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Kojima N, Kubo T, Mori T, Satomi K, Matsushita Y, Iwata S, Yatabe Y, Ichimura K, Kawai A, Ichikawa H, Yoshida A. Myxoid liposarcoma with nuclear pleomorphism: a clinicopathological and molecular study. Virchows Arch 2024; 484:71-81. [PMID: 37704823 DOI: 10.1007/s00428-023-03631-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/14/2023] [Accepted: 08/19/2023] [Indexed: 09/15/2023]
Abstract
Myxoid liposarcoma (MLS) is a common type of liposarcoma. It is characterized by variably lipogenic uniform cells in myxoid stroma with arborizing capillaries and DDIT3 fusion. Nuclear uniformity is the rule, which is maintained even in high-grade round cell examples. In this study, we conducted an in-depth investigation of four MLS tumors that demonstrated nuclear pleomorphism in three patients. These cases accounted for 2.1% of 142 patients with MLS. All patients were male aged 26, 33, and 49 years. Nuclear pleomorphism was observed in both primary and metastatic tumors in one patient, a primary tumor in one patient, and a metastatic tumor in another patient. Pleomorphism was severe in three tumors and moderate in one. Histology resembled that of dedifferentiated liposarcoma with myxoid features, pleomorphic liposarcoma with myxoid features, or myxoid pleomorphic liposarcoma in two tumors, pleomorphic sarcoma with focal cartilaginous and rhabdomyoblastic differentiation in one tumor, and epithelioid pleomorphic liposarcoma in one tumor. All tumors harbored FUS::DDIT3 fusions and immunohistochemically expressed DDIT3. All tumors had TP53 mutations, whereas previous specimens with uniform cytology from the same patients lacked TP53 mutations. One tumor showed RB1 deletion and complete loss of Rb expression, which was unclassifiable using DNA methylation-based methods. The rare occurrence of nuclear pleomorphism is underrecognized in MLS and increases the complexity to the diagnosis of liposarcoma. DDIT3 evaluation can be liberally considered in liposarcoma assessment even in the presence of nuclear pleomorphism.
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Affiliation(s)
- Naoki Kojima
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Takashi Kubo
- Department of Clinical Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Taisuke Mori
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kaishi Satomi
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
- Department of Pathology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yuko Matsushita
- Department of Brain Disease Translational Research, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shintaro Iwata
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
- Rare Cancer Center, National Cancer Center, Tokyo, Japan
| | - Yasushi Yatabe
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Koichi Ichimura
- Department of Brain Disease Translational Research, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
- Rare Cancer Center, National Cancer Center, Tokyo, Japan
| | - Hitoshi Ichikawa
- Department of Clinical Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Akihiko Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
- Rare Cancer Center, National Cancer Center, Tokyo, Japan.
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Wang T, Waworuntu KL, Shan FY. Metastatic Epithelioid Pleomorphic Liposarcoma in the Brain: A Case Report. Cureus 2023; 15:e50066. [PMID: 38186523 PMCID: PMC10769534 DOI: 10.7759/cureus.50066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Metastatic soft tissue sarcoma (STS) to the brain is rare, and metastatic pleomorphic liposarcoma (PLPS) to the brain is even rarer. We present the case of a 76-year-old male with an incidental finding of a brain mass on a brain magnetic resonance imaging (MRI) following a head injury. Additionally, multiple pulmonary nodules and a right gluteal mass were discovered. A core biopsy of the right gluteal mass revealed an epithelioid malignant neoplasm expressing transcription factor enhancer 3 (TFE3) by immunohistochemistry (IHC). Subsequently, the left middle fossa brain mass was removed and found to be an epithelioid PLPS, which was positive for TFE3 by IHC but lacked TFE3 rearrangement by fluorescence in situ hybridization (FISH), and negative for murine double minute (MDM2) amplification by FISH. The diagnosis of epithelioid PLPS mainly relies on histomorphology. This paper discusses the clinicopathological correlation of PLPS, including the epithelioid variant, with a focus on cases with brain metastases.
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Affiliation(s)
- Tengfei Wang
- Pathology, Baylor Scott & White Health, Temple, USA
| | | | - Frank Y Shan
- Pathology and Neurosurgery, Baylor Scott & White Health, Temple, USA
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Abe M, Hoshi N, Hoshi S, Hirabayashi K, Kikuta K, Hirozane T, Nakagawa R, Mizuno T, Nakamura H, Inoue K, Yamaguchi T. A Case of GATA3 Positive Pleomorphic Liposarcoma, Epithelioid Variant: A Diagnostic Pitfall. Case Rep Pathol 2023; 2023:9443027. [PMID: 37007224 PMCID: PMC10065854 DOI: 10.1155/2023/9443027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 04/04/2023] Open
Abstract
Pleomorphic liposarcoma is a rare malignant adipocytic tumor showing undifferentiated pleomorphic sarcoma morphology with various degrees of epithelioid features. It is sometimes difficult to distinguish from carcinoma metastasis. Immunohistochemical panel is very important for differential diagnosis; however, there is a risk that unexpected staining could lead to misinterpretation. We report a pleomorphic liposarcoma, epithelioid variant, in an 88-year-old man, with tricky-positive staining for GATA3. Histological examination revealed a tumor with epithelioid morphology. The tumor consists of solid sheets of epithelioid tumor cells with focal aggregates of pleomorphic lipoblasts. Immunohistochemically, the adipocytic tumor cell areas were positive for S100 protein, and the epithelioid tumor cells showed CAM 5.2 positivity. GATA3 was diffusely positive. The combination of CAM 5.2 and GATA3 staining suggested the possibility of metastatic cancer, but systemic clinical examinations did not detect any presence of a primary tumor, including urinary bladder, breasts, and salivary glands. The pathological diagnosis of pleomorphic liposarcoma, epithelioid variant, was made because of the presence of malignant lipoblasts. Our report may contribute for differential diagnosis of pleomorphic liposarcoma, epithelioid variant, with unexpected positive immunoreaction for GATA3.
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Affiliation(s)
- Makoto Abe
- Department of Pathology, Tochigi Cancer Center, 4-9-13, Yohnan, Utsunomiya, 320-0834 Tochigi, Japan
| | - Nobuo Hoshi
- Department of Pathology, Tochigi Cancer Center, 4-9-13, Yohnan, Utsunomiya, 320-0834 Tochigi, Japan
| | - Sayuri Hoshi
- Department of Pathology, Tochigi Cancer Center, 4-9-13, Yohnan, Utsunomiya, 320-0834 Tochigi, Japan
| | - Kaoru Hirabayashi
- Department of Pathology, Tochigi Cancer Center, 4-9-13, Yohnan, Utsunomiya, 320-0834 Tochigi, Japan
| | - Kazutaka Kikuta
- Department of Musculoskeletal Oncology and Orthopaedic Surgery, Tochigi Cancer Center, 4-9-13, Yohnan, Utsunomiya, 320-0834 Tochigi, Japan
| | - Toru Hirozane
- Department of Musculoskeletal Oncology and Orthopaedic Surgery, Tochigi Cancer Center, 4-9-13, Yohnan, Utsunomiya, 320-0834 Tochigi, Japan
| | - Rumi Nakagawa
- Department of Musculoskeletal Oncology and Orthopaedic Surgery, Tochigi Cancer Center, 4-9-13, Yohnan, Utsunomiya, 320-0834 Tochigi, Japan
| | - Tsukasa Mizuno
- Department of Musculoskeletal Oncology and Orthopaedic Surgery, Tochigi Cancer Center, 4-9-13, Yohnan, Utsunomiya, 320-0834 Tochigi, Japan
| | - Hiroshi Nakamura
- Department of Musculoskeletal Oncology and Orthopaedic Surgery, Tochigi Cancer Center, 4-9-13, Yohnan, Utsunomiya, 320-0834 Tochigi, Japan
| | - Koichi Inoue
- Department of Radiation Oncology and Image-Applied Therapy, Tochigi Cancer Center, 4-9-13, Yohnan, Utsunomiya, 320-0834 Tochigi, Japan
| | - Takehiko Yamaguchi
- Department of Pathology, Nikko Medical Center, Dokkyo Medical University, 145-1 Moritomo, Nikko, 321-1298 Tochigi, Japan
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