Liposarcoma of the perineum

Unusual bilateral vulvar liposarcoma

Liposarcoma of vulva is a rare malignant tumor. Only fifteen cases of vulvar liposarcoma have been reported in English literature. Because of extreme rarity of vulvar liposarcoma, it is initially misdiagnosed as benign tumor such as lipoma. This paper aims to present a unique case of liposarcoma of bilateral vulvae with a review of the literature of previously reported cases.

Soft-tissue tumours of the perineum

AIM

Primary perineal tumours in adults are rare entities that have been infrequently reported (one clinical series of nine patients with sarcoma and isolated case reports). We present our experience of perineal tumours better to characterize and define the natural history of this condition.

METHODS

Perineal tumours occurring in adults (>18 years) from January 1990 were identified from the Royal Marsden Hospital's Sarcoma Unit prospective database.

RESULTS

Nineteen perineal soft-tissue tumours (12 malignant and seven benign) were evaluated and treated at the Royal Marsden Hospital during this period. Liposarcoma (n=3) and aggressive angiomyxoma (n=4) were the most frequent histological subtypes. Three malignant and four benign tumours were larger than 10 cm. Most tumours were located deep to the deep fascia. Local recurrence in those with sarcoma occurred in one of five patients with negative microscopic margins and in one of two patients who had positive microscopic margins. One patient each with aggressive angiomyxoma and fibromatosis recurred locally.

CONCLUSION

Aggressive treatment in the form of wide local excision is associated with fewer local recurrences in adults with primary perineal soft-tissue tumours. The aim of surgical treatment should be to obtain negative resection margins without causing disturbance to urinary or anorectal function.

Lipoblastoma-like tumour of the vulva: report of three cases of a distinctive mesenchymal neoplasm of adipocytic differentiation

AIMS

We sought to delineate and describe three cases of a distinctive mesenchymal neoplasm of the vulva showing adipocytic differentiation and affecting young patients.

METHODS AND RESULTS

In three patients between 13 and 38 years of age, the vulvar tumours had well-circumscribed borders and ranged in size from 35 to 100 mm. Histologically, they were well circumscribed and lobulated. The lobules were separated by thin fibroconnective tissue septa and were composed of slender spindle cells showing slightly eosinophilic cytoplasm with indistinct boundaries, uniform nuclei with finely granular chromatin, and no nucleoli. The cells were embedded in a richly myxoid stroma. The background in all three tumours was a 'chicken-wire', capillary vascular network resembling that seen in myxoid liposarcomas. Two tumours had scattered signet-ring-type lipoblasts and the third a large number of such lipoblasts. Clusters of mature adipocytes were entrapped in the tumours. None had mitotic figures, necrosis, or pleomorphism. The neoplastic cells stained positively for vimentin and were negative for other immunohistochemical markers. Treatment for all three tumours was enucleation alone. After follow-up of 10 years, 7 years, and 1 year, all patients are well with no evidence of disease.

CONCLUSIONS

The benign behaviour of these neoplasms militates against the diagnosis of liposarcoma. We believe these are benign lesions of adipocytic differentiation akin to infantile lipoblastomas.

Radiotherapy for liposarcoma of the vulva

BACKGROUND

Primary liposarcoma of the vulva is extremely rare. We report a case of liposarcoma of the vulva which was treated with local excision and postoperative radiotherapy.

CASE

A 21-year-old woman complained of a painless lump in her labium majus which she first noticed 3 years earlier. An initial diagnosis of lipoma of the vulva was made. The patient was treated by surgical removal. On examination of the surgical specimen, the final pathological diagnosis was well-differentiated liposarcoma and the stalk was not excised completely. Radiotherapy was initiated because of the uncertainty of the patient's prognosis. Eighteen months after radiotherapy, no evidence of local recurrence, metastasis, and late complication has been seen.

CONCLUSION

This case is suggestive of the contribution of postoperative radiotherapy, although not conclusive, and continued monitoring is necessary because recurrence or metastasis can occur years later.

Liposarcoma of the perineum and scrotum

A case of liposarcoma of the perineum and scrotum, which presented as a huge haematoma and was left in place for three years prior to excision, is presented. The patient was treated by wide excision of the tumour, orchiopexy to the inguinal region and radiotherapy. To date, 30 months following surgery, the patient is completely asymptomatic and no tumour recurrence is evident either on physical and rectal examinations or on chest X-rays, ultrasonography and abdominal and pelvic computerized tomography.

Perineal liposarcoma: diagnosis and management

Perineal liposarcoma is excessively rare. Its clinical and pathological behavior can only be predicted by comparison with the behavior of liposarcoma in other parts of the body. We describe the management of a man who presented with symptoms related to bladder outlet obstruction and was found to have a prostatic mass on digital examination of the rectum. A needle biopsy was performed and the tissue was histologically consistent with sarcoma of the prostate. Computerized tomography suggested that the mass extended through the urogenital diaphragm and was contiguous with the corpus spongiosum and corpora cavernosa of the penis. Complete surgical extirpation was achieved through a perineal approach, although local extension of the growth beneath the internal anal sphincter and the urogenital diaphragm necessitated reconstruction of these structures. The surgical margins were free of tumor. We advocate local surgical extirpation rather than pelvic exenteration in these cases.