Distribution and Rate of Myxoid Liposarcoma Spine Metastases: Impact on Surveillance Imaging

BACKGROUND

Myxoid liposarcoma (LPS) has a unique tendency to spread to extrapulmonary sites, including osseous sites such as the spine, and adjacent sites such as the paraspinous tissue. No clear consensus exists to guide the approach to imaging in these patients.

OBJECTIVE

The aim of this study was to investigate the rate and distribution of spine metastases in patients with myxoid LPS and detection modality.

METHODS

Records of all patients with myxoid LPS evaluated at our sarcoma center were retrospectively reviewed. Disease patterns and imaging modality utilization were analyzed.

RESULTS

Between 2000 and 2020, 164 patients with myxoid LPS were identified. The majority (n = 148, 90%) presented with localized disease, with half (n = 82, 50%) of all patients developing metastases or recurrence during their disease course. With a median follow-up of 69.2 months, spine/paraspinous metastases developed in 38 patients (23%), of whom 35 (92%) already had synchronous, non-spine metastases. Spine disease was only visible on magnetic resonance imaging (MRI), as opposed to other imaging modalities, for over one-quarter of patients with spine metastases (n = 10). For patients with metastatic disease, spine metastases were associated with worse median overall survival (2.1 vs. 8.7 years, p < 0.001).

CONCLUSION

Spine metastases occurred in nearly one-quarter of patients with myxoid LPS and represented an advanced disease state, as they primarily presented in the setting of synchronous, non-spine metastases, and were associated with worse overall survival. Routine surveillance with spine MRI in patients with localized disease likely provides no benefit but may be considered in those with known metastatic disease.

Myxoid Liposarcoma: Prognostic Factors and Metastatic Pattern in a Series of 148 Patients Treated at a Single Institution

OBJECTIVES

The authors reported a retrospective study on myxoid liposarcomas (MLs), evaluating factors that may influence overall survival (OS), local recurrence-free survival (LRFS), metastasis-free survival (MFS), and analyzing the metastatic pattern.

METHODS

148 MLs were analyzed. The sites of metastases were investigated.

RESULTS

Margins (p = 0.002), grading (p = 0,0479), and metastasis (p < 0,0001) were significant risk factors affecting overall survival (OS). Type of presentation (p = 0.0243), grading (p = 0,0055), margin (p = 0.0001), and local recurrence (0.0437) were risk factors on metastasis-free survival (MFS). Authors did not observe statistically significant risk factors for local recurrence-free survival (LRFS) and reported 55% extrapulmonary metastases and 45% pulmonary metastases.

CONCLUSION

Margins, grading, presentation, local recurrence, and metastasis were prognostic factors. Extrapulmonary metastases were more frequent in myxoid liposarcoma.

Extensive left ventricular, pulmonary artery, and pericardial metastasis from myxoid liposarcoma 16 years after the initial detection of the primary tumour: a case report and review of the literature

Liposarcoma is regarded as the second most common soft tissue malignant tumour. Metastasis of liposarcoma to the heart is very rare, and to date, less than 40 cases have been reported in the literature. We report a 46 year-old male with myxoid liposarcoma of the lower extremity who developed extensive metastasis to the left ventricle, pulmonary artery, and pericardium. The patient presented with acute symptoms of dyspnea 16 years after surgical resection of the primary tumour, and his dyspnea progressed to cardio-respiratory arrest within the first few days of hospital admission.

Excellent Local Control Rates and Distinctive Patterns of Failure in Myxoid Liposarcoma Treated With Conservation Surgery and Radiotherapy

PURPOSE

To evaluate the local control rates and patterns of metastatic relapse in patients with localized myxoid liposarcoma treated with conservation surgery and radiotherapy (RT).

PATIENTS AND METHODS

Between 1960 and 2003, 127 patients with non-metastatic myxoid liposarcoma were treated with conservation surgery and RT at our institution. The median patient age was 39 years (range, 14-79 years). Of the 127 patients, 46% underwent preoperative RT (median dose, 50 Gy) and 54% underwent postoperative RT (median dose, 60 Gy). Also, 28% received doxorubicin-based chemotherapy as a part of their treatment.

RESULTS

The median follow-up was 9.1 years. The overall survival rate at 5 and 10 years was 87% and 79%, respectively. The corresponding disease-free survival rates were 81% and 73%. The local control rate at > or =5 years was 97%. The actuarial rate of distant metastases at 5 and 10 years was 15% and 24%, respectively. Of the 27 patients who developed distant metastases, 48% did so in the retroperitoneum, 22% in other extrapulmonary soft tissues, 22% in the lung, 15% in bone, and 4% in the liver.

CONCLUSION

The results of our study have shown that RT and conservation surgery for localized myxoid liposarcoma provide excellent local control. Distant metastatic relapse tended to occur in the retroperitoneum and other nonpulmonary soft tissues. Therefore, staging and surveillance imaging should include the abdomen and pelvis, as well as the thorax, for patients with localized myxoid liposarcoma.

Spinal metastases from myxoid liposarcoma warrant screening with magnetic resonance imaging

BACKGROUND

Myxoid liposarcoma (MLS) has an unusual tendency for extrapulmonary metastasis, particularly to the spine and soft tissues. The objective of this study was to determine the prevalence of spinal metastasis, treatment outcomes, and optimal screening method for spinal metastasis in patients with MLS.

METHODS

Data from patients with had spinal metastases were obtained from the authors' institutional soft tissue sarcoma database. The accuracy with which positron emission tomography (PET) scans and bone scans identified metastatic lesions was compared with the accuracy of magnetic resonance imaging (MRI). Clinical response to treatment was based on pain, neurologic scores, and survivorship analysis.

RESULTS

There were 33 patients who developed spinal metastasis after a median 36 months of follow-up (range, from 7.5 months to 33 years). Known spinal metastases were detected by bone scans in 16% of patients and by PET scans in 14% of patients. Patients who underwent surgery had high-grade spinal cord compression more often than patients who did not undergo surgery (72% vs 19%, respectively; P = .002). Pain and neurologic function were improved or maintained in all patients who received radiation alone (n = 8 patients) and in all but 1 patient who underwent surgery (n = 18 patients). The median overall survival was 51.4 months from the time of primary diagnosis and 21.9 months from the time of first metastasis.

CONCLUSIONS

Bone scans and PET scan lack sufficient sensitivity to detect spinal metastasis from MLS. Treatment of metastasis is palliative, but local treatment can yield long-term disease control in select patients. Screening with whole-spine MRI may lead to the earlier detection of spinal metastasis.

Skeletal metastases in myxoid liposarcoma: an unusual pattern of distant spread

BACKGROUND

Myxoid liposarcoma (MLS), the second most common subtype of liposarcoma, occurs predominantly in the extremities of young adults and has a disproportionately high tendency to metastasize to unusual soft tissue locations, before disseminated spread or pulmonary metastases. Anecdotal evidence, mainly supported by isolated case reports, suggests that a subset of these patients also develop bone metastasis, especially within the spine, which was previously under-appreciated.

STUDY DESIGN

In this study we investigate the incidence of osseous metastases in a well annotated sarcoma database and correlate this endpoint with clinicopathologic and molecular findings.

RESULTS

From a total of 230 patients with MLS diagnosis confirmed histologically, who were managed and followed prospectively at MSKCC, 40 (17%) developed skeletal metastases, comprising 56% of all metastatic events. A significant number of these bone metastases were identified early in the disease course, before the manifestation of disease in sites where sarcomas usually metastasize, such as lung. From the time of 1st metastasis, the 5 years median survival was 16%. The majority (78%) of MLS patients developing bone metastases had a histologic high grade primary tumor. The median overall survival for the high grade tumors was 55 months, as compared to 105 months for low grade cases. Eleven (84%) of 13 cases tested by RT-PCR demonstrated a type II TLS-CHOP fusion transcript.

CONCLUSION

These findings suggest that MLS has a high incidence of osseous metastases, with predilection to spine, and often associated with the most common type of TLS-CHOP transcript. Screening should include images of the spine in high-risk MLS patients to exclude spinal metastases.

Isolated pancreatic metastasis of extremity myxoid liposarcoma: Report of a case

Myxoid liposarcoma (ML) has a high predilection for extrapulmonary sites of metastases, including intra-abdominal metastases, but pancreatic involvement is extremely rare. Here, we report the case of a 66-year-old male patient, who underwent pancreaticoduodenectomy for isolated pancreatic metastasis of ML of the left lower extremity that had been excised 6 years before. Completion pancreatectomy was necessitated afterwards for a delayed haemorrage associated with pancreatic fistula. Currently the patient is alive with no evidence of disease. Highly selected patients with isolated pancreatic metastasis of soft tissue sarcoma may benefit from a curative surgical resection.

Myxoid liposarcoma metastatic to the thyroid gland: a case report and literature review

We present the second reported case of a myxoid liposarcoma metastatic to the thyroid gland in a 51-year-old gentleman with previous liposarcoma of the right thigh. Myxoid liposarcoma has a relatively good prognosis but tends to recur locally. Metastases affecting the thyroid gland are a rare entity and most commonly arise from the kidney, lung or breast. Clinical presentation, patterns of recurrence and prognosis of myxoid liposarcoma and metastases to the thyroid gland are discussed.

Lower-extremity liposarcoma metastatic to the larynx: case report

Distant metastases to the larynx are rare. We describe the case of a 46-year-old man who was referred to our head and neck surgery clinic with a 6-week history of sore throat and otalgia. He was found to have a laryngeal lesion that was consistent with a primary myxoid liposarcoma that had been extirpated from a lower extremity earlier To the best of our knowledge, no case of myxoid liposarcoma metastatic to the larynx has been previously reported in the English-language literature.

Metastatic myxoid liposarcoma in the mesentery: what is debated? Case report and a review of the literature

Myxoid liposarcoma, unlike other types of liposarcoma, has an unusual propensity to metastasize to extrapulmonary sites including the abdominal cavity. Metastatic myxoid liposarcoma is an important condition because it may indicate distant micrometastatic disease. We report the case of a 47-year-old woman with a metastatic myxoid liposarcoma in the mesentery. Surgical excision with a tumor-free margin was achieved, but cardiac and liver metastases developed. We review the available literature and discuss what is still debated about this disease.

Pericardial metastasis of myxoid liposarcoma causing cardiac tamponade

Although myxoid liposarcoma often metastasizes to various organs, cardiac metastasis is rare. We present herein a rare case with pericardial metastasis of myxoid liposarcoma, which expanded the pericardial sac extraordinarily and required an emergency operation because of acute cardiac tamponade. We undertook a review of the English literature regarding liposarcoma.

Extraskeletal myxoid chondrosarcoma metastatic to the pancreas: a case report

Extraskeletal myxoid chondrosarcoma (EMC) is a low-grade sarcoma characterized by developing metastases and local recurrence in high rate. It is mainly deep seated in the proximal extremities. The most common metastatic sites are the lungs, soft tissues, lymph nodes, bones and the brain. To our knowledge, no case of clearly defined EMC has been reported to date developing a metastasis in the pancreas. We describe a case of a man suffering from EMC who developed a single pancreatic metastasis 20 years after the initial diagnosis. A 49-year-old man was submitted to surgical excision of an EMC, in left thigh, 20 years ago. Fourteen years after the initial diagnosis a local recurrence in left thigh occurred. Multiple lesions of metastatic origin, in both lungs, were excised via thoracotomies until the time being. In 2003, as a part of a periodically performed imaging control, an abdominal CT scan was performed revealing a solid lesion in the pancreas. Distal pancreatectomy was performed. The histopathology of the excised specimen proved to be the one of metastatic lesion of EMC. The above-mentioned case of EMC is, as far as we know, the first one described developing a certain pancreatic metastasis.

Neck metastasis of a myxoid liposarcoma of the lower extremity

We report the clinical features of two cases presenting metastatic neck tumors (in the anterior neck and submandibular regions) secondary to myxoid liposarcoma of the lower extremity. Both cases underwent repeated resection of primary legions of the lower extremities because of recurrences. Such repeated surgical procedures are thought to be a risk factor for distant metastasis resulting from hematogeneous dissemination of tumor cells, although there is considerable debate about multicentricity versus metastasis in liposarcomas. Where possible, therapy for liposarcomas should initially comprise complete and wide resection of the lesions. Combined therapy consisting of surgery and postoperative radiation and chemotherapy should be investigated in the future.

Intra-abdominal metastases from soft tissue sarcoma

OBJECTIVE

To define the clinical features and prognosis of patients with abdominal metastasis from primary soft tissue sarcoma (STS) at other sites.

METHODS

All patients with abdominal metastasis from STS were identified from the Royal Marsden Hospital Sarcoma Unit prospective database from January 1990 to July 2001.

RESULTS

Nineteen patients developed abdominal metastasis out of a cohort of 2127 patients (0.9%) evaluated during the study interval. The median age was 49 (19-71) years. The median time to abdominal metastasis from diagnosis of the primary was 27 (8-91) months. The presenting complaints were incomplete intestinal obstruction (n = 5), abdominal pain (n = 4), mass (n = 2), gastrointestinal bleed (n = 2), urinary obstruction (n = 2), anorexia (n = 1), and abdominal distension (n = 1). Emergency laparotomy was done for perforative peritonitis (n = 2), intussusception (n = 2), and bleed in spleen (n = 1). Two patients were asymptomatic. The common histologies were myxoid liposarcoma (n = 6) and leiomyosarcoma (n = 4). The median follow-up of survivors post metastasis was 12 months. Abdominal metastatectomy was performed in 16 patients, 3 of these patients had abdominal recurrences. The 1- and 2-year overall disease specific survival for the 19 patients was 66% (SE = 11%) and 43% (SE = 13%) with a median survival of 13 months (95% CI = 11.8-14.7). Metastasectomy was associated with slight improved median post-metastasis survival (33 months vs. 8 months for unresected patients).

CONCLUSIONS

Although abdominal metastasis is rare, vigilance is warranted. Symptomatic patients should be examined and investigated thoroughly for metastases. Surgery is the treatment of choice for patients with an acute presentation; however, survival is dismal.

Intussusception secondary to metastasis from a low-grade retroperitoneal liposarcoma

Liposarcomas are the most prevalent soft tissue sarcomas in adults. Low-grade liposarcomas are the most frequent and least aggressive and are noted as having a low risk of metastasis. We present a case of low-grade myxoid liposarcoma that metastasized to the small bowel resulting in intussusception. This case involves a 44-year-old woman with a recurrent retroperitoneal liposarcoma. Approximately 30 months after initial diagnosis, the patient was found to have a solitary metastasis to the small bowel that presented as a jejunal intussusception. Interestingly, there was no indication of a round cell component in either the metastasis or recurrent tumor, although the original tumor did contain a small round cell component. This is the first report in the English literature of liposarcoma metastasizing to the small bowel. We suggest that atypical presentations of liposarcoma metastases should always be considered in the management of patients with a history of liposarcoma.

Unusual skeletal metastases from myxoid liposarcoma only detectable by MR imaging

We present two cases of skeletal metastases from myxoid liposarcoma, occurring several years after treatment of the primary tumors in the lower limb. The present two case reports have unusual radiological features only detectable by MR imaging and not by plain radiographs or bone scans. From the present two cases, we found that a negative plain radiograph of the spine or a negative bone scan could not exclude skeletal metastases from myxoid liposarcoma, and MRI was a more sensitive screening procedure for their detection, especially in T1-weighted images. Unusual radiological features of skeletal metastases from myxoid liposarcoma are not well documented and only a few cases have been previously reported. Our aim is to document two more patients exhibiting the unusual radiological features of skeletal metastases from myxoid liposarcoma to improve their early detection and management.

Solitary bone metastasis from myxoid liposarcoma

BACKGROUND

Extrapulmonary metastasis is more common in liposarcoma than in other soft tissue sarcomas. However, osseous metastases are rare.

CASE REPORT

We report the case of a 61-year-old woman with a solitary histologically proven bone metastasis of the right femur from primary myxoid liposarcoma of the left thigh. In September 2000 resection of the primary tumor was performed. Histology showed a high-grade liposarcoma with round cell differentiation. Postoperative radiotherapy with 60 Gy was performed. In a follow-up MRI examination 11 months after initial diagnosis, a suspicious formation in the marrow space of the right proximal femur was detected. CT-guided biopsy was performed and histology showed a metastasis from liposarcoma. PET examination confirmed the metastasis as solitary. Curettage of the metastasis was performed followed by radiotherapy with 60 Gy. The patient was without evidence of disease in the last follow-up.

CONCLUSIONS

No standard treatment exists for the management of solitary extrapulmonary metastases from soft tissue sarcoma. Interdisciplinary cooperation is advised and the therapy concept should be chosen individually.

Molecular variability of TLS-CHOP structure shows no significant impact on the level of adipogenesis: a comparative ultrastructural and RT-PCR analysis of 14 cases of myxoid/round cell liposarcomas

A specific TLS-CHOP fusion gene derived from the t(12;16) is present in at least 95% of myxoid/round cell liposarcomas (MLS). Rare cases of MLS show a variant t(12;22) translocation, resulting in EWS-CHOP fusion gene. The CHOP gene encodes a leucine-zipper transcription factor, which is implicated in both oncogenic transformation and inhibition of adipogenesis. To examine whether the molecular variability of TLS-CHOP or EWS-CHOP fusion transcript structure is associated with the degree of inhibition of adipogenesis, a comparative ultrastructural and RT-PCR-based analysis of 14 MLS was performed. The specimens consisted of 9 primary, 2 locally recurrent tumors, and one representative sample each from 3 patients with multifocal soft tissue metastases. Histologically, there were 8 high-grade and 6 low-grade MLS using 5% round cell (RC) component as the cutoff point. By RT-PCR assay there were 13 cases with TLS-CHOP fusion transcripts: 7 cases of type 5-2 (known as type II), 4 cases of type 7-2 (known as type I),1 case of type 8-2 (known as type III), and 1 unique case of type 6-2. The remaining 1 case showed an EWS-CHOP fusion transcript. Ultrastructural examination revealed that tumor cells were composed of a moderate-to-predominant proportion of well-formed lipoblasts in 4 cases, while in 6 cases such lipoblasts were very scant. The remaining 4 tumors were arrested in the stage of transitional cells. The heterogeneity of TLS-CHOP fusion transcript showed no apparent impact on adipogenesis, since both TLS-CHOP type I and II cases could randomly display various levels of lipoblastic differentiation. Furthermore, the 4 cases without definite lipoblasts showed no preference for any specific fusion variants and consisted of one each of TLS-CHOP subtypes. In addition, the fusion transcript variants did not correlate with other ultrastructural features, such as the presence and amount of glycogen, mitochondria, rough endoplasmic reticulum, vimentin-like intermediate filaments, and external lamina. However, there appeared to have a trend suggesting the predilections of glycogen particles and vimentin-like intermediate filaments in primitive mesenchymal cells and/or transitional cells. These findings cannot substantiate the hypothesis that the molecular variability of fusion transcripts has a biological impact on adipogenesis of MLS, and other factors might be implicated in their level of differentiation.

Giant metastatic myxoid liposarcoma causing cardiac tamponade: a case report

We report a case of a rapidly progressing isolated giant metastatic myxoid liposarcoma to the heart in a 54-year-old man, who presented with acute symptoms of cardiac tamponade. Surgery remains the best treatment option for this rare condition.

Cardiac encasement by metastatic myxoid liposarcoma

Isolated cardiac metastasis from a primary liposarcoma of noncardiac origin is a rare occurrence. A patient who presented with biventricular failure and constrictive hemodynamics years after successful resection of a primary liposarcoma of the thigh is described. Extensive cardiac encasement by tumor was suspected on diagnostic imaging. Hemodynamic instability and multiorgan failure necessitated urgent exploratory sternotomy. The patient died intraoperatively. Extensive metastatic sarcoma limited to the heart was confirmed during surgical procedure. This case suggests that in clinical and pathological investigation of a cardiac mass, knowledge of previous extracardiac involvement with soft tissue sarcoma is essential.

Metastatic patterns of extremity myxoid liposarcoma and their outcome

BACKGROUND AND OBJECTIVES

Extremity myxoid liposarcomas have a unique extrapulmonary metastatic potential. We studied the metastatic pattern of extremity liposarcomas to determine what types of posttreatment imaging may be of value in the follow-up these patients.

METHODS

Twenty-two patients from a total of 128 patients with primary extremity liposarcoma were treated at a tertiary care institution for subsequent metastases from January 1981 to January 2000. Median follow-up was 45 months (range: 6-270 months). Data on these patients was prospectively collected and then retrospectively analyzed for effect of metastatic pattern and treatment on outcome.

RESULTS

Of these 22 patients, extrapulmonary metastases developed in 10, combined pulmonary and extrapulmonary metastases developed in 6, and isolated pulmonary metastases developed in 6. Of the 16 patients with extrapulmonary metastases, 13 were of the myxoid subtype. Of the 49 patients with extremity myxoid liposarcomas, metastases developed in 14 (29%). The most common sites of metastases among these 14 patients include: the retroperitoneum, 10 patients (71)%; intra-abdominal extra-hepatic, 7 patients (50%); spinal/paraspinal, 6 patients (43%). Only 3 of the patients are alive and disease free and all 3 of these patients are from the subgroup of 10 patients with only extra-pulmonary metastases (2 intra-abdominal and 1 retroperitoneal).

CONCLUSIONS

Extremity myxoid liposarcomas have an unusually high predilection for extra-pulmonary metastases, frequently without any pulmonary metastases. After treatment of the primary tumor, these patients should be followed with periodic chest X-ray and abdominal/pelvic computed tomography (CT) scans. Any back or neurologic complaints should prompt additional imaging of the appropriate spinal area. Consideration should be given to surgical and adjuvant treatment of metastatic disease when appropriate.

Cardiac metastasis from a myxoid liposarcoma

Intracardiac metastases due to solid tumours are rare. We describe a patient with a myxoid liposarcoma of the thigh and a secondary lesion in the interventricular septum, which was treated with radiotherapy.

[Nocturnal back pain; a misdiagnosed symptom of spinal tumor]

Four patients had nocturnal back pain or pain that worsened when lying down. In one of these, a 49-year-old man, the medical history mentioned a malignancy, as a result of which a spinal metastasis was suspected. In the other three patients, a 52-year old woman and two men aged 48 and 60 years, the nocturnal back pain and the back pain worsening when lying down was not recognised as indication of a spinal tumour. As objective neurological symptoms were not established at initial investigation, a long period of discomfort and frustration followed before the spinal tumour was diagnosed eventually. The importance of recognising these early complaints is stressed. Nowadays, MRI is the technique of choice to answer the question whether there is a space occupying process in the spine.

Myxoid liposarcoma metastatic to the thoracic epidural space without bone involvement: report of two cases

Myxoid liposarcoma can frequently metastasize to extrapulmonary sites. We present two cases of myxoid liposarcoma metastatic to the epidural space. Both patients complained of back pain, but plain radiography revealed no abnormality. MR imaging clearly demonstrated metastatic tumors in the epidural space, but no involvement of vertebra. When patients with myxoid liposarcoma complain of back pain, metastasis in the epidural space should be considered even in patients without bone involvement.

A myxoid liposarcoma in the lower leg, with a large intra-abdominal metastasis

We report a patient with a large intra-abdominal metastasis of myxoid liposarcoma. The patient first noticed an asymptomatic mass in her left leg in 1985, when she was 20 years old. The mass was left untouched until she realized its rapid growth and consulted a local doctor in 1994. After needle biopsy, she was histologically diagnosed as having a myxoid liposarcoma. She disagreed with the recommendation for an amputation below the knee, made at another hospital. A marginal resection was performed as an alternative treatment. She subsequently underwent three more marginal resections and four intra-lesional resections for repeated local recurrences. In 1997, an abdominal computed tomography scan revealed the presence of multiple intra-abdominal metastases, and the lesions were judged to be inoperable. Ileus and respiratory distress, caused by compression by the abdominal mass, gradually worsened, and she died in 1999, at the age of 34. The girth of her abdomen was 135 cm at the time of death.

[Right atrioventricular metastasis of a myxoid liposarcoma. Case report and al review of the literature]

Malignant tumours of the heart and pericardium are rare. Secondary tumours are 20 to 40 times more common than primary tumours. The authors report the case of a cardiac metastasis of a myxoid liposarcoma of the inguinal region. Surgical ablation with chemotherapy significantly improved the patient' clinical and haemodynamic status. A review of the literature shows that postoperative survival does not exceed 2 years, but the prognosis is better when chemotherapy is associated with surgery. Transoesophageal echocardiography is an excellent diagnostic imaging method. It provides a better evaluation of the tumour and its location, compared to thoracic CT scan and transthoracic echocardiography.

Metastatic liposarcoma of the brain: case report and review of the literature

A 74-year-old woman presented with an acute left hemiplegia. CT demonstrated an irregular mass in the right parietal region of the brain. Two years previously, she had undergone wide local excision of a liposarcoma from her thigh. Craniotomy was performed and the lesion removed. Subsequent histology confirmed a liposarcoma. The brain is an exceptionally rare site of first recurrence of a liposarcoma. This case report presents a pathological rarity and briefly reviews the literature relevant to clinicians.

Myxoid liposarcoma--the frequency and the natural history of nonpulmonary soft tissue metastases

BACKGROUND

Myxoid liposarcomas (ML) make up the major subset of liposarcomas, which in most series represent the second or third most common type of soft tissue sarcoma. The tendency for ML to metastasize to other soft tissues (STM) in preference to lung parenchyma has been previously described; however, the natural history of this tumor's behavior is poorly documented. Our intent was to analyze the natural history of ML and further quantify the incidence of STM, concentrating on their significance in terms of survival.

METHODS

We reviewed the experience at the Royal Marsden Hospital over a 10-year period, documenting the clinicopathological behavior of ML, including the frequency of STM.

RESULTS

There were 50 patients, with a median follow-up of 43 months. The actuarial 5-year soft tissue metastasis rate was 31%, and the most common sites of STM were the retroperitoneum, abdominal wall, and abdominal cavity. In those 12 patients who had STM there was a median interval of 23 months after original diagnosis to the time the first metastasis became apparent (range, 0-142 months). Median survival following first metastasis was 35 months; 6 of the 12 patients died between 6 and 50 months. Four patients who had STM remain disease free at 15 to 59 months after their first STM. Any round cell component of the ML was associated with a significantly greater chance of metastatic disease (P = .02). In this series, the overall 5-year and 7-year survival rates were 85% and 68%. Patients with STM had an 11 times greater chance of dying than those who did not.

CONCLUSIONS

ML usually is an indolent disease, but there is a subset of patients who develop STM and have a significantly worse prognosis. STM can occur years after the initial diagnosis and can be associated with medium-long-term survival after they occur. STM should be managed aggressively because of this.

A rare chimeric TLS/FUS-CHOP transcript in a patient with multiple liposarcomas: a case report

Myxoid liposarcomas harbor a unique and specific t(12;16)(q13,p11) chromosomal translocation. The breakpoint has recently been identified, and involvement of the TLS/FUS gene on chromosome 16 and the CHOP gene on chromosome 12 was demonstrated. We report a case of a 45-year-old woman who developed multiple malignant lipomatous tumors of unknown origin and myxoid/round cell histology at different locations. To examine the diagnostic potential of this translocation and to develop a hypothesis on the origin of the tumors, we used cytogenetic and molecular cytogenetic methods (reverse transcription polymerase chain reaction, RT-PCR). We identified a chimeric RNA transcript in the second recurrence in the thigh/groin, as well as in another tumor in the mediastinum, which has an additional sequence of 33 bp, known as fusion transcript type III. Cytogenetic analysis of another tumor in retroperitoneal space revealed a rare type of unbalanced translocation der(16)t(12;16). We hypothesize that these tumors are metastases rather than multicentric tumors. The detection of the chimeric message in the present case is not only useful for differential diagnosis, but also for analyzing the origin of multiple neoplasms.

Liver metastases from extremity soft tissue sarcoma

Liver involvement by soft tissue sarcoma is an unfavorable prognostic factor for survival. Complete resection of liver metastases can bring improvement in selected patients, but chemotherapy remains the only palliative treatment option for most. Anecdotal long-term survival of patients with unresectable liver metastases treated with systemic chemotherapy has been reported, such as the patient presented here.

[Multicentric liposarcoma. Apropos of a case]

INTRODUCTION

Though rare, observations of multiple liposarcomas show that the development of secondary tumors occur in sites usually considered as primary locations. This would be more frequent for myxoid liposarcomas than for other subtypes of the disease. Their origin, either multicentric (i.e., coexistence of several primary tumors) or due to metastatic spreading, is still debated.

EXEGESIS

We report a case of myxoid-type multicentric (i.e., right popliteal fossa, retroperitoneum and soft tissue of the left arm) liposarcomas of different sizes, without pulmonary, hepatic or osseous involvement. These liposarcomas were simultaneously diagnosed in a patient who presented with pain in the right knee.

CONCLUSION

This support the hypothesis that multiple liposarcomas have a multicentric origin. Initial and follow-up staging of such tumors must investigate not only usual metastatic sites but also classical primary locations.

Iodine-123 BMIPP and Ga-67 scintigraphy in liposarcoma

A patient with recurrent retroperitoneal liposarcoma had multiple suspected metastases. I-123 BMIPP imaging showed areas of increased uptake due to accumulation in the myxoid components of the liposarcoma. Ga-67 showed accumulation in the undifferentiated components. The well-differentiated components showed little accumulation of either I-123 BMIPP or Ga-67. Differences in the accumulation of these radionuclides may reflect differences in cell densities, fatty acid metabolism, and the degree of malignancy. I-123 BMIPP and Ga-67 scintigraphy may be useful in determining the prognosis of liposarcoma.

[Metastatic epiduritis with invasiveness of the left renal vein]

We report a case of epidural metastasis with left renal vein invasion. This nonsymptomatic venous involvement was detected by ultrasonography and confirmed at CT and MR imaging. Such an unusual cause of renal vein tumor thrombus occurred through a lumbar vein which represents one of its usual collateral branches.

Liposarcoma: outcome and prognostic factors following conservation surgery and radiation therapy

PURPOSE

Liposarcoma is among the more common types of soft-tissue sarcoma. This retrospective review was performed to determine the outcome and delineate prognostic factors for this disease when treated by conservation surgery and radiation.

METHODS AND MATERIALS

Between 1964 and 1992, 112 consecutive patients with liposarcoma were treated with conservation surgery and radiotherapy. Univariate and multivariate statistics were used to evaluate the outcome with local control, metastatic relapse, and survival as end points, and to delineate independently significant prognostic factors.

RESULTS

Preoperative radiation to a mean dose of 50 Gy was used in 36 patients and postoperative radiation to a mean dose of 61 Gy was used in 76 patients. At a median follow-up of 9 years (range 2-25), 34 patients (30%) developed disease progression at some site. Local recurrence developed in 14 patients (13%), and the actuarial local relapse rate was 13% at 10 years. Metastases developed in 23 patients (21%) with an actuarial metastatic rate of 23% at 10 years. Five-, 10-, and 15-year survival rates were 79%, 69%, and 61%, respectively. The most important factor influencing outcome--whether local control, metastases, or survival--was tumor histologic subtype. Well-differentiated (15 patients) and myxoid (including round cell) (71 patients) subtypes had a local control rate exceeding 90% at 10 years. No patient with well-differentiated liposarcoma developed metastases. The actuarial metastatic rate for myxoid tumors was 22% at 10 years and was higher for large than small tumors. The pattern of metastases for this variant was atypical with a preponderance of extrapulmonary sites. Pleomorphic liposarcoma (26 patients) was a highly malignant tumor with a high local recurrence rate of 37% and a metastatic rate of 41% at 10 years. Larger pleomorphic tumors had a significantly higher metastatic rate than smaller ones. These biologic factors were reflected in progressively decreasing 10-year survival rates from 87% for well-differentiated lesions, through 76% for myxoid tumors, to 39% for pleomorphic tumors. Although other factors such as positive resection margins and prior local recurrence were also independently significant determinants of outcome, histology was the overriding factor.

CONCLUSION

Liposarcoma is a highly pleomorphic disease whose outcome is greatly determined by its histologic subtype: so greatly that results reported without histologic stratification are likely meaningless. Conservation surgery and radiation achieve excellent local results and with relatively little metastatic risk for patients with well-differentiated and myxoid liposarcomas. The same treatment strategy appears appropriate for pleomorphic liposarcoma, but with a much smaller expectation of a satisfactory outcome. The development of effective systemic therapy is an important goal for this variant of liposarcoma.

An unusual case of spinal metastasis from a liposarcoma

A 58-year-old man presented with spinal cord compression due to a metastatic liposarcoma of the thoracic spine. There was no evidence of vertebral bone involvement radiographically. This rare case is presented and its clinical features and diagnosis are discussed.

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.

Cardiac metastasis of liposarcoma

The authors describe a retroperitoneal liposarcoma with secondary involvement of the left ventricle. Therapy has been disappointing, and is guided by the nature of the primary tumor, previous therapy, extent of metastatic spread, and feasibility of cardiac resection. In selected patients whose primary tumor is well-controlled and progressing slowly, with no evidence of widespread disease, resection of the cardiac metastases can be performed when technically feasible.