Lipoma or liposarcoma? A cautionary case report

Jones, A.P.; Lewis, Christopher J.; Dildey, Petra; Hide, Geoff; Ragbir, Maniram

doi:10.1016/j.bjps.2011.08.004

Cited by 21 publications

(15 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Four days after the excision, the patient underwent placement of a split thickness skin graft without further reexcision. The graft initially healed, however, two weeks later (4 weeks after excision), the patient developed a local recurrence and succumbed to metastatic disease a few months later [6,22,23].…”

Section: Resultsmentioning

confidence: 98%

“…Cases where the diagnosis was not firmly established or confirmed, or where the focus was set on sparing the extremity instead of focusing on a long-term cure or patient survival under an established diagnosis, make an argument for delaying definitive reconstruction. Although not always possible in a preoperative or intraoperative setting, collecting the patient's complete clinical information may require the delay of reconstruction, but the delay may reduce the need for additional surgeries resulting from an inaccurate diagnosis or an uncertain situation regarding the margins [4][5][6][7][8][9]. Statistics such as a 25% chance of recurrence after a wide excision of an extremity soft tissue sarcoma, and up to a 95% chance of a high-risk cutaneous squamous cell carcinoma development (e.g., patients with bullous disease, immunosuppressed organ transplant recipients, scar-originating malignancy, deep or perineural invasion) within five years after primary excision, reaffirm the value of staged or delayed definitive reconstruction.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Working with Orthopedic Oncologists: When to Offer Immediate and when and why to Delay Definitive Reconstruction of an Extremity

Dobke¹,

Mackert²,

Goldin³

et al. 2017

J Clin Exp Orthop

View full text Add to dashboard Cite

A review of patients that were treated jointly by the plastic and the orthopedic surgery teams from 2011 to 2015 to evaluate the timing of definitive reconstruction of extremity defects was undertaken. The cohort consists of 81 patients, of which 4 presented with either a high-risk lesion or an advanced squamous cell carcinoma and of which the remaining 77 patients presented with different types of extremity sarcomas. In 58 cases, immediate-definitive reconstruction was performed, while in 23 cases the definitive procedure was delayed. Immediate definitive reconstruction, concurrent with ablative procedures, was offered whenever possible. In 16 cases, delayed reconstruction was due to diagnostic uncertainty (uncertain diagnosis per se or non-established negative margins). In 6 cases, delayed reconstruction was performed because of infection, in 1 case a bleeding disorder necessitated workup and in another, the intraoperative histology necessitated a plan-change, wound temporization and preparation of an arteriovenous fistula for microsurgical reconstruction. Indications for delayed reconstruction can be related to systemic conditions, donor or recipient site issues (infection, suspicion of margin-problems or tumor "not in continuity"). Although frozen sections have an overall diagnostic accuracy of 90%, changes in management were related to the inadequacy of frozen material, sampling errors resulting from heterogeneity or non-appositional growth of malignancy. A high rate (28%) of delayed reconstruction corresponds with new data reaffirming an old paradigm (radically excised margins "make a difference"), and with objectives dictated by customized, personalized, multimodal approaches. Wound temporization was offered whenever definitive reconstruction couldn't be performed immediately. Limb sparing, with the utilization of temporary spacers or distractors, mega-prostheses, or trials of reimplanting formerly tumorous bone autografts, which have been sterilized to eliminate malignant cells -may all necessitate temporary coverage or staged repair. Authors' clinical experience was evaluated in the context whether the rationale behind immediate versus delayed reconstruction was optimal.

show abstract

Section: Resultsmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Working with Orthopedic Oncologists: When to Offer Immediate and when and why to Delay Definitive Reconstruction of an Extremity

Dobke¹,

Mackert²,

Goldin³

et al. 2017

J Clin Exp Orthop

View full text Add to dashboard Cite

show abstract

“…Liposarcoma, while uncommon, has a predilection for the extremities and the retroperitoneum. 6 Some imaging features can be suggestive of liposarcoma rather than a benign lipoma, including calcification, thickened irregular septations, associated nonadipose tissue, and swirling or nodularity. 6 Sarcoma guidelines suggest that 4 features are important in assessing the likelihood of malignancy: 1) increasing size, 2) size greater than 5 cm, 3) location deep to the deep fascia, and 4) associated pain.…”

Section: Discussionmentioning

confidence: 99%

“…6 Some imaging features can be suggestive of liposarcoma rather than a benign lipoma, including calcification, thickened irregular septations, associated nonadipose tissue, and swirling or nodularity. 6 Sarcoma guidelines suggest that 4 features are important in assessing the likelihood of malignancy: 1) increasing size, 2) size greater than 5 cm, 3) location deep to the deep fascia, and 4) associated pain. 5 When these features are present, involvement of a sarcoma specialist should be considered, as treatment typically involves resection with clear margins followed by postoperative radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Evaluation and management of fibrofatty tumors of the extremities: case report

Wilson¹,

Joseph²,

Dillman³

et al. 2016

Journal of Neurosurgery: Pediatrics

View full text Add to dashboard Cite

Patients presenting with enlarging fibrofatty masses in the extremities pose an interesting dilemma to clinicians, as the differential diagnosis in such cases ranges from benign to malignant, and from lesions optimally managed operatively to those managed nonoperatively. The differential diagnosis includes benign lipoma, liposarcoma, lipoblastoma, and fibrolipomatous hamartoma (lipomatosis) of the nerves. The authors present the case of a 14-year-old girl with an enlarging fibrofatty mass of the forearm, initially thought, based on diagnostic imaging, to be a fibrolipomatous hamartoma of the median nerve, but found to be a lipoblastoma without direct nerve involvement based on histopathological examination of the operative specimen. This case serves to illustrate the diagnostic predicament that can exist with such masses. The authors advocate the need to establish a tissue diagnosis while having a contingency plan for each of the diagnostic possibilities because the management of each lesion is markedly different. In this report, the authors consider the differential diagnosis of fibrofatty masses of the extremities that the peripheral nerve surgeon may encounter, and they highlight the significant differences in management strategies for each possible diagnosis.

show abstract

“…Liposarcomas are a rare sarcoma subtype with an incidence of approximately 1 case per 2.5 million population 1. Liposarcoma of the spermatic cord only represents 7% of paratesticular sarcomas and just over 100 cases have been reported in the literature from 1952 to 2013 2–6…”

Section: Discussionmentioning

confidence: 99%

Paratesticular liposarcoma and contralateral angiolipoma in a 60-year-old patient

et al. 2015

View full text Add to dashboard Cite

We present the case of a 60-year-old man who was referred with a 1-year history of a slow-growing right scrotal lump. Following surgical excision together with a radical orchidectomy, the histological diagnosis was of a paratesticular dedifferentiated liposarcoma. Radiological staging showed no metastatic disease. Six months later the patient presented with a new left scrotal lump, which was felt to be separate from the testis. Owing to the previous history of a liposarcoma and indeterminate ultrasound findings, this was surgically excised without orchidectomy. Histological analysis showed this to be an angiolipoma. The patient remained on clinical and radiological surveillance. Paratesticular tumours are rare neoplasms and liposarcomas of the spermatic cord only represent 7% of these lesions. Any link between lipomatous tumours and liposarcomas remains controversial and is still under investigation. This is the first case to report a paratesticular liposarcoma and a contralateral angiolipoma in the same patient.

show abstract

Lipoma or liposarcoma? A cautionary case report

Cited by 21 publications

References 9 publications

Working with Orthopedic Oncologists: When to Offer Immediate and when and why to Delay Definitive Reconstruction of an Extremity

Working with Orthopedic Oncologists: When to Offer Immediate and when and why to Delay Definitive Reconstruction of an Extremity

Evaluation and management of fibrofatty tumors of the extremities: case report

Paratesticular liposarcoma and contralateral angiolipoma in a 60-year-old patient

Contact Info

Product

Resources

About