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Peng Y, Lv ML, Zhong JQ, Feng H. Primary large-cell neuroendocrine carcinoma on the back of left shoulder: A rare case in a rare site. Asian J Surg 2024; 47:2322-2323. [PMID: 38336491 DOI: 10.1016/j.asjsur.2024.01.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Affiliation(s)
- Yu Peng
- Department of Radiology, Zigong First People's Hospital, 643000, Zigong, PR China
| | - Min-Li Lv
- Department of Radiology, Zigong First People's Hospital, 643000, Zigong, PR China.
| | - Jian-Quan Zhong
- Department of Radiology, Zigong First People's Hospital, 643000, Zigong, PR China
| | - Hao Feng
- Department of Radiology, Zigong First People's Hospital, 643000, Zigong, PR China
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2
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Karbal J, Machmachi A, Bouziane W, Amahtil M, Laye Diene O, Daoudi A. Case report of a successful conservative surgical treatment of a giant liposarcoma of the forearm invading the median nerve. Radiol Case Rep 2024; 19:1537-1541. [PMID: 38317697 PMCID: PMC10839772 DOI: 10.1016/j.radcr.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 02/07/2024] Open
Abstract
Liposarcomas (LPS) are the most common malignant tumors among soft tissue sarcomas. We report a rare case of well-differentiated liposarcoma (lipoma-like) located along the anterior compartment of the right forearm, which was successfully treated with complete excision, resulting in good functional recovery without recurrence during a 2-year follow-up. Surgery is the primary treatment for localized forms, involving complete and radical excision with clear resection margins. LPS represents a heterogeneous group of soft tissue sarcomas, with diagnosis primarily relying on histological examination. Their care requires a multidisciplinary approach.
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Affiliation(s)
- Jamal Karbal
- Traumatology-Orthopedics Department, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy Mohammed First University Oujda, Oujda, Morocco
| | - Amine Machmachi
- Traumatology-Orthopedics Department, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy Mohammed First University Oujda, Oujda, Morocco
| | - Walid Bouziane
- Traumatology-Orthopedics Department, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy Mohammed First University Oujda, Oujda, Morocco
| | - Moncef Amahtil
- Traumatology-Orthopedics Department, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy Mohammed First University Oujda, Oujda, Morocco
| | - Ousmane Laye Diene
- Traumatology-Orthopedics Department, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy Mohammed First University Oujda, Oujda, Morocco
| | - Abdelkrim Daoudi
- Traumatology-Orthopedics Department, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy Mohammed First University Oujda, Oujda, Morocco
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Encinas Tobajas VM, Almeida González C, Marcilla D, Vallejo M, Cano Rodríguez A, Reina Sánchez de Movellán JI, Morales Pérez JM. Myxoid liposarcoma: MRI features with histological correlation. RADIOLOGIA 2023; 65 Suppl 2:S23-S32. [PMID: 37858349 DOI: 10.1016/j.rxeng.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 01/30/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS Myxoid liposarcoma is classified in the group of sarcomas with adipose differentiation, which is the second most common group of sarcomas. However, myxoid liposarcoma is not a homogeneous entity, because the behavior and clinical course of these tumours can vary widely. This study aimed to describe the magnetic resonance imaging (MRI) features of myxoid liposarcomas and to determine whether the MRI features are associated with the histologic grade and can differentiate between low-grade and high-grade tumours and thus help in clinical decision making. MATERIAL AND METHODS We studied 36 patients with myxoid liposarcomas treated at our centre between 2010 and 2018. We analysed clinical variables (age, sex, and tumour site) and MRI features (size, depth, borders, fatty component, myxoid component, non-fatty/non-myxoid component, apparent diffusion coefficient (ADC), and type of enhancement after the administration of intravenous contrast material). We correlated the MRI features with the histologic grade and the percentage of round cells. RESULTS In our series, patients with myxoid liposarcomas were mainly young adults (median age, 43 years). There were no differences between sexes; 97.2% were located in the lower limbs, 86.1% were deep, and 77.8% had well-defined borders. Of the 23 myxoid liposarcomas that contained no fat, 16 (69.6%) were high grade (p = 0.01). All the tumors with a myxoid component of less than 25% were high grade (p = 0.01); 83.3% of those with a non-fatty/non-myxoid component greater than 50% were high grade (p = 0.03) and 61.5% had more than 5% round cells (p = 0.01). Diffusion sequences were obtained in 14 of the 36 patients; ADC values were high (median, 2 × 10-3 mm2/s), although there were no significant associations between low-grade and high-grade tumours. Contrast-enhanced images were available for 30 (83.3%) patients; 83.3% of the tumours with heterogeneous enhancement were high grade (p = 0.01). CONCLUSIONS MRI can be useful for differentiating between high- and low-grade myxoid liposarcomas and can help in clinical decision making.
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Affiliation(s)
- V M Encinas Tobajas
- Unidad de Gestión Clínica de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - C Almeida González
- Unidad de Bioestadística, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - D Marcilla
- Unidad de Gestión Clínica de Anatomía Patológica, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - M Vallejo
- Unidad de Gestión Clínica de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A Cano Rodríguez
- Unidad de Gestión Clínica de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - J M Morales Pérez
- Unidad de Gestión Clínica de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Dewaguet J, Beaujot J, Leguillette C, Decanter G, Cordoba A, Penel N, Ceugnart L, Taieb S, Amor MBH. [Contribution of whole-body MRI to the initial assessment of myxoid liposarcoma]. Bull Cancer 2023; 110:1015-1026. [PMID: 37507239 DOI: 10.1016/j.bulcan.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/04/2023] [Accepted: 05/12/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Myxoid liposarcoma is a soft tissue sarcoma associated with multifocal metastases at diagnosis. These metastases are asymptomatic and occult on CT and FDG-PET and can alter the therapeutic management and prognosis. In this context, we evaluated the contribution of whole-body MRI to the initial workup of patients with myxoid liposarcoma. METHOD This retrospective study was conducted between January 2015 and December 2020 at the Oscar Lambret Center. We enrolled 22 patients who were diagnosed with myxoid liposarcoma and underwent whole-body MRI at diagnosis. The number of metastases at diagnosis, their location, and the visibility of these lesions on CT were evaluated. Associations between clinical features, presence of metastasis, and their impact on management were assessed. RESULTS Sixteen patients (72.7%) had non-metastatic disease at the initial diagnosis, and 15 of these patients were managed using local treatment. Six patients (27.3%) had metastases at multiple locations and received chemotherapy. The main locations were the bones (n=5) and lungs (n=3). In five patients with metastases, whole-body MRI demonstrated additional lesions that were not visible on CT (bone and soft tissue lesions). Only the presence of a round cell contingent (P=0.009) was found as a criterion associated with the presence of metastases. CONCLUSION The patients' young age, absence of reliable prognostic factors at diagnosis, asymptomatic nature of the lesions, and the benefits of early and targeted therapeutic management encourage the use of whole-body MRI as part of the initial work-up as it seems to provide a better initial staging compared with conventional imaging.
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Affiliation(s)
- Julie Dewaguet
- Centre Oscar-Lambret, département d'imagerie, 3, rue Combemale, 59020 Lille cedex, France.
| | - Juliette Beaujot
- Centre Oscar-Lambret, département d'anatomie et cytologie pathologique, 3, rue Combemale, 59020 Lille cedex, France
| | - Clémence Leguillette
- Centre Oscar-Lambret, unité de méthodologie et de biostatistiques, 3, rue Combemale, 59020 Lille cedex, France
| | - Gauthier Decanter
- Centre Oscar-Lambret, département de chirurgie, 3, rue Combemale, 59020 Lille cedex, France
| | - Abel Cordoba
- Centre Oscar-Lambret, département de radiothérapie, 3, rue Combemale, 59020 Lille cedex, France
| | - Nicolas Penel
- Centre Oscar-Lambret, Clinical Research and Innovation Department, Medical Oncology Department, 3, rue Combemale, 59020 Lille cedex, France; University Lille, CHU de Lille, ULR 2694 - Metrics : évaluation des technologies de santé et des pratiques médicales, 59000 Lille, France
| | - Luc Ceugnart
- Centre Oscar-Lambret, département d'imagerie, 3, rue Combemale, 59020 Lille cedex, France
| | - Sophie Taieb
- Centre Oscar-Lambret, département d'imagerie, 3, rue Combemale, 59020 Lille cedex, France
| | - Mariem Ben Haj Amor
- Centre Oscar-Lambret, département d'imagerie, 3, rue Combemale, 59020 Lille cedex, France
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Qiu M, Lin DR, Xiong ZK. Survival of a patient with five recurrences of retroperitoneal liposarcoma over a period of 13 years: A case report and review. Oncol Lett 2023; 26:367. [PMID: 37559572 PMCID: PMC10407717 DOI: 10.3892/ol.2023.13953] [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: 03/08/2023] [Accepted: 06/28/2023] [Indexed: 08/11/2023] Open
Abstract
Retroperitoneal liposarcoma (RPLS) is a rare tumor that occurs in the retroperitoneal region and accounts for ~0.2% of all malignant tumor incidence. The present study describes the treatment of a surviving patient with RPLS that recurred five times in 13 years. This case has a long survival time and numerous relapses, which is a rare occurrence. The 40-year-old female patient was admitted to Shaoxing Second Hospital (Shaoxing, China) with an abdominal mass. Abdominal computed tomography (CT) scan revealed multiple liposarcoma recurrences in the abdominal, pelvic and retroperitoneal areas. As the diagnosis of RPLS was the fifth recurrence, cytoreductive surgery was performed and post-operative pathology suggested mixed liposarcoma. The patient underwent six cycles of doxorubicin and ifosfamide regimen chemotherapy and targeted therapy with anlotinib following surgery; no evidence of disease progression was found on abdominal CT scan during follow-up. The present study also reviewed the literature in terms of the clinical diagnosis, treatment, pathological characteristics and similar cases of liposarcoma with the aim of improving diagnosis and treatment.
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Affiliation(s)
- Miao Qiu
- Department of Tumor Radiotherapy, Shaoxing Second Hospital, Shaoxing, Zhejiang 312000, P.R. China
| | - De-Rong Lin
- Department of Tumor Radiotherapy, Shaoxing Second Hospital, Shaoxing, Zhejiang 312000, P.R. China
| | - Zhong-Kui Xiong
- Department of Tumor Radiotherapy, Shaoxing Second Hospital, Shaoxing, Zhejiang 312000, P.R. China
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6
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Al Harrasi K, Al-Kindi AH, Al Lawati A, Al Hosni F, Al Shezawi A. Incidental Diagnosis of Primary Pleural Liposarcoma in a COVID-19-Positive Patient. Cureus 2023; 15:e42207. [PMID: 37602067 PMCID: PMC10439808 DOI: 10.7759/cureus.42207] [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: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
A few cases of primary liposarcoma of pleura have been reported worldwide. We report a young gentleman who was admitted with what was initially thought as coronavirus disease 2019 (COVID-19)-related pulmonary symptoms. His chest CT showed a large pleural effusion causing a mediastinal shift and compressing vital structures. He did not respond to conservative drainage intervention and subsequently underwent a left thoracotomy for his worsening clinical picture. He was found to have a large left pleural mass that was incompletely resected. Histopathology examination showed low-grade soft tissue sarcoma with lipogenic differentiation suggestive of myxoid liposarcoma. He was subsequently given adjuvant chemotherapy but succumbed and died because of the progression of the disease.
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Affiliation(s)
| | - Adil H Al-Kindi
- Cardiothoracic Surgery, Sultan Qaboos University Hospital, Muscat, OMN
| | - Abdullah Al Lawati
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, OMN
| | - Fatma Al Hosni
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, OMN
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Intermuscular extremity myxoid liposarcoma can be managed by marginal resection following neoadjuvant radiotherapy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:362-367. [PMID: 36243649 DOI: 10.1016/j.ejso.2022.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Compared with other soft tissue sarcomas, myxoid liposarcoma (MLS) occurs in younger patients, has a propensity for intermuscular locations and is highly radiosensitive. With pre-operative radiotherapy, intermuscular MLS demonstrates substantial volume reduction and can be easily separated from surrounding tissues during resection. However, it is unclear whether marginal excision of MLS is oncologically safe. This study aimed to assess the association between margins and survival in irradiated, intermuscular MLS. METHODS The study identified 198 patients from seven sarcoma centres with a first presentation of localized, extremity, intermuscular MLS that received pre-operative radiotherapy and was diagnosed between 1990 and 2017. Patient and treatment characteristics, radiological and histological responses to neoadjuvant treatment and clinical surveillance were recorded. RESULTS Margins were microscopically positive in 11% (n = 22), <1.0 mm in 15% (n = 29) and ≥1.0 mm in 72% (n = 143). There was no association between margin status and local recurrence-free, metastasis-free or overall survival. This finding held true even in patients at higher risk of worse overall survival based on multivariable analysis (% round cell≥5%, percentage ellipsoid tumour volume change ≤ -60.1%). CONCLUSION Irradiated, extremity, intermuscular myxoid liposarcoma can safely undergo marginal resection without compromising oncologic control.
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8
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Morán LM, Vega J, Gómez-León N, Royuela A. Myxomas and myxoid liposarcomas of the extremities: Our preliminary findings in conventional, perfusion, and diffusion magnetic resonance. Acta Radiol Open 2022; 11:20584601221131481. [PMID: 36225896 PMCID: PMC9549112 DOI: 10.1177/20584601221131481] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 09/22/2022] [Indexed: 11/22/2022] Open
Abstract
Background The differentiation between myxomas and myxoid liposarcomas (MLPS) often is a serious challenge for the radiologists. Magnetic resonance imaging (MRI) is the most useful imaging technique in characterization of the soft tissue tumors (STT). Purpose To evaluate in a sample of myxomas and MLPS of the extremities, what morphological findings in conventional MRI allow us to differentiate these two types of myxoid tumors, in addition to analyzing the validity of the apparent diffusion coefficient (ADC) values of diffusion-weighted MRI (DW-MRI). Material and Methods Magnetic resonance imaging studies in myxomas and MLPS of extremities searched in our PACS between 2015 and 2019. All studies had conventional MRI with T1, T2, and PD SPAIR sequences, while DW-MRI with ADC mapping and perfusion MRI with a T1 sequence repeated for 4 minutes after contrast injection were additional sequences only in some explorations. Two radiologists evaluated independently the MRI studies by examining the qualitative parameters. Apparent diffusion coefficient values were calculated using two methods-ADC global and ADC solid, and Receiver Operating Characteristic (ROC) curves were applied for analysis. Results The features were consistent with MLPS: size greater than 10 cm, heterogeneous signal on T1, and nodular enhancement, while the common findings for myxomas were a homogenously hypointense signal on T1 and diffuse peritumoral enhancement. The solid and global ADC values were higher in myxomas. We observed that the solid ADC value less than 2.06 x 10-3mm2 x s would support the diagnosis of MLPS against myxoma. Conclusion Overall, MRI with its different modalities improved the diagnostic accuracy when differentiating myxomas from MLPS of extremities.
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Affiliation(s)
- Luz M Morán
- Department of Radiology,
Hospital
Universitario Puerta de Hierro,
Majadahonda, Madrid, Spain,Luz M Morán, Department of Radiology,
Hospital Universitario Puerta de Hierro, C/Manuel de Falla, Majadahonda, Madrid
28300, Spain.
| | - Jesús Vega
- Department of Patology,
Hospital
Universitario Clínico San Carlos,
Madrid, Spain
| | - Nieves Gómez-León
- Department of Radiology,
Hospital
Universitario La Princesa, Madrid,
Spain
| | - Ana Royuela
- Department of Statistics,
Hospital
Universitario Puerta de Hierro,
Majadahonda, Madrid, Spain
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Lee J, King KG, Chopra S, Cheng PM. Perinephric myxoid pseudotumor of fat: a multimodality imaging case series. Abdom Radiol (NY) 2022; 48:1820-1830. [PMID: 36085375 DOI: 10.1007/s00261-022-03662-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022]
Abstract
Perinephric myxoid pseudotumor of fat (PMPF) is an unusual clinical entity with few prior imaging case reports. We report a multimodality imaging case series of PMPF, consisting of four cases seen in our department with both imaging studies and histopathologic confirmation. Three of the four patients had a history of advanced non-neoplastic renal disease. The perirenal masses in these cases varied in size and appearance. Some lesions resembled cysts or contained macroscopic fat. Enhancement was equivocal on CT, but prominent in one case on MRI and in another on contrast-enhanced ultrasound. Although not known to be malignant, PMPF may be confused for a cyst, liposarcoma, or hypovascular solid neoplasm on imaging. The dominant mass was resected in two cases because of concern for malignancy, while percutaneous CT-guided biopsy was performed in the other two. Mouse double minute 2 (MDM2) gene amplification by fluorescence in situ hybridization (FISH) was negative in all four cases, excluding well-differentiated liposarcoma. Radiologists should be familiar with PMPF to provide appropriate guidance on clinical management.
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Affiliation(s)
- Justin Lee
- Department of Radiology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Kevin G King
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Shefali Chopra
- Department of Pathology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Phillip M Cheng
- Department of Radiology, Keck School of Medicine of USC, 1441 Eastlake Ave., Suite 2315B, Los Angeles, CA, 90033, USA.
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Diagnostic and Therapeutic Pathways of Intramuscular Myxoma. Diagnostics (Basel) 2022; 12:diagnostics12071573. [PMID: 35885479 PMCID: PMC9316518 DOI: 10.3390/diagnostics12071573] [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: 05/31/2022] [Revised: 06/19/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
Intramuscular myxomas (IMMs) are benign tumors. Evidence regarding diagnostic and therapeutic pathways is rare, and guidelines do not exist due to their low incidence. The aim of this study was a retrospective analysis at a university cancer center and the interdisciplinary re-evaluation of the individual diagnostic and therapeutic procedures. Overall, 38 patients were included in the study. IMMs occurred mostly in middle-aged women. At the time of first consultation, 57.9% had few symptoms or were asymptomatic. In 92.1% of the cases, the tumor was localized in the extremities. The lower extremity was affected in 73.7%. The average size of IMMs was 5.0 cm. The proximally located tumors in the gluteus, thighs, and upper arms were significantly larger (p = 0.02) than the distally-located tumors in the forearms and lower legs. An MRI was performed in 97.4%. Based on imaging, an IMM was suspected in 5.6% by radiologists and in 54.1% by musculoskeletal surgeons. An incision biopsy was performed in 68.4% and led in 100.0% to the right histopathological diagnosis. In total, 89.5% of IMMs were resected. Postoperative complications requiring revision occurred in 8.8%. Recurrences or degenerations of IMMs were not reported in any of these cases.
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Ballhause TM, Weiss S, Reiter A, Frosch KH, Luebke AM, Bannas P, Schlickewei CW, Priemel MH. Can homogeneous, lipomatous tumors be primarily resected without biopsy? A retrospective analysis of 240 tumors. World J Surg Oncol 2022; 20:184. [PMID: 35676721 PMCID: PMC9178814 DOI: 10.1186/s12957-022-02665-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND According to guidelines, every soft tissue tumor (STT) larger than 3 cm should be biopsied before definitive resection. Advances in magnetic resonance imaging (MRI) improve the possibility to give a provisional diagnosis of the tumor's entity. Can lipomas and atypical lipomatous tumors (ALTs) of the extremities therefore be primarily marginally resected based on interpretation of MR images without a previous biopsy?. METHODS In this retrospective, single-center study, 240 patients with the suspicion of a lipomatous tumor in MRI and surgical treatment in our institution between 2011 and 2020 were included. MR imaging was performed before surgery. All resected specimens underwent histopathological analysis. RESULTS The collective comprised 142 tumors that were suspected as lipoma or ALT by the radiologist and underwent primary marginal resection (PMR). One case had myxoid liposarcoma that was underestimated on MRI and needed radical follow-up resection. One-hundred forty-one patients were cured after PMR. Ninety-eight patients were biopsied initially and in 93 cases resected afterwards according to the necessary oncological margins. CONCLUSION In our institution, PMR is performed if a lipoma or ALT is suspected on MR imaging. Our treatment method and the diagnostic algorithm are presented. Primary resection spares patients from one surgical procedure, but a slight risk for underestimation of the tumor remains.
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Affiliation(s)
- Tobias M Ballhause
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Sebastian Weiss
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alonja Reiter
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Trauma Surgery, Orthopedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Andreas M Luebke
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten W Schlickewei
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias H Priemel
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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12
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Lipomatous Tumors: A Comparison of MRI-Reported Diagnosis with Histological Diagnosis. Diagnostics (Basel) 2022; 12:diagnostics12051281. [PMID: 35626435 PMCID: PMC9141562 DOI: 10.3390/diagnostics12051281] [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: 03/15/2022] [Revised: 05/10/2022] [Accepted: 05/18/2022] [Indexed: 12/10/2022] Open
Abstract
Lipomatous tumors are among the most common soft tissue tumors (STTs). Magnetic resonance imaging (MRI) is a state-of-the-art diagnostic tool used to differentiate and characterize STTs. Radiological misjudgment can lead to incorrect treatment. This was a single-center retrospective study. Two hundred and forty lipomatous tumors were included. MRI diagnoses were categorized as benign, intermediate, or malignant and were compared with histological diagnoses. Tumor volumes were measured by MRI and from surgical specimens. The tumor was correctly categorized 73.3% of the time. A total of 21.7% of tumors were categorized as more malignant in MRI reports than they were by histology, and vice versa for 5.0% of tumors. Volume measured by MRI was not different from actual tumor size in pathology. Atypical lipomatous tumors (ALTs) and liposarcomas (LPSs) were larger when compared with lipomata and occurred in older patients. Based on the MRI-suspected tumor entity, surgical treatment can be planned. Large lipomatous tumors in elderly patients are more likely to be ALTs. However, a safe threshold size or volume for ALTs cannot be determined.
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13
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Layek A, Rajpoot A, Joshi P, Mishra M. Primary pleural liposarcoma: a rare differential for an opaque hemithorax. BMJ Case Rep 2022; 15:e246683. [PMID: 35217554 PMCID: PMC8883203 DOI: 10.1136/bcr-2021-246683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 11/04/2022] Open
Abstract
Primary pleural liposarcoma (PPL) is a rare primary malignant pleural tumour originating from primitive mesenchymal tissue. We report the case of a 25-year-old man with a 6-week history of shortness of breath, cough, chest pain and hoarseness of voice. Chest X-ray showed a left opacified hemithorax, and thoracic CT scan revealed a large, heterogeneous, hypodense mass in the left hemithorax. The patient was taken up for ultrasound-guided core biopsy of the mass lesion, and histopathological examination revealed the diagnosis as a pleomorphic variant of PPL. We highlight the importance of considering PPL as a differential diagnosis in cases of large hemithoracic masses.
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Affiliation(s)
- Avishek Layek
- Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, India
| | - Akhlesh Rajpoot
- Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, India
| | - Prashant Joshi
- Pathology & Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, India
| | - Mayank Mishra
- Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, India
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Hong YT, Yang Y, Lee H. A case report of primary myxoid liposarcoma mimicking as a parotid cystic lesion. Medicine (Baltimore) 2022; 101:e28473. [PMID: 35029195 PMCID: PMC8757944 DOI: 10.1097/md.0000000000028473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Myxoid liposarcoma (MLS) is an extremely rare tumor of the salivary gland and it arises from undifferentiated pluripotent mesenchymal cells. We report a rare case of a primary MLS in the parotid gland. PATIENT CONCERNS The patient was a 49-year-old female who presented with a hard fixed mass in the left parotid region. DIAGNOSIS On computed tomography and MR images, this tumor has a low attenuation center with a thick enhancing wall and ill-defined margins. The absence of high-signal-intensity foci on T1-weighted images makes a MLS indistinguishable from most other soft-tissue masses. Pathologically, the tumor was diagnosed as MLS. INTERVENTIONS The patient received total parotidectomy with facial nerve preservation and selective neck dissection. OUTCOMES Immediate facial nerve function was House Brackmann Grade III and recovered within 3 months after the surgery. Follow-up period is 57 months and there was no recurrence until now. LESSONS In this report, we report a rare case of primary MLS mimicking a cystic lesion of the parotid gland.
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15
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Fattahi N, Moeini A, Morani AC, Elsayes KM, Bhosale HR, Badawy M, Menias CO, Rezvani M, Gaballah AH, Shaaban AM. Fat-containing pelvic lesions in females. Abdom Radiol (NY) 2022; 47:362-377. [PMID: 34673996 DOI: 10.1007/s00261-021-03299-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022]
Abstract
Pelvic tumors are common in females and have a broad differential diagnosis. The clinical management of pelvic tumors varies widely-from observation to surgical resection-and imaging plays a pivotal role in diagnosis and clinical decision-making in these cases. In particular, imaging can help determine the organ of origin and tissue content of these tumors, which are the most important steps to narrowing the differential diagnosis. Fat has a characteristic appearance and is often easily identified on ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). The amount and distribution of intralesional fat varies in different types of tumors. Macroscopic intralesional fat is often easily recognized by its hyperechoic appearance on US and low attenuation on CT similar to subcutaneous fat. On MRI, macroscopic fat is hyperintense on T1-weighted (T1W) images, with characteristic signal loss on fat-saturated sequences and India-ink artifact on opposed-phase T1W images. Macroscopic fat is the hallmark of teratomas, which are the most common ovarian neoplasms. Uterine lipoleiomyomas, peritoneal loose bodies, intraperitoneal and extraperitoneal primary lipomatous tumors such as lipoma and liposarcomas, and extra-adrenal myelolipomas are other pelvic masses distinguished by the presence of macroscopic fat. However, the imaging diagnosis of pelvic masses containing minimal or microscopic fat, such as immature ovarian teratomas, steroid cell ovarian neoplasms, and extramedullary hematopoiesis, can present a diagnostic challenge owing to their nonspecific appearance on US or CT. Obtaining MRI with in-phase and opposed-phase dual-echo T1W sequences and depicting chemical shift artifacts can be helpful in distinguishing these lesions.
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Affiliation(s)
- Nikoo Fattahi
- Department of Diagnostic and Interventional Imaging, The University of Texas John P. and Katherine G. McGovern Medical School, Houston, TX, USA
| | - Aida Moeini
- Department of Diagnostic Imaging, The University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Ajaykumar C Morani
- Division of Diagnostic Imaging, Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Khaled M Elsayes
- Division of Diagnostic Imaging, Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | | | - Mohamed Badawy
- Division of Diagnostic Imaging, Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | | | - Maryam Rezvani
- Department of Diagnositc Imaging, The University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ayman H Gaballah
- Department of Radiology, The University of Missouri Health Care, Columbia, MO, USA
| | - Akram M Shaaban
- Department of Diagnositc Imaging, The University of Utah School of Medicine, Salt Lake City, UT, USA
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16
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Walter SS, Fritz J. MRI of Muscular Neoplasms and Tumor-Like Lesions: A 2020 World Health Organization Classification-based Systematic Review. Semin Roentgenol 2022; 57:252-274. [DOI: 10.1053/j.ro.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/03/2022] [Accepted: 01/08/2022] [Indexed: 11/11/2022]
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17
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Overview of malignant soft-tissue sarcomas of the limbs. Clin Radiol 2021; 76:940.e1-940.e16. [PMID: 34607656 DOI: 10.1016/j.crad.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/25/2021] [Indexed: 01/29/2023]
Abstract
Although soft-tissue masses are common, sarcomas are rare malignant neoplasms showing variable mesenchymal differentiation and can occur at any anatomical site. Limb soft-tissue sarcomas (STS) are rare, but often lethal tumours. Although there are scores of historical pathological subtypes, this article will deal with the commonest: liposarcoma, leiomyosarcoma (LMS), undifferentiated pleomorphic sarcoma (UPS), synovial sarcoma, myxofibrosarcoma, malignant peripheral nerve sheath tumour (MPNST), epithelioid sarcoma, alveolar rhabdosarcoma, angiosarcoma and radiation-induced sarcoma (RIS). Following a review of >4,000 adult patients with limb sarcoma from our specialist soft-tissue tumour database, we summarise the literature and their imaging findings, with emphasis on radiological hallmarks that can aide in diagnosis and management. Increased awareness of sarcoma when challenged with a new mass in the extremity can ensure timely and appropriate treatment.
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18
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Kousi E, Messiou C, Miah A, Orton M, Haas R, Thway K, Hopkinson G, Zaidi S, Smith M, Barquin E, Moskovic E, Fotiadis N, Strauss D, Hayes A, Schmidt MA. Descriptive analysis of MRI functional changes occurring during reduced dose radiotherapy for myxoid liposarcomas. Br J Radiol 2021; 94:20210310. [PMID: 34545764 PMCID: PMC9328045 DOI: 10.1259/bjr.20210310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Myxoid liposarcomas (MLS) show enhanced response to radiotherapy due to their distinctive vascular pattern and therefore could be effectively treated with lower radiation doses. This is a descriptive study to explore the use of functional MRI to identify response in a uniform cohort of MLS patients treated with reduced dose radiotherapy. METHODS 10 patients with MLS were imaged pre-, during, and post-radiotherapy receiving reduced dose radiotherapy and the response to treatment was histopathologically assessed post-radiotherapy. Apparent diffusion coefficient (ADC), T2* relaxation time, volume transfer constant (Ktrans), initial area under the gadolinium curve over 60 s (IAUGC60) and (Gd) were estimated for a central tumour volume. RESULTS All parameters showed large inter- and intrasubject variabilities. Pre-treatment (Gd), IAUGC60 and Ktrans were significantly different between responders and non-responders. Post-radiotherapy reductions from baseline were demonstrated for T2*, (Gd), IAUGC60 and Ktrans for responders. No statistically significant ADC differences were demonstrated between the two response groups. Significantly greater early tumour volume reductions were observed for responders. CONCLUSIONS MLS are heterogenous lesions, characterised by a slow gradual contrast-agent uptake. Pre-treatment vascular parameters, early changes to tumour volume, vascular parameters and T2* have potential in identifying response to treatment. The delayed (Gd) is a suitable descriptive parameter, relying simply on T1 measurements. Volume changes precede changes in MLS functionality and could be used to identify early response. ADVANCES IN KNOWLEDGE MLS are are characterised by slow gradual contrast-agent uptake. Measurement of the delayed contrast-agent uptake (Gd) is simple to implement and able to discriminate response.
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Affiliation(s)
- Evanthia Kousi
- MRI unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - Christina Messiou
- Radiology department, The Royal Marsden NHS Foundation Trust, London, UK
| | - Aisha Miah
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Matthew Orton
- MRI unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - Rick Haas
- Sarcoma Unit, Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Khin Thway
- Molecular pathology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Georgina Hopkinson
- MRI unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - Shane Zaidi
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Myles Smith
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Eleanor Moskovic
- Radiology department, The Royal Marsden NHS Foundation Trust, London, UK
| | - Nicos Fotiadis
- Department of Interventional Radiology, The Royal Marsden NHS Foundation trust, London, UK
| | - Dirk Strauss
- Sarcoma/Melanoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Andrew Hayes
- Sarcoma/Melanoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Maria A Schmidt
- MRI unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
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19
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Encinas Tobajas VM, Almeida González C, Marcilla D, Vallejo M, Cano Rodríguez A, Reina Sánchez de Movellán JI, Morales Pérez JM. Myxoid liposarcoma: MRI features with histological correlation. RADIOLOGIA 2021; 65:S0033-8338(21)00052-7. [PMID: 33722389 DOI: 10.1016/j.rx.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 01/27/2021] [Accepted: 01/30/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Myxoid liposarcoma is classified in the group of sarcomas with adipose differentiation, which is the second most common group of sarcomas. However, myxoid liposarcoma is not a homogeneous entity, because the behavior and clinical course of these tumors can vary widely. This study aimed to describe the magnetic resonance imaging (MRI) features of myxoid liposarcomas and to determine whether the MRI features are associated with the histologic grade and can differentiate between low-grade and high-grade tumors and thus help in clinical decision making. MATERIAL AND METHODS We studied 36 patients with myxoid liposarcomas treated at our center between 2010 and 2018. We analyzed clinical variables (age, sex, and tumor site) and MRI features (size, depth, borders, fatty component, myxoid component, non-fatty / non-myxoid component, apparent diffusion coefficient (ADC), and type of enhancement after the administration of intravenous contrast material). We correlated the MRI features with the histologic grade and the percentage of round cells. RESULTS In our series, patients with myxoid liposarcomas were mainly young adults (median age, 43 years). There were no differences between sexes; 97.2% were located in the lower limbs, 86.1% were deep, and 77.8% had well-defined borders. Of the 23 myxoid liposarcomas that contained no fat, 16 (69.6%) were high grade (p=0.01). All the tumors with a myxoid component of less than 25% were high grade (p=0.01); 83.3% of those with a non-fatty / non-myxoid component greater than 50% were high grade (p=0.03) and 61.5% had more than 5% round cells (p=0.01). Diffusion sequences were obtained in 14 of the 36 patients; ADC values were high (median, 2 x 10-3 mm2/s), although there were no significant associations between low-grade and high-grade tumors. Contrast-enhanced images were available for 30 (83.3%) patients; 83.3% of the tumors with heterogeneous enhancement were high grade (p=0.01). CONCLUSIONS MRI can be useful for differentiating between high- and low-grade myxoid liposarcomas and can help in clinical decision making.
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Affiliation(s)
- V M Encinas Tobajas
- Unidad de Gestión Clínica de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - C Almeida González
- Unidad de Bioestadística, Hospital Universitario Virgen de Valme, Sevilla, España
| | - D Marcilla
- Unidad de Gestión Clínica de Anatomía Patológica, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M Vallejo
- Unidad de Gestión Clínica de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A Cano Rodríguez
- Unidad de Gestión Clínica de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - J M Morales Pérez
- Unidad de Gestión Clínica de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España
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20
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Paixao C, Lustig JP, Causeret S, Chaigneau L, Danner A, Aubry S. Tumors and pseudotumors of the soft tissues: Imaging semiology and strategy. J Clin Imaging Sci 2021; 11:13. [PMID: 33767905 PMCID: PMC7981940 DOI: 10.25259/jcis_135_2020] [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: 08/07/2020] [Accepted: 02/17/2021] [Indexed: 11/26/2022] Open
Abstract
The aims of this educational review are to learn the semiological basis of soft-tissue lesions and, with the help of diagnostic algorithms, to apply the current recommendations for the management of soft-tissue tumors. Pseudotumors must first be identified and excluded. Among primary tumors, the search for macroscopic fat content on MRI is decisive; since it restricts the diagnostic range to adipocytic tumors. Key imaging features of non-adipocytic tumors are highlighted. When a deep soft-tissue mass is found, therapeutic abstention or simple monitoring is only appropriate when there is diagnostic certainty: This is only the case for typical pseudotumors, typical benign tumors, and fat tumors without atypical criteria. In all other cases, histological evidence is required. If there is any suspicion of soft-tissue sarcoma or any undetermined lesion, the patient should be referred to a sarcoma referral center before biopsy.
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Affiliation(s)
- Charlinne Paixao
- Department Radiology, Musculoskeletal Imaging Unit, CHU Besancon, Besancon, France
| | - Jean-Philippe Lustig
- Department Radiology, Musculoskeletal Imaging Unit, CHU Besancon, Besancon, France
| | - Sylvain Causeret
- Department of Surgery, CHU Dijon, Centre Georges-François Leclerc, Dijon, France
| | - Loic Chaigneau
- Department of Oncology, CHU Besancon, CHU de Besancon, Besancon, France
| | - Alexis Danner
- Department Radiology, Musculoskeletal Imaging Unit, CHU Besancon, Besancon, France
| | - Sebastien Aubry
- Department Radiology, Musculoskeletal Imaging Unit, CHU Besancon, Besancon, France
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21
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Image-Guided Core Needle Biopsy of Adipocytic Tumors: Diagnostic Accuracy and Concordance With Final Surgical Pathology. AJR Am J Roentgenol 2021; 216:997-1002. [PMID: 33624523 DOI: 10.2214/ajr.20.23080] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE. Diagnostic accuracy of core needle biopsy (CNB) for adipocytic tumors can be low because of sampling error from these often large, heterogeneous lesions. The purpose of this study was to evaluate the diagnostic accuracy of image-guided CNB for various adipocytic tumors in comparison with excisional pathology. MATERIALS AND METHODS. Adipocytic tumors (n = 77) of all adult patients undergoing image-guided CNB and subsequent surgical excision of an adipocytic tumor at a tertiary referral center between 2005 and 2019 were studied. To determine concordance, we compared pathologic diagnoses based on CNB to the reference standard of pathologic diagnoses after surgical excision. Tumors were divided into three categories (benign lipomatous tumors [lipoma, lipoma variants, hibernomas], atypical lipomatous tumors [ALTs] or well-differentiated liposarcomas [WDLs], and higher grade liposarcomas [myxoid, dedifferentiated, pleomorphic]), and diagnostic accuracy was calculated for each category. RESULTS. In 73 of 77 adipocytic tumors (95%), diagnosis at CNB and diagnosis after excision were concordant. Accuracy of diagnosis was poorer for ALTs and WDLs than for the other two categories, and the difference was statistically significant (p < .002). For the 29 benign lipomatous tumors and the 27 higher-grade liposarcomas, diagnoses at CNB and after excision were concordant in all cases (100%). Seventeen of the 21 tumors (81%) diagnosed as ALTs or WDLs at CNB had a concordant diagnosis after excision; four of the 21 were upgraded (dedifferentiated liposarcoma, n = 3; myxoid liposarcoma, n = 1). CONCLUSION. CNB provides high diagnostic accuracy for adipocytic tumors, particularly for benign lipomatous tumors and higher grade liposarcomas. However, though still high at 81%, diagnostic accuracy of CNB is not as high for tumors diagnosed as ALTs or WDLs. Awareness of this limitation is important when determining management, particularly of cases of ALT or WDL for which surgery is not planned.
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22
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Zhang Y, Huang J, Ding J. Imaging manifestations and pathological analysis of intramuscular myxoma: A case report and literature review. Radiol Case Rep 2020; 16:300-304. [PMID: 33304439 PMCID: PMC7711187 DOI: 10.1016/j.radcr.2020.10.053] [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: 07/27/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 11/26/2022] Open
Abstract
Intramuscular Myxoma(IM) is a rare benign soft tissue tumor, and its etiology and histology source is still unclear. It is important to understand the pathological components of IM and its corresponding imaging features, as well as performing accurate and careful imaging assessments of IM before surgery. We present a case of a 43-year-old male who presented a lump in his left thigh and gradually enlarged during the past 8 years. The patient underwent CT, MRI, and CTA examined and was later pathologically confirmed as IM. This article will combine the literature,to explore the imaging manifestations and its pathological basis of intramuscular myxoma.
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Affiliation(s)
- Yi Zhang
- Departments of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
| | - Jie Huang
- Departments of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
| | - Jianping Ding
- Departments of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
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23
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Leporq B, Bouhamama A, Pilleul F, Lame F, Bihane C, Sdika M, Blay JY, Beuf O. MRI-based radiomics to predict lipomatous soft tissue tumors malignancy: a pilot study. Cancer Imaging 2020; 20:78. [PMID: 33115533 PMCID: PMC7594281 DOI: 10.1186/s40644-020-00354-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 10/01/2020] [Indexed: 12/14/2022] Open
Abstract
Objectives To develop and validate a MRI-based radiomic method to predict malignancies in lipomatous soft tissue tumors. Methods This retrospective study searched in the database of our pathology department, data from patients with lipomatous soft tissue tumors, with histology and gadolinium-contrast enhanced T1w MR images, obtained from 56 centers with non-uniform protocols. For each tumor, 87 radiomic features were extracted by two independent observers to evaluate the inter-observer reproducibility. A reduction of learning base dimension was performed from reproducibility and relevancy criteria. A model was subsequently prototyped using a linear support vector machine to predict malignant lesions. Results Eighty-one subjects with lipomatous soft tissue tumors including 40 lipomas and 41 atypical lipomatous tumors or well-differentiated liposarcomas with fat-suppressed T1w contrast enhanced MR images available were retrospectively enrolled. Based on a Pearson’s correlation coefficient threshold at 0.8, 55 out of 87 (63.2%) radiomic features were considered reproducible. Further introduction of relevancy finally selected 35 radiomic features to be integrated in the model. To predict malignant tumors, model diagnostic performances were as follow: AUROC = 0.96; sensitivity = 100%; specificity = 90%; positive predictive value = 90.9%; negative predictive value = 100% and overall accuracy = 95.0%. Conclusion This work demonstrates that radiomics allows to predict malignancy in soft tissue lipomatous tumors with routinely used MR acquisition in clinical oncology. These encouraging results need to be further confirmed in an external validation population.
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Affiliation(s)
- Benjamin Leporq
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Villeurbanne, France.
| | | | - Frank Pilleul
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Villeurbanne, France.,Department of Radiology, CRLCC Léon Berard, Lyon, France
| | - Fabrice Lame
- Department of Radiology, CRLCC Léon Berard, Lyon, France
| | | | - Michael Sdika
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Villeurbanne, France
| | | | - Olivier Beuf
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Villeurbanne, France
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24
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Chen F, Desai MA, Cernigliaro JG, Edgar MA, Alexander LF. Perinephric myxoid pseudotumor of fat: A very rare entity that can mimic a renal cyst and retroperitoneal liposarcoma on imaging. Clin Imaging 2020; 69:139-144. [PMID: 32731105 DOI: 10.1016/j.clinimag.2020.06.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/11/2020] [Accepted: 06/26/2020] [Indexed: 12/15/2022]
Abstract
We present a case of perinephric myxoid pseudotumor of fat, a rare benign entity that often occurs in patients with non-neoplastic renal disease. In our case, an 80 year old man with end-stage renal disease was imaged over the course of 5 years during evaluation for renal transplantation. Imaging identified a left perinephric mass whose appearance over time and on different imaging modalities variably suggested a simple cyst, cystic neoplasm, and liposarcoma. Contrast enhanced examination was necessary to discern the solid nature of this mass, and ultimately, tissue sampling with histopathologic evaluation and molecular testing were required to make the diagnosis of myxoid pseudotumor of fat and exclude the imaging mimics.
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Affiliation(s)
- Frank Chen
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States of America.
| | - Madhura A Desai
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States of America
| | - Joseph G Cernigliaro
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States of America
| | - Mark A Edgar
- Department of Lab Medicine and Pathology, Mayo Clinic, Jacksonville, FL, United States of America
| | - Lauren F Alexander
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States of America
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25
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Ballard DH, Mazaheri P, Oppenheimer DC, Lubner MG, Menias CO, Pickhardt PJ, Middleton WD, Mellnick VM. Imaging of Abdominal Wall Masses, Masslike Lesions, and Diffuse Processes. Radiographics 2020; 40:684-706. [PMID: 32330085 DOI: 10.1148/rg.2020190170] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abdominal wall masses, masslike lesions, and diffuse processes are common and often incidental findings at cross-sectional imaging. Distinguishing among these types of masses on the basis of imaging features alone can be challenging. The authors present a diagnostic algorithm that may help in distinguishing different types of abdominal wall masses accurately. Hernias may mimic discrete masses at clinical examination, and imaging is often ordered for evaluation of a possible abdominal wall mass. Once a discrete mass is confirmed to be present, the next step is to determine if it is a fat-containing, cystic, or solid mass. The most common fat-containing masses are lipomas. Fluid or cystic masses include postoperative abscesses, seromas, and rectus sheath hematomas. Solid masses are the most common abdominal wall masses and include desmoid tumors, sarcomas, endometriomas, and metastases. Multiple masses and other diffuse abdominal wall processes are often manifestations of an underlying condition or insult. The most frequently found diffuse processes are multiple injection granulomas from administration of subcutaneous medication. This article offers an algorithmic approach to characterizing abdominal wall masses on the basis of their composition and reviews abdominal wall diffuse processes. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- David H Ballard
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Parisa Mazaheri
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Daniel C Oppenheimer
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Meghan G Lubner
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Christine O Menias
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Perry J Pickhardt
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - William D Middleton
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
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26
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Hegazi TM, Al-Sharydah AM, Lee KS, Mortele K. Retroperitoneal cystic masses: magnetic resonance imaging features. Abdom Radiol (NY) 2020; 45:499-511. [PMID: 31583446 DOI: 10.1007/s00261-019-02246-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The objective of this review is to discuss the clinical and histopathologic features, MRI characteristics, and management options of retroperitoneal cystic masses. Radiologists should be familiar with the MR imaging characteristics of retroperitoneal cystic masses to allow for a refined differential diagnosis, assist with lesion management, and prevent unnecessary invasive procedures.
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Affiliation(s)
- Tarek M Hegazi
- Department of Radiology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | | | - Karen S Lee
- Division of Abdominal Imaging/Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Koenraad Mortele
- Division of Abdominal Imaging/Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
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27
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Saifuddin A, Siddiqui S, Pressney I, Khoo M. The incidence and diagnostic relevance of chemical shift artefact in the magnetic resonance imaging characterisation of superficial soft tissue masses. Br J Radiol 2019; 93:20190828. [PMID: 31834812 DOI: 10.1259/bjr.20190828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Chemical shift artefact (CSA) is often encountered during MRI evaluation of superficial soft tissue masses. The study aim was to determine the incidence and diagnostic relevance of CSA in a consecutive series of superficial soft tissue masses referred to a specialist musculoskeletal sarcoma service. METHODS All patients referred over a 6 month period with a non-lipomatous superficial soft tissue mass were prospectively analysed. Patients characteristics (age, gender), lesion features (anatomical location, size, relationship to the skin and deep fascia), presence of CSA and final histopathological diagnosis were collected. The presence of CSA was statistically analysed against these clinical, imaging and histopathological variables. RESULTS 128 patients fulfilled the inclusion criteria [63 males, 65 females; mean age = 50.6 years (7-96 years)]. CSA was present in 50 cases (39.1%) overall, but in 39 (41.5%) of 94 cases with histological diagnosis. There was no statistically significant relationship to any assessed variable apart from relationship to the deep fascia, CSA being more frequent in lesions contacting the fascia compared to lesions contacting both skin and fascia (p-value 0.02). In particular, the presence of CSA did not allow differentiation between non-malignant and malignant lesions. CONCLUSION The presence of CSA is a not infrequent finding in the MRI assessment of superficial soft tissue masses but does not appear to be of any significance in differentiating between non-malignant and malignant lesions. ADVANCES IN KNOWLEDGE CSA is a relatively common finding in association with superficial soft tissue masses, but does not indicate a particular histological diagnosis or help in the differentiation of non-malignant from malignant lesions.
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Affiliation(s)
- Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Shuaib Siddiqui
- Department of Accident & Emergency, East Surrey Hospital, Redhill, UK
| | - Ian Pressney
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Michael Khoo
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
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28
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Mujtaba B, Wang F, Taher A, Aslam R, Madewell JE, Nassar S. Myxoid Liposarcoma With Skeletal Metastases: Pathophysiology and Imaging Characteristics. Curr Probl Diagn Radiol 2019; 50:66-73. [PMID: 31813645 DOI: 10.1067/j.cpradiol.2019.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/17/2019] [Accepted: 10/23/2019] [Indexed: 12/14/2022]
Abstract
Liposarcoma is a commonly occurring soft tissue sarcoma that can be divided into 4 subtypes. Myxoid and round cell liposarcoma (MRCL) represent one of these subtypes and are classified together due to their shared chromosomal translocation. Histologic analysis of MRCL reveals a myxoid matrix with a delicate capillary network and dispersed lipoblasts. Varying degrees of round cell component are also observed, with greater amounts of round cells indicating a higher histologic grade and poorer prognosis. MRCL has a unique pattern of spread due to its initial tendency to spread to extrapulmonary sites. Additionally, skeletal metastases are frequently found in cases of MRCL. While various imaging techniques are used to visualize MRCL and metastases, magnetic resonance imaging is generally the preferred method. This article reviews the pathophysiology and imaging features of MRCL as well as the imaging characteristics, advantages, and drawbacks of multiple imaging modalities for visualizing bone metastases.
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Affiliation(s)
- Bilal Mujtaba
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Felicia Wang
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Ahmed Taher
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rizwan Aslam
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - John E Madewell
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sameh Nassar
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
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29
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Prabhakar N, Vaiphei K, Vishwajeet V, Ramamoorthy E, Gorsi U, Dhooria S, Kapoor R, Sandhu MS. Primary pleural liposarcoma: A rare entity. Lung India 2019; 36:438-440. [PMID: 31464217 PMCID: PMC6710966 DOI: 10.4103/lungindia.lungindia_246_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Primary pleural liposarcoma (PPL) is a rare malignant tumor of the pleura. The diagnosis of PPL may be suspected on chest imaging based on radiologic features such as large pleural mass showing areas of fat with or without calcification. Herein, we present the case of a 32-year-old male whose contrast-enhanced computed tomography scan of the chest revealed a large, heterogeneous, hypodense, right pleural-based mass with small areas of fat and calcification within it. An ultrasound-guided biopsy was performed, which confirmed the diagnosis of a myxoid variant of pleural liposarcoma.
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Affiliation(s)
- Nidhi Prabhakar
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kim Vaiphei
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikarn Vishwajeet
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Eniyavel Ramamoorthy
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kapoor
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - M S Sandhu
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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30
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Giant Lower Limb Myxoid Liposarcoma Causing Deep Vein Thrombosis, Complicated with Pulmonary Embolism Case Report. ARS MEDICA TOMITANA 2019. [DOI: 10.2478/arsm-2019-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Liposarcoma (LPS) is one of the most common histologic subtypes of adult soft tissue sarcoma. Here, we report the case of a 52-year-old woman complaining of shortness of breath, chest pain, painful leg swelling 24 hour before presentation at our institution.
Despite a vascular, soft part ultrasound and CTA, which suspected a voluminous haematoma, a huge tumour was found and a myxoid liposarcoma was identified by surgical excision and a histological examination, respectively.
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31
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Paasch C, Isbruch A, Strik MW, Siegel R. Malignant intestinal obstruction during twin pregnancy: surgical resection of a myxoid liposarcoma without induction of labour. BMJ Case Rep 2019; 12:12/7/e229742. [PMID: 31289166 DOI: 10.1136/bcr-2019-229742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Myxoid liposarcoma (MLS) represents one of the three main morphological subgroups of liposarcomas. Extrapulmonary recurrence to the retroperitoneum and abdomen is common in MLS. A pregnant patient was referred to our hospital due to abdominal pain and obstipation. In the past, she had received a multimodal treatment of an MLS of the left dorsal thigh. Now, MRI revealed a 14.6×10.1×12.4 cm-sized tumour adjacent to the uterus with a known twin pregnancy (26th week). We performed surgery under tocolytic therapy. The tumour has been completely removed. The histopathological examination revealed a nodular manifestation of a moderately differentiated MLS arising from the mesentery. Eleven weeks later, our patient delivered healthy twins. This is the first report of surgical resection of MLS during a twin pregnancy. With a multidisciplinary approach and a concerted treatment by surgeons and obstetricians, surgical resection resolved malignant intestinal obstruction and enabled an uncomplicated continuation of pregnancy.
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Affiliation(s)
- Christoph Paasch
- General, Visceral and Oncology Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Annette Isbruch
- Obstetrics and Gynaecology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Martin W Strik
- General, Visceral and Oncology Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Robert Siegel
- General, Visceral and Oncology Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany.,Faculty of Health, Witten/Herdecke University, Witten, Germany
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32
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Short tau inversion recovery magnetic resonance imaging for staging and screening in myxoid liposarcoma. J Orthop 2019; 16:206-210. [PMID: 30906124 DOI: 10.1016/j.jor.2019.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 02/17/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose Myxoid liposarcoma has a propensity to metastasize to bone. MRI is the preferred modality for detecting bone disease. We evaluated multiple MRI sequences to determine an optimal screening method. Methods Whole body MRI was performed on all patients. The number and locations of metastases found by imaging and round cell component of the sites sampled were evaluated. Results We found a total of 68 osseous lesions. Whole body MRI utilizing STIR only sequences decreased imaging time by 83.6% and demonstrated the lesions the best. Conclusions STIR sequences can be exclusively used during staging and screening of myxoid liposarcoma.
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33
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18F-FDG PET/CT and MRI features of myxoid liposarcomas and intramuscular myxomas. Skeletal Radiol 2018; 47:1641-1650. [PMID: 29926115 DOI: 10.1007/s00256-018-3000-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the imaging characteristics of intramuscular myxomas (IM) and myxoid liposarcomas (MLS) on 18F-FDG PET/CT and MRI. MATERIALS AND METHODS With IRB approval, our institutional imaging database was searched for pathologically proven IM and MLS evaluated by 18F-FDG PET/CT and MRI. PET/CT and MRI imaging characteristics were recorded and correlated with pathologic diagnosis. RESULTS We found eight patients (2 M, 6 F) with IM (mean age 65.6 ± 10.4 years) and 16 patients (7 F, 9 M) with MLS (mean age 42.8 ± 16.3 years). MRI was available in 7/8 IM and 15/16 MLS patients. There was no significant difference between the two groups in SUVmax (IM 2.7 ± 0.8, MLS 3.0 ± 1.0; p = 0.35), SUVmean (1.7 ± 0.4, 1.5 ± 0.5; p = 0.40), total lesion glycolysis (101.8 ± 127.3, 2420.2 ± 4003.3 cm3*g/ml; p = 0.12), metabolic tumor volume (62.3 ± 71.1, 1742.9 ± 3308.0 cm3; p = 0.17) or CT attenuation (p = 0.70). MLS occurred in younger patients (p = 0.0015), were larger (16.4 ± 8.2 vs. 5.6 ± 2.5 cm; p = 0.0015), more often T1 hyperintense (p = 0.03), with nodular enhancement (p = 0.006), and macroscopic fat on CT (p = 0.0013) and MRI (p = < 0.001) compared to myxomas. CONCLUSIONS IM and MLS most commonly demonstrate low-grade FDG activity and overlapping metabolic measures on PET/CT. MRI is useful in differentiation, but MLS can present without macroscopic fat on MRI, underscoring the importance of radiologic-pathologic correlation for accurate diagnosis.
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34
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Morag Y, Yablon C, Brigido MK, Jacobson J, Lucas D. Imaging appearance of well-differentiated liposarcomas with myxoid stroma. Skeletal Radiol 2018; 47:1371-1382. [PMID: 29663025 DOI: 10.1007/s00256-018-2940-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 03/21/2018] [Accepted: 03/25/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Describe the imaging appearance of well-differentiated liposarcoma with myxoid stroma (WDLMS) and correlate with histopathology. MATERIALS AND METHODS A keyword search of the institution medical records was performed from 1 January 2000 to 30 June 2017. The histopathology slides of cases identified in this fashion were then reviewed by a pathologist. Additional cases were prospectively collected from extramural referrals and tumor boards. Diagnostic imaging studies of pathologically proven cases of WDLMS were then reviewed in consensus and correlated with pathology. RESULTS Ten cases of pathologically proven WDLMS were identified (7 men, 3 women, ages 26-81). Tumor location included the retroperitoneum (n = 5), thigh (n = 4), and the shin (n = 1). Nine patients had macroscopic fat on imaging. The nonlipomatous components had a variable appearance, including septal, nodular, and lacelike patterns. Two cases included two distinct areas that were predominantly myxoid or lipomatous ("bi-morphic"). One tumor had no macroscopic fat on imaging. On CT, the nonlipomatous nodular components were hypodense/had hypodense areas. On MRI, the nodular components had intermediate/bright T2W signal. Interval nonlipomatous nodular growth was identified in 3 cases. CONCLUSION WDLMS may present on imaging as a mass with variable morphology and amounts of nonlipomatous components. Histopathological diagnosis of WDLMS is challenging and imaging correlation may be helpful, as this tumor may have ≥50% fatty volume, may have a myxoid nodular component or bi-morphic appearance, or may be located in the retroperitoneum, features that are unusual for myxoid liposarcoma. WDLMS with a nodular component cannot be distinguished from dedifferentiated liposarcoma based on imaging alone.
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Affiliation(s)
- Yoav Morag
- Department of Radiology, University of Michigan Hospitals, Taubman Center 2910F, SPC 5326, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5326, USA.,Department of Pathology, University of Michigan Hospitals, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5326, USA
| | - Corrie Yablon
- Department of Radiology, University of Michigan Hospitals, Taubman Center 2910F, SPC 5326, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5326, USA.,Department of Pathology, University of Michigan Hospitals, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5326, USA
| | - Monica Kalume Brigido
- Department of Radiology, University of Michigan Hospitals, Taubman Center 2910F, SPC 5326, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5326, USA.,Department of Pathology, University of Michigan Hospitals, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5326, USA
| | - Jon Jacobson
- Department of Radiology, University of Michigan Hospitals, Taubman Center 2910F, SPC 5326, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5326, USA.,Department of Pathology, University of Michigan Hospitals, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5326, USA
| | - David Lucas
- Department of Radiology, University of Michigan Hospitals, Taubman Center 2910F, SPC 5326, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5326, USA. .,Department of Pathology, University of Michigan Hospitals, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5326, USA.
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35
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Kuyumcu G, Rubin BP, Bullen J, Ilaslan H. Quantification of fat content in lipid-rich myxoid liposarcomas with MRI: a single-center experience with survival analysis. Skeletal Radiol 2018; 47:1411-1417. [PMID: 29948035 DOI: 10.1007/s00256-018-2974-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 05/01/2018] [Accepted: 05/08/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the fat content of myxoid liposarcomas (MLS) on MRI and to identify any association between lipid content and survival. MATERIALS AND METHODS The fat percentage of MLS diagnosed between January 2006 and December 2016 at a single institution was assessed by two radiologists on preoperative MR images. A Cox proportional hazard model was used to determine any association between tumor fat percentage and survival time. Tumor fat percentage was the single predictor in the model. A significance level of 0.05 was used. The Kaplan-Meier estimator was also used to provide a nonparametric estimate of the survivor function within the entire sample and within two patient subgroups consists of lipid-rich and lipid-poor tumors. Lipid-rich tumors were defined as any tumors showing more than 20% of fat on MRI. A 20% cutoff was determined arbitrarily. RESULTS Of the 43 cases identified through retrospective review, 8 tumors demonstrated ≥10% fat on MRI, and 4 tumors demonstrated ≥20% fat (highest fat percentage, 38%). There was no significant survival difference between patients with high tumor fat, which was defined as ≥20% fat, compared with those with little to no tumor fat. CONCLUSION Myxoid liposarcomas may demonstrate a higher fat content on MRI than has previously been reported in the literature. Increased tumor fat percentage in lipid-rich tumors was not found to be associated with increased risk of death. Radiologists must be aware of the existence of MLS lesions with higher fat content.
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Affiliation(s)
- Gokhan Kuyumcu
- Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Brian P Rubin
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Jennifer Bullen
- Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Hakan Ilaslan
- Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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36
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Liu W, Liang W, Peng Z. Positron emission tomography/computed tomography manifestations of primary hepatic myxoid liposarcoma: A case report. Medicine (Baltimore) 2018; 97:e12307. [PMID: 30278507 PMCID: PMC6181573 DOI: 10.1097/md.0000000000012307] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Computed tomography (CT) and magnetic resonance imaging (MRI) are conventional used to evaluate liver tumors. Detection of fat component is considered an important clue to the imaging diagnosis of hepatic myxoid liposarcoma. However, the positron emission tomography (PET)/CT report of hepatic myxoid liposarcoma is scarce, and the metabolic characteristics of primary hepatic myxoid liposarcoma are still unknown. PATIENT CONCERNS In this report, we report the PET/CT manifestations of a rare case of primary hepatic myxoid liposarcoma that was confirmed by pathologic examination. A 29-year-old male patient presented with a nodule adjacent to the umbilicus that had been present for 2 weeks. PET/CT showed a hypoattenuating mass with moderate uptake (maximum standardized uptake value [SUVmax] 1.9), except for a slightly hyperattenuating focal area with intense uptake (SUVmax 3.1). DIAGNOSES The final pathologic diagnosis was confirmed, by means of laparotomy, to be a primary hepatic myxoid liposarcoma with multiple extrahepatic metastases. INTERVENTIONS The lesions in the left liver and periumbilical abdominal wall were punctured. During the laparotomy, hepatic malignant tumors were confirmed and metastasized widely in the abdominal cavity. OUTCOMES An abdominal CT performed 4 months after initial presentation showed extensive metastasis. LESSONS Primary hepatic myxoid liposarcoma may manifest as moderate metabolism with less fat on PET/CT. PET/CT is not only valuable in reflecting the round cell component of hepatic myxoid liposarcoma, but also in estimating its origin.
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Affiliation(s)
- Weihai Liu
- Department of Radiology, Beilun Branch Hospital of the First Affiliated Hospital, College of Medicine, Zhejiang University, the People's Hospital of Beilun District, Ningbo, Zhejiang
| | - Wenjie Liang
- Department of Radiology, First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, China
| | - Zhiyi Peng
- Department of Radiology, First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, China
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37
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Homogeneous myxoid liposarcomas mimicking cysts on MRI: A challenging diagnosis. Eur J Radiol 2018; 102:41-48. [DOI: 10.1016/j.ejrad.2018.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 02/07/2018] [Accepted: 03/01/2018] [Indexed: 02/07/2023]
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38
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Jagannathan JP, Tirumani SH, Ramaiya NH. Imaging in Soft Tissue Sarcomas: Current Updates. Surg Oncol Clin N Am 2018; 25:645-75. [PMID: 27591491 DOI: 10.1016/j.soc.2016.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Soft tissue sarcomas (STS) are heterogeneous malignant tumors that have nonspecific imaging features. A combination of clinical, demographic, and imaging characteristics can aid in the diagnosis. Imaging provides important information regarding the tumor extent, pretreatment planning, and surveillance of patients with STS. In this article, we illustrate the pertinent imaging characteristics of the commonly occurring STS and some uncommon sarcomas with unique imaging characteristics.
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Affiliation(s)
- Jyothi P Jagannathan
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Sree Harsha Tirumani
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Nikhil H Ramaiya
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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39
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Kovitwanichkanont T, Naidoo P, Guio-Aguilar P, Leong J. Hibernoma: a rare benign soft tissue tumour resembling liposarcoma. BJR Case Rep 2018; 4:20170067. [PMID: 31489209 PMCID: PMC6711274 DOI: 10.1259/bjrcr.20170067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 01/24/2018] [Accepted: 01/27/2018] [Indexed: 12/25/2022] Open
Abstract
Hibernoma is a rare benign soft tissue tumour that can mimic a liposarcoma on
radiographic imaging. Our case series review illustrates the clinical
presentation and radiographic appearances of four patients with histologically
confirmed hibernoma. Hibernoma is usually hypointense relative to subcutaneous
fat on T1 weighted MRI and demonstrates partial fat suppression on
fat-saturated sequences. Large intratumoral vessels likely support the diagnosis
of hibernoma but are not invariably present. Fludeoxyglucose avidity on PET scan
is not beneficial in distinguishing hibernoma from soft tissue malignancy
because of its inherent, metabolically active property. Owing to the
radiographic heterogeneity of hibernoma, it is currently not possible to
diagnose hibernoma based on imaging characteristics alone. Given the excellent
prognosis of hibernoma with marginal excision alone, an appreciation of the
radiographic features is helpful in the appropriate pre-operative workup of soft
tissue tumours.
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Affiliation(s)
- Tom Kovitwanichkanont
- Department of Rheumatology, Monash Health, Melbourne, VIC, Australia.,Department of Dermatology, Monash Health, Melbourne, VIC, Australia.,University of Sydney, Sydney, NSW, Australia
| | - Parm Naidoo
- Department of Radiology, Monash Health, Melbourne, VIC, Australia.,Monash University, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
| | - Pedro Guio-Aguilar
- Department of Plastic Surgery and Reconstructive Surgery, Monash Health, Melbourne, VIC, Australia
| | - James Leong
- Monash University, Melbourne, VIC, Australia.,Department of Plastic Surgery and Reconstructive Surgery, Monash Health, Melbourne, VIC, Australia
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40
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Abstract
Soft tissue tumors represent a special challenge in interdisciplinary cooperation. Malignant tumors require a multimodal therapy concept so that patient treatment in a specialized tumor center is recommended. The task of the surgeon in close cooperation with the radiologist is the resection of the tumor in sano with the required safety margin. The aim of diagnostic imaging is to describe the primary expansion of the tumor size and a possible tumor infiltration of adjacent compartments. The most important diagnostic imaging for this purpose is magnetic resonance imaging (MRI), especially T1-weighted fat-suppressed gadolinium-enhanced sequences. Together with T2-weighted sequences a reliable differentiation between necrosis and vital tumor tissue is possible, which enables a targeted biopsy of vital tumor tissue. For the differentiation between benign and malignant soft tissue tumors and for determination of histological differentation a core needle biopsy, either computer tomography-guided or under sonographic control and increasingly more by MRI guidance, is currently the gold standard in most tumor centers. A representative biopsy from vital tumor tissue leads to the diagnosis with a very high degree of certainty.
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Affiliation(s)
- L Fenzl
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Kirrbergerstraße, 66424, Homburg/Saar, Deutschland.
| | - K Bubel
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Kirrbergerstraße, 66424, Homburg/Saar, Deutschland
| | - M Mehrmann
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Kirrbergerstraße, 66424, Homburg/Saar, Deutschland
| | - G Schneider
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Kirrbergerstraße, 66424, Homburg/Saar, Deutschland
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Bansal AG, Rosenberg HK. Sonography of pediatric superficial lumps and bumps: illustrative examples from head to toe. Pediatr Radiol 2017; 47:1171-1183. [PMID: 28779193 DOI: 10.1007/s00247-017-3859-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/21/2017] [Accepted: 04/05/2017] [Indexed: 02/07/2023]
Abstract
Superficial lumps and bumps are extremely common in children, and the vast majority ultimately prove to be benign. Duplex/color Doppler ultrasound (US) has emerged as the first-line imaging modality for the evaluation of these superficial pediatric masses because it provides a means for rapid acquisition of information including size, shape, location, internal content and vascularity. More important, it does so without utilizing radiation, iodinated contrast material or sedation/anesthesia. In this review, we present the sonographic findings of a variety of cases ranging from head to toe that are either uncommonly seen or were diagnosed in an atypical fashion (i.e. ultrasound). In situations where the lesion is too deep, hyperechoic or large to be fully assessed within the field of view or if malignancy is suspected, then additional cross-sectional imaging is warranted for further evaluation.
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Affiliation(s)
- Anmol Gupta Bansal
- Department of Radiology, Kravis Children's Hospital at the Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Henrietta Kotlus Rosenberg
- Department of Radiology, Kravis Children's Hospital at the Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY, 10029, USA
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Abstract
Lipomatous lesions are common musculoskeletal lesions that can arise within the soft tissues, bone, neurovascular structures, and synovium. The majority of these lesions are benign, and many of the benign lesions can be diagnosed by radiologic evaluation. However, radiologic differences between benign and malignant lipomatous lesions may be subtle and pathologic correlation is often needed. The use of sonography, computed tomography (CT), and magnetic resonance imaging (MRI) is useful not only in portraying fat within the lesion, but also for evaluating the presence and extent of soft tissue components. Lipomas make up most soft tissue lipomatous lesions, but careful evaluation must be performed to distinguish these lesions from a low-grade liposarcoma. In addition to the imaging appearance, the location of the lesion and the patient demographics can be utilized to help diagnose other soft tissue lipomatous lesions, such as elastofibroma dorsi, angiolipoma, lipoblastoma, and hibernoma. Osseous lipomatous lesions such as a parosteal lipoma and intraosseous lipoma occur less commonly as their soft tissue counterpart, but are also benign. Neurovascular and synovial lipomatous lesions are much rarer lesions but demonstrate more classic radiologic findings, particularly on MRI. A review of the clinical, radiologic, and pathologic characteristics of these lesions is presented.
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Affiliation(s)
- Ashley M Burt
- Department of Radiology, University of California San Diego, 200 West Arbor Drive, Mail Code: 8756, San Diego, CA 92130, USA
| | - Brady K Huang
- Department of Radiology, University of California San Diego, 200 West Arbor Drive, Mail Code: 8756, San Diego, CA 92130, USA
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43
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Song Y, Yoon YC, Chong Y, Seo SW, Choi YL, Sohn I, Kim MJ. Diagnostic performance of conventional MRI parameters and apparent diffusion coefficient values in differentiating between benign and malignant soft-tissue tumours. Clin Radiol 2017; 72:691.e1-691.e10. [PMID: 28274509 DOI: 10.1016/j.crad.2017.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/23/2017] [Accepted: 02/03/2017] [Indexed: 12/15/2022]
Abstract
AIM To compare the abilities of conventional magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) in differentiating between benign and malignant soft-tissue tumours (STT). MATERIAL AND METHODS A total of 123 patients with STT who underwent 3 T MRI, including diffusion-weighted imaging (DWI), were retrospectively analysed using variate conventional MRI parameters, ADCmean and ADCmin. RESULTS For the all-STT group, the correlation between the malignant STT conventional MRI parameters, except deep compartment involvement, compared to those of benign STT were statistically significant with univariate analysis. Maximum diameter of the tumour (p=0.001; odds ratio [OR], 8.97) and ADCmean (p=0.020; OR, 4.30) were independent factors with multivariate analysis. For the non-myxoid non-haemosiderin STT group, signal heterogeneity on axial T1-weighted imaging (T1WI; p=0.017), ADCmean, and ADCmin (p=0.001, p=0.001), showed significant differences with univariate analysis between malignancy and benignity. Signal heterogeneity in axial T1WI (p=0.025; OR, 12.64) and ADCmean (p=0.004; OR, 33.15) were independent factors with multivariate analysis. CONCLUSION ADC values as well as conventional MRI parameters were useful in differentiating between benign and malignant STT. The ADCmean was the most powerful diagnostic parameter in non-myxoid non-haemosiderin STT.
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Affiliation(s)
- Y Song
- Department of Radiology, Hanyang University Hospital, Seoul, Republic of Korea; Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Y C Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
| | - Y Chong
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - S W Seo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Y-L Choi
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea; Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - I Sohn
- Department of Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Republic of Korea
| | - M-J Kim
- Biostatistics Team, Samsung Biomedical Research Institute, Seoul, Republic of Korea
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44
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Gimber LH, Montgomery EA, Morris CD, Krupinski EA, Fayad LM. MRI characteristics associated with high-grade myxoid liposarcoma. Clin Radiol 2017; 72:613.e1-613.e6. [PMID: 28256200 DOI: 10.1016/j.crad.2017.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 11/28/2016] [Accepted: 01/30/2017] [Indexed: 10/20/2022]
Abstract
AIM To identify magnetic resonance imaging (MRI) features differentiating high-grade (>5% round-cell component) from low-grade myxoid liposarcomas (LPS) (≤5% round-cell component). MATERIALS AND METHODS Informed consent was waived. Patients with myxoid LPS and MRI before biopsy, neoadjuvant therapy, and surgery were included retrospectively. High-grade components were recorded from histological specimens by a pathologist (24 years of experience). Images were evaluated by a senior radiologist (>12 years of experience) for tumour size, location, tissue layer, and MRI features (signal intensity, heterogeneity, margin, and perilesional characteristics). Descriptive statistics, Fisher's exact test to identify associations with a round-cell component, and multivariate logistic regression to identify independent predictors of high-grade tumours were used. RESULTS Thirty-one patients (16 women [mean 51.1 years; range 19-79 years] and 15 men [mean 45.5 years; range 18-95 years]) with myxoid LPS (23 low-grade, eight high-grade) were included. All high-grade lesions had lipid signal, a peritumoural capsule and peritumoural contrast enhancement, and more commonly exhibited heterogeneous signal; however, the average size of ≥10 cm was the strongest independent indicator of high-grade status (odds ratio [OR], 14.6; 95% confidence interval [CI]: 1.6, 131). CONCLUSION Size ≥10 cm is most strongly associated with high-grade myxoid LPS (round-cell component >5%). Other features possibly differentiating high-grade from low-grade status include lesion margin, lipid signal, and perilesional characteristics.
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Affiliation(s)
- L H Gimber
- Department of Medical Imaging, The University of Arizona, College of Medicine, Banner - University Medical Center, 1501 N Campbell Ave., P.O. Box 245067, Tucson, AZ 85724, USA.
| | - E A Montgomery
- Department of Pathology, The Johns Hopkins University, Weinberg Bldg, Rm. 2242, 401 North Broadway, Baltimore, MD 21231, USA
| | - C D Morris
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, 601 N Caroline St, Baltimore, MD 21287, USA
| | - E A Krupinski
- Department of Radiology & Imaging Sciences, Emory University, 1364 Clifton Rd NE D107, Atlanta, GA 30322, USA
| | - L M Fayad
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins University School of Medicine, 601 North Wolfe Street, Baltimore, MD 21287, USA
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45
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Primary Extremity Liposarcoma: MRI Features, Histopathology, and Clinical Outcomes. J Comput Assist Tomogr 2017; 40:791-8. [PMID: 27224232 DOI: 10.1097/rct.0000000000000431] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study aimed to describe magnetic resonance imaging (MRI) features of extremity liposarcoma (LPS) subtypes, correlating with histopathology and clinical outcomes. METHODS In this retrospective study, we included 125 patients (80 men, 45 women; mean age, 53 years) with extremity LPS [23 atypical lipomatous tumor (ALT), 9 dedifferentiated (DDLPS), 70 myxoid (MLPS), 23 pleomorphic (PLPS)]. Pretreatment MRI of primary tumors in 56 patients (10 ALT, 4 DDLPS, 28 MLPS, 14 PLPS) was reviewed. RESULTS All subtypes were predominantly T1 isointense relative to skeletal muscle (DDLPS = 3/4, MLPS = 28/28, PLPS = 13/14) and T2 hyperintense (ALT = 10/10, DDLPS = 3/4, MLPS = 28/28, PLPS = 14/14) except for ALT which were T1 hyperintense (8/10). Within MLPS, high grade was associated with unencapsulated margins (P = 0.05) and solid, nodular enhancement (P < 0.0001). Peritumoral edema (P = 0.03) and T2 heterogeneity (P = 0.05) predicted pulmonary (rather than extrapulmonary) metastases in MLPS. Tumor subtype correlated with mortality (P = 0.04). CONCLUSIONS The MRI features can help to distinguish between extremity LPS subtypes, and can predict histopathologic grade and metastatic pattern in myxoid LPS.
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46
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Sheybani EF, Eutsler EP, Navarro OM. Fat-containing soft-tissue masses in children. Pediatr Radiol 2016; 46:1760-1773. [PMID: 27866258 DOI: 10.1007/s00247-016-3690-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 06/28/2016] [Accepted: 08/12/2016] [Indexed: 12/27/2022]
Abstract
The diagnosis of soft-tissue masses in children can be difficult because of the frequently nonspecific clinical and imaging characteristics of these lesions. However key findings on imaging can aid in diagnosis. The identification of macroscopic fat within a soft-tissue mass narrows the differential diagnosis considerably and suggests a high likelihood of a benign etiology in children. Fat can be difficult to detect with sonography because of the variable appearance of fat using this modality. Fat is easier to recognize using MRI, particularly with the aid of fat-suppression techniques. Although a large portion of fat-containing masses in children are adipocytic tumors, a variety of other tumors and mass-like conditions that contain fat should be considered by the radiologist confronted with a fat-containing mass in a child. In this article we review the sonographic and MRI findings in the most relevant fat-containing soft-tissue masses in the pediatric age group, including adipocytic tumors (lipoma, angiolipoma, lipomatosis, lipoblastoma, lipomatosis of nerve, and liposarcoma); fibroblastic/myofibroblastic tumors (fibrous hamartoma of infancy and lipofibromatosis); vascular anomalies (involuting hemangioma, intramuscular capillary hemangioma, phosphate and tensin homologue (PTEN) hamartoma of soft tissue, fibro-adipose vascular anomaly), and other miscellaneous entities, such as fat necrosis and epigastric hernia.
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Affiliation(s)
- Elizabeth F Sheybani
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.,Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric P Eutsler
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Oscar M Navarro
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada. .,Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
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47
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Wang S, Chan LW, Tang X, Su C, Zhang C, Sun K, Shen D, Chen H, Guo W. A weighted scoring system to differentiate malignant liposarcomas from benign lipomas. J Orthop Surg (Hong Kong) 2016; 24:216-21. [PMID: 27574266 DOI: 10.1177/1602400219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To construct a scoring system to differentiate malignant liposarcomas from benign lipomas by comparing their clinical and magnetic resonance imaging (MRI) features. METHODS Clinical and MRI features of 33 women and 33 men aged 17 to 83 (mean, 53) years who underwent resection of malignant liposarcomas (n=32) or benign lipomas (n=34) were reviewed. RESULTS The 5 strongest predictors of liposarcoma were male gender, larger tumour maximum dimension, deep to fascia, thick non-fatty septum or nodule, and internal cystic change. A weighted scoring system was constructed using the 5 strongest predictors as: Z score=10X1+X2+12X3+15X4+10X5, respectively. A cut-off score of 35 was used; all 32 malignant liposarcomas and 4 of 34 benign lipomas scored >35. The cut-off score of ≤35 could predict 30 of 66 lipomatous tumours as benign with a negative predictive value of 100% (p<0.0001). CONCLUSION The 5 strongest clinical and MRI features were identified to construct a scoring system to differentiate malignant from benign lipomatous tumours. Further validation in independent populations is required.
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Affiliation(s)
- S Wang
- Musculoskeletal Tumour Centre of Peking University People's Hospital, China & Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - L Wm Chan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - X Tang
- Musculoskeletal Tumour Centre of Peking University People's Hospital, China
| | - C Su
- Clinical Research Unit, Khoo Teck Pual Hospital, Singapore
| | - C Zhang
- Department of Statistics, Peking University People's Hospital, China
| | - K Sun
- Department of Pathology, Peking University People's Hospital, China
| | - D Shen
- Department of Pathology, Peking University People's Hospital, China
| | - H Chen
- Department of Radiology, Peking University People's Hospital, China
| | - W Guo
- Musculoskeletal Tumour Centre of Peking University People's Hospital, China
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Christian D, Leland HA, Osias W, Eberlin S, Howell L. Delayed Presentation of a Chronic Morel-Lavallée Lesion. J Radiol Case Rep 2016; 10:30-39. [PMID: 27761187 DOI: 10.3941/jrcr.v10i7.2698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Morel-Lavellée lesions are soft tissue degloving injuries resulting from shearing trauma that induces separation of the superficial and deep fascias creating a potential space that becomes filled with hemolymph. Here we present a case of a 28-year-old male presenting with a persistent Type I Morel-Lavallée lesion 2.5 years after an automobile versus pedestrian accident. These lesions can be visualized via computed tomography, plain film and ultrasound, but magnetic resonance imaging is the modality of choice for their identification and characterization.
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Affiliation(s)
- David Christian
- Keck School of Medicine of USC, LAC+USC Medical Center, Los Angeles, CA, USA
| | - Hyuma A Leland
- Division of Plastic and Reconstructive Surgery, LAC+USC Medical Center, Los Angeles, CA, USA
| | - Walter Osias
- Department of Radiology, LAC+USC Medical Center, Los Angeles, CA, USA
| | - Seth Eberlin
- Division of Plastic and Reconstructive Surgery, LAC+USC Medical Center, Los Angeles, CA, USA
| | - Lori Howell
- Division of Plastic and Reconstructive Surgery, LAC+USC Medical Center, Los Angeles, CA, USA
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49
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Papo M, Crockett F, Gounant V, Assouad J, Schlemmer F, Bergeron A, Antoine M, Naccache JM. Cystic Pulmonary Myxoid Liposarcoma Mimicking Endobronchial Blood Clot. J Bronchology Interv Pulmonol 2016; 23:152-4. [PMID: 27058719 DOI: 10.1097/lbr.0000000000000188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 71-year-old-man was transferred to our hospital in November 2012 for a bronchial artery embolization in the context of recurrent blood clots obstructing the left lower bronchus. Since June 2012, he had been explored for a cystic hypermetabolic lesion of the entire left lobe, and underwent 3 bronchoscopies and 2 computed tomography scan-guided biopsies, with no success. A fourth bronchoscopy enabled the extraction of a large blood clot (8×1.5 cm) that obstructed the left main bronchus. The pathologic examination of the mucosal biopsy samples was inconclusive, whereas the cytologic examination of the blood clot revealed myxoid liposarcoma. Liposarcomas are the most common histologic types of soft-tissue sarcomas. They preferentially metastasize to the lungs and can appear as cystic mass. Bronchial obstruction by blood clots is not a rare finding on bronchoscopy, their main problem is their removal which could require rigid bronchoscope and large forceps. However, bronchial blood clot containing tumoral process had never been reported before. In conclusion, this case conveys 2 messages. First, pulmonary metastasis of myxoid liposarcoma can appear as cyst secondary to endobronchial tumoral growth. Second, endobronchial blood clots should always be sent for pathologic analysis.
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Affiliation(s)
- Matthias Papo
- *Service de Pneumologie †Service de Chirurgie Thoracique §Service d'anatomo-pathologie, Hôpital Tenon, Université Pierre et Marie Curie ‡Service de Pneumologie, Hôpital Saint-Louis, Université Denis Diderot, Assistance Publique-Hôpitaux de Paris, Paris, France
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Kaneuchi Y, Hakozaki M, Yamada H, Tajino T, Watanabe K, Otani K, Hojo H, Hasegawa T, Konno S. Primary dumbbell-shaped epidural myxoid liposarcoma of the thoracic spine: A case report and review of the literature. Oncol Lett 2016; 11:1421-1424. [PMID: 26893754 DOI: 10.3892/ol.2016.4089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 10/21/2015] [Indexed: 11/05/2022] Open
Abstract
Myxoid liposarcoma frequently occurs in the deep soft tissue of the extremities, particularly in the thigh. The present study describes an extremely rare case of primary dumbbell-shaped epidural myxoid liposarcoma of the thoracic spine occurring in a 22-year-old woman. Although preoperative magnetic resonance imaging findings were thought to be compatible with schwannoma, the pathological diagnosis of the resected tumor was myxoid liposarcoma. The patient underwent three courses of adjuvant chemotherapy with doxorubicin and ifosfamide, and exhibited no symptoms or signs of local recurrence or metastasis for 18 months post surgery. The present case suggests that, when radiologically diagnosing spinal epidural tumors, clinicians should consider the possibility of myxoid liposarcoma.
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Affiliation(s)
- Yoichi Kaneuchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Michiyuki Hakozaki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hitoshi Yamada
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Takahiro Tajino
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; Division of Orthopaedic Surgery, Southern Tohoku Fukushima Hospital, Fukushima 960-2102, Japan
| | - Kazuyuki Watanabe
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hiroshi Hojo
- Department of Diagnostic Pathology, Aizu Medical Center, Fukushima Medical University, Fukushima 969-3492, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Hokkaido 060-8453, Japan
| | - Shinichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
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