, Children's of Alabama, Birmingham, Alabama
| | - Daniel W Young
- Department of Radiology, Children's of Alabama, Birmingham, Alabama
| | - David C Cleveland
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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14
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Molecular cytogenetics of pediatric adipocytic tumors. Cancer Genet 2015; 208:469-81. [DOI: 10.1016/j.cancergen.2015.06.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/16/2015] [Accepted: 06/23/2015] [Indexed: 12/20/2022]
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15
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Shinkai T, Masumoto K, Ono K, Yano E, Kobayashi C, Fukushima T, Sumazaki R, Satomi K, Noguchi M. A case of unusual histology of infantile lipoblastoma confirmed by PLAG1 rearrangement. Surg Case Rep 2015; 1:42. [PMID: 26943407 PMCID: PMC4747941 DOI: 10.1186/s40792-015-0042-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/05/2015] [Indexed: 12/28/2022] Open
Abstract
Lipoblastoma, a relatively rare benign adipose neoplasm, predominantly affects children younger than 3 years of age. We herein report the case of a 7-month-old girl with an unusual myxomatous histology of lipoblastoma. A rapidly growing mass was detected in the subcutaneous area of the left buttock. Histologically, the tumor consisted of abundant myxoid stroma exhibiting cellular atypia and a high mitotic activity. Although the histological findings were unusual, the tumor was diagnosed as a lipoblastoma according to both PLAG1 immunohistochemistry and the presence of PLAG1 rearrangement on fluorescence in situ hybridization.
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Affiliation(s)
- Toko Shinkai
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Kouji Masumoto
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Kentaro Ono
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Eri Yano
- Department of Pediatrics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Chie Kobayashi
- Department of Pediatrics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Takashi Fukushima
- Department of Pediatrics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Ryo Sumazaki
- Department of Pediatrics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Kaishi Satomi
- Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Masayuki Noguchi
- Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
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16
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Yoshida H, Miyachi M, Ouchi K, Kuwahara Y, Tsuchiya K, Iehara T, Konishi E, Yanagisawa A, Hosoi H. Identification of COL3A1 and RAB2A as novel translocation partner genes of PLAG1 in lipoblastoma. Genes Chromosomes Cancer 2014; 53:606-11. [PMID: 24700772 DOI: 10.1002/gcc.22170] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/12/2014] [Indexed: 12/15/2022] Open
Abstract
Lipoblastoma is a rapidly growing, benign neoplasm in children. Surgical excision is usually curative, with a recurrence rate of about 20%. Because the histology of lipoblastoma is heterogeneous and overlaps with other lipomatous tumors, some lipoblastoma cases have been difficult to diagnose. The detection of PLAG1 gene rearrangement is useful for the diagnosis of lipoblastoma. Three fusion partner genes are known in relation to PLAG1 in lipoblastoma HAS2 at 8q24.1, COL1A2 at 7q22, and RAD51L1 at 14q24. Herein, we describe another two novel fusion genes in lipoblastoma tumor specimens. We checked six tumors for the presence of two known fusion genes, HAS2-PLAG1 and COL1A2-PLAG1. Only HAS2-PLAG1 was found in one of the cases. Next, we attempted to identify potential PLAG1 fusion partners using 5'RACE. Sequence analysis revealed two novel fusion genes, COL3A1-PLAG1 in three cases and RAB2A-PLAG1 in one case, respectively. As a result of the translocations, the constitutively active promoter of the partner gene drives the ectopic expression of PLAG1. We also evaluated whether a high level of PLAG1 expression can be used to help differentiate lipomatous tumors. PLAG1 expression was evaluated by real-time PCR in five lipoblastoma tumor specimens. The expressions were 70-150 times higher in lipoblastomas than in human adipocytes. However, PLAG1 expression was low in one case of lipoma. These results demonstrate that PLAG1 overexpression is a potential marker of lipoblastoma. Our findings, in agreement with previous studies, show that lipoblastoma is a group of lipomatous tumors with PLAG1 rearrangement and overexpression. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Hideki Yoshida
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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17
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Choi J, Bouron Dal Soglio D, Fortier A, Fetni R, Mathonnet G, Cournoyer S, Lallier M, Isler M, Beaulieu Bergeron M, Patey N. Diagnostic utility of molecular and cytogenetic analysis in lipoblastoma: a study of two cases and review of the literature. Histopathology 2014; 64:731-40. [DOI: 10.1111/his.12317] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 10/24/2013] [Indexed: 12/19/2022]
Affiliation(s)
- Jungah Choi
- Department of Pathology; CHU Sainte Justine; Montreal QC Canada
| | - Dorothée Bouron Dal Soglio
- Department of Pathology; CHU Sainte Justine; Montreal QC Canada
- Research Center of CHU Sainte Justine; Montreal QC Canada
- University of Montreal; Montreal QC Canada
| | - Amanda Fortier
- Department of Pathology; CHU Sainte Justine; Montreal QC Canada
| | - Raouf Fetni
- Department of Pathology; CHU Sainte Justine; Montreal QC Canada
| | | | | | - Michel Lallier
- Department of Surgery; CHU Sainte Justine; Montreal QC Canada
| | - Marc Isler
- Department of Surgery; CHU Sainte Justine; Montreal QC Canada
| | - Mélanie Beaulieu Bergeron
- Department of Genetics; Children's Hospital of Eastern Ontario; Ottawa ON Canada
- Department of Pathology and Laboratory Medicine; University of Ottawa; Ottawa ON Canada
| | - Natalie Patey
- Department of Pathology; CHU Sainte Justine; Montreal QC Canada
- Research Center of CHU Sainte Justine; Montreal QC Canada
- University of Montreal; Montreal QC Canada
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18
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Deen M, Ebrahim S, Schloff D, Mohamed AN. A novel PLAG1-RAD51L1 gene fusion resulting from a t(8;14)(q12;q24) in a case of lipoblastoma. Cancer Genet 2013; 206:233-7. [PMID: 23890983 DOI: 10.1016/j.cancergen.2013.05.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 05/23/2013] [Accepted: 05/27/2013] [Indexed: 11/29/2022]
Abstract
Lipoblastomas are rare benign tumors that arise from embryonic adipose tissue and occur predominantly in the pediatric population. Here, we report a case of lipoblastoma in an 8-month-old boy. Surgical excision and subsequent histopathologic examination were consistent with features of lipoblastoma. Chromosome analysis of the tumor revealed a clonal unbalanced t(8;14) translocation. Genomic microarray analysis of the tumor delineated the exact breakpoints at 8q12.1 and 14q24.1, which involved the PLAG1 and RADA51L1 genes, respectively. Furthermore, fluorescence in situ hybridization demonstrated that the translocation fused the PLAG1-RAD51L1 genes. These results suggest that RAD51L1 is an alternative fusion partner gene for the PLAG1 gene in a lipoblastoma with an 8q12 rearrangement.
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Affiliation(s)
- Mazin Deen
- Cytogenetic Laboratory, Department of Pathology, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA
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19
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Fallon SC, Brandt ML, Rodriguez JR, Vasudevan SA, Lopez ME, Hicks MJ, Kim ES. Cytogenetic analysis in the diagnosis and management of lipoblastomas: results from a single institution. J Surg Res 2013; 184:341-6. [PMID: 23751806 DOI: 10.1016/j.jss.2013.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 04/18/2013] [Accepted: 05/02/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lipoblastomas are rare, benign, soft tissue tumors that occur primarily in young children. Treatment includes complete excision and surveillance for recurrence. Lipoblastomas can be indistinguishable from other benign lipomatous tumors and liposarcomas. Cytogenetic analysis can provide the definitive diagnosis in questionable cases, because benign and malignant lipomatous tumors exhibit specific nonrandom cytogenetic abnormalities. The purpose of the present study was to discuss the disease management and outcomes in a large contemporary group of patients with lipoblastoma. MATERIALS AND METHODS A retrospective chart review of patients diagnosed with lipoblastoma presenting from 2000-2011 was conducted. The data from these patients were compared with data from a previously published historical group of patients (1985-1999) from the same children's hospital. RESULTS We identified 37 patients in the contemporary cohort group and compared them with 25 patients from the historical group. The tumor involvement sites were similar. The current cohort group had a lower recurrence rate, although this might have been underestimated owing to a shorter follow-up period (median 1.4 y, range 2 wk to 11.0 y). Preoperative imaging findings led to an incorrect diagnosis in 62% of the patients. Cytogenetic analysis was used to help determine the final diagnosis in 50% of the cases. In 39% of cases, translocations involved the long arm of chromosome 8, the most common anomaly in lipoblastoma. CONCLUSIONS Lipoblastomas are rare tumors in young children that can be misclassified as other malignant or benign lipomatous tumors with markedly different outcomes and treatments. We recommend that cytogenetic analysis be routinely used for all pediatric lipomatous tumors to provide an accurate diagnosis and guide appropriate therapy and follow-up.
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Affiliation(s)
- Sara C Fallon
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA
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20
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Kirkham YA, Yarbrough CM, Pippi Salle JL, Allen LM. A rare case of inguinolabial lipoblastoma in a 13-month-old female. J Pediatr Urol 2013; 9:e64-7. [PMID: 23103129 DOI: 10.1016/j.jpurol.2012.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 08/22/2012] [Indexed: 11/18/2022]
Abstract
Lipoblastoma is a rare, rapidly growing, benign mesenchymal tumor composed of various stages of maturing adipocytes that most often occurs in children under the age of 3. The common locations are the extremities and the trunk. Presentation in the genitoinguinal area is rare. We report a case of a 13-month-old female infant with a 4-month history of a progressively enlarging left labial mass that encompassed her left labium majora and inguinal region. Pelvic MRI confirmed growth from previous ultrasound size of 3 × 2 × 1 cm to 7 × 2 × 2 cm. Composition was suggestive of adipose tissue. The mass was excised through a left inguinal incision. The final pathology results described a lipoblastoma. Six year follow-up has not revealed any signs or symptoms of recurrence. Circumscribed lipoblastomas should be distinguished from their infiltrative counterpart, diffuse lipoblastoma or lipoblastomatosis, which can be more difficult to excise and thus, more likely to recur. Lipoblastoma should also be distinguished from myxoid liposarcoma, which has malignant features, carries a high risk of recurrence, and requires a more aggressive management protocol. Although rare, lipoblastoma should be considered as part of the differential diagnosis of a rapidly growing vulvar mass in prepubertal children.
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Affiliation(s)
- Yolanda A Kirkham
- Section of Pediatric and Adolescent Gynecology, Gynecology Clinic, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, Canada.
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21
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Brinkman AS, Maxfield B, Gill K, Patel NJ, Gosain A. A novel t(3;8)(p13;q21.1) translocation in a case of lipoblastoma. Pediatr Surg Int 2012; 28:737-40. [PMID: 22488564 DOI: 10.1007/s00383-012-3081-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2012] [Indexed: 12/19/2022]
Abstract
Lipoblastoma is a rare benign neoplasm of embryonic white fatty tissue primarily found in the extremities of children <3 years old (Batanian et al., Cancer Genet Cytogenet 125(1):10-13, 2001; McVay MR et al., J Pediatr Surg 41(6):1067-1071, 2006; Kamal et al., J Pediatr Surg 46(7):E9-E12, 2011). Translocations affecting the 8q11-13 region are commonly reported with lipoblastoma and proper diagnosis requires cytogenetic analysis to distinguish it from malignant myxoid liposarcoma (Miller et al., J Pediatr Surg 32(12):1771-1772, 1997; Morerio et al., Pediatr Blood Cancer 52(1):132-134, 2009). We describe an additional case of lipoblastoma containing a new translocation t(3;8)(p13;q21.1), which has not previously been reported in a healthy asymptomatic child.
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Affiliation(s)
- Adam S Brinkman
- Section of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI 53792-7375, USA.
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22
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Abstract
Adipose and myxoid tumors in children are an unusual and challenging group of neoplasms that have some unique aspects in contrast to these tumors in adults. Less than 10% of soft tissue neoplasms in the 1st 2 decades of life have an adipose phenotype and most are benign. The most common are various types of lipoma and lipoblastoma. Liposarcoma in young patients is rare and has a distinctive distribution of histologic subtypes, including classic myxoid liposarcoma, and unusual variants, such as pleomorphic-myxoid liposarcoma. Pathologic examination enhanced by adjunct techniques, such as immunohistochemistry and cytogenetic or molecular genetic studies, is useful for classification of difficult cases. Myxoid tumors can overlap with adipose tumors and are included in this review because of the morphologic similarities and importance of diagnostic accuracy. This article reviews the clinicopathologic features of adipose and myxoid tumors with an emphasis on the unique aspects of these neoplasms in children and adolescents and the differential diagnosis.
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Affiliation(s)
- Cheryl M Coffin
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, USA.
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23
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A novel t(8;13)(q21;q22) translocation in a pediatric lipoma. Cancer Genet 2011; 204:629-33. [DOI: 10.1016/j.cancergen.2011.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 10/17/2011] [Accepted: 10/19/2011] [Indexed: 11/18/2022]
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24
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Contributions of cytogenetics and molecular cytogenetics to the diagnosis of adipocytic tumors. J Biomed Biotechnol 2011; 2011:524067. [PMID: 21274402 PMCID: PMC3025394 DOI: 10.1155/2011/524067] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Accepted: 12/15/2010] [Indexed: 12/14/2022] Open
Abstract
Over the last 20 years, a number of tumor-specific chromosomal translocations and associated fusion genes have been identified for mesenchymal neoplasms including adipocytic tumors. The addition of molecular cytogenetic techniques, especially fluorescence in situ hybridization (FISH), has further enhanced the sensitivity and accuracy of detecting nonrandom chromosomal translocations and/or other rearrangements in adipocytic tumors. Indeed, most resent molecular cytogenetic analysis has demonstrated a translocation t(11;16)(q13;p13) that produces a C11orf95-MKL2 fusion gene in chondroid lipoma. Additionally, it is well recognized that supernumerary ring and/or giant rod chromosomes are characteristic for atypical lipomatous tumor/well-differentiated liposarcoma and dedifferentiated liposarcoma, and amplification of 12q13–15 involving the MDM2, CDK4, and CPM genes is shown by FISH in these tumors. Moreover, myxoid/round cell liposarcoma is characterized by a translocation t(12;16)(q13;p11) that fuses the DDIT3 and FUS genes. This paper provides an overview of the role of conventional cytogenetics and molecular cytogenetics in the diagnosis of adipocytic tumors.
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25
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Lipoma-like lipoblastoma arising from the femoral vein. J Orthop Sci 2011; 16:114-8. [PMID: 21249406 DOI: 10.1007/s00776-010-0001-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Accepted: 03/03/2010] [Indexed: 10/18/2022]
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26
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Toma R, Ferris S, Coombs CJ, Johnstone BR, McCombe DB. Lipoblastoma: An important differential diagnosis of tumours of the hand in children. J Plast Surg Hand Surg 2010; 44:257-9. [DOI: 10.3109/02844311003679653] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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28
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29
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30
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Meloni-Ehrig AM, Riggott L, Christacos NC, Mowrey PN, Johal J. A case of lipoblastoma with seven copies of chromosome 8. ACTA ACUST UNITED AC 2009; 190:49-51. [DOI: 10.1016/j.cancergencyto.2008.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Accepted: 12/01/2008] [Indexed: 11/15/2022]
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31
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Alvegård T, Hall KS, Bauer H, Rydholm A. The Scandinavian Sarcoma Group: 30 years' experience. ACTA ORTHOPAEDICA. SUPPLEMENTUM 2009; 80:1-104. [PMID: 19919379 DOI: 10.1080/17453690610046602] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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32
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Morerio C, Nozza P, Tassano E, Rosanda C, Granata C, Conte M, Panarello C. Differential diagnosis of lipoma-like lipoblastoma. Pediatr Blood Cancer 2009; 52:132-4. [PMID: 18798558 DOI: 10.1002/pbc.21747] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Lipoblastomas are rare benign tumors of white fatty tissue that occur primarily in young children. Occasionally, heterogeneity of morphological appearance and histological overlap with other lipogenic tumors are described. In such cases fluorescence in situ hybridization (FISH) analysis of PLAG1, a gene specifically rearranged in lipoblastoma, is necessary to prevent misdiagnosis. We present a case of lipoblastoma arising in an atypical site with histological features characteristic of lipoma. The correct diagnosis was made possible on cytogenetic grounds through the identification of the characteristic PLAG1-HAS2 fusion gene, thus allowing an appropriate clinical approach.
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Affiliation(s)
- Cristina Morerio
- Department of Pediatric Hematology/Oncology, Giannina Gaslini Institute, Genova, Italy
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33
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Ende L, Upton J, Richkind KE, Vargas SO. Lipoblastoma: appreciation of an expanded spectrum of disease through cytogenetic analysis. Arch Pathol Lab Med 2008; 132:1442-4. [PMID: 18788858 DOI: 10.5858/2008-132-1442-laoaes] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2008] [Indexed: 11/06/2022]
Abstract
Lipoblastomas are rare soft tissue tumors that predominantly affect the pediatric population. We describe a lipoblastoma of the right hand in a 16-month-old boy. Radiographically the tumor appeared large but fairly well circumscribed and composed primarily of fat. Pathologic evaluation revealed variably sized lobules of adipose tissue and myxoid immature mesenchymal tissue separated by prominent fibrous trabeculae. Cytogenetic analysis showed a clonal chromosomal rearrangement with a breakpoint involving chromosome 8q11.2, confirming the diagnosis of lipoblastoma and thus helping to expand the clinicopathologic spectrum of tumors in this diagnostic category.
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Affiliation(s)
- Lauren Ende
- Department of Pathology, Children's Hospital, Boston, MA 02115, USA
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34
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Speer AL, Schofield DE, Wang KS, Shin CE, Stein JE, Shaul DB, Mahour GH, Ford HR. Contemporary management of lipoblastoma. J Pediatr Surg 2008; 43:1295-300. [PMID: 18639685 DOI: 10.1016/j.jpedsurg.2007.10.068] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Revised: 10/28/2007] [Accepted: 10/30/2007] [Indexed: 11/27/2022]
Abstract
PURPOSE Lipoblastoma is a rare, benign, adipose tissue tumor. We report the largest single institution experience managing these uncommon neoplasms. METHODS We retrospectively reviewed 32 cases of lipoblastoma entered in the pathology database at our institution between January 1991 and August 2005. We conducted a comprehensive literature review of lipoblastoma and summarized the results of the largest series published. RESULTS Most patients presented with an enlarging, palpable, firm, nontender, mobile mass. The male-to-female ratio was 1.9:1. The anatomical distribution was trunk (n = 12), extremity (n = 12), groin (n = 5), and neck (n = 3). Average age at resection was 2.8 years (range, 2.6 months to 12 years). Thirty-one cases were completely excised, although 1 patient underwent staged partial excision to preserve nerve function. Chromosomal analysis performed in selected patients revealed characteristic aberrations in chromosome 8. Complications included keloid formation (n = 3), wound infection/dehiscence (n = 2), wound seroma (n = 1), and transient brachial plexus neurapraxia (n = 1). Average follow-up was 7.4 months (range, 1 day to 6.5 years); 2 patients were lost to follow-up. There were no recurrences. CONCLUSIONS A staged approach with meticulous sparing of the neurovascular bundle provides excellent functional outcome for patients with large tumors. Nonmutilating surgical excision is the treatment of choice.
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Affiliation(s)
- Allison L Speer
- Department of Surgery at the University of Southern California, Los Angeles, CA 90033, USA
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35
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Brandal P, Panagopoulos I, Bjerkehagen B, Gorunova L, Skjeldal S, Micci F, Heim S. Detection of a t(1;22)(q23;q12) translocation leading to an EWSR1-PBX1 fusion gene in a myoepithelioma. Genes Chromosomes Cancer 2008; 47:558-64. [PMID: 18383210 DOI: 10.1002/gcc.20559] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Chromosome banding as well as molecular cytogenetic methods are of great help in the diagnosis of mesenchymal tumors. Myoepithelial neoplasms of soft tissue including myoepitheliomas, mixed tumors, and parachordomas are diagnoses that have been increasingly recognized the last few years. It is still debated which neoplasms should be included in these morphologically heterogeneous entities, and the boundaries between them are not clear-cut. The pathogenetic mechanisms behind myoepithelial tumors are unknown. Only five parachordomas and one mixed tumor have previously been karyotyped, and nothing is known about their molecular genetic characteristics. We present a mesenchymal tumor classified as a myoepithelioma that had a balanced translocation t(1;22)(q23;q12) as the sole karyotypic change. A novel EWSR1-PBX1 fusion gene consisting of exons 1-8 of the 5'-end of EWSR1 and exons 5-9 of the 3'-end of PBX1 was shown to result from the translocation. Both genes are known to be targeted also by other neoplasia-specific translocations, PBX1 in acute lymphoblastic leukemia and EWSR1 in several solid tumors, most of which are malignant. Based on the structure of the novel fusion gene detected, its transforming mechanism is thought to be the same as for other fusion genes involving EWSR1 or PBX1.
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Affiliation(s)
- Petter Brandal
- Department of Oncology, Division of Cancer Medicine and Radiotherapy, The Norwegian Radium Hospital, Rikshospitalet University Hospital, Montebello, Oslo, Norway.
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36
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Bartuma H, Domanski HA, Von Steyern FV, Kullendorff CM, Mandahl N, Mertens F. Cytogenetic and molecular cytogenetic findings in lipoblastoma. ACTA ACUST UNITED AC 2008; 183:60-3. [DOI: 10.1016/j.cancergencyto.2008.01.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Revised: 01/21/2008] [Accepted: 01/28/2008] [Indexed: 10/22/2022]
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37
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Röpke A, Kalinski T, Kluba U, von Falkenhausen U, Wieacker P, Röpke M. PLAG1 activation in lipoblastoma coinciding with low-level amplification of a derivative chromosome 8 with a deletion del(8)(q13q21.2). Cytogenet Genome Res 2007; 119:33-8. [DOI: 10.1159/000109616] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 05/24/2007] [Indexed: 11/19/2022] Open
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38
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Bartuma H, Hallor KH, Panagopoulos I, Collin A, Rydholm A, Gustafson P, Bauer HCF, Brosjö O, Domanski HA, Mandahl N, Mertens F. Assessment of the clinical and molecular impact of different cytogenetic subgroups in a series of 272 lipomas with abnormal karyotype. Genes Chromosomes Cancer 2007; 46:594-606. [PMID: 17370328 DOI: 10.1002/gcc.20445] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Conventional lipomas harbor karyotypic changes that could be subdivided into four, usually mutually exclusive, categories: rearrangement, in particular through translocations, of chromosome bands 12q13-15, resulting in deregulation of the HMGA2 gene, loss of material from or rearrangement of chromosome 13, supernumerary ring or giant marker chromosomes, and aberrations of chromosome band 6p21. In the present study, 272 conventional lipomas, two-thirds of them deep-seated, with acquired clonal chromosome changes were assessed with regard to karyotypic and clinical features. A nonrandom distribution of breakpoints and imbalances could be confirmed, with 83% of the cases harboring one or more of the previously known cytogenetic hallmarks. Correlation with clinical features revealed that lipomas with rings/giant markers were larger, occurred in older patients, were more often deep-seated, and seemed to have an increased tendency to recur locally, compared with tumors with other chromosome aberrations. The possible involvement of the HMGA2 gene in cases that did not show any of the characteristic cytogenetic changes was further evaluated by locus-specific metaphase fluorescence in situ hybridization (FISH) and RT-PCR, revealing infrequent cryptic disruption of the gene but abundant expression of full length or truncated transcripts. By FISH, we could also show that breakpoints in bands 10q22-23 do not affect the MYST4 gene, whereas breakpoints in 6p21 or 8q11-12 occasionally target the HMGA1 or PLAG1 genes, respectively, also in conventional lipomas.
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Abstract
Lost-on-transformation 1 (LOT1) (PLAGL1/ZAC1) is a member of the novel subfamily of zinc-finger transcription factors, designated as PLAG family. The other members in this group include PLAG1 and PLAGL2, which share high homology with each other and with LOT1, particularly in their zinc-finger amino-terminal region. They are structurally similar but functionally different. For example, the LOT1 gene encodes a growth suppressor protein and is localized on human chromosome 6q24-25, a chromosomal region that is frequently deleted in many types of human cancers. The gene is maternally imprinted and is linked to developmental disorders such as growth retardation and transient neonatal diabetes mellitus (TNDM). LOT1 is a target of growth factor signaling pathway(s) and silenced by epigenetic mechanisms, as well as by the loss of heterozygosity in different tumor tissues. PLAG1 is a protooncogene that is localized on chromosome 8q12 and was found to be a target of several types of chromosomal rearrangement including the one identified in pleomorphic adenomas of the salivary gland. Since the discovery of the PLAG family members in 1997, much has been learned about their structure and function, as are summarized in this review. While the available data suggest that these proteins may play important roles in regulating normal physiological functions in the mammals, a great deal more about their signaling pathway(s), potential role in the complex pathologies such as cancer and developmental disorders, and functional relationship between different family members and splice variants still remains to be uncovered.
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Affiliation(s)
- Abbas Abdollahi
- Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, Pennsylvania 19122, USA.
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40
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Craver RD, Henrich S, Kao YS. Fibrous lipoblastoma with 8q11.2 abnormality. ACTA ACUST UNITED AC 2007; 171:112-4. [PMID: 17116489 DOI: 10.1016/j.cancergencyto.2006.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Revised: 06/13/2006] [Accepted: 06/16/2006] [Indexed: 11/28/2022]
Abstract
A 3-month-old African American female infant had a rapidly growing lipoblastoma with a prominent fibrous component in the soft tissue of the left lateral knee, which recurred at 10 months. Cytogenetic analysis revealed deletion of 8(q11.2q13) with a 19(q12q13.3) insertion at that site, confirming that this is closely related to the conventional lipoblastoma. The presence of multivacuolated lipoblasts and the staining characteristics (no staining for CD99, CD34, or smooth muscle actin) distinguish this from the recently described lipofibromatosis.
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MESH Headings
- Chromosome Aberrations
- Chromosome Deletion
- Chromosomes, Human, Pair 19
- Chromosomes, Human, Pair 8
- Female
- Humans
- Infant
- Knee
- Neoplasm Recurrence, Local/genetics
- Neoplasms, Adipose Tissue/genetics
- Neoplasms, Adipose Tissue/pathology
- Neoplasms, Fibrous Tissue/genetics
- Neoplasms, Fibrous Tissue/pathology
- Translocation, Genetic
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Affiliation(s)
- Randall D Craver
- Department of Pathology, Louisiana State University Health Science Center, New Orleans, LA 70112, USA.
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Moholkar S, Sebire NJ, Roebuck DJ. Radiological-pathological correlation in lipoblastoma and lipoblastomatosis. Pediatr Radiol 2006; 36:851-6. [PMID: 16775739 DOI: 10.1007/s00247-006-0175-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Accepted: 03/12/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Lipoblastoma and lipoblastomatosis are uncommon benign mesenchymal lesions that predominantly occur in infancy and early childhood. OBJECTIVE To evaluate the imaging and histological features of lipoblastoma and lipoblastomatosis. MATERIALS AND METHODS Retrospective review of the radiological and pathological findings in children with lipoblastoma and lipoblastomatosis treated at a single centre between 1997 and 2004. RESULTS Eight children (median age 18 months) had undergone imaging and surgery at our institution. An infiltrative growth pattern was identified at imaging in two children with lipoblastomatosis, and a well-defined mass in six children with lipoblastoma. In all patients, imaging showed a lesion composed mostly, but not entirely, of fat. There were no recurrences at follow-up of between 1 and 91 months. CONCLUSION In infancy and early childhood, the identification of a tumour composed mostly of fat should suggest the diagnosis of lipoblastoma or lipoblastomatosis.
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Affiliation(s)
- Shruti Moholkar
- Department of Radiology, Great Ormond Street Hospital, London, WC1N 3JH, UK
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