Abstract. Myxoid liposarcoma (MLPS) is the second most common histologic subtype of liposarcoma. However, cartilaginous differentiation within MLPS is an extremely rare phenomenon, with only 7 cases of MLPS with cartilaginous differentiation reported to date. The majority of MLPS cases show the t(12;16)(q13;p11) translocation, resulting in the fused in sarcoma-DNA damage-inducible transcript 3 (FUS-DDIT3) fusion gene. This fusion gene as a hallmark of MLPS is very useful for differential diagnosis from other soft tissue sarcomas, and the associated protein, FUS-DDIT3, performs an important role in the phenotypic selection of targeted multipotent mesenchymal cells during oncogenesis. In this report, a case of MLPS with cartilaginous differentiation that occurred in the thigh of a 44-year-old woman is described. Histopathologically, the tumor was composed of a typical myxoid liposarcoma area and a mature hyaline cartilaginous area. Using fluorescence in situ hybridization analysis, rearrangement of the DDIT3 gene was detected in not only the liposarcomatous area but also in the chondrocytes of the cartilaginous area. Based on these findings, the cartilaginous differentiation area appears to be partially associated with oncogenesis through the specific fusion gene FUS-DDIT3.
IntroductionLiposarcoma is one of the most common soft tissue sarcomas in adults, representing an estimated 17-25% of all sarcomas (1,2). The tumor occurs at all ages, but is most commonly identified in individuals between 40 and 60 years of age. A total of four distinct histologic subtypes of liposarcoma are recognized by the World Health Organization: i) Atypical lipomatous tumor (ALT); ii) dedifferentiated liposarcoma (DLPS); iii) myxoid liposarcoma (MLPS); and iv) pleomorphic liposarcoma (PLPS). ALT and DLPS are genetically defined by a giant marker or ring chromosomes with an amplification on chromosome 12 affecting, among others, the genes mouse double minute 2 homolog and cyclin-dependent kinase 4 (3). MLPS denotes one such entity and is the second most common liposarcoma following ALT (4). A significant proportion of MLPS cases have the major cytogenetic hallmark of the t(12;16) (q13;p11) chromosomal translocation. This translocation leads to fusion of fused in liposarcoma (FUS; also termed translocated in liposarcoma) and DNA damage-inducible transcript 3 (DDIT3; also termed CCAAT/enhancer-binding protein homologous protein) genes, resulting in the production of the FUS-DDIT3 fusion protein (5). In another subset of MLPS, a minor chromosomal translocation, t(12;22)(q13;q12), results in fusion of the Ewing's sarcoma (EWSR1) and DDIT3 genes (6). PLPS is less frequent and harbors a complex genomic profile with numerous gains and losses similar to the genomic profile observed in poorly differentiated sarcoma (7).The histopathological findings of MLPS are typically composed of well-circumscribed lobulated tumors. These contain a mixture of uniform round to oval-shaped nonlipogenic mesenchymal cells and signet ring lipoblasts in a prominent ...