Is perioperative chemotherapy effective in patients with localized myxoid liposarcoma?

BACKGROUND

This study aimed to compare the local recurrence, distant metastasis and disease-specific survival rates of patients with localized myxoid liposarcoma in the surgery and adjuvant chemotherapy group versus the surgery alone group.

METHODS

A total of 456 patients in the Japanese National Bone and Soft Tissue Tumour Registry database who had localized myxoid liposarcoma and underwent surgery and adjuvant chemotherapy or surgery alone between 2001 and 2019 were included in this retrospective study. The study adjusted for background differences between patients who underwent surgery and adjuvant chemotherapy (n = 228) or surgery alone (n = 228) using propensity score matching.

RESULTS

Univariate analysis showed no significant difference in local recurrence rate between the two groups (5-year local recurrence-free survival: 98.6% [95% confidence interval: 95.9-99.6] vs. 94.0% [95% confidence interval: 89.7-96.6], P = 0.052). Univariate analysis showed no difference in the incidence of distant metastases between the two groups (5-year distant metastasis-free survival: 80.5% [95% confidence interval: 73.9-85.8] vs. 75.1% [95% confidence interval: 67.7-81.2], P = 0.508). Univariate analysis showed no difference in disease-specific survival between the two groups (5-year disease-specific survival: 92.6% [95% confidence interval: 86.1-96.2] vs. 93.2% [95% confidence interval: 87.6-96.4], P = 0.804). In the high-risk group (n = 203) with high-grade tumours and tumour size ≥10 cm, there were no significant differences in the local recurrence, distant metastasis and disease-specific survival rates between the surgery and adjuvant chemotherapy group and the surgery alone group.

CONCLUSION

The effect of adjuvant chemotherapy on localized myxoid liposarcoma appears to be limited.

Diffuse intra-abdominal sarcomatosis in myxoid pleomorphic liposarcoma

We present a case of an extremely rare type of soft-tissue sarcoma with an atypical clinical presentation. The patient, a female in her 20s with Li Fraumeni syndrome, had prior surgery for a large intra-abdominal tumour that was given the diagnosis of malignant myxoid spindle cell neoplasm. Her recurrence manifested as diffuse intra-abdominal sarcomatosis for which she ultimately underwent subtotal debulking with palliative intent. Final pathology rendered the diagnosis of myxoid pleomorphic liposarcoma, a newly described entity, distinct from the more common liposarcoma subtypes. The optimal treatment for this typically aggressive disease is currently unknown; until that is better defined, management should be carried out by sarcoma specialists.

Primary Orbital Myxoid Liposarcoma

Although liposarcoma is the most prevalent soft tissue sarcoma in adults, head and neck liposarcomas are rare and account for less than 5% of all liposarcomas. The primary orbital location is even more exceptional, with fewer than 100 cases documented in the medical literature. Given the scarcity of cases of orbital liposarcoma and the limited familiarity of physicians and pathologists with this pathology, there is an increased risk of non-diagnosis or misdiagnosis, which may lead to inappropriate patient management. To address these challenges, we present a case of primary orbital myxoid liposarcoma and subsequently discuss the primary findings of this case based on the evidence documented in the medical literature. This comprehensive text is designed to serve as a valuable resource for healthcare professionals and pathologists, with the goal of promoting both clinical suspicion and accurate diagnosis and treatment of this rare condition in future cases.

Patterns of Metastatic Recurrence of Genetically Confirmed Myxoid Liposarcoma

BACKGROUND

Most sarcomas metastasize predominantly to the lungs, and chest x-ray, or computed tomography, is the most commonly used staging investigation. Myxoid liposarcomas (MLSs) are rare tumors with a tendency to metastasize to extrapulmonary loci. The aim of this study was to assess the locations of the first metastases in MLS patients, to guide the design of effective staging and follow-up imaging protocols.

METHODS

Patients treated for MLS between 1987 and 2017 were identified in a prospectively maintained register. Histology of the tumors was reassessed. In addition, the presence of one of the pathognomonic gene translocations was confirmed, uniquely for a retrospective series. The surgical and oncological outcomes were reviewed. A comprehensive review of the literature was performed on the metastatic pattern of MLS, including series with 10 or more MLS patients with metastatic disease.

RESULTS

A total of 32 patients with genetically confirmed MLS were identified, with a median follow-up of 7.6 years. Seven patients (22%) developed metastatic disease, five initially intra-abdominally and only one to the lungs. The comprehensive review included 14 series with 1853 patients, 348 (19%) of whom had metastases. The location of the first metastases was soft tissues in 32% of patients, intra-abdominal in 26%, pulmonary in 24%, and bone in 17%.

CONCLUSIONS

MLSs metastasize often intra-abdominally and to extra-abdominal soft tissues. Thus, whole-body imaging may be indicated during the initial assessment and follow-up of these patients.

Myxoid pleomorphic liposarcoma in the teres minor muscle: A case report

RATIONALE

Myxoid pleomorphic liposarcoma (MPL) is a rare aggressive adipocytic tumor that mainly presents in children and adolescents. It is most frequently observed in the mediastinum and rarely in the head and neck, perineal region, or back. Herein, we report the first published case of MPL of the teres minor muscle.

PATIENT CONCERNS

A 24-years-old woman presented with a painless palpable mass in her right shoulder.

DIAGNOSES

Magnetic resonance imaging identified a 9.0 × 7.0 × 4.0 cm mass suspected to be a sarcoma in the teres minor muscle. Positron emission tomography/computed tomography revealed no evidence of distant metastasis. Histopathological examination revealed the mass to be an MPL, which was assigned a histologic grade of 3 according to the French Federation of Cancer Centers Sarcoma Group system. No tumor cells were observed along the resected margins.

INTERVENTIONS

Under general anesthesia, the right teres minor muscle containing the mass was excised en bloc and frozen biopsy confirmed that the tumor cells did not invade the surrounding tissues.

OUTCOMES

The patient underwent radiotherapy and was followed up for 6 months without complications.

LESSONS

Although MPL in the teres minor muscle is rare, it should be considered in the differential diagnosis in patients with a mass in the teres minor muscle due to its poor prognosis.

A case report of primary myxoid liposarcoma mimicking as a parotid cystic lesion

RATIONALE

Myxoid liposarcoma (MLS) is an extremely rare tumor of the salivary gland and it arises from undifferentiated pluripotent mesenchymal cells. We report a rare case of a primary MLS in the parotid gland.

PATIENT CONCERNS

The patient was a 49-year-old female who presented with a hard fixed mass in the left parotid region.

DIAGNOSIS

On computed tomography and MR images, this tumor has a low attenuation center with a thick enhancing wall and ill-defined margins. The absence of high-signal-intensity foci on T1-weighted images makes a MLS indistinguishable from most other soft-tissue masses. Pathologically, the tumor was diagnosed as MLS.

INTERVENTIONS

The patient received total parotidectomy with facial nerve preservation and selective neck dissection.

OUTCOMES

Immediate facial nerve function was House Brackmann Grade III and recovered within 3 months after the surgery. Follow-up period is 57 months and there was no recurrence until now.

LESSONS

In this report, we report a rare case of primary MLS mimicking a cystic lesion of the parotid gland.

[Neoadjuvant Use of Isolated Limb Perfusion in Large Myxoid Liposarcoma of the Thigh: a Case Report]

Large unresectable STS presents a therapeutic challenge. Several options are being explored to avoid amputation without compromising the oncological outcome. Neoadjuvant chemotherapy delivers inconsistent and rather unsatisfactory results, preoperative radiotherapy compromises healing, hence it can impede adjuvant systemic treatment. We present a case report of neoadjuvant use of isolated limb perfusion with TNF-alfa and Alkeran (Melphalan) in a patient with initially unresectable large myxoid liposarcoma of the thigh. We achieved 55% reduction in size of the tumor that allowed for wide resection with a safe margin. Pathology confirmed 99% tumor necrosis. The patient has a full function of his extremity and is disease-free at one year follow-up. ILP should be considered as a treatment option which, in selected cases, can contribute to limb sparing surgery. Key words: sarcoma, soft tissue, regional perfusion, chemotherapy, surgery, orthopedic, limb salvage.

A case of laparoscopic resection of myxoid liposarcoma of the greater omentum

Primary omental liposarcoma is a rare clinical entity with less than 20 cases being reported in the literature. Laparotomy has been the traditional approach for resection, with no reports of laparoscopic resection. A 39-year-old lady presented at the Sarawak General Hospital, Kuching, Malaysia with a history of a progressive, painless left upper quadrant abdominal swelling for a year. CT scan showed a well-defined heterogeneously enhancing cystic mass measuring 7.5x7.5x8.1cm with a poor plane with the adjacent greater curvature of stomach and transverse colon. Upper and lower endoscopy was normal. The tumour was completely dissected from the adjacent transverse colon and removed laparoscopically. Histopathological examination of the resected specimen revealed a myxoid liposarcoma. She had an uneventful recovery and was discharged well on the third postoperative day. She subsequently underwent adjuvant chemotherapy and was well at 1-year follow-up with PET CT showing no evidence of recurrence or metastases.

Primary Liposarcoma with Cholesteatoma in Mastoid

Liposarcoma is a soft tissue neoplasm that commonly develops in the lower extremities and rarely in the head and neck region. Herein, we report the case of a patient with primary liposarcoma that was detected in the mastoid antrum during staged tympanoplasty for cholesteatoma. The tumor adjacent to the attic cholesteatoma was resected completely, and the pathological diagnosis was that of myxoid-type liposarcoma. Because positron emission tomography after the surgery showed no signs of tumor remnants or systemic metastasis, a second-stage surgery was performed 8 months after the first surgery. After confirming that there was no recurrence, tympanoplasty type III with interposition between the stapes and malleus and canal reconstruction was performed. No recurrence was observed for 5 years, and to date, good hearing has been maintained. This is the first report on long-term follow-up of a patient with liposarcoma in the mastoid antrum.

Division of Sacrospinous and Sacrotuberous Ligaments Expands Access Through Greater Sciatic Foramen: Anatomic Study with Application to Resection of Greater Sciatic Foramen Tumors

OBJECTIVE

Tumors of the greater sciatic foramen remain difficult to treat. They often have both intrapelvic and extrapelvic components that may limit visualization and make safe resection of the tumor difficult. Therefore the goal of the present anatomic study was to quantitate how much additional surgical working space could be gained by transection of the sacrospinous and sacrotuberous ligaments.

METHODS

Sixteen sides from 9 fresh-frozen Caucasian cadaveric torsos underwent transgluteal dissection and exposure of the greater sciatic foramen and associated liagments. With the piriformis in place, the vertical and horizontal diameters of the greater sciatic foramen were measured. Next, the sacrotuberous and sacrospinous ligaments were cut at their ischial attachments. The vertical diameter of the now confluent greater and lesser sciatic foramina (V₂) was measured.

RESULTS

The mean vertical diameter of the greater sciatic foramen (V₁) was 54.8 ± 9.7 mm. The horizontal diameter of the greater sciatic foramen had a mean of 44.3 ± 6.1 mm with a range of 30-52 mm. After transection of the sacrotuberous and sacrospinous ligaments, the vertical distance of the greater and lesser sciatic foramina (V₂) had a mean of 74.8 ± 6.8 mm with a range of 60.1-90 mm. The mean ratio of V₂ to V₁ was 1.40.

CONCLUSIONS

The vertical length of the greater sciatic foramen increased, on average, 40% after resection of the sacrotuberous and sacrospinous ligaments. The results of this study support an alternative technique for resecting large intrapelvic tumors via a transgluteal approach.

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.

[Liposarcoma in the renal compartment: about two cases and literature review]

Retroperitoneal sarcomas are rare and heterogeneous tumors. We here report two cases of liposarcoma in the renal compartment with a literature review in order to emphasize on the anatomical and surgical features of this tumor location and on its possible prognostic implications. The first reported case was a 45-year old female patient with liposarcoma at the level of the left renal compartment. The diagnosis of myxoid liposarcoma was based on anatomo-pathological examination of the surgical specimen. The second reported case was a 70-year old man with liposarcoma at the level of the right renal compartment. The diagnosis of dedifferentiated liposarcoma was based on anatomo-pathological examination of the surgical specimen. Retroperitoneal sarcomas are often diagnosed with a palpable mass. The gold standard treatment is complete tumor resection with healthy resection margins and without damage or rupture. For this purpose resection involving adjacent organs is recommended by some authors. However the anatomical constraints of tretroperitoneal compartment and the often important tumor volume limit the possibilities to achieve a satisfactory resection. CT scan and MRI are very useful imaging techniques. Histological diagnosis poses some problems; therefore immunohistochemistry and sometimes molecular biology are significantly helpful. Patient evolution is marked by the frequent occurrence of recurrences. A specialized multidisciplinary management of these rare and very varied tumors is recommended in order to optimize therapeutic outcomes.

Retroperitoneal or mesenteric primary liposarcoma: clinical and prognostic evaluations on five cases

BACKGROUND

Retroperitoneal or mesenteric primary liposarcoma is a malignant neoplasia whose prognosis depends on the biological variants, the radical resection surgery and the histological subtypes, as well as on local and remote recurrences. Liposarcoma is the most common variant of this tumour among tumours of soft retroperitoneal tissue. The purpose of this study is to evaluate whether the treatment of this disease, carried out at the Ivrea Hospital for urgent reasons, may be considered in line with the experience of high-volume Centres.

PATIENTS AND METHODS

Between 1982 and 2016 five patients were hospitalized with a diagnosis of acute abdomen due to retroperitoneal or mesenteric primary liposarcoma: one myxoid of the mesentery, one well-differentiated of lesser epiploon, one well-differentiated of mesentery, and two dedifferentiates of the retroperitoneum.

RESULTS

The five patients, all males, had a average age of 59 years (range 48-86) and were all subjected to general anaesthesia and open technique for total tumour removal. Only the patient with the myxoid liposarcoma had two recurrences. All are alive and healthy after a follow-up of 177 months (range 9-420).

CONCLUSION

These tumours should be removed radically, if necessary in conjunction with contiguous organs. Rarity and therapeutic complexity require a treatment, sometimes even multimodal, in highvolume centres. Patients admitted in General Surgery Unit for unpostponable urgency should be operated by surgeons experienced in the treatment of abdominal disease to achieve survival results in line to those achievable in Hub Centres.

[Anterior Mediastinal Myxoid Liposarcoma Detected by Chest Computed Tomogram in the Patient with Pneumothorax]

A 57-year-old woman visited our hospital with left chest pain. Chest computed tomography (CT) scanning showed left pneumothorax with apical bullae and a nodular shadow in the left anterior mediastinum accidentally. However, a week later, we could not detect a mediastinal shadow on chest CT image after healing of left pneumothorax. Video assisted thoracoscopic surgery was scheduled in order to remove bullae and evaluate an anterior mediastinal lesion. The mediastinal lesion was tumorous and resected with around pericardial fat tissue. Pathological diagnosis was a myxoid liposarcoma of 15×10mm in size without infiltration into the surrounding tissue. The postoperative course was uneventful without recurrence 6 months later.

[Myxoid liposarcoma localised in the peritoneal cavity case report]

INTRODUCTION

Liposarcoma is one of rare soft tissue tumours. Usually, it is localised in soft tissues of the extremities, can however be localised even in body cavities. The prognosis depends on the localisation and differentiation of the tumour.

CASE REPORT

We present a patient indicated for surgical revision due to recurrence (or persistence) after previous surgery and debulking of a myxoid liposarcoma. Laparotomy with debulking, low anterior rectal resection with coloanal anastomosis, and protective ileostomy were done. No adverse events occurred in the postoperative period. However, another recurrence was observed in the subsequent follow-up.

CONCLUSION

Myxoid liposarcoma is a rare tumour with a relatively good prognosis when radically removed; in case of intraperitoneal localisation it however remains a virtually unsolvable problem.Key words: liposarcoma - debulking recurrence.

12 years of fighting liposarcoma: a case report

The proportion of liposarcoma in the structure of cancer incidence is from 10 to 35% of all mesenchymal tumors. This clinical observation describes an 12-year struggle with myxoid liposarcoma of the left upper arm, during which 17 surgeries were performed due to local recurrences, 17 radiation therapy courses and 5 chemotherapy courses were conducted. Clinical observation shows the whole complexity of myxoid liposarcoma treatment. The effectiveness of therapeutic management is determined by persistent surgery, and also by the lack of expression of Pgp, glutathione-S-transferase, metallothionein and mutant p53 in tumor structure.

Paratesticular dedifferentiated liposarcoma with prominent myxoid stroma: report of a case and review of the literature

Paratesticular sarcoma is rare, but liposarcoma is its most common type. Paratesticular liposarcoma sometimes presents as dedifferentiated liposarcoma. Both high-grade and low-grade dedifferentiation have been reported. Herein, we presented a unique case of a 64-year-old man with low-grade dedifferentiated liposarcoma with prominent myxoid stroma. Well-differentiated liposarcoma components extended along the spermatic cord. The constituent cells of the dedifferentiated component were peculiar in that, they were relatively uniform cells with atypia and did not have pleomorphism to such an extent that it mimicked myxofibrosarcoma. This myxoid component was confidently differentiated from myxoid liposarcoma with the help of immunohistochemical analysis using CDK4 and MDM2. These two markers were also expressed in the well-differentiated component. It could therefore be confirmed that this sarcoma is dedifferentiated liposarcoma but is not mixed-type liposarcoma comprising well-differentiated liposarcoma and myxoid liposarcoma.

Myxoid liposarcoma in the abdominal wall: a case report

A liposarcoma is the most common type of soft tissue sarcoma, and most liposarcomas are malignant. The extremities are the most common site for liposarcomas. There are 5 histologic types of liposarcoma, as follows: well differentiated; myxoid; round cell; pleomorphic; and dedifferentiated. Myxoid liposarcomas (MLSs) represent a subgroup of liposarcomas. There has been no report of MLSs in the abdominal wall. We report a rare case of a MLS of a 43-year-old male who presented with tensile force on the abdominal wall. Computed tomography (CT) found a tumor in abdominal wall. There was no other abnormal symptom and the laboratory testing was also unusual. At last, the tumor was successfully excised, which was diagnosed MLSs in pathology. Following standard principles, after complete excision, the patient received radiotherapy. The patient was followed up for 8 month and no disease recurrence was identified. MLSs are rarely seen in the clinic, irrespective of the presenting signs, but also based on histologic features. The aim of this report was to present the differential diagnosis of an abdominal wall mass, and to remind us of MLSs.

[Myxoid liposarcoma of the anterior mediastinum. A case report and bibliography review]

Five cases per year. Of those cases 50% are located in the extremities and 40% are located in the trunk and retroperitoneum. Primary mediastinal liposarcomas represent less than 1% of mediastinal tumors.

CLINICAL CASE

A 53 year old female, native and resident of Tabasco, with a history of anterior mediastinal tumor was treated with resection at the National Institute of Cancerology about 16 years ago with histopathological diagnosis of pleomorphic liposarcoma. She started her condition with chest pain, cough and hyaline expectoration, managed as pneumonia in her unit. Other symptoms occurred, moderate exertion dyspnea and edema of lower limbs, chest computed tomography prompted for documenting mediastinal tumor measured to be 9 × 9 cm and sent to our unit which is managed with resection.

[Myxoid liposarcoma of the lumbosacral spine. Clinical case report]

BACKGROUND

liposarcoma is a malignant tumor of soft tissue and the most common sarcoma in the adult life. The myxoid liposarcoma accounts for 30 to 35 % of all liposarcomas. It is commonly seen on the thighs. Only two cases in which the liposarcoma was found in the vertebral column have been reported.

CLINICAL CASE

this is a 28 year old woman with symptoms of spinal cord injury by compression (tottering gait, weakness 4/5 and decreased sensibility in right leg). The MRI showed a right paravertebral multinodular mass from L4 to S2, with solid and cystic aspects, following the S1 and S2 intervertebral foramen to the presacral space, with low signal intensity on T1 and high on T2. The diagnosis of neurofibroma was concluded. The patient was scheduled for surgery. Extra and intraspinal excision was performed and a mass was removed. Histopathologic study reported myxoid liposarcoma.

CONCLUSIONS

liposarcoma is a malignant tumor of soft tissues. The spine is a rare location for this neoplasm, even for metastases. It is difficult to achieve a complete resection in this localization, so the recurrence rate is high.

Resection of soft tissue tumors extending through the obturator ring

Pelvic soft tissue sarcomas are rare tumors often presenting larger than other soft tissue sarcomas and can extend into the thigh through various anatomic routes. Surgical resection is the main modality of curative treatment. En bloc tumor excision with wide, negative margins may reduce the risk of local recurrence. Soft tissue sarcomas extending through the obturator foramen create unique challenges to operative management. This case report describes 2 cases of lipomatous lesions that extend through the obturator foramen, presenting as dumbbell-shaped lesions with large intra- and extrapelvis portions. One possible surgical approach performed in both patients is detailed with long-term follow-up. Postoperatively, 1 incidence of infection was reported. Functional outcomes were acceptable, with full restoration of ambulation without assistive devices in both cases and no hernia observed. Oncologic outcomes included locoregional recurrence in 1 patient at 24 months outside the radiation field. The ideal primary treatment for all localized soft tissue sarcomas, including those extending through the obturator foramen, is resection. However, the unique subgroup of obturator ring soft tissue sarcomas has undefined outcomes and complications. The authors' goal was to achieve en bloc resection with wide negative margins while preserving ipsilateral limb function. The surgical approach described in this case study offers a description of feasibility and discussion of theoretical and observed complications.

A case of myxoid liposarcoma of the breast

A 70-year-old woman visited a local hospital complaining of a nodulein the right breast, present since 1 month. She was referred to our hospital for further evaluation. Following mammotome (MMT) biopsy, the nodule was diagnosed as myxoid/round cell liposarcoma. She underwent total mastectomy of the right breast. Histological analysis indicated that the tumor was almost entirely composed of proliferating small round mesenchymal cells in amyxoid matrix background with capillary-like vessels with partial necrosis (<10%). Immunohistochemically, p53 positive cells were seen focally (<1%) only, and the Ki-67 labeling index was approximately 20%. Since the surgical margin was histologically positive despite pathologic findings of high-grade malignancy, adjuvant treatment involving local radiation therapy (60Gy) was administered. The patient was free from any symptoms of local recurrence and metastases 1 year and 8 months after surgery.

Risk factors affecting operative approach, conversion, and morbidity for adrenalectomy: a single-institution series of 402 patients

BACKGROUND

Risk factors for selecting patients for open adrenalectomy (OA) and for conversion are limited in most series. This study aimed to investigate variables that are important in selecting patients for OA, predict risk of conversion from laparoscopic adrenalectomy (LA), and impact 30-day outcomes of OA and LA.

METHODS

A retrospective cohort study of prospectively collected data was conducted. Patients (≥ 16 years old) who underwent adrenalectomy in the Division of General Surgery at Barnes-Jewish Hospital (1993-2010) were grouped by operative approach (LA vs. OA) and compared using nonparametric tests and regression analyses (α < 0.05).

RESULTS

In total, 402 patients underwent 422 adrenalectomies. Compared to LA patients, those in the OA group were older (p = 0.02), had higher ASA scores (p = 0.04), larger tumor size (p < 0.01), and fewer functioning lesions (p < 0.01). OA patients more often required concurrent procedures (p < 0.01), had a longer operative time (p = 0.04), more intraoperative complications (p = 0.02), higher estimated blood loss (EBL), and larger transfusion requirement. Preoperative factors that predicted selection for OA were higher patient age (p = 0.01), higher ASA score (p = 0.03), larger tumor size (p < 0.01), nonfunctioning lesion (p < 0.01), diagnosis of adrenocortical carcinoma (p < 0.01), and the need for concomitant procedures (p < 0.01). Conversion to open or hand-assisted approach occurred in 6.2 % of LA patients. Preoperative risks for conversion included large tumor size (>8 cm) and need for concomitant procedures (p < 0.01). Multivariate analysis revealed that large indeterminate adrenal mass, adrenocortical carcinoma, tumor size (>6 cm), an open operation, conversion, concomitant procedures, operative time >180 min, and EBL >200 mL were predictors of 30-day morbidity.

CONCLUSIONS

Adrenal tumor size and need for concurrent procedures significantly impact the selection of patients for OA, the likelihood of conversion, and perioperative morbidity. These metrics should be considered when assessing operative approach and risks for adrenalectomy.

Pedicle omental flap transfer combined with vascular reconstruction after wide resection of a myxoid liposarcoma in the inguinal region

We describe a case with an inguinal myxoid liposarcoma that showed a favorable postoperative course after wide resection followed by arterial reconstruction and pedicle omental flap transfer for a wide defect including the femoral artery and vein. To our knowledge, this is the first report of the vascular reconstruction combined with pedicle omental flap transfer. In the long postoperative follow-up of 6 years, the course has been both oncologically and functionally favorable. Therefore, this reconstruction technique can be considered as a good treatment option.

Huge myxoid liposarcoma of the esophagus: a case report

Although esophageal liposarcoma is an extremely rare tumor, liposarcoma is the most common soft tissue sarcoma in adults. Liposarcoma is currently classified into the types of well-differentiated, myxoid, round cell, pleomorphic and dedifferentiated liposarcoma. Up to now only a few cases of esophagus liposarcoma have been described in the world literature. We describe a myxoid type liposarcoma of the esophagus in a 68 year old man presented with hoarseness and intermittent dysphagea to solid food. He had a huge mass in his mouth which was mobile with gag reflex. A barium swallow, esophageal manometery and CT scan of the esophagus have not clearly revealed the mass. After endoscopic surgical resection of the tumor the histological examination revealed a myxoid liposarcoma. Both the presenting signs and symptoms and the histology type are rare for such tumor. This case demonstrate a rare differential diagnosis of intermittent dysphagia as early diagnosis is so important in those tumors and should kept in mind them, although they are quite rare.

Liposarcoma of the extremities: MR imaging features and their correlation with pathologic data

OBJECTIVE

To describe the MRI features of liposarcomas of the extremities and correlate them with data from the histologic subtypes.

MATERIAL AND METHODS

Retrospective study of 20 cases of liposarcoma of the extremities identified on MRI, surgically removed and confirmed at pathology. On MRI examination, T1- and T2-weighted fat-suppressed and non-fat-suppressed images were acquired then gadolinium-enhanced fat-suppressed T1-weighted images were obtained in at least two orthogonal planes.

RESULTS

Sixteen female and four male patients aged 12 to 77 years old at presentation, in 16 cases, with a slowly enlarging painless mass (demonstrating no associated local or general inflammatory components), located in the lower extremity (16 cases) and predominantly located in the thigh (13 cases). Pathologic examination revealed three cases of well-differentiated liposarcoma, 12 cases of myxoid liposarcoma one of which with round cells, three cases of pleomorphic liposarcoma, one case of dedifferentiated liposarcoma and one case of mixed-type liposarcoma. MR images mostly showed well-circumscribed tumors (19 cases) . Well-differentiated liposarcomas typically demonstrated a very specific diagnostic appearance as a predominantly adipose mass containing nonlipomatous components seen as thick septa that may show nodularity. Other subtypes of liposarcoma demonstrated a small amount of adipose tissue thus producing a marbled textural pattern on T1-weighted images particularly in myxoid liposarcomas (9 cases), or even nonlipomatous elements in high-grade liposarcomas (in round cell liposarcoma and in two out of three pleomorphic liposarcomas). The myxoid subtype has also a relatively characteristic appearance as a low signal intensity noted on T1-weighted images and a marked high signal intensity on T2. The dedifferentiated liposarcoma has a very specific radiologic appearance as a nonlipomatous component within a predominantly adipose mass, simulating that of well-differentiated liposarcomas.

CONCLUSION

MRI of extremity liposarcomas is a highly reliable and sensitive method to characterize liposarcomas. Besides its value in the diagnosis of liposarcoma and locoregional extension control, it allows proper identification of the specific histologic subtypes of liposarcoma.

LEVEL OF EVIDENCE

Level IV. Rétrospective diagnostic study.

A unique case of infraorbital myxoid liposarcoma

Liposarcomas of the head and neck are rare, owing to the paucity of adipose tissue in this region. We present what we believe is a unique case of a myxoid liposarcoma in the infraorbital region, which arose in a 38-year-old man. The patient had presented with a slowly growing mass under his left eye that had been present for about 3 months. A wide local excision was performed, and the tumor was removed in its entirety. The final pathology report identified the mass as a well-differentiated myxoid liposarcoma. The patient's postoperative course was uneventful, and at the 12-month follow-up, he exhibited no evidence of disease.

Irradiation of myxoid/round cell liposarcoma induces volume reduction and lipoma-like morphology

The aim of the study was to investigate the clinical and morphological effects of radiotherapy in the treatment of myxoid/round cell liposarcoma (MLS/RCLS). Thirty-three primary and metastatic MLS/RCLS tumours in 15 patients were treated with radiation therapy. Twenty-seven of the 33 tumours were surgically removed after preoperative radiation (34-46 Gy) while six tumours were treated with radiotherapy alone (44-60 Gy). The pretreatment diagnosis was established in all 15 patients based on fine needle aspirates or histological findings. Tumour size was measured by CT or MRI before and after radiotherapy in 30 tumours. Thirteen tumours from 11 patients were genetically characterised before and/or after radiation therapy. Twenty-three of 30 irradiated tumours showed a median reduction in tumour volume of 52% and seven lesions a median progression of 36%. All 27 surgically removed tumours revealed histological features of radiation response. The most striking morphological changes were lipoma-like appearance, paucicellularity and hyalinisation. Twelve of 13 tumours analysed before and/or after radiation therapy showed the FUS-DDIT3 translocation. Radiation therapy of MLS/RCLS induces histopathologic accumulation of mature lipoma-like areas and tumour volume reduction that may facilitate resectability.

Validation of immature adipogenic status and identification of prognostic biomarkers in myxoid liposarcoma using tissue microarrays

Myxoid liposarcoma displays variably aggressive behavior and responds poorly to available systemic therapies. Expression profiling followed by tissue microarray validation linked to patient outcome is a powerful approach for validating biological mechanisms and identifying prognostic biomarkers. We applied these techniques to independent series of primary myxoid liposarcomas in an effort to assess markers of adipose differentiation in myxoid liposarcoma and to identify prognostic markers that can be efficiently assessed by immunohistochemistry. Candidate genes were selected based on analysis of expression profiles from 9 primary myxoid/round liposarcomas and 45 other soft tissue tumors, and by reference to publicly available data sets. Protein products were validated on an adipose neoplasm tissue microarray, including 32 myxoid liposarcomas linked to patient outcome. Results were scored visually and correlated with clinical outcome by Kaplan-Meier and Cox regression analyses. In the study, by examining expression patterns of several lipogenic regulatory gene products, an immature adipogenic status was verified in myxoid liposarcomas. We also found that expression levels of the ret proto-oncogene, insulin-like growth factor 1 receptor, and insulin-like growth factor 2 correlate with poor metastasis-free survival, supporting a role for ERK/MAPK and PI3K/AKT pathways in clinically aggressive myxoid liposarcomas.

Case report: two-step malignant transformation of a liposclerosing myxofibrous tumor of bone

We present the case of a patient with malignant transformation of a liposclerosing myxofibrous tumor. The patient had a histologically confirmed liposclerosing myxofibrous tumor that, during a course of 22 months, spontaneously transformed into a lesion appearing like a benign giant cell reactive lesion and subsequently into a high-grade bone sarcoma. Few such cases of spontaneous malignant transformation of liposclerosing myxofibrous tumor have been reported. We report what we believe to be the first case documenting spontaneous transformation of a liposclerosing myxofibrous tumor into an intermediate lesion with benign-appearing histologic features and then into a high-grade malignant tumor.

A myxoid liposarcoma arising in a leiomyoma of the uterus: a case report

BACKGROUND

A liposarcoma is the most frequent soft tissue sarcoma found in adults, however, a liposarcoma arising in uterus is extremely rare. Indeed, a liposarcoma coexistent with a leiomyoma is even rarer and there is only one case has been reported in the English literature to date.

CASE

We describe a case of the uterine liposarcoma arising in a leiomyoma in 48-year-old woman who presented with dysmenorrhea, brownish vaginal discharge, and a rapidly enlarging lower abdominal mass. The tumor emerged from the lower segment of the endometrium and filled the endometrial cavity as a polypoid lesion. The authors of this study documented the adipocyte origin of the tumor with immunohistochemical and electron microscopical studies, the available literature was reviewed and the possible histogenesis was discussed.

CONCLUSION

We herein report a case of very rare primary liposarcoma arising in a submucosal uterine leiomyoma.

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.

An unusual presentation of myxoid liposarcoma: a case report

A 50 year old female had a myxoid liposarcoma of left thigh that was widely excised. After three years, she presented with a soft tissue mass in right hypochondriac region, which was diagnosed as myxoid liposarcoma on fine needle aspiration cytology (FNAC) and was confirmed histologically.

[Liposarcoma histologic subtypes: four cases reports]

The liposarcoma is a malignant tumor of mesodermic origin derived of the adipose tissue. Liposarcoma s types, according to his histological diagnosis, are: mixoide, pleomorphic, well differentiated and dedifferentiated. It can get to reach enormous proportions, mainly when it is located at abdominal level. His treatment is the radical surgery, it is possible, together with radiation therapy and/or chemotherapy. Four patients diagnosed of liposarcoma are shown up, a case of liposarcoma well differentiated, another case of liposarcoma pleomorphic and two cases about liposarcoma mixoide; with the characteristic that one of these two cases presented a local recidivation with a dediferenciation of itself. The evolution of the four cases, was in a different way. So, their prognosis is going to depend on their histopathologic variety and on a possible multicentricidad that is going to difficult the complete radical surgical exeresis.

[Acral myxoinflammatory fibroblastic sarcoma: a report of two cases]

Acral myxoinflammatory fibroblastic sarcoma is a rare low-grade malignant soft tissue tumor, usually observed in the extremities of middle-aged adults. We report two cases which occurred in the thumb and knee of middle-aged women. Both tumors showed a multinodular architecture, with cellular areas, occasional foci of hyalinized fibrosis, and hypocellular areas with a myxoid background. Various neoplastic cells were identified including spindled or rounded epithelioid cells and occasional bizarre giant cells, morphologically mimicking Reed-Sternberg cells or ganglion cells. Tumor cells were strongly immunoreactive for vimentin, and variably positive for CD68 and CD34. Both tumors were completely resected and patients were free of disease without any further treatment after a mean follow-up of 14 months.

Subacute complete ophthalmoplegia: an anti-Hu paraneoplastic manifestation of myxoid liposarcoma

Paraneoplastic neurological syndromes are well-known sequelae of some cancers. Based on the current literature, this is the first report of a complete ophthalmoplegia preceding the diagnosis of a myxoid liposarcoma associated with the anti-Hu antibody. An 83-year-old woman presented with a several-month history of progressive ophthalmoplegia without any other neurological symptoms or signs. After resection of her myxoid liposarcoma grade 1, her ophthalmoplegia resolved. Her paraneoplastic syndrome was associated with the anti-Hu antibody. It is important to consider an underlying malignancy when an isolated, complete ophthalmoplegia presents subacutely and when other more common aetiologies are ruled out.

Liposarcoma of the retropharyngeal space: Report of a case and review of literature

Liposarcoma is a soft tissue malignant tumor that is common in adults, though the incidence of this type of tumor in the head and neck region is extremely low. Herein, we report a case of myxoid liposarcoma occurring in the retropharyngeal space. We were unable to make a proper diagnosis of this tumor prior to surgery because of the radiographic findings and the anatomical location resembled those of neurogenic tumor. Myxoid liposarcoma often recurs. So its excision must be carried out carefully and radical dissection is recommended. In the past, liposarcomas arising in the retropharyngeal space were not radically resected because the extent of resection in the head and neck area risked poor functional outcome. In the present case, functional resection and radiotherapy were performed and proved to be efficacious in that no recurrence was observed for 2 years.

[Fine needle aspiration cytology of myxoid lesions of soft tissues: a study of 24 cases]

OBJECTIVE

To summarize the diagnostic features of fine needle aspiration cytology (FNAC) of myxoid lesions in soft tissue, and to define the cytological criteria for differentiating benign lesions from sarcomas and between various myxoid lesions.

METHODS

FNAC data of 24 soft tissue myxoid lesions (14 benign lesions, 10 malignant lesions) from 1993 to 2006 from Kiang Wu Hospital, Macau were reviewed in correlation with the clinical course or the results of biopsy.

RESULTS

Ganglion, myxoma, and myxoid nodular fasciitis were the most common benign myxoid lesions of the soft tissues, all of which had low cellularity and lack of marked cellular atypia in smears in common. Ganglion was characterized by the disappearance of or the gradual minimization of the nodule after aspiration and the lack of blood vessel in smears. Myxoid nodular fasciitis was characterized by a pleomorphic pattern of proliferative cells and the presence of ganglion cell-like cells. Myxoid liposarcoma, extraskeletal myxoid chondrosarcoma and myxofibrosarcoma were the most common myxoid sarcomas. Cytologically, they had high cellularity and various degrees of cellular atypia. Myxoid liposarcoma exhibited branching chicken-wire like capillary vessels and/or lipoblasts; myxofibrosarcoma were prominent in both pleomorphic and atypia of the cells. The data revealed that the diagnostic accuracy of FNAC was nearly 100% in differentiating benign and malignant myxoid lesions of the soft tissues. The coordinate rate to the histopathology diagnosis of the common myxoid lesions of the soft tissues was above 75% (benign 71.4% and malignancy 80% respectively).

CONCLUSIONS

FNAC is an effective method in diagnosing myxoid lesions of soft tissue, in correlation with the clinical data and the accessory examinations. FNAC can provide an objective basis for the treatment of myxoid lesions and prevention of unnecessary surgical operations.

Clinicopathologic prognostic factors in myxoid liposarcoma: a retrospective study of 49 patients with long-term follow-up

BACKGROUND

The main goal of this retrospective study was to investigate prognostic factors influencing the survival of myxoid liposarcoma (MLS) with emphasis on the role of transitional areas (TLS) and round cell morphology (RCLS).

METHODS

From 1977 to 2004, 49 patients-28 men (57%) and 21 women (43%) with a median age of 44 years (range, 7-83 years)-were diagnosed with an MLS. In 42 patients, the histology could be reviewed, and tumors were classified as MLS, TLS, or RCLS. Clinicopathologic factors were analyzed for influence on survival by univariate and multivariate methods.

RESULTS

The median follow-up of 49 patients was 101 months (range, 4-550 months). Of the 42 patients for whom histology was reviewed, 16 tumors were classified as MLS (38%), 19 as TLS (45%), and 7 as RCLS (17%). Sixteen patients (33%) developed a local recurrence after a median follow-up of 21 months (range, 2-108 months). Thirteen patients (27%) developed metastases. The median interval between diagnosis and metastasis was 41 months (range, 0-222 months). Median survival after metastasis was 18 months (range, 1-179 months). The 5- and 10-year disease-specific survival rates were 85% and 72%, whereas the 5- and 10-year overall survival rates were 83% and 68%, respectively. Age at presentation (P = .02), tumor grade (P = .01), and tumor size (P = .005) were significant prognostic factors associated with survival. Tumor grade was the only independent prognostic variable that remained significant with multivariate analysis. A TLS presentation had no negative influence on patient survival.

CONCLUSIONS

Age at presentation, tumor grade, and tumor size had a negative influence on survival by univariate analysis, whereas tumor grade was the only independent prognostic factor by multivariate analysis. TLS was not associated with poor outcome.

Combined Use of Surgery and Radiation in the Treatment of an Intradural Myxoid Liposarcoma in a Dog

An intradural-extramedullary myxoid liposarcoma of the high cervical spine was diagnosed in a 9-year-old, spayed female Cavalier King Charles spaniel that was presented for a 2-month history of cervical pain and tetraparesis. Radiation therapy applied after surgery resulted in complete remission of the neurological deficits. The tumor recurred 18 months after surgical excision. A second surgery and another course of radiotherapy again resulted in complete remission of the clinical signs. The dog was euthanized 11 months after the second surgery because of tumor recurrence.

[A case of myxoid liposarcoma in the right inguinal region: a case report]

We report a case of myxoid liposarcoma developed in the right inguinal region. A 45-year-old man visited our hospital with a chief complaint of painless right inguinal mass. He was diagnosed with right direct inguinal hernia for the first time and received a hernia repair. However, the size of the inguinal mass increased gradually after the operation. Then, the tumor was re-evaluated by imaging study such as ultrasonography, computed tomography and magnetic resonance imaging. A fatty mass 4.0 cm in diameter was demonstrated and the tumor was diagnosed as a liposarcoma preoperatively. In addition to the right high orchiectomy, surrounding fatty tissue was also removed at the time of the operation. Histological examination revealed a myxoid liposarcoma and the existence of several daughter regions outside the pseudo-capsule. Right spermatic cord and testis were intact. Postoperatively, he received 54 Gy dose of radiation therapy to right inguinal region for the prevention of the local recurrence of the disease.