Developing a clinical scoring system to differentiate deep-seated atypical lipomatous tumor from lipoma of soft tissue

Cheng, Yin; Ko, An-Ta; Huang, Jow-Lay; Lee, Bo-Ching; Yang, Rong‐Sen; Liang, Cher‐Wei; Tai, Hao–Chih; Cheng, Nai‐Chen

doi:10.1016/j.asjsur.2018.12.012

Cited by 20 publications

(42 citation statements)

References 25 publications

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“…Preoperative pathology did not indicate malignancy, possible because the tumor volume was too large and part of the tissue necrosis reduced the accuracy of pathological diagnosis. Preoperative pathology through biopsy is sometimes imprecise because atypical cells may be concentrated and easily missed [19]. Histological and immunohistochemical examinations are the "gold standard" for the diagnosis of pleomorphic lipoma.…”

Section: Discussionmentioning

confidence: 99%

Giant Pleomorphic Lipoma With Malignant Transformation in the Buttock: a Rare Case Report and Literature Review

Feng¹,

Xu²,

Xu³

et al. 2021

Preprint

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Background: Pleomorphic lipoma is a benign tumor, which is often located in the neck, shoulder, and other subcutaneous tissues. Pleomorphic lipoma with malignant transformation in the buttock is rarely reported.Case Presentation: A 53-year-old male attended to our department with a large mass in his buttock that had been present for about one year, leading to difficulty with walking and defecation. Computed tomography (CT) showed a 10. 2 × 8. 3 cm mass with lumpy and mixed low to medium density shadows in the right side of the lower part of the tailbone. Color Doppler ultrasound showed that the skin and subcutaneous tissues of the right buttock were thickened with lymphedema. Pre-operative pathology revealed a large amount of adipose and fusiform fibrous tissues with obvious blood vessels. The patient underwent complete resection of the mass in the right buttock. Postoperative pathology indicated that the tumor was pleomorphic lipoma with malignant transformation. The patient recovered well and was discharged from the hospital at day 12 post-surgery. Follow up at 6 months did not find any symptoms of tumor recurrence.Conclusions: Pleomorphic lipoma with malignant transformation is rare. CT, magnetic resonance imaging (MRI) and histopathology are the main methods used to diagnose pleomorphic lipoma. Complete resection of the tumor is vital to treat giant pleomorphic lipoma successfully.

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Section: Discussionmentioning

confidence: 99%

Giant Pleomorphic Lipoma With Malignant Transformation in the Buttock: a Rare Case Report and Literature Review

Feng¹,

Xu²,

Xu³

et al. 2021

Preprint

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“…It is important to distinguish deep-seated giant lipomas from the ALTs in which they can be confused preoperatively with both clinical and imaging findings. Various clinical risk factors were defined to differentiate ALTs from deep-seated giant lipomas including patients over 60 years old, tumour size larger than 10 cm, tumours located in the lower limb (especially thigh) and male gender [36][37][38]. Thickened septa (> 2 mm), non-adipose masses, foci of T2-weighted lesions and contrast enhancement are the characteristic MRI findings that differentiate ALTs from lipomas [25,28,39,40].…”

Section: Discussionmentioning

confidence: 99%

Distribution of intramuscular giant lipomas in the functional compartments of the forearm: a report of 12 cases

Çapkın

Cavit

Yılmaz

et al. 2019

Handchir Mikrochir Plast Chir

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Purpose The aim of this study was to investigate the distribution of intramuscular giant lipomas in the functional compartments of the forearm and to compare their clinical, radiological and histopathological features with those reported in the current literature. Methods The study included 12 patients who were surgically treated for intramuscular lipomas > 5 cm in size located in the forearm that had been confirmed histopathologically between April 2006 and March 2017. Data about the patients with respect to age, sex, affected side, localisation of the lipomas in the forearm functional compartments, size, histopathological features and recurrence were collected. According to the clinical complaints, direct radiography and magnetic resonance imaging were applied. Results The average diameter was 6.5 cm (range: 5.5–9 cm). All lipomas had a well-defined border. All the patients presented with soft-tissue masses that were painless in seven patients. Five patients had nerve compression symptoms. When the lipomas were classified according to the functional compartments of the forearm, six of them were located in the superficial volar compartment, two in the deep volar compartment, two in the deep dorsal compartment and two in the lateral compartment. All lipomas were surgically removed by marginal excision. None had complications or recurrence at a mean of 6.5 years follow-up (range: 1–12 years) after surgery. Conclusions Intramuscular lipoma is a relatively uncommon tumour, especially in the forearm. Because of the proximity to the neurovascular structures in the forearm, excision of lipomas should be performed with care and include wide incisions. Additionally, knowing the anatomical features of the compartment where the lipoma is localised in the forearm is important in planning surgery to enable easier dissection of the lipoma and lessen the risk of damage to adjacent neurovascular structures. Level of evidence Level 4

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“…It has been di cult to differentiate between ALT/WDLS and lipoma preoperatively because their magnetic resonance imaging (MRI) ndings are similar [1], and small biopsy samples are insu cient for histopathological diagnosis [7]. The selection of surgical resection margins in these tumors remains controversial.…”

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confidence: 99%

“…ALT and WDLS are classi ed as intermediate (locally aggressive) and malignant tumors, respectively. They rarely metastasize, but a risk of local recurrence of them is higher than lipoma [7].…”

Section: Read Full License Introductionmentioning

confidence: 99%

“…Although there have been some reports regarding the usefulness and high accuracy of the assessment, such as uorescence in situ hybridization (FISH) for murine double-minute 2 (MDM2) and cyclindependent kinase 4 (CDK4) for the diagnosis of ALT/WDLS [9][10][11][12][13][14][15][16], these technologies requires special equipment and reagents, so not all medical institutions can perform this examination [7]. The assessment with MRI and hematoxylin and eosin (HE) staining remains the standard method of diagnosis for adipocytic tumors, so it is crucial to determine the diagnosis by a comprehensive assessment of clinical, radiological, and histopathological examinations.…”

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confidence: 99%

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A scoring system combining clinical, radiological, and histopathological examinations for differential diagnosis between lipoma and atypical lipomatous tumor/well-differentiated liposarcoma

Asano

Miwa

Yamamoto

et al. 2021

Preprint

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Background: Preoperative differential diagnosis between atypical lipomatous tumor (ALT)/well-differentiated liposarcoma (WDLS) and lipoma is important to determine the appropriate resection margin. However, since their radiological and histopathological findings are similar, it may be difficult to make a differential diagnosis. In this study, we evaluated the diagnostic accuracies of clinical, radiological, and histopathological examinations for diagnosing ALT/WDLS and developed a new combined scoring system.Methods: Eighty-nine ALT/WDLS and 56 lipomas were included and their clinical characteristics, magnetic resonance imaging (MRI) findings, histological findings by hematoxylin and eosin (HE) staining were investigated, and compared between ALT/WDLS and lipoma. Then, univariate analyses and multivariate logistic regression analyses were performed for the findings, and a combined scoring system consisted of predictive factors of ALT/WDLS was developed. Results: The univariate and multivariate logistic regression analyses revealed that tumor location (lower extremity), deep site, and size (>11cm), thick septa (>2mm), enhancement of septa or nodular lesions on MRI, and lipoblasts in HE staining were significantly different for the diagnosis of ALT/WDLS. Based on the six predictive factors, we developed a combined scoring system (total 0–16 points, the cutoff was 9 points). The mean score of ALT/WDLS was significantly higher than lipoma (11.9 vs. 5.6, p<0.0001). The area under the curve was 0.945, and sensitivity was 87.6% and specificity was 91.1% by the receiver operating characteristics curve.Conclusions: We developed a new combined scoring system based on comprehensive examinations that excluded examination which requires special equipment and reagents such as fluorescence in situ hybridization (FISH), and this can be used in many medical institutions. The diagnostic accuracy of ALT/WDLS was high and it may be useful for preoperative diagnosis and surgical plan.

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Developing a clinical scoring system to differentiate deep-seated atypical lipomatous tumor from lipoma of soft tissue

Cited by 20 publications

References 25 publications

Giant Pleomorphic Lipoma With Malignant Transformation in the Buttock: a Rare Case Report and Literature Review

Giant Pleomorphic Lipoma With Malignant Transformation in the Buttock: a Rare Case Report and Literature Review

Distribution of intramuscular giant lipomas in the functional compartments of the forearm: a report of 12 cases

A scoring system combining clinical, radiological, and histopathological examinations for differential diagnosis between lipoma and atypical lipomatous tumor/well-differentiated liposarcoma

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Developing a clinical scoring system to differentiate deep-seated atypical lipomatous tumor from lipoma of soft tissue

Cited by 20 publications

References 25 publications

Giant Pleomorphic Lipoma With Malignant Transformation in the Buttock: a Rare Case Report and Literature Review

Giant Pleomorphic Lipoma With Malignant Transformation in the Buttock: a Rare Case Report and Literature Review

﻿Distribution of intramuscular giant lipomas in the functional compartments of the forearm: a report of 12 cases

A scoring system combining clinical, radiological, and histopathological examinations for differential diagnosis between lipoma and atypical lipomatous tumor/well-differentiated liposarcoma

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Distribution of intramuscular giant lipomas in the functional compartments of the forearm: a report of 12 cases