Orbital Liposarcoma: A Surveillance, Epidemiology and End Results Database Study

PURPOSE

Orbital liposarcoma is a challenging tumor to treat due to its rarity and high rate of local recurrence, and the role of radiotherapy and chemotherapy remain unclear. Analysis of big data may improve our overall understanding of orbital disease and role of adjuvant therapies.

METHODS

Data were extracted from the Surveillance, Epidemiology and End Results (SEER) Research Plus database from 1975 to 2017. All patients with a diagnosis of liposarcoma (ICD-O3 codes 8850-8858, 8869-8862, 8870, 8880, 8881) were included. Cases were divided into 4 groups by primary site: orbit, retroperitoneum, soft tissue, and other.

RESULTS

A total of 16,958 patients were included. Patients with orbital involvement were younger and more likely to be female ( p  < 0.05). Among orbital lesions, myxoid liposarcoma was the most common histologic subtype (6/19; 31.6%) followed by well differentiated (5/19; 26.3%). This differed from the distribution of histologic subtypes encountered elsewhere, for which well-differentiated liposarcoma was the most common (retroperitoneum 979/3,136; 31%, soft tissue 3,493/11,671; 30%, and other sites 497/2,132; 23%, p  < 0.05). Dedifferentiated histologic subtype was the second most common subtype found in the retroperitoneum (946/3,136; 30%), whereas it was less common in the orbit (2/19; 11%) and soft tissue (1,396/11,671; 12%) ( p  < 0.001). Patients with orbital liposarcoma had similar disease-specific mortality compared with soft-tissue location ( p  = 0.825) and lower disease-specific mortality compared with retroperitoneal location ( p  < 0.001). When all locations were combined, patients with well-differentiated liposarcoma had the lowest disease-specific mortality.

CONCLUSIONS

Patients with orbital liposarcoma tend to be younger, female, and have a better prognosis than those with retroperitoneal disease, likely due to the lower incidence of dedifferentiated histologic subtype.

Histologic Subtype Defines the Risk and Kinetics of Recurrence and Death for Primary Extremity/Truncal Liposarcoma

OBJECTIVE

We sought to define the prognostic significance of histologic subtype for extremity/truncal liposarcoma (LPS).

BACKGROUND

LPS, the most common sarcoma, is comprised of 5 histologic subtypes. Despite their distinct behaviors, LPS outcomes are frequently reported as a single entity.

METHODS

We analyzed data on all patients from a single-institution prospective database treated from July 1982 to September 2017 for primary, nonmetastatic, extremity or truncal LPS of known subtype. Clinicopathologic variables were tested using competing risk analyses for association with disease-specific death (DSD), distant recurrence (DR), and local recurrence (LR).

RESULTS

Among 1001 patients, median follow-up in survivors was 5.4 years. Tumor size and subtype were independently associated with DSD and DR. Size, subtype, and R1 resection were independently associated with LR. DR was most frequent among pleomorphic and round cell LPS; the former recurred early (43% by 3 years), and the latter over a longer period (23%, 3 years; 37%, 10 years). LR was most common in dedifferentiated LPS, in which it occurred early (24%, 3 years; 33%, 5 years), followed by pleomorphic LPS (18%, 3 years; 25%, 10 years).

CONCLUSIONS

Histologic subtype is the factor most strongly associated with DSD, DR, and LR in extremity/truncal LPS. Both risk and timing of adverse outcomes vary by subtype. These data may guide selective use of systemic therapy for patients with round cell and pleomorphic LPS, which carry a high risk of DR, and radiotherapy for LPS subtypes at high risk of LR when treated with surgery alone.

Spectrum of liposarcomas-a study of 106 cases

BACKGROUND

Liposarcoma is a malignant tumour that arises in fat cells in deep soft tissue. This study was conducted to access the spectrum of liposarcomas

METHODS

This descriptive study was conducted at Armed Forces Institute of Pathology (AFIP), Rawalpindi from 1st January 2008 to 31st December, 2012 and included all the cases diagnosed as liposarcomas. Records of the malignant tumors of soft tissue that presented during this period were analysed and out of this spectrum of liposarcomas were studied.

RESULTS

A total of 19367 malignant tumours were diagnosed during study period. Out of these, 615 were malignant soft tissue tumours. Out of these 106 cases were liposarcoma with an overall frequency of 0.54% of the malignant neoplasm and 17.24% of soft tissue sarcomas .The age ranged from 26-85 years. Out of these 106 cases 77 were male and 29 were female with a male to female ratio of 2.6:1. The most common tumour seen was pleomorphic liposarcoma (42.5%) followed by myxoid liposarcoma (22.6%), dedifferentiated liposarcoma (19.8%) and well differentiated liposarcoma (15.1%). Fifty five (51.9%) of liposarcomas originated in lower extremity, the second most commonly involved site was upper extremity (22.6%)

CONCLUSION

Pleomorphic Liposarcoma is the commonest liposarcoma of extremities and their frequency is much high in our population.

Primary spermatic cord tumors: disease characteristics, prognostic factors, and treatment outcomes

INTRODUCTION

Experience with management of spermatic cord tumors (SCTs) is uncommon. We utilized a large population-based cancer registry to characterize the demographic, pathological, treatment characteristics, and outcomes of SCTs.

MATERIAL AND METHODS

The Surveillance, Epidemiology, and End Results database (1973-2007) was queried.

RESULTS

From the database, 362 patients were identified with SCT. The annual incidence of SCT was 0.3 cases per million and did not change over time. The most common histologic types were liposarcoma (46%), leiomyosarcoma (20%), histiocytoma (13%), and rhabdomyosarcoma (9%). The median age of diagnosis for rhabdomyosarcomas was (26.3 y), whereas for other SCTs, it was (64.7 y) (P<0.001). On multivariate analysis, a worse outcome was observed with undifferentiated tumor grade, distant disease, positive lymph nodes, and leiomyosarcoma or histiocytoma cell histology.

CONCLUSION

We describe the largest cohort of SCT studied to date. Liposarcoma was most common, while leiomyosarcoma and histiocytoma histologic subtypes were observed to be the most aggressive. Multivariate analysis revealed that tumor grade, stage, histologic type, and lymph node involvement were independently predictive of prognosis.

A fifty-year review of soft tissue sarcomas in Jamaica: 1958-2007

OBJECTIVE

To determine the distribution of histologic subtypes of soft tissue sarcomas (STS) in Kingston and St Andrew, Jamaica, according to age and topography.

METHODS

From the Jamaica Cancer Registry (JCR) archives, all cases of STS diagnosed between 1958 and 2007 were extracted. For each case, age, gender, histological diagnosis and anatomical site of tumour were recorded. Patients were categorized according to age at diagnosis as: children (0-14 years) and adults (> 14 years), and the distribution of histologic diagnoses with respect to age and anatomical site were analysed.

RESULTS

There were 432 cases (67 children, 364 adults, one person of unknown age) of STS recorded in the JCR over the 50-year period (218 males, 214 females). The commonest STS in adults were "sarcoma, not otherwise specified [NOS]" (20.1%), malignant fibrous histiocytoma [MFH] (17.9%), fibrosarcoma (12.4%), liposarcoma (10.7%) and malignant peripheral nerve sheath tumour [MPNST] (10.2%). In children, they were neuroblastoma (38.8%), rhabdomyosarcoma (23.9%), "sarcoma, NOS" (9%), fibrosarcoma (6%) and MFH (6%). In adults, the lower limb was the commonest location, followed by trunk and/or upper limb for MFH, fibrosarcoma and liposarcoma, and head and neck for MPNST. In children, head and neck was the commonest site for rhabdomyosarcoma, head and neck and upper limb for MFH, retroperitoneum for neuroblastoma and trunk for fibrosarcoma.

CONCLUSION

A high proportion of soft tissue sarcomas in Jamaica are unclassified and the anatomical distribution of common classified sarcomas shows some differences with the literature. Limited access to immunohistochemistry/molecular diagnostics and increasing core biopsy diagnosis may contribute to these phenomena.

Liposarcoma of the extremities: a review of the cases seen and managed in a major tertiary hospital in Singapore

INTRODUCTION

Liposarcoma is one of the more common types of soft tissue sarcomas, presenting with a wide spectrum of clinical behaviour. However, there is little information on the outcome, management and survivability of patients with extremity liposarcoma in Singapore.

METHODS

A retrospective review of all the patients with extremity liposarcoma, diagnosed between 1997 and 2007, was performed. Univariate and multivariate statistics were used on the data to evaluate the clinical presentations, treatment, outcome and survivability of patients seen.

RESULTS

Over a ten-year period, 30 patients were seen for primary liposarcoma of the extremities. Three patients dropped out and 27 were managed and followed-up. Management included surgery and/or radiotherapy. Histological subtypes included 14 (51.9 percent) well-differentiated, five (18.5 percent) myxoid, four (14.8 percent) de-differentiated, and two (7.4 percent) each of round cell and pleomorphic variants. Four patients (14.8 percent) developed local or metastatic recurrent disease. The mean follow-up was 53 months, and the survival rate with primary disease at 53 months was 92.6 percent. The recurrence-free survival for primary disease at 53 months was 85.2 percent.

CONCLUSION

Liposarcoma of the extremities is relatively rare compared to other major soft tissue tumours. It is a highly pleomorphic disease, whose outcome is dependent on the histological subtype. Limb-sparing management includes wide resection of the tumour with/without radiation postoperatively.

Giant primary synchronously bilateral mesenteric dedifferentiated liposarcoma with hyperparathyroidism, hyperthyroidism, type-2 diabetes mellitus and hypertension

Liposarcomas represent the single most common type of soft tissue sarcoma, occurring most commonly in the extremities and retroperitoneum. There is no relation between liposarcomas and multiple endocrine syndromes. We presented a 61-year old woman with giant primary synchronously bilateral mesenteric dedifferentiated liposarcoma with hyperparathyroidism, hyperthyroidism, Type-2 diabetes mellitus (T2DM) and hypertension. The mesenteric liposarcoma was reported neither synchronously bilateral nor with endocrine disorders. We must note if the patients' presentation was a co-incidence or an undescribed syndrome, waiting to be discovered.

Analysis of soft tissue sarcomas in 1118 cases

BACKGROUND

It is important to analyze and compare soft tissue sarcomas periodically so as to update the incidence, the clinical diagnosis, the treatment, and the ongoing research. The present study was conducted to determine the relative frequency of each type of soft tissue sarcoma.

METHODS

A total of 1118 cases of primary soft tissue sarcomas treated between January 1993 and December 2006 were evaluated in a retrospective analysis.

RESULTS

According to the pathologic grouping, the diseases with the highest proportion were malignant fibrous histiocytomas (35.24%), synovial sarcomas (17.08%), liposarcomas (16.28%), and rhabdomyosarcomas (12.61%). Soft tissue sarcomas were detected in every age group and occurred in all parts of the body. The number of cases increased gradually over the years.

CONCLUSIONS

Malignant fibrous histiocytomas had the highest frequency among the soft tissue sarcomas. The number of cases increased gradually over the years.

Incidence patterns of soft tissue sarcomas, regardless of primary site, in the surveillance, epidemiology and end results program, 1978-2001: An analysis of 26,758 cases

Soft tissue sarcomas (STS) are a heterogeneous group of uncommon tumors that show a broad range of differentiation that may reflect etiologic distinction. Routine tabulations of STS are not morphology-specific. Further, the lack of inclusion of sarcomas arising in all organs in most standard evaluations underestimates the true rates. We analyzed the 1978-2001 Surveillance, Epidemiology and End Results program incidence rates of STS regardless of primary site, except bones and joints, using the 2002 criteria of the WHO classification. There were 26,758 cases available for analysis. Leiomyosarcomas accounted for 23.9%, malignant fibrous histiocytomas 17.1%, liposarcomas 11.5%, dermatofibrosarcomas 10.5%, rhabdomyosarcomas 4.6% and angiosarcomas 4.1%. Almost half (47.9%) of the sarcomas arose in the soft tissues, 14.0% in the skin and 7.0% in the uterus. Overall, incidence rates were highest among black women (6.26/100,000 woman-years) and the lowest among white women (4.60/100,000). Age-adjusted rates increased at 1.2% and 0.8% per year among white males and females, respectively, both trends statistically significant, while rates among blacks declined slightly. About 40% of leiomyosarcomas among women were uterine in origin, with a black/white rate ratio of 1.7. This rate ratio increased to 2.0 when we accounted for the lower prevalence of intact uteri among black compared to white women. Total STS rates rose exponentially with age. Rates for both uterine leiomyosarcoma and dermatofibrosarcoma increased rapidly during the childbearing years, peaking at about age 40 and 50, respectively. Incidence patterns of STS varied markedly by histologic type, supporting the notion that these tumors may be etiologically distinct.

Risk assessment in liposarcoma patients based on FDG PET imaging

PURPOSE

Tumor grade and subtype are considered standard parameters for risk assessment in patients with liposarcoma. The aim of this study was to assess the clinical value of [(18)F]fluorodeoxyglucose (FDG) PET-derived maximum standardized uptake value (SUV(max)) for prediction of outcome in liposarcoma patients.

METHODS

(18)F-FDG PET was performed in 54 patients with liposarcoma prior to therapy. SUV(max) was calculated for each tumor and results were correlated with tumor grade, subtype, and relapse-free survival.

RESULTS

SUV(max) ranged from 0.4 to 15.9 (mean 3.6) and was significantly lower in grade I than in grade II and grade III tumors. SUV(max) was 2.3+/-1.7, 3.5+/-1.5, 4.8+/-2.5, and 5.6+/-5.8 in well-differentiated, myxoid/round cell, dedifferentiated, and pleomorphic subtypes, respectively. Borderline differences (p=0.059) were found between tumor SUV(max) in patients with and without relapse. Using a SUV of 3.6 as cut-off, the accuracy in predicting a relapse was 75%. Tumor grade yielded a lower accuracy for predicting relapse (50%), as did tumor subtype (35%). In Kaplan-Meier survival analysis, patients with a SUV(max) >3.6 had a significantly shorter disease-free survival of 21 months compared with 44 months in patients with a SUV(max) </=3.6. Tumor grading and tumor subtype did not yield significant differences.

CONCLUSION

Pretherapy tumor SUV obtained by FDG PET imaging was a more useful parameter for risk assessment in liposarcoma than tumor grade or subtype. A SUV(max) of more than 3.6 resulted in a significantly reduced disease-free survival and identified patients at high risk for developing early local recurrences or metastatic disease.

[A case of liposarcoma of spermatic cord]

An 84-year-old male was referred to our hospital with the chief complaint of a painless inguinal mass. An elastic hard mass was palpable in the right inguinal region next to the spermatic cord. Ultrasonography and computed tomography showed an inguinal homogeneous mass which was slightly enhanced. Since the operation appearance indicated the tumor was arising from the right spermatic cord, right radical orchiectomy was performed. Histopathological examination revealed a well-differentiated liposarcoma of the right spermatic cord. This is the 70th case of liposarcoma of the spermatic cord reported in Japan.

Primary liposarcoma of esophagus: A case report

Liposarcoma is the most common soft tissue sarcoma in adult life while esophageal liposarcoma is an extremely rare tumor. In the world literature, only 14 cases of esophageal liposarcomas have been described. We report a 72-year old male patient who was urgently admitted to our hospital for acute epigastric pain with a burning retrosternal sensation, persistent nausea, vomiting and dysphagia. Barium swallow, upper gastrointestinal (GI) endoscopy, esophageal manometry and CT scan, failed to accurately diagnose the lesion. After surgical resection of an esophageal polypoid tumor, the histological examination revealed a well-differentiated grade I liposarcoma. Diagnostic and therapeutic tools were discussed and the results of literature were reviewed.

[liposarcoma. Aspects of pathomorphology--an analysis of 209 tumos]

BACKGROUND

Among the heterogeneous group of adult soft tissue sarcomas, liposarcomas represent the largest entity along with malignant fibrous histiocytomas (MFH).

PATIENTS AND METHODS

This article summarizes the results of pathomorphological data on 209 liposarcomas resected over a 10-year period.

RESULTS

The most common tumor site was the thigh, and the peak age incidence was in the 5th and 6th decades. In general, three major subtypes of liposarcoma can be distinguished in terms of pathomorphology: well-differentiated/dedifferentiated liposarcoma, myxoid/round cell liposarcoma, and pleomorphic liposarcoma. Well-differentiated liposarcomas represent malignancy grade 1 tumors without biological potential to metastasize, but which are able to relapse locally in cases of incomplete resection. When a local relapse has occurred, the liposarcoma may show dedifferentiation and may metastasize.

CONCLUSIONS

In the pathologic-anatomical diagnosis of liposarcomas, conventional light-microscopic findings are decisive. Additional methods of molecular pathology may help in single cases to gain further insights.

Deep-seated, well differentiated lipomatous tumors of the chest wall and extremities: the role of cytogenetics in classification and prognostication

BACKGROUND

Intramuscular lipomas and atypical lipomatous tumors (ALT) are common deep-seated lipomatous tumors of the chest wall and extremities. Distinguishing between these two entities can be difficult based on histologic analysis alone. However, the cytogenetic profiles of ALT and intramuscular lipomas are distinct. Correct classification is important, because aggressive local disease recurrence occurs more frequently in patients with ALT than in patients with intramuscular lipoma. The authors examined their single institutional experience and correlated their classification with clinical features and outcome.

METHODS

In the current study, 106 patients with deep-seated, well differentiated adipose tumors of the chest wall and extremities were classified as having ALT or intramuscular lipoma using a combined approach of histology and cytogenetics, if available. The classification was correlated with clinicopathologic features and follow-up data.

RESULTS

Fifty-five patients were classified as having intramuscular lipoma and 51 were classified as having ALT. Classification did not correlate with age and gender (P = 0.28 and P = 0.96, respectively). Intramuscular lipomas were smaller than ALTs (P < 0.0001), but there was significant overlap between the 2 groups. ALT occurred preferentially in the lower extremity (P < 0.0009). Four percent of patients with intramuscular lipomas and 27% of patients with ALTs developed local disease recurrence (P = 0.0006). Disease recurrence did not correlate with patient age at diagnosis, patient gender, tumor size, and tumor location (P = 0.45, P = 0.26, P = 0.49, and P = 0.28, respectively). Within the subset of patients with ALTs, disease recurrence did not correlate with patient age at diagnosis, patient gender, or tumor location (P = 0.38, P = 0.54, and P = 0.86, respectively).

CONCLUSIONS

Classification of deep-seated, well differentiated lipomatous tumors of the extremities and chest wall using a combined approach of histology and cytogenetics correlated well with biologic behavior/disease recurrence. This combined approach is advocated to better stratify patients for treatment purposes and follow-up.

Primary pleomorphic liposarcoma of the parotid gland: a case report and review of the literature

Although liposarcomas are the most common type of sarcoma in adults, they are rare in the head and neck region. Pleomorphic liposarcoma is the least common histologic subtype in all locations. To our knowledge, there have been only 11 reported cases of primary liposarcomas of the major salivary glands, and the pleomorphic variant arising in the parotid gland has been reported only once before. Only 2 of the 11 reported cases of liposarcoma of the major salivary glands in the literature have died of disease, and both cases were of the pleomorphic subtype. We report a case of pleomorphic liposarcoma arising in the left parotid gland of an 80-year-old woman. This case report highlights that, despite conservative surgery followed by 2 local recurrences, our patient is doing well with minimal local morbidity and no demonstrable metastases 30 months after the initial diagnosis. We also present a review of the literature on the subject.

Histologic subtype and margin of resection predict pattern of recurrence and survival for retroperitoneal liposarcoma

OBJECTIVE

The aim of this study was to determine the pattern of recurrence and prognostic significance of histologic subtype in a large series of patients with primary retroperitoneal liposarcoma.

SUMMARY BACKGROUND DATA

Classification of liposarcoma into subtypes, based on morphologic features and cytogenetic aberrations, is now widely accepted. Previous studies have shown that high histologic grade and incomplete gross resection are the most important prognostic factors for survival in patients with retroperitoneal sarcoma and suggest that patients with liposarcoma have a 3-fold higher risk of local recurrence compared with other histologies.

METHODS

A prospective database was used to identify 177 patients with primary retroperitoneal liposarcoma treated between July 1982 and June 2002. Histology at primary presentation was reviewed by a sarcoma pathologist and subtyped into 4 distinct groups according to strict criteria. The influence of clinicopathological factors on local recurrence, distant recurrence, and disease-specific survival was analyzed.

RESULTS

Of 177 patients with primary retroperitoneal liposarcoma operated on for curative intent, 99 (56%) presented with well-differentiated, 65 (37%) with dedifferentiated, 9 (5%) with myxoid, and 4 (2%) with round cell morphology. The tumor burden was determined by the sum of the maximum tumor diameters. The median tumor burden was 26 cm (5-139). Median follow-up time for 92 (52%) surviving patients was 37 (mean, 0.5-192) months. Multivariate analysis showed that dedifferentiated liposarcoma subtype was associated with a 6-fold increased risk of death compared with well-differentiated histology (P < 0.0001). In addition to histologic subtype, incomplete resection (P < 0.0001), contiguous organ resection (excluding nephrectomy; P = 0.05), and age (P = 0.03) were important independent prognostic factors for survival in retroperitoneal liposarcoma. Retroperitoneal dedifferentiated liposarcoma was associated with an 83% local recurrence rate and 30% distant recurrence rate at 3 years.

CONCLUSIONS

The histologic subtype and margin of resection are prognostic for survival in primary retroperitoneal liposarcoma. Dedifferentiated histologic subtype and the need for contiguous organ resection (excluding nephrectomy) was associated with an increase risk of local and distant recurrence. Nephrectomy may be needed to achieve complete resection, but has no measurable influence on disease specific survival.

[Frequency of genetic diseases and cancer antecedents in 493 adults with visceral or soft tissue sarcomas]

Little is known about epidemiology of adults soft tissue and visceral sarcomas (ASTS). The frequency of previous cancers and associated genetic diseases has been analyzed out of 493 ASTS, treated between 1997 and 2002 at Oscar Lambret Cancer Center. Median age is 51, sex ratio is close to 1. Liposarcomas and malignant fibrous histiocytofibromas are the two main types (respectively 104 and 86 cases). Upper and lower limbs are the two main locations (respectively 176 and 75 cases). Fifteen patients had associated genetic disease, including 12 cases of Recklinghausen diseases. 7 out of those 15 patients have neurosarcoma. 30 patients have previous cancers, including 7 breast cancers, 3 lymphomas and 3 chronic lymphocytic leukemias. Four out of those 30 patients have two different previous cancers. 13 patients have radiation-induced sarcomas, after an average 10-year-period, and an average dose of 53 Gy. Undifferenciated sarcomas are the main histologic type (8/13), followed by angiosarcomas (2/13). Radiation-induced sarcomas are located in the chest wall (7/13), in pelvis (2/13) and head and neck (2/13). Those sarcomas are high grade (10 grade III tumours). ASTS epidemiology is complex with different risk factors depending on histologic type.

Liposarcoma of the spermatic cord masquerading as an incarcerated inguinal hernia

We present a rare case of liposarcoma of the spermatic cord. There are only 61 reports in the literature. The presenting complaint is usually a painless bulge in the inguinal or scrotal region. Our patient presented with a new-onset inguinoscrotal swelling that was misdiagnosed preoperatively as an incarcerated indirect hernia. The treatment for a spermatic cord liposarcoma is radical orchiectomy with high ligation of the cord. Radiation therapy is recommended in addition to surgery in situations with evidence of tumor with propensity for more aggressive behavior (i.e., high-grade tumor, lymphatic invasion, inadequate margin, or recurrence). The current literature, diagnosis, and management of malignant tumors of the spermatic cord are reviewed.

Clinico-pathological data and prognostic factors in completely resected AJCC stage I-III liposarcomas

BACKGROUND

In general, although biological behavior and prognosis of liposarcomas (LPS) are more favorable compared with most other soft tissue sarcomas (STS), prognosis can vary widely depending on tumor characteristics, especially histological subtype and tumor grade.

PATIENTS AND METHODS

All consecutive, completely resected stage I-III LPS (as determined by the American Joint Committee on Cancer staging guidelines), treated at the Groningen University Hospital from 1977-2000, were analyzed.

RESULTS

A total of 69 patients, 35 males and 34 females, median age 51 (range 11-80) years, were reviewed. After a median follow-up of 71 (range 5-231) months, the overall local recurrence and metastasis rate at five years after diagnosis were 27% and 16%, respectively. Retroperitoneal localization was a significant negative prognostic factor regarding local recurrence; dedifferentiation, grade II-III, and deep location regarding distant metastasis; and dedifferentiation, grade II-III, stage II-III, size >20 cm and non-radical resection regarding survival.

CONCLUSIONS

LPS have a relatively mild biologic behavior, with the exception of very large, deeply located, dedifferentiated and/or grade II-III LPS. Radical resection is important for disease-specific survival. LPS have a relatively mild biologic behavior, with the exception of very large, deeply located, dedifferentiated and/or grade II-III LPS.

[Malignant phyllodes tumor with liposarcomatous differentiation. Description of a clinical case]

Sarcoma of the breast are a rare group of neoplasms representing less than 5% of Soft Tissue Sarcomas (STS). Between 1980 and 1995 in the National Institute foe Cancer Research (IST) of Genoa, 2188 patients were submitted to surgery for breast cancer. Seven of them were found to be affected by sarcoma, confirmed by histologic diagnosis. All the patients were between 39 and 87 years-old. Surgical treatments were: wide excision (1 case), total mastectomy (2 cases), radical mastectomy following Halsted (4 cases). A case of a 53 year-old woman with a phyllodes tumor initially transforming in to liposarcoma is reported. The patient was submitted to surgery (total mastectomy) and nowadays is alive and free of disease after 29 months. All authors agree that the treatment for sarcoma of the breast is early and complete surgical excision of the mass. The role of chemotherapy and radiotherapy is still uncertain. Outcome is based on histologic type, degree of differentiation and tumor size.

A mesenteric liposarcoma with production of granulocyte colony-stimulating factor

A 77-year-old female was admitted to our hospital because of pyrexia and a right retroperitoneal mass. Leukocytosis and other inflammatory findings were noted. Bone-marrow aspiration revealed hypercellularity with no malignant cells. An additional mass was detected sonographically in the pelvis. The serum concentration of granulocyte colony-stimulating factor (G-CSF) was highly elevated (299 pg/ml). The tumors were removed at laparotomy, and the pelvic mass was found to arise from the ileocecal mesentery. Postoperatively, white blood cell count and serum G-CSF concentrations decreased to normal levels. The mesenteric tumor showed weakly positive immunostaining for human G-CSF, and Northern and polymerase chain reaction (PCR) analyses detected CSF and its mRNA in the mesenteric tumor.

Trends in the incidence of upper extremity soft tissue malignancies: a 40-year review of the Connecticut State Tumor Registry

BACKGROUND

Although soft tissue malignancies of the upper extremity are rare, the management of these lesions has been controversial and the etiologic factors associated with the occurrence of these tumors are not well understood. The purpose of this study was to identify possible epidemiologic factors related to a recently noted rise in the occurrence of these tumors in the state of Connecticut.

METHODS

The occurrence of upper extremity soft tissue tumors over the past 40 years was reviewed in the Connecticut State Tumor Registry. Demographic data collected included occupational history, residence, and presence of concomitant malignancies. Tumor histology, the extent of resection, and the incidence of recurrences were also noted. Factors associated with recurrence were identified using linear regression analysis.

RESULTS

During the 40-year study period, 359 patients having upper extremity soft tissue tumors were entered into the Connecticut State Tumor Registry. An increasing trend in the number of upper extremity soft tissue tumors was evident. Many patients were involved in heavy industry or related fields. Fibrosarcoma and liposarcoma were the most common tumor types, occurring in 111 (30.3%) and 48 patients (13.2%), respectively. Sixty-seven patients presented with a synchronous second primary malignancy of the breast (49 patients), lung (seven patients), or gastrointestinal tract (five patients). Most patients (69.9%) underwent local excision of the soft tissue tumors, with fewer undergoing wide excision (20.3%) or radical excision (9.7%). Recurrence, which occurred in 144 patients, was found to be associated with extent of resection, occupational history, and concomitant malignancy. Delineation of such risk factors may be helpful in identifying patients in whom aggressive management may decrease recurrence and improve survival.

[Lipomas and liposarcomas. 10-year incidence in a local area]

The aim of this study was to show the clinical expression and histologic diagnosis in 105 patients, 46 males and 59 females, treated for lipomas of the extremities. The coincidence between the histological and peroperative diagnosis was also evaluated. The patients were successively treated at the Department of Orthopaedic Surgery, Glostrup county Hospital in the period 1978-88. Ninety-seven patients were found to have a lipoma and eight of the patients had a malignant tumour (liposarcoma). There were no significant differences in the appearance of malignancy with respect to age or sex. Tumours greater than 100 cm2 in size were significantly more often malignant than those less than 100 cm2. There was a considerable discrepancy between the surgeon's peroperative judgement of malignancy and the histological diagnosis. The tumours were located in the humeroscapular region (39), the femoral region (30), the crural region (10), and in the forearm region (7). We conclude that diagnostic clearing and treatment ought to be centralized in regional centres, where liposarcomas might also be diagnosed. However, the liposarcomas should afterwards be treated in oncological centres. Furthermore, we conclude that histological examination of lipomas in imperative.

Liposarcoma of the base of tongue and tonsillar fossa: A possibly underdiagnosed neoplasm

Liposarcomas of the head and neck are exceedingly rare, and fewer than 90 cases have been reported in the literature. Liposarcoma of the oral cavity is an even less common entity, and to our knowledge only nine cases have been reported to date. We report the clinical and pathologic findings of a case of well-differentiated liposarcoma of the base of tongue and tonsillar fossa. The patient is a 76-year-old white man with a long-standing history of a mass in the oral cavity and hypopharynx. The mass had been resected several times over the span of 23 years, and diagnoses of lipoma, neurofibroma, mesenchymoma, and angiofibrolipoma have been rendered on different occasions. At the last admission, a polypoid mass of the left tonsillar fossa and base of tongue was resected. The tumor was multinodular and measured 2.5 cm in greatest diameter. Histologically the tumor was ill-defined with infiltrating borders and was composed predominantly of mature adipose tissue with occasional lipoblasts. A small proportion of the tumor consisted of clusters of spindle cells and pleomorphic lipoblasts. Mitotic activity was not seen. The pleomorphic cells were positive for S100 protein and negative for muscle-specific markers. Ultrastructural analysis confirmed the nature of the lipoblasts. Our case depicts the typical natural history and histologic features of liposarcoma of the oral cavity. This tumor is usually well differentiated and has a high recurrence rate and almost no tendency for metastasis. Based on our case and review of the literature, it appears that well-differentiated liposarcoma of the oral cavity can occasionally be underdiagnosed because of the low mitotic activity and long latent period between the original diagnosis and first recurrence.

Thymus-related liposarcoma: report of a case and review of the literature

We report herein the case of a 77-year-old woman who was admitted to our hospital for further evaluation of an abnormal shadow in the right upper mediastinum that had been revealed by a routine chest X-ray. Computed tomography (CT) and magnetic resonance imaging (MRI) scans confirmed the presence of a thymic tumor, but did not show any evidence of invasion into the central vessels or adjacent structures. Thus, an extended thymectomy with resection of the tumor was performed. Microscopically, normal thymic tissue was found among the tumor cells, and a pathological diagnosis of well-differentiated liposarcoma was established. From the operative and microscopic findings, it is apparent that the tumor was related to the thymus. Postoperative irradiation of 60 Gy was delivered to the operative site and the patient has remained free of disease for 29 months since the operation.

Liposarcoma in the oral and maxillofacial region: an analysis of 10 consecutive patients

Ten consecutive patients with liposarcoma in the oral and maxillofacial region were analyzed retrospectively. Contrary to the majority of previous reviews, a female preponderance (two males and eight females) and younger incidence peak age (33 years) were found. Tumor sites were face (three), parotid (three), oral cavity (two), and mandible (two). Using a current histologic system, seven patients were classified as myxoid, and three as well-differentiated, round-cell, and pleomorphic lesions, respectively. Three patients died of recurrent disease 7 months, 20 months, and 4 years, respectively, after treatment; one patient died of metastatic liver and lung lesions and six patients remain free of disease (2 to 3 years). Clinical and histologic features, tumor behavior, treatment options, and patient prognosis are discussed and the literature is reviewed.

[Computed tomography in malignant primary soft tissue tumors]

The results of CT examinations in 36 patients suffering from histologically confirmed malignant primary tumours of the soft tissues are presented (6 rhabdomyosarcomas, 4 leiomyosarcomas, 6 liposarcomas, 4 malignant schwannomas, 5 malignant fibrous histiocytomas, 4 malignant haemangiopericytomas, 3 angiosarcomas, 1 fibrosarcoma, 1 renal sarcoma, 2 malignant mesenchymal tumours without histologically clear classification). The CT image alone will not yield information on the type of tumour or on the tumour status. However, CT continues to rank in the diagnosis of tumours of the soft tissues and is even superior to MR especially in the identification of gas accumulations due to infection in a tumour of the soft tissues that is otherwise unclear. Comparing the literature conclude that MR is now the imaging method of choice in the diagnosis of soft tissue tumours.

Liposarcoma: a population-based epidemiologic and prognostic study of features of 43 patients, including tumor DNA content

Different conceptions exist regarding the epidemiology and prognosis of liposarcoma, and several classification systems are in use. We analyzed a population-based, 25-year series of 43 patients with liposarcoma of the extremity or trunk wall. Follow-up was complete. The annual incidence was 0.12/10(5). The thigh was the most common location. One of 6 tumors was subcutaneous. Deep-seated tumors were larger than s.c. tumors. Among the 42 surgically treated patients, grade II (4-grade scale) was the most common malignancy grade. Four tumors were well-differentiated, 24 were predominantly myxoid, 4 predominantly round-cell, and 10 were predominantly of pleomorphic type. The 5-year metastasis-free survival rate was 69%. By univariate analysis increasing malignancy grade, tumor necrosis, vascular invasion, mitotic count, subtype other than well-differentiated, and high cellularity were prognostic for metastatic disease. However, in the multivariate analysis only tumor necrosis was an independent risk factor. Tumor necrosis should be considered when prognosis of liposarcoma of the extremity and trunk wall is evaluated.

A 6 kg retroperitoneal liposarcoma in a 42-year-old woman. Case report

A large retroperitoneal liposarcoma (6 kg) is described in a 42-year-old woman. Retroperitoneal tumours are rare, produce nonspecific symptoms, and are often extensive when diagnosed. The main treatment of these tumours is radical excision, but the tendency to local recurrence makes the prognosis poor.

Recurrent primary liposarcoma of the pericardium: management by repeated resections

In 1979 we published a report of a patient with primary liposarcoma of the pericardium treated by surgical resection. Since then we have performed a total of seven resections on the same patient for recurrent liposarcoma, which have given excellent symptomatic relief, and her life was prolonged for 14 years. Repeated resection of recurrent liposarcoma of the mediastinum should always be considered as the appropriate management for these patients.

[Methodology, technical prerequisites and postoperative morbidity of intraoperative radiotherapy (IORT) of soft tissue sarcomas. Heidelberg Krankengut 6/91-9/92]

Since June 1991 the IORT facility has operated a dedicated linear accelerator, which was installed within the central operating theater of the Department of Surgery. As of 9/92 a total of 28 patients suffering from peripheral (n = 20) or centrally (n = 8) located soft tissue sarcomas had been were treated. Thirteen patients revealed a primary and 15 patients a recurrent tumor. Tumor resection with negative margins was performed in 20 patients, positive margins remained in 5 patients, and gross macroscopic residual disease in 3 patients. Combined intraoperative and external beam radiotherapy was applied in 22 patients, using IORT doses of 10-20 Gy and an external beam dose of 26-50 Gy. Three patients were irradiated intraoperatively twice with a time interval of 24 h. After a median follow-up of 9.9 months, 20 patients are disease free. Two patients died 4 and 5 months after the end of therapy with rapidly progressive distant metastases. An infield failure within the external beam target volume was seen in 1 patient and local failure at the field margin of the external field in 3 patients. So far, there have been no IORT infield failures. Follow-up is performed with magnetic resonance imaging. In 3 patients a second operation was necessary because of a severe wound infection, including one patient suffering from osteomyelitis of a neighboring bone. Mild sensory neuropathy occurred in 1 patient 7 months after treatment. Overall only mild and reversible postoperative and posttherapeutic complications were seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Limb-sparing treatment with surgery and intraoperative radiotherapy (IORT) for a second local recurrence of myxoid liposarcoma in the popliteal region, after previous surgery and high-dose radiation

A 46-year-old man with a second local recurrence of a myxoid liposarcoma in the fossa poplitea, after surgery and high-dose external beam radiotherapy, was successfully treated by a limb-sparing procedure combining marginal excision, intraoperative radiotherapy and reconstructive surgery. After a 48-month follow-up, there was no evidence of disease, and the function of the leg and knee was normal.

Liposarcoma

Liposarcoma is second in frequency only to malignant fibrous histiocytoma among the soft-tissue sarcomas. It occurs almost exclusively in adults and is found most often in the thigh or retroperitoneum. It rarely arises from a lipoma and does not occur in the subcutaneous tissues. Liposarcomas are divided into histologic subtypes with different microscopic appearances and slightly different behavior characteristics. Surgical resection with a wide surgical margin is the treatment of choice. When amputation is required to obtain an adequate surgical margin, local irradiation can be used as an adjuvant and a limb-sparing operation can be done. Currently, no evidence exists that adjuvant chemotherapy is indicated for patients with liposarcoma, although numerous studies are being done to investigate its use. As is the case for all sarcomas, the lung is the most common site of metastasis; however, liposarcoma has an unusual propensity to metastasize to the retroperitoneum, mediastinum, and bone.

Bone cancer occurrence among beagles given 239Pu as young adults

The occurrence of skeletal malignancies has been documented among 234 young adult beagles given single intravenous injections of monomeric 239Pu citrate. Occurrence has also been documented among 132 comparable control group animals surviving the minimum latent time period of 2.79 y for radiation-induced bone cancer, who were maintained for lifespan observation. Injected amounts ranged from about 0.02-106 kBq kg-1 body mass with factors of 2 or 3 between dose levels. There were 84 radiographically apparent bone tumors in 76 plutonium-injected dogs and one tumor in a control group dog. Most of these were osteosarcomas except for seven chondrosarcomas, one liposarcoma, and one plasma cell myeloma of bone. The relationship between percent of dogs at any dose level with bone malignancy and average skeletal dose at the presumed time of tumor initiation of 1 y before death appeared to be linear below about 1.3 Gy average skeletal dose. The observed data can be approximated by the expression A = 0.76 + 75 D, where A = percent of dogs with bone cancer at any dose level, D = average skeletal dose in Gy (for doses up to 1.3 Gy) at tumor initiation, and 0.76 represents the percent tumor response in the control animals not given plutonium. Similar analysis of our corresponding data for beagles given 226Ra, excluding the two highest dose levels (approximately 100% occurrence), yielded the expression A = 0.76 + 4.7 D, where D = the average skeletal dose in Gy (for doses up to 20 Gy) at 1 y before death. The ratio of coefficients indicates the effectiveness for bone cancer induction of 239Pu relative to 226Ra, or [(75 +/- 22.5)(4.7 +/- 0.47)-1] = 16 +/- 5 for a single, brief intake of either nuclide into blood.

Intraarterial chemotherapy with limb-sparing resection of large soft-tissue sarcomas of the extremities

Fifteen patients with large (average, 15-cm), high-grade soft-tissue sarcomas of the extremities received prolonged selective intraarterial infusions of chemotherapeutic agents in an attempt to permit limb-sparing resection of these tumors, which would otherwise have required amputation. There were seven malignant fibrous histiocytomas, four liposarcomas, two fibrosarcomas, one leiomyosarcoma, and one rhabdomyosarcoma; 73% were grade III. Seven patients underwent two catheterizations, for a total of 22 infusions, which averaged 11.3 days each. There were four catheterization-related complications, including catheter occlusion or dislodgement in one patient each and two cases of arterial thromboembolism in patients in whom anticoagulant dose was not adequate. Both of the latter patients required thrombectomy; one developed gangrene, which precluded limb-sparing surgery. Thirteen of the 15 patients underwent limb-sparing resections, and two underwent amputations. No wound complications occurred. With a median follow-up of 36 months (mean, 34 months), life-table analysis indicates overall and disease-free survivals of 72% and 59%, respectively, at 2 years and 64% and 59% at 3 years. In comparison to other reported therapies, this technique permits limb salvage in most patients without the high wound complication rate associated with preoperative radiation therapy, with equivalent local disease control and survival.

Necrosis observed on CT enhancement is of prognostic value in soft tissue sarcoma

Fifty-one patients with deep-seated soft tissue sarcoma of the extremities and trunk wall were examined with contrast-enhanced CT for presence of nonenhanced tumor areas (CT necrosis). After a median follow-up time of 3 years, 19 of the 41 patients with CT necrosis had developed metastases, compared to none of the 10 patients who had tumors without CT necrosis. Tumors with CT necrosis were larger than tumors without, but in tumors of similar size, absence of CT necrosis was a favorable prognostic sign.

Liposarcoma of the renal capsule

We report a case of liposarcoma of the renal capsule. The literature is reviewed, and diagnosis and management are discussed.

Incidence of cutaneous T cell lymphoma and other rare skin cancers in a defined population

Between 1970 and 1984 in Rochester, Minnesota, rare skin cancers developed in 15 local residents: cutaneous T cell lymphoma (six subjects), dermatofibrosarcoma protuberans (four), adenocarcinoma of sweat glands (two), Merkel cell carcinoma (one), liposarcoma (one), and extramammary Paget's disease (one). These cases were identified through a unique computerized retrieval system that is maintained at the Mayo Clinic for the population of Rochester, Minnesota. The annual incidences of these cancers in the Rochester population were 0.9, 0.5, 0.3, 0.2, 0.2, and 0.2 per 100,000 residents, respectively (standardized to 1980 U.S. population). To our knowledge, this is the first report of the incidences of these rare skin cancers in a well-defined population.

[Retroperitoneal liposarcoma: a report of 2 cases and review of 163 cases in Japan]

Two cases of retroperitoneal liposarcoma are reported. Case I was a 71-year-old-male presenting with a mass in the left abdomen. On X-ray examination, a large extrarenal tumor was found in the left retroperitoneal space. The tumor appeared to invade the psoas muscle and the aorta. Exploratory laparotomy was carried out. The histological diagnosis of the tumor was myxoid-type liposarcoma. He died of the disease. Case 2 was a 44-year-old-male who presented with a mass in the left abdomen. On X-ray examination, a large tumor was found in the left retroperitoneal space, and left kidney and the descending colon were markedly displaced by the tumor. Excisional surgery was carried out. The tumor was almost completely removed. The histological diagnosis was myxoid-type liposarcoma. A combination chemotherapy (actinomycin D, vincristine, cyclophosphamide) was started. but soon switched to radiation therapy because of liver dysfunction. Four months following the operation, there is no evidence of residual disease. One hundred sixty three cases of retroperitoneal liposarcoma reported in Japan are reviewed.

Primary retroperitoneal sarcoma in the female pelvis. A report of three cases

Retroperitoneal sarcoma can occur in the female pelvis and be confused with other pelvic masses. Its diagnosis depends on an awareness of its occurrence. Aggressive surgery to completely excise the tumor determines survival.

Liposarcoma: a ten year experience

A retrospective study of all patients presenting with liposarcoma at Southend General Hospital between the years 1970 and 1979 is presented. There were 13 patients in the group treated with various combinations of surgery and radiotherapy. The histology has been reviewed: 7 patients had myxoid tumours, 2 well differentiated and 4 pleomorphic. The patients were followed up for between 18-109 months with 7 patients followed for more than 5 years. Local recurrence was seen only in myxoid tumours whereas pleomorphic tumours showed a high incidence of distant metastases. The length of survival was found to correlate with the histology, pleomorphic tumours being associated with the shortest survival. The series illustrates that the histological type of liposarcoma predicts the pattern of behaviour of the tumour and is the major determinant in prognosis.

Liposarcoma: the Manitoba experience

In a retrospective review all cases of liposarcoma recorded in the province of Manitoba from 1944 to 1978 were studied. There were 104 patients. Follow-up was obtained in all. Sites of tumour were peripheral limb in 45 patients, limb girdle in 15, retroperitoneal area in 23 and trunk and neck in 21. Fifty-seven percent of the patients were men: the disease was most commonly found in patients aged 50 to 69 years. Initial treatment was excision in 96 patients with irradiation in 26 and chemotherapy in 6. The 5- and 10-year survival rates were 60% and 49% respectively. In those who had definitive surgery the prognosis was somewhat better, while radiotherapy had little beneficial effect. Prognosis was also related to the pathologic type; well differentiated and myxoid types had a better prognosis than round cell or pleomorphic tumours. Trunk and peripheral limb tumours were associated with higher survival rates than limb girdle or retroperitoneal neoplasms. At least 37 patients had local recurrences; distant metastases occurred in at least 26, most commonly to the lungs, bones and liver. Unusual cases consisted of a patient with a multicentric tumour involving bones, a young boy with a neck liposarcoma and a woman with a breast liposarcoma.

[Rare kidney tumours (author's transl)]

In 508 patients with tumours of the kidney, 14 rare neoplasms has been found. These are analyzed with regard to diagnosis, therapy, and prognosis.