Liposarcoma of the forearm in a man with type 1 neurofibromatosis: a case report

TNM classification of malignant tumors: Eighth edition for retroperitoneal liposarcoma. Ways to improve

AIM

This study was aimed at assessing the prognostic significance of the "TNM: Classification of Malignant Tumors" eighth edition (TNM8) in the most common retroperitoneal tumors - liposarcoma.

METHODS

The study included 192 patients with retroperitoneal liposarcoma (RLPS). The distribution of patients by stages and survival in accordance with the TNM8 were studied.

RESULTS

In the TNM8, only the degree of malignancy of the tumor has a prognostic value. The T-category does not reflect the actual size of the RLPS and is considered as T4 in 93%, which leads to inadequate staging. During the 15-year period, there were no cases with stages II and IIIA, and the survival rate was estimated only in patients with stages I and IIIB. The tumor node metastasis (TNM) classification with new values of the T-category was proposed by us, which demonstrated a more adequate distribution of patients by stages and the reliability of intergroup differences in the survival rate.

CONCLUSION

It is advisable to create a special TNM classification for RLPS, which makes up more than half of all retroperitoneal sarcomas. The TNM8 does not accurately reflect the prevalence of the tumor and the prognosis in RLPS. Revision of the T-staging is necessary to improve the accuracy of the prognosis in RLPS. The modified by us TNM classification demonstrated a more adequate distribution of patients by stages.

Synchronous recurrence of concurrent colon adenocarcinoma and dedifferentiated liposarcoma

A 62-year-old man presented with concurrent sigmoid colon adenocarcinoma and small bowel mesenteric dedifferentiated liposarcoma. Following surgical resection of the colon cancer, complete excision of the mesenteric sarcoma and adjuvant folinic acid, fluorouracil and oxaliplatin (FOLFOX) chemotherapy, the patient demonstrated no radiological evidence of disease for more than 2 years. The patient then developed synchronous recurrence of both cancers: the colon cancer metastasised to the liver and a pelvic lymph node, and the liposarcoma recurred in the original location. The patient underwent additional chemotherapy with complete response of the metastatic colon cancer and stable disease for the liposarcoma. The recurrent mesenteric tumour was subsequently resected. Although concurrent cancers have been reported, this unique case of synchronous recurrence raises interesting hypotheses regarding host-tumour interaction and immune surveillance.

Second Primary Malignancies in Patients with Well-differentiated/Dedifferentiated Liposarcoma

BACKGROUND

Well-differentiated/dedifferentiated (WD/DD) liposarcoma is a rare malignancy of putative adipocyte origin. To our knowledge, there have only been isolated case reports describing second primary cancer in patients with this disease. We report on a combined case series of such patients and explore the frequency of this occurrence using a national cancer database.

MATERIALS AND METHODS

Demographics and clinicopathological data were collected from patients with WD/DD liposarcoma who were found to have a concurrent or subsequent second primary cancer, at one of three sarcoma referral centers from 2014-2016. The Surveillance, Epidemiology and End Results (SEER) database was also queried to identify adult patients diagnosed with WD/DD liposarcoma between 1973-2012. Observed/expected (O/E) ratios of second primary malignancies among these cases were calculated by comparison to the age-adjusted cancer incidence in the general population using SEER*stat software.

RESULTS

In total, 26 out of 312 consecutive patients (8.3%) with WD/DD liposarcoma at our centers had a second primary cancer identified within 2 years of liposarcoma diagnosis. In the SEER database, among 1,845 patients with WD/DD liposarcoma, 75 (4.1%) had a second cancer within 2 years after liposarcoma diagnosis (O/E ratio=1.81, 99% confidence interval(CI)=1.33-2.40). Patients less than 50 years old at the time of liposarcoma diagnosis had a higher O/E ratio for second primary malignancy compared to older patients. A total of 269 patients (14.6%) developed a second cancer (O/E=1.33, 99% CI=1.15-1.54).

CONCLUSION

In some patients with WD/DD liposarcoma, there appears to be an increased risk of having a second primary cancer. Further validation and investigation is needed, as this finding may have implications (e.g. closer screening) for patients with this disease.

Coincident liposarcoma, carcinoid and gastrointestinal stromal tumor complicating type 1 neurofibromatosis: Case report and literature review

Neurofibromatosis type 1 (NF1) is associated with increased risk of multiple neoplasms. We present a case of a female patient with NF1 who presented with a rectal low-grade neuroendocrine (carcinoid) tumor. Computed tomography imaging found a well-differentiated liposarcoma and a well-circumscribed gastro-intestinal stromal tumor (GIST). Although GIST and carcinoid tumors are frequently found in NF1 patients, liposarcoma complicating NF1 is quite rare and this is the first reported case of well-differentiated liposarcoma in NF1. In summary, we report a case of coincident abdominal carcinoid tumor, GIST and well-differentiated liposarcoma, which illustrates the variability of neoplasms in NF1 patients.

Recurrent retroperitoneal liposarcoma in a patient with neurofibromatosis type I

INTRODUCTION

Liposarcoma complicating neurofibromatosis is very rare. Only a few cases have been described until now. We present a case of recurrent dedifferentiated retroperitoneal liposarcoma in a patient with neurofibromatosis type I (NF-1).

CASE PRESENTATION

A 47-year-old Caucasian woman with NF-1 presented to the hospital initially complaining of left lumbar pain irradiating to the anterior thigh and knee. Physical examination showed atrophy of the lower extremities bilaterally and decreased motor strength on the left lower extremity. Radiological studies demonstrated an enhancing lesion in the left paraspinal region, suggesting malignancy. The patient underwent local resection of tumour with safety margins. Pathological examination was consistent with dedifferentiated liposarcoma (DDLS) with positivity for MDM2 and CDK4 markers. No evidence of metastasis was noted on the radiological studies. The final diagnosis was DDLS, high-grade (G3), pT2bN0M0, stage III. After 6 weeks post-tumour resection, the patient experienced recurrence of malignancy. Chemotherapy with cisplatin and doxorubicin was initiated in the patient.

CONCLUSIONS

Liposarcoma in the context of neurofibromatosis is very rare. To the best of our knowledge, only six cases have been reported until now in the literature. We are presenting this case to underline the possibility of recurrence in the case of retroperitoneal DDLSs despite local tumour resection. Also, although the role of chemotherapy is controversial we decided to start treatment with cisplatin and doxorubicin given the success of chemotherapy in similar case presentations.

Lipomas of the hand: a review and 13 patient case series

OBJECTIVE

In this article, the presentation, pathophysiology, diagnosis, treatment, and complications of lipomas of the hand are reviewed and evaluated.

METHODS

A thorough review of the literature is completed, and a series of 13 patients are summarized and briefly examined.

RESULTS

Lipomas may present as asymptomatic tumors or produce concerning signs and symptoms such as muscular atrophy and paralysis. Some lipomas may be identified by physical examination alone. However, magnetic resonance imaging best facilitates definitive diagnosis.

CONCLUSIONS

In the absence of mechanical impairment or cosmetic concern, observation remains the clinical standard of care. When pain, compression neuropathy, disfigurement, or decreased function affect the patient, surgical resection is typically curative. Malignant transformation rarely occurs.