Difference between revisions of "Adipocytic tumours"
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*[http:// | *[http://pubs.rsna.org/doi/full/10.1148/radiographics.20.4.g00jl021007 Myxoid liposarcoma (rsna.org)].<ref name=pmid10903690>{{Cite journal | last1 = Sung | first1 = MS. | last2 = Kang | first2 = HS. | last3 = Suh | first3 = JS. | last4 = Lee | first4 = JH. | last5 = Park | first5 = JM. | last6 = Kim | first6 = JY. | last7 = Lee | first7 = HG. | title = Myxoid liposarcoma: appearance at MR imaging with histologic correlation. | journal = Radiographics | volume = 20 | issue = 4 | pages = 1007-19 | month = | year = | doi = 10.1148/radiographics.20.4.g00jl021007 | PMID = 10903690 }}</ref> | ||
*[http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt{actionForm.contentReference}=cap_foundation%2FcaseOfMonth%2Ffeb13%2Ffeb_2013_cotm_diagnosis.html&_state=maximized&_pageLabel=cntvwr Myxoid liposarcoma (cap.org)]. | *[http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt{actionForm.contentReference}=cap_foundation%2FcaseOfMonth%2Ffeb13%2Ffeb_2013_cotm_diagnosis.html&_state=maximized&_pageLabel=cntvwr Myxoid liposarcoma (cap.org)]. | ||
Revision as of 18:04, 25 November 2013
Adipocytic tumours fall into the grouping soft tissue lesions and includes things that are very common (e.g. lipoma) and everything from benign to malignant.
Overview
This grouping includes a number of tumours, which can be divided based on their behaviour into benign, intermediate and malignant.
Benign
Benign adipocytic tumours:[1]
- Lipoma.
- Angiolipoma.
- Myolipoma.
- Pleomorphic lipoma/spindle cell lipoma.
- Lipomatosis.
- Lipomatosis of nerve.
- Lipoblastoma.
- Extrarenal angiomyolipoma.
- Extra-adrenal myelolipoma.
- Hibernoma.
Intermediate
Intermediate adipocytic tumours:[1]
- Atypical lipomatous tumour.
Malignant
Malignant adipocytic tumours:[1]
- Dedifferentiated liposarcoma.
- Myxoid liposarcoma.
- Pleomorphic liposarcoma.
- Mixed-type liposarcoma.
- Liposarcoma NOS.
Detail section
Normal mature fat
Microscopic
Features:
- Adipocytes of approximately equal size.
- Not vascular.
- No nuclear hyperchromasia.
Notes:
- May have nuclear pseudoinclusions (Lockhern cell).[2]
- There is some suggestion this is not benign.[3]
IHC
- S100 +ve.
Lipoblastoma
General
- Rare paediatric tumour.[4]
Usual presentation:[4]
- Painless neck mass.
Microscopic
Features:
- Nests of cells in the dermis with abundant pale cytoplasm - vaguely resemble adipocytes.
- Smaller than mature adipocytes.
DDx:
Images:
Lipoma
Main article: Lipoma
Pleomorphic lipoma
General
Gross
- Classically shoulder and neck region in adults.[8]
DDx - shoulder lesions:
Microscopic
Features:
- Multinucleated cells - "floret cells" - key feature.
- Solid eosinophilic cytoplasm.
- Peripheral nuclei - impart a knobby border to the cells.
- Fibrous septa.
Notes:
- May overlap with spindle cell lipoma.[9]
- Floret cell - may look similar to Touton giant cells.
Images:
- Pleomorphic lipoma - low mag. (webpathology.com).
- Pleomorphic lipoma - high mag. (webpathology.com).
DDx:
- Liposarcoma.
- Ancient neurofibroma.
- Ancient schwannoma.
IHC
- AR +ve - ~95% in men, ~85% in women.[7]
Spindle cell lipoma
General
- Rare.
- Predominantly men.[10]
Note:
- Spindle cell lipoma may immunohistochemically and histomorphologically overlap with mammary-type myofibroblastoma[11] - see: mammary myofibroblastoma.
Microscopic
Features:[10]
- Aligned bland spindled cells adjacent to fat.
- Rope-like collagen bundles - key feature.
- May be described as "shreaded wheat".
- +/-Myxoid component.
- +/-Staghorn-like vessels.
Notes:
- May overlap with pleomorphic lipoma.[9]
DDx:
- Neurofibroma.
- Spindle cell liposarcoma - extremely rare.[12]
Image
www:
IHC
- CD34 +ve.[13]
- Desmin +ve.
- S100 -ve. (???)
Hibernoma
Main article: Hibernoma
Atypical lipomatous tumour
- AKA well-differentiated liposarcoma, abbreviated WDLPS.
- Abbreviated ALT/WDLPS.
General
- Atypical lipomatous tumour is a term used to save people with a (curable) peripheral liposarcoma from getting denied life insurance.
Microscopic
Features:[14]
- Large adipocytes.
- Atypical lipoblasts - focal, scattered:
- Nuclear hyperchromasia.
- +/-Multinucleated.
Liposarcoma
General
- Most common malignant sarcoma in the retroperitoneum.
- Not all (large) retroperitoneal adipocytic tumours are liposarcomas.
Notes:
- Retroperitoneal sarcomas: #1: liposarcoma, #2: pleomorphic undifferentiated sarcoma, #3: leiomyosarcoma, #4: MPNST.
- Extremely rare in retroperitoneum: synovial sarcoma.
Microscopic
Features:
- Lipoblasts - key feature.
- Large sharply demarcated vacuole.
- Nucleus:
- Hyperchromatic (dark staining) nucleus.
- Eccentric location.
- Nuclear indentation.
- Chicken wire-like vascular.
- +/-Myxoid background.
- Cell size variation.
DDx:
Images:
- Myxoid liposarcoma (WC).
- Myxoid liposarcoma (WC).
- Lipoblasts (john-libbey-eurotext.fr).
- Dediff. liposarcoma - lipoblasts - very high mag. (WC).
- Dediff. liposarcoma - shows dediff. component - intermed. mag. (WC).
- Poorly diff. liposarcoma - several images (upmc.edu).
Subtypes
Main subtypes:[1]
- Dedifferentiated liposarcoma.
- Myxoid liposarcoma.
- Mixed-type liposarcoma.
- Pleomorphic liposarcoma.
- Liposarcoma not otherwise specified (NOS).
Additional reported type:
- Spindle cell liposarcoma.[12]
Myxoid liposarcoma
Gross
Location:[17]
- 90% in lower limb.
- 81% deep.
Microscopic
Features:
- Chickenwire-type blood vessels.
- Clear spaces.
- Adipocytes - may be rare.
DDx:
Images:
Molecular
Typically has a translocation:
- t(12;16)(q13;p11) TLS-CHOP.[19]
- May have the translocation usually seen in clear cell sarcoma:
- t(12;22)(q13;q12) EWS-ATF1.[20]
Dedifferentiated liposarcoma
- Has an undifferentiated component that, if seen alone, would be diagnosed as pleomorphic undifferentiated sarcoma.
- The diagnosis depends on the presence of the differentiated component of the tumour, i.e. the presence of lipoblasts.
IHC
- IHC is of limited value.
- S-100 +ve ~1/3 of the time.
- Reticulin ???.
See also
References
- ↑ 1.0 1.1 1.2 1.3 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 601. ISBN 978-0781765275.
- ↑ URL: http://journals.lww.com/amjdermatopathology/Citation/2004/12000/Original_Observation_to_Rediscovery__Nuclear.9.aspx. Accessed on: 18 April 2011.
- ↑ URL: http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970574-5. Accessed on: 18 April 2011.
- ↑ 4.0 4.1 Pham, NS.; Poirier, B.; Fuller, SC.; Dublin, AB.; Tollefson, TT. (Jul 2010). "Pediatric lipoblastoma in the head and neck: a systematic review of 48 reported cases.". Int J Pediatr Otorhinolaryngol 74 (7): 723-8. doi:10.1016/j.ijporl.2010.04.010. PMID 20472310.
- ↑ Nagano, A.; Ohno, T.; Nishimoto, Y.; Hirose, Y.; Miyake, S.; Shimizu, K. (2011). "Lipoblastoma mimicking myxoid liposarcoma: a clinical report and literature review.". Tohoku J Exp Med 223 (1): 75-8. PMID 21212605.
- ↑ Persichetti, P.; Di Lella, F.; Marangi, GF.; Cagli, B.; Simone, P.; Tenna, S.; Rabitri, C.; Cassandro, R. et al. "Pleomorphic lipoma: a definite histopathological entity.". Anticancer Res 24 (5B): 3157-9. PMID 15510605.
- ↑ 7.0 7.1 Syed, S.; Martin, AM.; Haupt, H.; Podolski, V.; Brooks, JJ. (Jan 2008). "Frequent detection of androgen receptors in spindle cell lipomas: an explanation for this lesion's male predominance?". Arch Pathol Lab Med 132 (1): 81-3. doi:10.1043/1543-2165(2008)132[81:FDOARI]2.0.CO;2. PMID 18181679.
- ↑ URL: http://www.webpathology.com/image.asp?n=2&Case=435. Accessed on: 3 October 2011.
- ↑ 9.0 9.1 URL: http://surgpathcriteria.stanford.edu/softfat/spindle_cell_lipoma/. Accessed on: 4 December 2010.
- ↑ 10.0 10.1 Murphey, MD.; Carroll, JF.; Flemming, DJ.; Pope, TL.; Gannon, FH.; Kransdorf, MJ.. "From the archives of the AFIP: benign musculoskeletal lipomatous lesions.". Radiographics 24 (5): 1433-66. doi:10.1148/rg.245045120. PMID 15371618.
- ↑ McMenamin, ME.; Fletcher, CD. (Aug 2001). "Mammary-type myofibroblastoma of soft tissue: a tumor closely related to spindle cell lipoma.". Am J Surg Pathol 25 (8): 1022-9. PMID 11474286.
- ↑ 12.0 12.1 Dei Tos, AP.; Mentzel, T.; Newman, PL.; Fletcher, CD. (Sep 1994). "Spindle cell liposarcoma, a hitherto unrecognized variant of liposarcoma. Analysis of six cases.". Am J Surg Pathol 18 (9): 913-21. PMID 8067512.
- ↑ Wood, L.; Fountaine, TJ.; Rosamilia, L.; Helm, KF.; Clarke, LE. (Dec 2010). "Cutaneous CD34+ spindle cell neoplasms: Histopathologic features distinguish spindle cell lipoma, solitary fibrous tumor, and dermatofibrosarcoma protuberans.". Am J Dermatopathol 32 (8): 764-8. doi:10.1097/DAD.0b013e3181d0c587. PMID 20559119.
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 605. ISBN 978-0781765275.
- ↑ Smith, TA.; Easley, KA.; Goldblum, JR. (Feb 1996). "Myxoid/round cell liposarcoma of the extremities. A clinicopathologic study of 29 cases with particular attention to extent of round cell liposarcoma.". Am J Surg Pathol 20 (2): 171-80. PMID 8554106.
- ↑ Conyers, R.; Young, S.; Thomas, DM. (2011). "Liposarcoma: molecular genetics and therapeutics.". Sarcoma 2011: 483154. doi:10.1155/2011/483154. PMID 21253554.
- ↑ Moreau, LC.; Turcotte, R.; Ferguson, P.; Wunder, J.; Clarkson, P.; Masri, B.; Isler, M.; Dion, N. et al. (Apr 2012). "Myxoid\Round Cell Liposarcoma (MRCLS) Revisited: An Analysis of 418 Primarily Managed Cases.". Ann Surg Oncol 19 (4): 1081-1088. doi:10.1245/s10434-011-2127-z. PMID 22052112.
- ↑ Sung, MS.; Kang, HS.; Suh, JS.; Lee, JH.; Park, JM.; Kim, JY.; Lee, HG.. "Myxoid liposarcoma: appearance at MR imaging with histologic correlation.". Radiographics 20 (4): 1007-19. doi:10.1148/radiographics.20.4.g00jl021007. PMID 10903690.
- ↑ Knight, JC.; Renwick, PJ.; Dal Cin, P.; Van den Berghe, H.; Fletcher, CD. (Jan 1995). "Translocation t(12;16)(q13;p11) in myxoid liposarcoma and round cell liposarcoma: molecular and cytogenetic analysis.". Cancer Res 55 (1): 24-7. PMID 7805034.
- ↑ Suzuki, K.; Matsui, Y.; Endo, K.; Kubo, T.; Hasegawa, T.; Kimura, T.; Ohtani, O.; Yasui, N. (Nov 2010). "Myxoid liposarcoma with EWS-CHOP type 1 fusion gene.". Anticancer Res 30 (11): 4679-83. PMID 21115923.