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1
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Luongo M, Laurenziello P, Cesta G, Bochicchio AM, Omer LC, Falco G, Milone MR, Cibarelli F, Russi S, Laurino S. The molecular conversations of sarcomas: exosomal non-coding RNAs in tumor's biology and their translational prospects. Mol Cancer 2024; 23:172. [PMID: 39174949 PMCID: PMC11340101 DOI: 10.1186/s12943-024-02083-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 08/13/2024] [Indexed: 08/24/2024] Open
Abstract
Exosomes mediate cell-to-cell crosstalk involving a variety of biomolecules through an intricate signaling network. In recent years, the pivotal role of exosomes and their non-coding RNAs cargo in the development and progression of several cancer types clearly emerged. In particular, tumor bulk and its microenvironment co-evolve through cellular communications where these nanosized extracellular vesicles are among the most relevant actors. Knowledge about the cellular, and molecular mechanisms involved in these communications will pave the way for novel exosome-based delivery of therapeutic RNAs as well as innovative prognostic/diagnostic tools. Despite the valuable therapeutic potential and clinical relevance of exosomes, their role on sarcoma has been vaguely reported because the rarity and high heterogeneity of this type of cancer. Here, we dissected the scientific literature to unravel the multifaceted role of exosomal non-coding RNAs as mediator of cell-to-cell communications in the sarcoma subtypes.
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Affiliation(s)
- Margherita Luongo
- Laboratory of Preclinical and Translational Research, IRCCS CROB Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture (PZ), 85028, Italy
| | - Pasqualina Laurenziello
- Laboratory of Preclinical and Translational Research, IRCCS CROB Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture (PZ), 85028, Italy
| | - Giuseppe Cesta
- Laboratory of Preclinical and Translational Research, IRCCS CROB Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture (PZ), 85028, Italy
| | - Anna Maria Bochicchio
- Experimental Oncology Unit, IRCCS CROB Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture (PZ), 85028, Italy
| | - Ludmila Carmen Omer
- Experimental Oncology Unit, IRCCS CROB Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture (PZ), 85028, Italy
| | - Geppino Falco
- Department of Biology, University of Naples Federico II, Naples, 80126, Italy
| | | | | | - Sabino Russi
- Laboratory of Preclinical and Translational Research, IRCCS CROB Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture (PZ), 85028, Italy.
| | - Simona Laurino
- Laboratory of Preclinical and Translational Research, IRCCS CROB Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture (PZ), 85028, Italy
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2
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Karbal J, Machmachi A, Bouziane W, Amahtil M, Laye Diene O, Daoudi A. Case report of a successful conservative surgical treatment of a giant liposarcoma of the forearm invading the median nerve. Radiol Case Rep 2024; 19:1537-1541. [PMID: 38317697 PMCID: PMC10839772 DOI: 10.1016/j.radcr.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 02/07/2024] Open
Abstract
Liposarcomas (LPS) are the most common malignant tumors among soft tissue sarcomas. We report a rare case of well-differentiated liposarcoma (lipoma-like) located along the anterior compartment of the right forearm, which was successfully treated with complete excision, resulting in good functional recovery without recurrence during a 2-year follow-up. Surgery is the primary treatment for localized forms, involving complete and radical excision with clear resection margins. LPS represents a heterogeneous group of soft tissue sarcomas, with diagnosis primarily relying on histological examination. Their care requires a multidisciplinary approach.
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Affiliation(s)
- Jamal Karbal
- Traumatology-Orthopedics Department, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy Mohammed First University Oujda, Oujda, Morocco
| | - Amine Machmachi
- Traumatology-Orthopedics Department, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy Mohammed First University Oujda, Oujda, Morocco
| | - Walid Bouziane
- Traumatology-Orthopedics Department, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy Mohammed First University Oujda, Oujda, Morocco
| | - Moncef Amahtil
- Traumatology-Orthopedics Department, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy Mohammed First University Oujda, Oujda, Morocco
| | - Ousmane Laye Diene
- Traumatology-Orthopedics Department, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy Mohammed First University Oujda, Oujda, Morocco
| | - Abdelkrim Daoudi
- Traumatology-Orthopedics Department, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy Mohammed First University Oujda, Oujda, Morocco
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3
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Review of primary superficial soft tissue mesenchymal tumors of malignant or intermediate biological potential. Skeletal Radiol 2023; 52:435-445. [PMID: 35867123 DOI: 10.1007/s00256-022-04127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 02/02/2023]
Abstract
The majority of the sarcomas are deep in location, larger than 5 cm in size, and heterogenous in imaging appearance. However, when sarcomas occur superficially, these typical features may be absent, failing to alert the radiologist to a malignancy and mimicking one of the more numerous benign superficial tumors that make up the bulk of soft tissue mass evaluations. This manuscript will discuss the current role of imaging in recognizing features concerning for superficial soft tissue sarcomas. Provided is an overview of the demographic, clinical, and imaging features of the most commonly encountered superficial soft tissue sarcomas, including undifferentiated pleomorphic, leiomyosarcoma, synovial sarcoma, liposarcoma, myxofibrosarcoma, dermatofibrosarcoma protuberans, epithelioid sarcoma, and angiosarcoma. A less common but primary superficial tumor, angiomatoid fibrous histiocytoma, is also reviewed as the diagnosis may be confounding both clinically and on imaging studies.
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Popova E, Tkachev S, Reshetov I, Timashev P, Ulasov I. Imaging Hallmarks of Sarcoma Progression Via X-ray Computed Tomography: Beholding the Flower of Evil. Cancers (Basel) 2022; 14:cancers14205112. [PMID: 36291896 PMCID: PMC9600487 DOI: 10.3390/cancers14205112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/13/2022] [Accepted: 10/15/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Sarcomas represent the largest group of rare solid tumors that arise from mesenchymal stem cells and are a leading cause of cancer death in individuals younger than 20 years of age. There is an immediate need for the development of an algorithm for the early accurate diagnosis of sarcomas due to the high rate of diagnostic inaccuracy, which reaches up to 30%. X-ray computed tomography is a non-invasive imaging technique used to obtain detailed internal images of the human or animal body in clinical practice and preclinical studies. We summarized the main imaging features of soft tissue and bone sarcomas, and noted the development of new molecular markers to reach tumor type-specific imaging. Also, we demonstrated the possibility of the use X-ray computed microtomography for non-destructive 3D visualization of sarcoma progression in preclinical studies. Finding correlations between X-ray computed tomography modalities and the results of the histopathological specimen examination may significantly increase the accuracy of diagnostics, which leads to the initiation of appropriate management in a timely manner and, consequently, to improved outcomes. Abstract Sarcomas are a leading cause of cancer death in individuals younger than 20 years of age and represent the largest group of rare solid tumors. To date, more than 100 morphological subtypes of sarcomas have been described, among which epidemiology, clinical features, management, and prognosis differ significantly. Delays and errors in the diagnosis of sarcomas limit the number of effective therapeutic modalities and catastrophically worsen the prognosis. Therefore, the development of an algorithm for the early accurate diagnosis of sarcomas seems to be as important as the development of novel therapeutic advances. This literature review aims to summarize the results of recent investigations regarding the imaging of sarcoma progression based on the use of X-ray computed tomography (CT) in preclinical studies and in current clinical practice through the lens of cancer hallmarks. We attempted to summarize the main CT imaging features of soft-tissue and bone sarcomas. We noted the development of new molecular markers with high specificity to antibodies and chemokines, which are expressed in particular sarcoma subtypes to reach tumor type-specific imaging. We demonstrate the possibility of the use of X-ray computed microtomography (micro-CT) for non-destructive 3D visualization of solid tumors by increasing the visibility of soft tissues with X-ray scattering agents. Based on the results of recent studies, we hypothesize that micro-CT enables the visualization of neovascularization and stroma formation in sarcomas at high-resolution in vivo and ex vivo, including the novel techniques of whole-block and whole-tissue imaging. Finding correlations between CT, PET/CT, and micro-CT imaging features, the results of the histopathological specimen examination and clinical outcomes may significantly increase the accuracy of soft-tissue and bone tumor diagnostics, which leads to the initiation of appropriate histotype-specific management in a timely manner and, consequently, to improved outcomes.
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Affiliation(s)
- Elena Popova
- World-Class Research Centre “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Sergey Tkachev
- World-Class Research Centre “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Igor Reshetov
- University Clinical Hospital No. 1, I. M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), 119991 Moscow, Russia
| | - Peter Timashev
- World-Class Research Centre “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Ilya Ulasov
- Group of Experimental Biotherapy and Diagnostic, Institute for Regenerative Medicine, World-Class Research Centre “Digital Biodesign and Personalized Healthcare”, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- Correspondence: ; Tel.: +7-901-797-5406
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Hong YT, Yang Y, Lee H. A case report of primary myxoid liposarcoma mimicking as a parotid cystic lesion. Medicine (Baltimore) 2022; 101:e28473. [PMID: 35029195 PMCID: PMC8757944 DOI: 10.1097/md.0000000000028473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/15/2021] [Indexed: 01/05/2023] Open
Abstract
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.
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Paixao C, Lustig JP, Causeret S, Chaigneau L, Danner A, Aubry S. Tumors and pseudotumors of the soft tissues: Imaging semiology and strategy. J Clin Imaging Sci 2021; 11:13. [PMID: 33767905 PMCID: PMC7981940 DOI: 10.25259/jcis_135_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 02/17/2021] [Indexed: 11/26/2022] Open
Abstract
The aims of this educational review are to learn the semiological basis of soft-tissue lesions and, with the help of diagnostic algorithms, to apply the current recommendations for the management of soft-tissue tumors. Pseudotumors must first be identified and excluded. Among primary tumors, the search for macroscopic fat content on MRI is decisive; since it restricts the diagnostic range to adipocytic tumors. Key imaging features of non-adipocytic tumors are highlighted. When a deep soft-tissue mass is found, therapeutic abstention or simple monitoring is only appropriate when there is diagnostic certainty: This is only the case for typical pseudotumors, typical benign tumors, and fat tumors without atypical criteria. In all other cases, histological evidence is required. If there is any suspicion of soft-tissue sarcoma or any undetermined lesion, the patient should be referred to a sarcoma referral center before biopsy.
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Affiliation(s)
- Charlinne Paixao
- Department Radiology, Musculoskeletal Imaging Unit, CHU Besancon, Besancon, France
| | - Jean-Philippe Lustig
- Department Radiology, Musculoskeletal Imaging Unit, CHU Besancon, Besancon, France
| | - Sylvain Causeret
- Department of Surgery, CHU Dijon, Centre Georges-François Leclerc, Dijon, France
| | - Loic Chaigneau
- Department of Oncology, CHU Besancon, CHU de Besancon, Besancon, France
| | - Alexis Danner
- Department Radiology, Musculoskeletal Imaging Unit, CHU Besancon, Besancon, France
| | - Sebastien Aubry
- Department Radiology, Musculoskeletal Imaging Unit, CHU Besancon, Besancon, France
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7
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Image-Guided Core Needle Biopsy of Adipocytic Tumors: Diagnostic Accuracy and Concordance With Final Surgical Pathology. AJR Am J Roentgenol 2021; 216:997-1002. [PMID: 33624523 DOI: 10.2214/ajr.20.23080] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE. Diagnostic accuracy of core needle biopsy (CNB) for adipocytic tumors can be low because of sampling error from these often large, heterogeneous lesions. The purpose of this study was to evaluate the diagnostic accuracy of image-guided CNB for various adipocytic tumors in comparison with excisional pathology. MATERIALS AND METHODS. Adipocytic tumors (n = 77) of all adult patients undergoing image-guided CNB and subsequent surgical excision of an adipocytic tumor at a tertiary referral center between 2005 and 2019 were studied. To determine concordance, we compared pathologic diagnoses based on CNB to the reference standard of pathologic diagnoses after surgical excision. Tumors were divided into three categories (benign lipomatous tumors [lipoma, lipoma variants, hibernomas], atypical lipomatous tumors [ALTs] or well-differentiated liposarcomas [WDLs], and higher grade liposarcomas [myxoid, dedifferentiated, pleomorphic]), and diagnostic accuracy was calculated for each category. RESULTS. In 73 of 77 adipocytic tumors (95%), diagnosis at CNB and diagnosis after excision were concordant. Accuracy of diagnosis was poorer for ALTs and WDLs than for the other two categories, and the difference was statistically significant (p < .002). For the 29 benign lipomatous tumors and the 27 higher-grade liposarcomas, diagnoses at CNB and after excision were concordant in all cases (100%). Seventeen of the 21 tumors (81%) diagnosed as ALTs or WDLs at CNB had a concordant diagnosis after excision; four of the 21 were upgraded (dedifferentiated liposarcoma, n = 3; myxoid liposarcoma, n = 1). CONCLUSION. CNB provides high diagnostic accuracy for adipocytic tumors, particularly for benign lipomatous tumors and higher grade liposarcomas. However, though still high at 81%, diagnostic accuracy of CNB is not as high for tumors diagnosed as ALTs or WDLs. Awareness of this limitation is important when determining management, particularly of cases of ALT or WDL for which surgery is not planned.
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8
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Shimamori N, Kishino T, Okabe N, Morii T, Matsushima S, Yamasaki S, Ohtsuka K, Shibahara J, Ohnishi H, Watanabe T. Discrimination of well-differentiated liposarcoma from benign lipoma on sonography: an uncontrolled retrospective study. J Med Ultrason (2001) 2020; 47:617-623. [PMID: 32960385 DOI: 10.1007/s10396-020-01051-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Well-differentiated liposarcoma, the most common subtype of liposarcoma, should be discriminated from benign lipoma. However, features on sonography for discriminating these two types of tumor have not been fully investigated. The present study was therefore aimed at clarifying differences in sonographic findings between well-differentiated liposarcoma and lipoma. METHODS The study population comprised 23 cases of well-differentiated liposarcoma and 181 cases of lipoma. We investigated differences in sonographic appearance and pathological findings between the two types of tumor. RESULTS Well-differentiated liposarcoma tended to develop more frequently in older patients and in the lower extremities including the gluteal region, compared with lipoma. Concerning sonographic findings, both tumors exhibited well-defined margins and heterogeneous internal echogenicity, including typical tiny striated hyperechoic lines. Well-differentiated liposarcoma was characterized by a higher frequency of the following findings compared with lipoma: (1) deep location, (2) irregular shape, (3) large diameter, (4) hyperechogenicity compared to surrounding tissue, and (5) presence of vascularity on Doppler sonography (p < 0.01 each). Notably, hyperechogenicity corresponded to the intermingled sclerosing component within the adipocytic component when sonographic findings were compared with those of pathology. CONCLUSION The present study suggests that several sonographic findings including hyperechogenicity and presence of vascularity might be key features for discriminating well-differentiated liposarcoma from lipoma.
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Affiliation(s)
- Naoko Shimamori
- Department of Clinical Laboratory, Kyorin University Hospital, Mitaka, Tokyo, Japan
| | - Tomonori Kishino
- Department of Clinical Laboratory, Kyorin University Hospital, Mitaka, Tokyo, Japan. .,Department of Laboratory Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan. .,Department of Clinical Engineering, Kyorin University Faculty of Health Sciences, Mitaka, Tokyo, Japan.
| | - Naota Okabe
- Department of Pathology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Takeshi Morii
- Department of Orthopaedic Surgery, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Satsuki Matsushima
- Department of Laboratory Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Satoko Yamasaki
- Department of Clinical Laboratory, Kyorin University Hospital, Mitaka, Tokyo, Japan.,Department of Laboratory Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Kouki Ohtsuka
- Department of Clinical Laboratory, Kyorin University Hospital, Mitaka, Tokyo, Japan.,Department of Laboratory Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Junji Shibahara
- Department of Pathology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Hiroaki Ohnishi
- Department of Clinical Laboratory, Kyorin University Hospital, Mitaka, Tokyo, Japan.,Department of Laboratory Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Takashi Watanabe
- Department of Clinical Laboratory, Kyorin University Hospital, Mitaka, Tokyo, Japan.,Department of Laboratory Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
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9
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Burt JR, Limback J, Molina M, Suarez J, Mekhail T, Fanaian N, Aquino G, Kabakus I, Weyant A, Scherer K. Fat-Finding Mission: Primary Pleomorphic Liposarcoma of the Heart and Pericardium. JACC Case Rep 2020; 2:1520-1526. [PMID: 34317009 PMCID: PMC8302169 DOI: 10.1016/j.jaccas.2020.05.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/21/2020] [Accepted: 05/29/2020] [Indexed: 11/30/2022]
Abstract
Primary cardiac liposarcomas are rare tumors with a poor prognosis and no well-defined imaging characteristics or treatment guidelines. Here, we present a case of primary pleomorphic liposarcoma of the heart and pericardium with multimodality imaging findings and our institution’s treatment approach. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Jeremy R Burt
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Joseph Limback
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Melanie Molina
- College of Medicine, University of Central Florida, Orlando, Florida
| | - Jorge Suarez
- Departments of Surgery, Internal Medicine, Radiology, and Pathology, Advent Health Orlando, Orlando, Florida
| | - Tarek Mekhail
- Departments of Surgery, Internal Medicine, Radiology, and Pathology, Advent Health Orlando, Orlando, Florida
| | - Naim Fanaian
- Departments of Surgery, Internal Medicine, Radiology, and Pathology, Advent Health Orlando, Orlando, Florida
| | - Gilberto Aquino
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Ismail Kabakus
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Austin Weyant
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Kurt Scherer
- Departments of Surgery, Internal Medicine, Radiology, and Pathology, Advent Health Orlando, Orlando, Florida
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10
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Jelinek JS, Wu A, Wallace M, Kumar D, Henshaw RM, Murphey MJ, Van Horn A, Aboulafia AJ. Imaging of spindle cell lipoma. Clin Radiol 2020; 75:396.e15-396.e21. [PMID: 31932047 DOI: 10.1016/j.crad.2019.11.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/26/2019] [Indexed: 11/28/2022]
Abstract
AIM To review the evaluation, diagnosis, and treatment of spindle cell lipoma (SCL) with emphasis on the location of these tumours and the spectrum of magnetic resonance imaging (MRI) and computed tomography (CT) appearances. MATERIALS AND METHODS The MRI and CT findings of 27 histopathologically proven SCLs were evaluated retrospectively. Imaging features evaluated included margins, percentage visible fat, MRI signal characteristics, oedema, and contrast enhancement patterns. RESULTS Patient ages ranged from 18 to 80 years with an average age of 56.5 years. Men were affected twice as frequently as women (M=18, F=9). SCLs ranged in size from 2 to 10 cm, with an average greatest dimension of 5.5 cm. Five lesions (19%) contained no visible fat on CT or MRI, and the leading differential diagnosis of high-grade soft-tissue sarcoma diagnosis was suggested by referring surgeons. Five lesions (19%) had <50% fatty areas, nine lesions (52%) demonstrated >50% but <90% fat at MRI or CT. Only three of 25 lesions (12%) had an appearance of a typical lipoma on unenhanced MRI sequences. All SCLs that were imaged with contrast medium (n = 18) demonstrated some degree of enhancement, with eight (44%) showing marked enhancement, four (22%) showing moderate, and six (33%) minimal enhancement. CONCLUSION SCLs have considerably variable imaging appearances and may have minimal or no visible fat at MRI or CT. Imaging features may make it difficult to distinguish this benign tumour from a potentially higher-grade malignant tumour.
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Affiliation(s)
- J S Jelinek
- Department of Radiology, MedStar Washington Hospital Center, 110 Irving Street, NW, Washington DC, 20010, USA.
| | - A Wu
- Department of Internal Medicine, MedStar Franklin Square Medical Center, 9000 Franklin Square Drive, Baltimore, MD, 21237, USA
| | - M Wallace
- Department of Orthopedic Oncology, MedStar Franklin Square Medical Center, 9000 Franklin Square Drive, Baltimore, MD, 21237, USA
| | - D Kumar
- Department of Radiology, MedStar Washington Hospital Center, 110 Irving Street, NW, Washington DC, 20010, USA
| | - R M Henshaw
- Department of Orthopedic Oncology, MedStar Franklin Square Medical Center, 9000 Franklin Square Drive, Baltimore, MD, 21237, USA
| | - M J Murphey
- American Institute for Radiologic Pathology, 1100 Wayne Avenue, Silver Spring, MD, 20910, USA
| | - A Van Horn
- Department of Orthopedic Oncology, MedStar Franklin Square Medical Center, 9000 Franklin Square Drive, Baltimore, MD, 21237, USA
| | - A J Aboulafia
- Department of Orthopedic Oncology, MedStar Franklin Square Medical Center, 9000 Franklin Square Drive, Baltimore, MD, 21237, USA
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11
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Li M, Zhang L, Xu XJ, Shi Z, Zhao XM. CT and MRI features of tumors and tumor-like lesions in the abdominal wall. Quant Imaging Med Surg 2019; 9:1820-1839. [PMID: 31867236 DOI: 10.21037/qims.2019.09.03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Masses involving the abdominal wall are common in clinical practice and have many etiologies, including tumors and tumor-like lesions. Abdominal wall tumors include primary and secondary tumors, the former of which constitute a heterogeneous group of soft tissue tumors with their own unique spectrum. Tumor-like lesions, such as hernias, are more common and must be distinguished from true tumors. Medical imaging is valuable for discovering, diagnosing, and evaluating the extent of abdominal wall masses. With the increasing application of computed tomography (CT) and magnetic resonance imaging (MRI), determining a diagnosis or narrowing the differential diagnosis is often possible, thus facilitating effective management. In this article, we comprehensively review the spectrum of common abdominal wall masses and present the CT and MRI features of typical cases in our hospital. A systematic stepwise diagnostic approach is also proposed for clinical practice.
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Affiliation(s)
- Meng Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Li Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiao-Juan Xu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zhuo Shi
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xin-Ming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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12
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Mujtaba B, Wang F, Taher A, Aslam R, Madewell JE, Nassar S. Myxoid Liposarcoma With Skeletal Metastases: Pathophysiology and Imaging Characteristics. Curr Probl Diagn Radiol 2019; 50:66-73. [PMID: 31813645 DOI: 10.1067/j.cpradiol.2019.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/17/2019] [Accepted: 10/23/2019] [Indexed: 12/14/2022]
Abstract
Liposarcoma is a commonly occurring soft tissue sarcoma that can be divided into 4 subtypes. Myxoid and round cell liposarcoma (MRCL) represent one of these subtypes and are classified together due to their shared chromosomal translocation. Histologic analysis of MRCL reveals a myxoid matrix with a delicate capillary network and dispersed lipoblasts. Varying degrees of round cell component are also observed, with greater amounts of round cells indicating a higher histologic grade and poorer prognosis. MRCL has a unique pattern of spread due to its initial tendency to spread to extrapulmonary sites. Additionally, skeletal metastases are frequently found in cases of MRCL. While various imaging techniques are used to visualize MRCL and metastases, magnetic resonance imaging is generally the preferred method. This article reviews the pathophysiology and imaging features of MRCL as well as the imaging characteristics, advantages, and drawbacks of multiple imaging modalities for visualizing bone metastases.
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Affiliation(s)
- Bilal Mujtaba
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Felicia Wang
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Ahmed Taher
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rizwan Aslam
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - John E Madewell
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sameh Nassar
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
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Shimamori N, Kishino T, Morii T, Okabe N, Motohashi M, Matsushima S, Yamasaki S, Ohtsuka K, Shibahara J, Ichimura S, Ohnishi H, Watanabe T. Sonographic Appearances of Liposarcoma: Correlations with Pathologic Subtypes. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2568-2574. [PMID: 31202456 DOI: 10.1016/j.ultrasmedbio.2019.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 05/14/2019] [Accepted: 05/17/2019] [Indexed: 06/09/2023]
Abstract
Liposarcoma is the second most common malignant soft-tissue tumor. This entity is pathologically categorized into 4 subtypes: well-differentiated, myxoid, dedifferentiated and pleomorphic. Although features on magnetic resonance imaging and computed tomography for these 4 subtypes have been reported quite precisely, those on sonography have not been fully investigated. The present study was therefore aimed at clarifying the sonographic appearances of each liposarcoma subtype and assessing correlations with histopathology. The study population was made up of 35 cases, including 21 cases of well-differentiated liposarcoma, 6 cases of myxoid liposarcoma, 6 cases of dedifferentiated liposarcoma and 2 cases of pleomorphic liposarcoma. Compared with the other subtypes, well-differentiated liposarcoma was characterized by the high frequency of the following findings: isoechogenicity, tiny hyperechoic lines and hypovascularity (p < 0.01, in each). Myxoid liposarcomas were characterized by low echogenicity, intermingled with anechoic areas and moderate vascularity (p < 0.01, in each). Dedifferentiated liposarcomas showed a specific biphasic pattern of hyperechoic and hypoechoic areas and hypervascularity (p < 0.01, in each). Pleomorphic liposarcomas showed a specific gyrus-like mixture of hyperechoic and hypoechoic areas (p < 0.01). In conclusion, the present study revealed different characteristics of sonographic appearance among the 4 histopathologic subtypes of liposarcoma.
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Affiliation(s)
- Naoko Shimamori
- Department of Clinical Laboratory, Kyorin University Hospital, Tokyo, Japan
| | - Tomonori Kishino
- Department of Clinical Laboratory, Kyorin University Hospital, Tokyo, Japan; Department of Laboratory Medicine, Kyorin University School of Medicine, Tokyo, Japan; Department of Clinical Engineering, Kyorin University Faculty of Health Sciences, Tokyo, Japan.
| | - Takeshi Morii
- Department of Orthopaedic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Naota Okabe
- Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan
| | - Mitsue Motohashi
- Department of Clinical Laboratory, Kyorin University Hospital, Tokyo, Japan
| | - Satsuki Matsushima
- Department of Laboratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Satoko Yamasaki
- Department of Clinical Laboratory, Kyorin University Hospital, Tokyo, Japan; Department of Laboratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Kouki Ohtsuka
- Department of Clinical Laboratory, Kyorin University Hospital, Tokyo, Japan; Department of Laboratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Junji Shibahara
- Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan
| | - Shoichi Ichimura
- Department of Orthopaedic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Hiroaki Ohnishi
- Department of Clinical Laboratory, Kyorin University Hospital, Tokyo, Japan; Department of Laboratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Takashi Watanabe
- Department of Clinical Laboratory, Kyorin University Hospital, Tokyo, Japan; Department of Laboratory Medicine, Kyorin University School of Medicine, Tokyo, Japan
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Lake JCW, Tsui E, Wu J, Baker M, Kieffer K. Case reports of diagnostic error: liposarcoma mistaken for hematoma in an obese female with concurrent ipsilateral thrombosis on rivaroxaban. ACTA ACUST UNITED AC 2019; 6:301-305. [PMID: 30511930 DOI: 10.1515/dx-2018-0092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/19/2018] [Indexed: 11/15/2022]
Abstract
We report the case of a morbidly obese 49-year-old female found to have a 16×14×10 cm high grade myxoid liposarcoma of the thigh initially diagnosed as a hematoma. Recent initiation of rivaroxaban for a coincident ipsilateral popliteal vein thrombosis placed hematoma high in the differential diagnosis. Despite its large size, the mass was not directly appreciable on physical exam due to excess adjacent adipose tissue. Diagnostic success was achieved only after anchoring bias was abandoned and adaptive expertise was applied.
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Affiliation(s)
| | - Edison Tsui
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Jennifer Wu
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Michael Baker
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Kelly Kieffer
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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15
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Suarez-Kelly LP, Baldi GG, Gronchi A. Pharmacotherapy for liposarcoma: current state of the art and emerging systemic treatments. Expert Opin Pharmacother 2019; 20:1503-1515. [PMID: 31136210 DOI: 10.1080/14656566.2019.1618271] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introduction: Liposarcomas are a heterogeneous group of soft tissue tumors that arise from adipose tissue and are one of the most common soft tissue sarcomas found in adults. Liposarcomas are subclassified into four subtypes with distinct histologic and biologic features that influence their treatment and management. Areas covered: This manuscript reviews the key clinicopathologic and cytogenic characteristics of the liposarcoma histologic subtypes and summarizes the results of recent clinical trials, treatment options, and future directions in the pharmacotherapy for the management of liposarcoma. Expert opinion: Despite significant advancements in the management of this disease, the treatment of liposarcoma continues to be a challenge. Surgical resection remains the mainstay of treatment for localized disease; however, use of systemic therapies in conjunction with surgery may be considered in patients where tumor shrinkage could reduce surgical morbidity and in patients with high-risk of micrometastatic disease. Anthracycline-based chemotherapy regimens remain the standard first-line treatment for unresectable/metastatic liposarcoma. Trabectedin and eribulin are currently the two most promising and evidenced-based second-line treatment options for liposarcomas. However, multiple clinical trials dedicated to patients with liposarcoma evaluating novel targeted agents are ongoing. Every effort should be made to enroll patients with liposarcoma into histotype-specific clinical trials.
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Affiliation(s)
- Lorena P Suarez-Kelly
- Complex General Surgical Oncology Fellow, The Ohio State University , Columbus , OH , USA
| | - Giacomo G Baldi
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato , Prato , Italy.,Adult mesenchymal and Rare Tumor Unit, Department of Cancer Medicine, Fondazione IRCCS-Istituto Nazionale dei Tumori , Milan , Italy
| | - Alessandro Gronchi
- Sarcoma Service of the Department of Surgery, Fondazione IRCCS-Istituto Nazionale dei Tumori , Milan , Italy
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16
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18F-FDG PET/CT and MRI features of myxoid liposarcomas and intramuscular myxomas. Skeletal Radiol 2018; 47:1641-1650. [PMID: 29926115 DOI: 10.1007/s00256-018-3000-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the imaging characteristics of intramuscular myxomas (IM) and myxoid liposarcomas (MLS) on 18F-FDG PET/CT and MRI. MATERIALS AND METHODS With IRB approval, our institutional imaging database was searched for pathologically proven IM and MLS evaluated by 18F-FDG PET/CT and MRI. PET/CT and MRI imaging characteristics were recorded and correlated with pathologic diagnosis. RESULTS We found eight patients (2 M, 6 F) with IM (mean age 65.6 ± 10.4 years) and 16 patients (7 F, 9 M) with MLS (mean age 42.8 ± 16.3 years). MRI was available in 7/8 IM and 15/16 MLS patients. There was no significant difference between the two groups in SUVmax (IM 2.7 ± 0.8, MLS 3.0 ± 1.0; p = 0.35), SUVmean (1.7 ± 0.4, 1.5 ± 0.5; p = 0.40), total lesion glycolysis (101.8 ± 127.3, 2420.2 ± 4003.3 cm3*g/ml; p = 0.12), metabolic tumor volume (62.3 ± 71.1, 1742.9 ± 3308.0 cm3; p = 0.17) or CT attenuation (p = 0.70). MLS occurred in younger patients (p = 0.0015), were larger (16.4 ± 8.2 vs. 5.6 ± 2.5 cm; p = 0.0015), more often T1 hyperintense (p = 0.03), with nodular enhancement (p = 0.006), and macroscopic fat on CT (p = 0.0013) and MRI (p = < 0.001) compared to myxomas. CONCLUSIONS IM and MLS most commonly demonstrate low-grade FDG activity and overlapping metabolic measures on PET/CT. MRI is useful in differentiation, but MLS can present without macroscopic fat on MRI, underscoring the importance of radiologic-pathologic correlation for accurate diagnosis.
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Kuyumcu G, Rubin BP, Bullen J, Ilaslan H. Quantification of fat content in lipid-rich myxoid liposarcomas with MRI: a single-center experience with survival analysis. Skeletal Radiol 2018; 47:1411-1417. [PMID: 29948035 DOI: 10.1007/s00256-018-2974-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 05/01/2018] [Accepted: 05/08/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the fat content of myxoid liposarcomas (MLS) on MRI and to identify any association between lipid content and survival. MATERIALS AND METHODS The fat percentage of MLS diagnosed between January 2006 and December 2016 at a single institution was assessed by two radiologists on preoperative MR images. A Cox proportional hazard model was used to determine any association between tumor fat percentage and survival time. Tumor fat percentage was the single predictor in the model. A significance level of 0.05 was used. The Kaplan-Meier estimator was also used to provide a nonparametric estimate of the survivor function within the entire sample and within two patient subgroups consists of lipid-rich and lipid-poor tumors. Lipid-rich tumors were defined as any tumors showing more than 20% of fat on MRI. A 20% cutoff was determined arbitrarily. RESULTS Of the 43 cases identified through retrospective review, 8 tumors demonstrated ≥10% fat on MRI, and 4 tumors demonstrated ≥20% fat (highest fat percentage, 38%). There was no significant survival difference between patients with high tumor fat, which was defined as ≥20% fat, compared with those with little to no tumor fat. CONCLUSION Myxoid liposarcomas may demonstrate a higher fat content on MRI than has previously been reported in the literature. Increased tumor fat percentage in lipid-rich tumors was not found to be associated with increased risk of death. Radiologists must be aware of the existence of MLS lesions with higher fat content.
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Affiliation(s)
- Gokhan Kuyumcu
- Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Brian P Rubin
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Jennifer Bullen
- Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Hakan Ilaslan
- Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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18
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Liu W, Liang W, Peng Z. Positron emission tomography/computed tomography manifestations of primary hepatic myxoid liposarcoma: A case report. Medicine (Baltimore) 2018; 97:e12307. [PMID: 30278507 PMCID: PMC6181573 DOI: 10.1097/md.0000000000012307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Computed tomography (CT) and magnetic resonance imaging (MRI) are conventional used to evaluate liver tumors. Detection of fat component is considered an important clue to the imaging diagnosis of hepatic myxoid liposarcoma. However, the positron emission tomography (PET)/CT report of hepatic myxoid liposarcoma is scarce, and the metabolic characteristics of primary hepatic myxoid liposarcoma are still unknown. PATIENT CONCERNS In this report, we report the PET/CT manifestations of a rare case of primary hepatic myxoid liposarcoma that was confirmed by pathologic examination. A 29-year-old male patient presented with a nodule adjacent to the umbilicus that had been present for 2 weeks. PET/CT showed a hypoattenuating mass with moderate uptake (maximum standardized uptake value [SUVmax] 1.9), except for a slightly hyperattenuating focal area with intense uptake (SUVmax 3.1). DIAGNOSES The final pathologic diagnosis was confirmed, by means of laparotomy, to be a primary hepatic myxoid liposarcoma with multiple extrahepatic metastases. INTERVENTIONS The lesions in the left liver and periumbilical abdominal wall were punctured. During the laparotomy, hepatic malignant tumors were confirmed and metastasized widely in the abdominal cavity. OUTCOMES An abdominal CT performed 4 months after initial presentation showed extensive metastasis. LESSONS Primary hepatic myxoid liposarcoma may manifest as moderate metabolism with less fat on PET/CT. PET/CT is not only valuable in reflecting the round cell component of hepatic myxoid liposarcoma, but also in estimating its origin.
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Affiliation(s)
- Weihai Liu
- Department of Radiology, Beilun Branch Hospital of the First Affiliated Hospital, College of Medicine, Zhejiang University, the People's Hospital of Beilun District, Ningbo, Zhejiang
| | - Wenjie Liang
- Department of Radiology, First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, China
| | - Zhiyi Peng
- Department of Radiology, First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, China
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19
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Homogeneous myxoid liposarcomas mimicking cysts on MRI: A challenging diagnosis. Eur J Radiol 2018; 102:41-48. [DOI: 10.1016/j.ejrad.2018.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 02/07/2018] [Accepted: 03/01/2018] [Indexed: 02/07/2023]
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20
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Kransdorf MJ, Murphey MD, Wessell DE, Cassidy RC, Czuczman GJ, Demertzis JL, Lenchik L, Motamedi K, Pierce JL, Sharma A, Walker EA, Ying-Kou Yung E, Beaman FD. ACR Appropriateness Criteria ® Soft-Tissue Masses. J Am Coll Radiol 2018; 15:S189-S197. [DOI: 10.1016/j.jacr.2018.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 02/07/2023]
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21
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Unusual Thoracic Lipoma - Case Report and Literature Review. IRANIAN JOURNAL OF RADIOLOGY 2018. [DOI: 10.5812/iranjradiol.61304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Abstract
Soft tissue tumors represent a special challenge in interdisciplinary cooperation. Malignant tumors require a multimodal therapy concept so that patient treatment in a specialized tumor center is recommended. The task of the surgeon in close cooperation with the radiologist is the resection of the tumor in sano with the required safety margin. The aim of diagnostic imaging is to describe the primary expansion of the tumor size and a possible tumor infiltration of adjacent compartments. The most important diagnostic imaging for this purpose is magnetic resonance imaging (MRI), especially T1-weighted fat-suppressed gadolinium-enhanced sequences. Together with T2-weighted sequences a reliable differentiation between necrosis and vital tumor tissue is possible, which enables a targeted biopsy of vital tumor tissue. For the differentiation between benign and malignant soft tissue tumors and for determination of histological differentation a core needle biopsy, either computer tomography-guided or under sonographic control and increasingly more by MRI guidance, is currently the gold standard in most tumor centers. A representative biopsy from vital tumor tissue leads to the diagnosis with a very high degree of certainty.
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Affiliation(s)
- L Fenzl
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Kirrbergerstraße, 66424, Homburg/Saar, Deutschland.
| | - K Bubel
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Kirrbergerstraße, 66424, Homburg/Saar, Deutschland
| | - M Mehrmann
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Kirrbergerstraße, 66424, Homburg/Saar, Deutschland
| | - G Schneider
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Kirrbergerstraße, 66424, Homburg/Saar, Deutschland
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23
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Schmidt I. Irreparable Radial Nerve Palsy Due to Delayed Diagnostic Management of a Giant Lipoma at the Proximal Forearm Resulting in a Triple Tendon Transfer Procedure: Case report and Brief Review of Literature. Open Orthop J 2017; 11:794-803. [PMID: 28979592 PMCID: PMC5620405 DOI: 10.2174/1874325001711010794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/14/2017] [Accepted: 07/19/2017] [Indexed: 12/20/2022] Open
Abstract
Background: Non-traumatic radial nerve palsy (RNP) caused by local tumors is a rare and uncommon entity. Methods: A 62-year-old female presented with a left non-traumatic RNP, initially starting with weakness only. It was caused by a benign giant lipoma at the proximal forearm that was misdiagnosed over a period of 2 years. The slowly growth of the tumor led to an irreparable overstretching-related partial nerve disruption. For functional recovery of the patient, a triple tendon transfer procedure had to be performed. Results: Four months after surgery, the patient was completely able to perform her activities of daily living again. At the 10-months follow-up, strength of wrist extension, thumb's extension and abduction, and long fingers II-V extension had all improved to grade 4 in Medical Research Council scale (0-5). In order to restore motion, the patient reported that she would undergo the same triple tendon transfer procedure a second time where necessary. Due to the initially misdiagnosed tumor, there was an overall delayed duration of time for functional recovery of the patient. Conclusion: The triple tendon transfer procedure offers a useful and reliable method to restore functionality for patients sustaining irreparable RNP. However, it must be noted critically with our patient that this procedure probably would have been avoided. Initially, there was weakness only by entrapment of the radial nerve. RNP caused by local tumors are uncommon but known from the literature, and so it should be considered generally in differential diagnosis of non-traumatic RNP.
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Affiliation(s)
- Ingo Schmidt
- SRH Poliklinik Gera GmbH, Straße des Friedens 122, 07548 Gera, Germany
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24
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Abstract
BACKGROUND Soft tissue sarcomas are challenging to oncologists due to their unique character, the infrequency of their occurrence, and the difficulties in predicting outcomes. Advances in imaging, as well as improvements in surgical techniques and adjunctive treatment methods, have improved care for patients with these unusual disorders. METHODS The various types of soft tissue tumors are defined, and the statistics for the Orthopaedic Oncology Group in relation to them are reviewed and compared with literature references. RESULTS The overall survival rate for 1,220 tumors treated at our institute from June 1972 to June of 2001 was 72%, with a wide range. Patients with leiomyosarcomas, clear cell sarcomas, and malignant fibrous histiocytomas had a poorer survival rate, while those with fibrosarcomas, liposarcomas, and neurofibrosarcomas fared better. Outcome was affected by patient age, tumor anatomic site, tumor stage, and a history of recurrence. CONCLUSIONS Competent imaging, predictive immunological and genetic studies, improved surgery, and newer methods of adjunctive and neoadjunctive treatment should result in improvements in outcomes for patients with these tumors.
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25
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Bansal AG, Rosenberg HK. Sonography of pediatric superficial lumps and bumps: illustrative examples from head to toe. Pediatr Radiol 2017; 47:1171-1183. [PMID: 28779193 DOI: 10.1007/s00247-017-3859-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/21/2017] [Accepted: 04/05/2017] [Indexed: 02/07/2023]
Abstract
Superficial lumps and bumps are extremely common in children, and the vast majority ultimately prove to be benign. Duplex/color Doppler ultrasound (US) has emerged as the first-line imaging modality for the evaluation of these superficial pediatric masses because it provides a means for rapid acquisition of information including size, shape, location, internal content and vascularity. More important, it does so without utilizing radiation, iodinated contrast material or sedation/anesthesia. In this review, we present the sonographic findings of a variety of cases ranging from head to toe that are either uncommonly seen or were diagnosed in an atypical fashion (i.e. ultrasound). In situations where the lesion is too deep, hyperechoic or large to be fully assessed within the field of view or if malignancy is suspected, then additional cross-sectional imaging is warranted for further evaluation.
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Affiliation(s)
- Anmol Gupta Bansal
- Department of Radiology, Kravis Children's Hospital at the Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Henrietta Kotlus Rosenberg
- Department of Radiology, Kravis Children's Hospital at the Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY, 10029, USA
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Matone J, Okazaki S, Maccapani GN, Amancio TT, Filippi RZ, Macedo ALDV. Giant gastric lipossarcoma: case report and review of the literature. EINSTEIN-SAO PAULO 2017; 14:557-560. [PMID: 28076606 PMCID: PMC5221385 DOI: 10.1590/s1679-45082016rc3770] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/21/2016] [Indexed: 12/21/2022] Open
Abstract
Liposarcoma is one of the most common soft tissue sarcomas in adults, occurring in 15 to 20% of all patients with sarcoma. Primary liposarcoma of the stomach is rare. We report a case of patient with giant gastric liposarcoma who underwent surgery after a gastrointestinal bleeding. Preoperative hystopathological diagnosis was not established, even after three biopsy attempts. We discuss differential diagnosis, genetic causes, diagnosis strategies and treatment.
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Affiliation(s)
- Jacques Matone
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Samuel Okazaki
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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27
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Primary Extremity Liposarcoma: MRI Features, Histopathology, and Clinical Outcomes. J Comput Assist Tomogr 2017; 40:791-8. [PMID: 27224232 DOI: 10.1097/rct.0000000000000431] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study aimed to describe magnetic resonance imaging (MRI) features of extremity liposarcoma (LPS) subtypes, correlating with histopathology and clinical outcomes. METHODS In this retrospective study, we included 125 patients (80 men, 45 women; mean age, 53 years) with extremity LPS [23 atypical lipomatous tumor (ALT), 9 dedifferentiated (DDLPS), 70 myxoid (MLPS), 23 pleomorphic (PLPS)]. Pretreatment MRI of primary tumors in 56 patients (10 ALT, 4 DDLPS, 28 MLPS, 14 PLPS) was reviewed. RESULTS All subtypes were predominantly T1 isointense relative to skeletal muscle (DDLPS = 3/4, MLPS = 28/28, PLPS = 13/14) and T2 hyperintense (ALT = 10/10, DDLPS = 3/4, MLPS = 28/28, PLPS = 14/14) except for ALT which were T1 hyperintense (8/10). Within MLPS, high grade was associated with unencapsulated margins (P = 0.05) and solid, nodular enhancement (P < 0.0001). Peritumoral edema (P = 0.03) and T2 heterogeneity (P = 0.05) predicted pulmonary (rather than extrapulmonary) metastases in MLPS. Tumor subtype correlated with mortality (P = 0.04). CONCLUSIONS The MRI features can help to distinguish between extremity LPS subtypes, and can predict histopathologic grade and metastatic pattern in myxoid LPS.
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28
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Spoldi E, Schwarz T, Sabattini S, Vignoli M, Cancedda S, Rossi F. COMPARISONS AMONG COMPUTED TOMOGRAPHIC FEATURES OF ADIPOSE MASSES IN DOGS AND CATS. Vet Radiol Ultrasound 2016; 58:29-37. [DOI: 10.1111/vru.12445] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- Elisa Spoldi
- Small Animal Clinical Sciences; University of Florida College of Veterinary Medicine; Gainesville FL 32610
| | - Tobias Schwarz
- Royal (Dick) School of Veterinary Studies, Easter Bush Veterinary Centre; University of Edinburgh; Roslin Midlothian, Scotland UK
| | - Silvia Sabattini
- Department of Veterinary Medical Sciences; University of Bologna; Ozzano Emilia Bologna Italy
| | - Massimo Vignoli
- Universita degli Studi di Teramo Facolta di Medicina Veterinaria; Teramo Abruzzo Italy
| | | | - Federica Rossi
- Clinica Veterinaria dell'Orologio; Sasso Marconi Bologna Italy
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29
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Fuerst JA, Reichle JK, Szabo D, Cohen EB, Biller DS, Goggin JM, Griffin JF, Aarsvold S, Emerson SE. COMPUTED TOMOGRAPHIC FINDINGS IN 24 DOGS WITH LIPOSARCOMA. Vet Radiol Ultrasound 2016; 58:23-28. [DOI: 10.1111/vru.12436] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/03/2016] [Accepted: 09/13/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
| | | | - David Szabo
- Animal Specialty and Emergency Center; Los Angeles CA 90025
| | - Eli B. Cohen
- College of Veterinary Medicine; North Carolina State University; Raleigh NC 27607
| | - David S. Biller
- College of Veterinary Medicine; Kansas State University; Manhattan KS
| | | | - John F. Griffin
- Department of Veterinary Large Animal Clinical Sciences; Texas A&M University; College Station TX 77845
| | - Stacie Aarsvold
- Cummings School of Veterinary Medicine; Tufts University; North Grafton MA 01536
| | - Susan E. Emerson
- College of Veterinary Medicine & Biomedical Sciences; Colorado State University; Fort Collins CO 80525
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Abstract
Most extremity soft tissue sarcomas present as a painless mass. Work-up should generally involve cross-sectional imaging with MRI and a core biopsy for pathologic diagnosis. Limb-sparing surgery is the standard of care, and may be supplemented with radiation for histologic subtypes at higher risk for local recurrence and chemotherapy for those at higher risk for distant metastases. This article reviews the work-up and surgical approach to extremity soft tissue sarcomas, and the role for radiation and chemotherapy, with particular attention given to the distinguishing characteristics of some of the most common subtypes.
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Affiliation(s)
- Aimee M Crago
- Sarcoma Disease Management Team, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, H1220, New York, NY 10065, USA; Department of Surgery, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.
| | - Ann Y Lee
- Sarcoma Disease Management Team, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, H1220, New York, NY 10065, USA
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31
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Abstract
INTRODUCTION Liposarcoma is a rare malignant mesenchymal tumour. Very few cases of retropharyngeal liposarcoma have been reported in the literature. SUMMARY A 30-year-old woman with no notable history reported swallowing disorders for the past year associated with dysphonia. Nasal endoscopic examination demonstrated a tumour arising from the left lateral pharyngeal wall, ascending as far as the junction of the free margin of the epiglottis, aryepiglottic fold, and pharyngoepiglottic fold and obliterating the ipsilateral pyriform sinus with preservation of cord mobility. The rest of the physical examination was normal. The preoperative assessment was completed by gadolinium-enhanced MRI of the neck. Open surgery was performed. Definitive histological examination concluded on dedifferentiated liposarcoma with negative resection margins. Following staging chest computed tomography that did not reveal any metastases, the multidisciplinary consultation meeting decided to deliver adjuvant volumetric modulated arc therapy. No recurrence was observed nine months post-treatment. DISCUSSION Retropharyngeal liposarcoma is a rare tumour. The authors report the first case of a dedifferentiated histological subtype in this site. A review of the literature completes this case report by providing a description of prognostic factors and the various treatments.
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Crago AM, Dickson MA. Liposarcoma: Multimodality Management and Future Targeted Therapies. Surg Oncol Clin N Am 2016; 25:761-73. [PMID: 27591497 DOI: 10.1016/j.soc.2016.05.007] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There are 3 biologic groups of liposarcoma: well-differentiated and dedifferentiated liposarcoma, myxoid/round cell liposarcoma, and pleomorphic liposarcoma. In all 3 groups, complete surgical resection is central in treatment aimed at cure and is based on grade. Radiation can reduce risk of local recurrence in high-grade lesions or minimize surgical morbidity in the myxoid/round cell liposarcoma group. The groups differ in chemosensitivity, so adjuvant chemotherapy is selectively used in histologies with metastatic potential but not in the resistant subtype dedifferentiated liposarcoma. Improved understanding of the genetic aberrations that lead to liposarcoma initiation is allowing for the rapid development of targeted therapies for liposarcoma.
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Affiliation(s)
- Aimee M Crago
- Sarcoma Disease Management Team, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, H1220, New York, NY 10065, USA; Department of Surgery, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA.
| | - Mark A Dickson
- Sarcoma Disease Management Team, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Sarcoma Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA; Department of Medicine, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
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Minami S, Miyake Y, Kinoshita H. Lipoma arborescens arising in the extra-articular bursa of the knee joint. SICOT J 2016; 2:28. [PMID: 27382924 PMCID: PMC4935798 DOI: 10.1051/sicotj/2016019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 05/15/2016] [Indexed: 11/14/2022] Open
Abstract
Lipoma arborescens arising in the extra-articular bursa of the knee joint is extremely rare. We describe an 11-year-old boy who complained of a gradual swelling mass of the lateral knee joint. Magnetic resonance imaging (MRI) showed a high signal intensity tumor on T1- and T2-weighted images with a thickened septa and nodular lesion that showed low signal intensity. The radiologist suggested the possible differential diagnosis of well-differentiated liposarcoma. At operation, the tumor was found under the iliotibial tract and was not in contact with the knee joint. Histopathologically, this lesion was diagnosed as lipoma arborescens arising in the extra-articular bursa of the knee joint. On MRI, the appearance of lipoma arborescens arising in the extra-articular bursa of the knee joint differed from that of conventional intra-articular lipoma arborescens. In this report, we describe a case of extra-articular lipoma arborescens of the knee joint bursa and discuss the diagnosis and etiology.
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Affiliation(s)
- Shinji Minami
- Department of Orthopedic Surgery, Naga Municipal Hospital, 1282 Uchita, Kinokawa, Wakayama 649-6414, Japan
| | - Yusuke Miyake
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Hirofumi Kinoshita
- Department of Orthopedic Surgery, Naga Municipal Hospital, 1282 Uchita, Kinokawa, Wakayama 649-6414, Japan
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Kaneuchi Y, Hakozaki M, Yamada H, Tajino T, Watanabe K, Otani K, Hojo H, Hasegawa T, Konno S. Primary dumbbell-shaped epidural myxoid liposarcoma of the thoracic spine: A case report and review of the literature. Oncol Lett 2016; 11:1421-1424. [PMID: 26893754 DOI: 10.3892/ol.2016.4089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 10/21/2015] [Indexed: 11/05/2022] Open
Abstract
Myxoid liposarcoma frequently occurs in the deep soft tissue of the extremities, particularly in the thigh. The present study describes an extremely rare case of primary dumbbell-shaped epidural myxoid liposarcoma of the thoracic spine occurring in a 22-year-old woman. Although preoperative magnetic resonance imaging findings were thought to be compatible with schwannoma, the pathological diagnosis of the resected tumor was myxoid liposarcoma. The patient underwent three courses of adjuvant chemotherapy with doxorubicin and ifosfamide, and exhibited no symptoms or signs of local recurrence or metastasis for 18 months post surgery. The present case suggests that, when radiologically diagnosing spinal epidural tumors, clinicians should consider the possibility of myxoid liposarcoma.
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Affiliation(s)
- Yoichi Kaneuchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Michiyuki Hakozaki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hitoshi Yamada
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Takahiro Tajino
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; Division of Orthopaedic Surgery, Southern Tohoku Fukushima Hospital, Fukushima 960-2102, Japan
| | - Kazuyuki Watanabe
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hiroshi Hojo
- Department of Diagnostic Pathology, Aizu Medical Center, Fukushima Medical University, Fukushima 969-3492, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Hokkaido 060-8453, Japan
| | - Shinichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
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Mohsen M, Ilaslan H, Naous R, Sundaram M. Fat Necrosis Presenting as a Soft Tissue Mass. Orthopedics 2015; 38:526, 582-3. [PMID: 26375523 DOI: 10.3928/01477447-20150902-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
Retroperitoneal liposarcomas are rare mesenchymal tumors of the retroperitoneum that typically present with advanced disease and often carry a poor prognosis. Because of their rarity and anatomic location, these malignant tumors can cause a diagnostic dilemma and present several therapeutic challenges. They are usually associated with a high rate of recurrence despite grossly complete resection, thus requiring long-term and often indefinite follow-up. Relevant data on this topic was procured and synthesized with the aid of a comprehensive Medline search in addition to oncologic, pathologic, urologic, radiologic, and surgical literature review on retroperitoneal sarcomas. This article provides an in-depth review into the natural history, pathology, clinical manifestations, and prognostic features of retroperitoneal liposarcomas. It also discusses the reliability of diagnostic procedures and novel curative approaches that are currently being evaluated for the disease.
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Huo D, Liu L, Tang Y. Giant retroperitoneal liposarcoma during pregnancy: a case report. World J Surg Oncol 2015; 13:145. [PMID: 25886056 PMCID: PMC4405913 DOI: 10.1186/s12957-015-0555-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The peak prevalence of retroperitoneal liposarcoma (RPLS) is between the age of 40 to 70 years, usually seen in male 1.43:1. RPLS during pregnancy is extremely rare and a challenge for both the surgeon and the pregnant woman. CASE PRESENTATION A 27-year-old woman was discovered to have a giant retroperitoneal tumor incidentally during her routine obstetric examination at 16 weeks of gestation. The en bloc resection was performed with preservation of the fetus at 20 weeks of gestation and the final pathology was consistent with low-grade myxoid liposarcoma. The patient had an uneventful pregnancy course with a termed delivery. A CT scan was taken 6 months following the surgery, and no local recurrence was detected. CONCLUSION With a thorough consultation and multidiscipline collaboration, en bloc resection of retroperitoneal liposarcoma with preservation of the fetus could be feasible in the late second trimester.
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Affiliation(s)
- DongFang Huo
- Department of General Surgery, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, NO. 168 Litang Road, Changping District, Beijing, 102218, China.
| | - Lin Liu
- Department of General Surgery, PLA General Hospital, No. 28, FuXing Road, Beijing, 100853, China.
| | - Yun Tang
- Department of General Surgery, PLA General Hospital, No. 28, FuXing Road, Beijing, 100853, China.
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Gagliardo C, Falanga G, Sutera R, La Tona G, Lo Casto A, Midiri M, Lagalla R. Presacral myelolipoma. A case report and literature review. Neuroradiol J 2014; 27:764-9. [PMID: 25489902 DOI: 10.15274/nrj-2014-10092] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 08/24/2014] [Indexed: 11/12/2022] Open
Abstract
Many reports have described adrenal myelolipomas but there have been only a few reports of extra-adrenal myelolipomas. We describe a 74-year-old woman who came to our observation for MRI of the lumbar spine for typical lumbar back pain. In addition to signs of mild scoliosis and spondylo disc arthrosis, MR imaging revealed a presacral mass showing a heterogeneously high signal in all pulse sequences and almost completely suppressed on inversion recovery sequences for fat tissue. CT imaging confirmed the fatty nature of the lesion and no signs of bone involvement. These findings were most consistent with a diagnosis of a rare presacral myelolipoma as confirmed at histopathologic analysis. This work reports a case of one of the rarest presacral masses, emphasizing the role of imaging in the differential diagnosis of other presacral masses.
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Affiliation(s)
- Cesare Gagliardo
- Department of Biopathology and Medical and Forensic Biotechnologies, Section of Radiological Sciences, University of Palermo; Italy - -
| | - Giorgia Falanga
- Department of Biopathology and Medical and Forensic Biotechnologies, Section of Radiological Sciences, University of Palermo; Italy
| | - Raffaello Sutera
- Department of Biopathology and Medical and Forensic Biotechnologies, Section of Radiological Sciences, University of Palermo; Italy
| | - Giuseppe La Tona
- Department of Biopathology and Medical and Forensic Biotechnologies, Section of Radiological Sciences, University of Palermo; Italy
| | - Antonio Lo Casto
- Department of Biopathology and Medical and Forensic Biotechnologies, Section of Radiological Sciences, University of Palermo; Italy
| | - Massimo Midiri
- Department of Biopathology and Medical and Forensic Biotechnologies, Section of Radiological Sciences, University of Palermo; Italy
| | - Roberto Lagalla
- Department of Biopathology and Medical and Forensic Biotechnologies, Section of Radiological Sciences, University of Palermo; Italy
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Löwenthal D, Zeile M, Niederhagen M, Fehlberg S, Schnapauff D, Pink D, Tunn PU, Reichardt P, Hamm B, Dudeck O. Differentiation of myxoid liposarcoma by magnetic resonance imaging: a histopathologic correlation. Acta Radiol 2014; 55:952-60. [PMID: 24123962 DOI: 10.1177/0284185113508114] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Myxoid liposarcomas represent a heterogeneous group of soft tissue tumors in which prognosis is dependent on differentiation. PURPOSE To identify magnetic resonance imaging (MRI) criteria to distinguish low-grade from high-grade myxoid liposarcomas. MATERIAL AND METHODS MR images of 30 histologically proven myxoid liposarcomas were retrospectively reviewed. Tumors were evaluated according to size, localization, tumor border, and structure as well as tumor composition. These imaging criteria were correlated with histopathological findings. RESULTS Nineteen myxoid liposarcomas were histologically classified as low-grade myxoid liposarcomas, whereas 11 were considered high-grade myxoid liposarcomas. Mean tumor volume of low-grade myxoid liposarcomas (710.1 ± 960.1 ccm) was significantly smaller as compared to high-grade myxoid liposarcomas (2737.0 ± 3423.7 ccm; P = 0.04). In addition to necrotic areas, three tumor components - fatty, myxoid, as well as contrast-enhancing non-fatty, non-myxoid - could be identified. The mean fraction of fatty tumor areas in low-grade myxoid liposarcomas was 10 ± 11% as compared to 6 ± 4% for high-grade myxoid liposarcomas (P = 0.66). Myxoid components accounted for 88 ± 16% in low-grade myxoid liposarcomas, but only for 45 ± 25% in high-grade myxoid liposarcomas (P < 0.0001). The non-fatty, non-myxoid tumor fraction was significantly higher in high-grade myxoid liposarcomas (50 ± 25%) as compared to low-grade myxoid liposarcomas (2 ± 9%; P < 0.0001). A proportion of > 5% of this tumor fraction was found to be a precise unique predictor for high-grade myxoid liposarcomas with a sensitivity of 100% and a specificity of 95%. CONCLUSION Tumor components with contrast-enhancing non-fatty, non-myxoid imaging features were predominantly found in high-grade myxoid liposarcomas, which may histologically resemble round cell clusters.
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Affiliation(s)
- D Löwenthal
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - M Zeile
- Department of Radiology, Hospital Reinbek, Reinbek, Germany
| | - M Niederhagen
- Dr. Senckenbergisches Institute for Pathology, University Hospital Frankfurt, Frankfurt, Germany
| | - S Fehlberg
- Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - D Schnapauff
- Department of Radiology, Charite Universitätsmedizin, Berlin, Germany
| | - D Pink
- Department of Hematology, Oncology and Palliative Care, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Bad Saarow, Bad Saarow, Germany
| | - PU Tunn
- Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - P Reichardt
- Department of Hematology, Oncology and Palliative Care, Sarcoma Center Berlin-Brandenburg, Helios Klinikum Bad Saarow, Bad Saarow, Germany
| | - B Hamm
- Department of Radiology, Charite Universitätsmedizin, Berlin, Germany
| | - O Dudeck
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
- Department of Radiology, Charite Universitätsmedizin, Berlin, Germany
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Thornhill RE, Golfam M, Sheikh A, Cron GO, White EA, Werier J, Schweitzer ME, Di Primio G. Differentiation of lipoma from liposarcoma on MRI using texture and shape analysis. Acad Radiol 2014; 21:1185-94. [PMID: 25107867 DOI: 10.1016/j.acra.2014.04.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/06/2014] [Accepted: 04/11/2014] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES To determine if differentiation of lipoma from liposarcoma on magnetic resonance imaging can be improved using computer-assisted diagnosis (CAD). MATERIALS AND METHODS Forty-four histologically proven lipomatous tumors (24 lipomas and 20 liposarcomas) were studied retrospectively. Studies were performed at 1.5T and included T1-weighted, T2-weighted, T2-fat-suppressed, short inversion time inversion recovery, and contrast-enhanced sequences. Two experienced musculoskeletal radiologists blindly and independently noted their degree of confidence in malignancy using all available images/sequences for each patient. For CAD, tumors were segmented in three dimensions using T1-weighted images. Gray-level co-occurrence and run-length matrix textural features, as well as morphological features, were extracted from each tumor volume. Combinations of shape and textural features were used to train multiple, linear discriminant analysis classifiers. We assessed sensitivity, specificity, and accuracy of each classifier for delineating lipoma from liposarcoma using 10-fold cross-validation. Diagnostic accuracy of the two radiologists was determined using contingency tables. Interreader agreement was evaluated by Cohen kappa. RESULTS Using optimum-threshold criteria, CAD produced superior values (sensitivity, specificity, and accuracy are 85%, 96%, and 91%, respectively) compared to radiologist A (75%, 83%, and 80%) and radiologist B (80%, 75%, and 77%). Interreader agreement between radiologists was substantial (kappa [95% confidence interval]=0.69 [0.48-0.90]). CONCLUSIONS CAD may help radiologists distinguish lipoma from liposarcoma.
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Affiliation(s)
| | | | - Adnan Sheikh
- Department of Medical Imaging, The Ottawa Hospital, General Campus, 501 Smyth Rd, Ottawa, Ontario, K1H 8L Canada.
| | - Greg O Cron
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Eric A White
- Keck Medical Center of USC, Los Angeles, California
| | - Joel Werier
- The Ottawa Hospital, Ottawa, Ontario, Canada
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Chen G, Qiu X, Liu Y, Qiao Y, Shi T, Chen J, Zhou Q. Primary mediastinal pleomorphic liposarcoma involving the superior vena cava. Thorac Cancer 2014; 5:265-70. [PMID: 26767011 DOI: 10.1111/1759-7714.12084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 11/21/2013] [Indexed: 12/01/2022] Open
Abstract
Primary mediastinal liposarcomas are extremely rare. They are primarily diseases of adults; however, they may be encountered in children. They are characterized by their large size and variable histologic subtypes, which correlate with clinical behavior and prognosis. Although the overall prognosis is poor, it is dependent upon the histologic subtype and completeness of surgical excision. Herein we present a case of a primary mediastinal pleomorphic liposarcoma in a 49-year-old male who received an en-bloc resection and superior vena cava replacement with Gortex graft. The patient has been disease-free after surgery for over 14 months.
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Affiliation(s)
- Gang Chen
- Department of Lung Cancer Surgery, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital Tianjin, China
| | - Xiaoming Qiu
- Department of Lung Cancer Surgery, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital Tianjin, China
| | - Yi Liu
- Department of Lung Cancer Surgery, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital Tianjin, China
| | - Yanjie Qiao
- Department of Lung Cancer Surgery, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital Tianjin, China
| | - Tao Shi
- Department of Lung Cancer Surgery, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital Tianjin, China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital Tianjin, China
| | - Qinghua Zhou
- Department of Lung Cancer Surgery, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital Tianjin, China
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Abete L, Simonato A, Toncini C, Carmignani G, Derchi LE. Myxoid liposarcoma of the spermatic cord: US and MR imaging findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:96-99. [PMID: 23861011 DOI: 10.1002/jcu.22068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/29/2013] [Accepted: 05/03/2013] [Indexed: 06/02/2023]
Abstract
We report a patient with myxoid liposarcoma of the spermatic cord in whom combined use of both ultrasound (US) and MRI helped to suggest the diagnosis. The lesion was solid at US and vascularized at color Doppler. T1-weighted MRI did not show fat within it; on T2-weighted images it had high signal intensity, with a cyst-like appearance. It is known that fat-poor myxoid liposarcomas with high water content may mimic a cystic lesion on non-contrast-enhanced MR; then, a combination of MRI findings, suggesting a cyst, and of US findings, showing the mass was actually solid and vascularized, allowed preoperatively the diagnosis of fat-poor myxoid liposarcoma.
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Affiliation(s)
- Luca Abete
- Dipartimento Scienze Chirurgiche, Settore Anatomia Patologica, Università di Genova, Genova, Italy
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Beals C, Rogers A, Wakely P, Mayerson JL, Scharschmidt TJ. Hibernomas: a single-institution experience and review of literature. Med Oncol 2013; 31:769. [DOI: 10.1007/s12032-013-0769-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 11/08/2013] [Indexed: 10/26/2022]
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Ramos-Pascua L, Guerra-Álvarez O, Sánchez-Herráez S, Izquierdo-García F, Maderuelo-Fernández J. Intramuscular lipomas: Large and deep benign lumps not to be underestimated. Review of a series of 51 cases. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013. [DOI: 10.1016/j.recote.2013.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Ramos-Pascua LR, Guerra-Álvarez OA, Sánchez-Herráez S, Izquierdo-García FM, Maderuelo-Fernández JÁ. [Intramuscular lipomas: Large and deep benign lumps not to underestimated. Review of a series of 51 cases]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013; 57:391-7. [PMID: 24183389 DOI: 10.1016/j.recot.2013.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/09/2013] [Accepted: 09/12/2013] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To review a poorly studied pathology in the scientific literature. MATERIAL AND METHODS An observational, longitudinal and ambispective study of a series of 51 intramuscular lipomas in 50 patients. The frequency distribution of qualitative variables, and the median and the interquartile range (IQR) for continuous variables were calculated. The relationship between the size of the lipomas (recoded into two values) and the study variables were analyzed using the Fisher exact test. RESULTS Men made up 62% of the series, and the median age was 61 years, with 55% of the total being overweight. About half of the patients were diagnosed in the upper limb. More than three-quarters (78%) were strictly intramuscular lipomas. Location, clinical and image presentation, treatment and results are described. DISCUSSION Intramuscular lipomas have their own particular characteristics. Nevertheless, MRI is sometimes unable to distinguish them from well differentiated liposarcomas. Using size as the only criterion for referring a patient with a soft tissue injury to a reference center is still debatable. CONCLUSIONS Patients with intramuscular lipomas, although they may be typical in their presentation, especially when they are large and show findings that can be confused with a well-differentiated low grade liposarcoma, should be treated in experienced centers.
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Affiliation(s)
- L R Ramos-Pascua
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León, Gerencia Regional de Salud de Castilla y León (SACYL), León, España.
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Sclerosing variant of well-differentiated liposarcoma: relative prevalence and spectrum of CT and MRI features. AJR Am J Roentgenol 2013; 201:154-61. [PMID: 23789670 DOI: 10.2214/ajr.12.9462] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the relative prevalence of the sclerosing variant of well-differentiated liposarcoma at one institution and to elucidate the CT and MRI characteristics of this subtype of well-differentiated liposarcoma. MATERIALS AND METHODS A retrospective computerized search was conducted to calculate the relative prevalence of the sclerosing variant of well-differentiated liposarcoma among all well-differentiated liposarcoma subtypes at one institution. The MRI and CT features of a total of 19 cases of pathologically proven sclerosing variant of well-differentiated liposarcoma were evaluated (seven identified from the study institution database and 12 cases contributed by other institutions). RESULTS The cases of a total of 36 patients with well-differentiated liposarcoma were identified in the pathology database; six (17%) cases had evidence of dedifferentiation. Seven (19%) cases of sclerosing variant of well-differentiated liposarcoma were identified. Of these, three (43%) had evidence of dedifferentiation. On images, the sclerosing variant of well-differentiated liposarcoma typically presented as a large (average, 16.6 cm) well-circumscribed heterogeneous mass most commonly situated in the retroperitoneum (58%). Sixteen of the 19 tumors evaluated (84%) had predominantly well-circumscribed margins. Tumor composition ranged from predominantly fatty to entirely devoid of macroscopic fat; only three (16%) were composed of more than 75% fat. Variable amounts of nonlipomatous elements were identified in all cases. Enhancement of these elements was evident at CT or MRI in all 14 cases in which enhancement could be reliably assessed. CONCLUSION The sclerosing variant of well-differentiated liposarcoma should be included in the differential diagnosis of any well-circumscribed lipomatous mass containing variable amounts of nonlipomatous elements, particularly when located in the retroperitoneum. Unlike other subtypes of well-differentiated liposarcoma, the sclerosing variant is less likely to be composed predominantly of fat and may be associated with an increased propensity for dedifferentiation.
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Bermejo A, De Bustamante TD, Martinez A, Carrera R, Zabía E, Manjón P. MR Imaging in the Evaluation of Cystic-appearing Soft-Tissue Masses of the Extremities. Radiographics 2013; 33:833-55. [DOI: 10.1148/rg.333115062] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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48
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Slow-growing giant liposarcoma in the extremity: a case report. EUROPEAN JOURNAL OF PLASTIC SURGERY 2013. [DOI: 10.1007/s00238-011-0674-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Stramare R, Beltrame V, Gazzola M, Gerardi M, Scattolin G, Coran A, Faccinetto A, Rastrelli M, Riccardo Rossi C. Imaging of soft-tissue tumors. J Magn Reson Imaging 2012; 37:791-804. [DOI: 10.1002/jmri.23791] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 07/27/2012] [Indexed: 02/06/2023] Open
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Abstract
The retroperitoneum is the compartmentalized space bounded anteriorly by the posterior parietal peritoneum and posteriorly by the transversalis fascia. It extends from the diaphragm superiorly to the pelvic brim inferiorly. This article discusses clinically relevant anatomy of the abdominal retroperitoneal spaces, their cross-sectional imaging evaluation with computed tomography and magnetic resonance imaging, and the imaging features of common retroperitoneal pathologic processes.
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Affiliation(s)
- Ajit H Goenka
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue - Hb6, Cleveland, OH 44195, USA
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