Liposarcoma of the Oral and Salivary Gland Region: A Clinicopathologic Study of 18 Cases with Emphasis on Specific Sites, Morphologic Subtypes, and Clinical Outcome

Abstract

Liposarcoma is rare in the oral and salivary gland region (OSG), previously described in only case reports and two small series. Clinicopathologic features of a large series of these tumors were studied. Cases coded as "liposarcoma or lipoma" from 1970 to 2000 were searched for in our files. Inclusion required an OSG location and diagnosis by established soft tissue criteria. Dermal, other soft tissue, and intraosseous liposarcomas were excluded. Clinical and pathologic material was reviewed and follow-up obtained. Eighteen liposarcomas were included: 10 from males and 8 from females. The median patient age was 51 years (range, 30-70 years). Specific anatomic locations included buccal mucosa (n ‫؍‬ 7), tongue (n ‫؍‬ 4), parotid gland (n ‫؍‬ 3), soft tissue overlying the mandible (n ‫؍‬ 2), and one each of palate and submandibular gland. The average tumor size was 4.2 cm (range, 1.5 to 6.0 cm). Histologically, most tumors were well differentiated, including one atypical lipoma (n ‫؍‬ 10), followed by myxoid (n ‫؍‬ 5) and dedifferentiated (n ‫؍‬ 3). OSG liposarcomas of all subtypes had increased numbers of lipoblasts. All patients were treated with surgical excision alone. Follow-up on 15 patients (83%) over a mean of 16.5 years (range, 2 to 53 years) revealed that three patients had between one and six local recurrences over periods of 18 months to 6 years. Twelve patients were without recurrence, with a mean follow-up of 12.8 years (range, 2-23 years). No patients, including those with dedifferentiated liposarcoma, had metastases or died of disease. OSG liposarcomas are rare tumors of adults, occurring most commonly in the buccal mucosa, tongue, and then parotid gland. There were no pleomorphic liposarcomas in this series; well-differentiated liposarcoma was the most common subtype, which can locally recur but, even with high-grade dedifferentiation, does not necessarily predict poor outcome. Therefore, OSG liposarcomas have better prognosis than liposarcoma in other soft-tissue locations, perhaps based on smaller size at presentation. Complete local excision and careful patient follow-up, without adjuvant therapy, appears to be the best treatment for OSG liposarcoma.

Well-Differentiated Liposarcoma/Atypical Lipomatous Tumor of the Oral Cavity: Report of Three Cases and Review of the Literature

“…As has been shown in previous studies, head and neck liposarcomas [7,12] and intraoral liposarcomas [8][9][10] show a male predominance, in contrast to the reported female predilection for ALT/WDLS's of various locations [1,6,42]. The mean age of 64 patients with available information was 54.05 ± 17.84 years (age range 6 months to 86 years; median 54 years), with 78.1% of patients (50/64) being C40 years-old.…”

“…Oral liposarcomas show a much lower incidence, as relevant reviews have reported a limited number of documented cases [8][9][10][11]. In a review of head and neck liposarcomas between 1911 and 2005, approximately 46% of cases (36/78) were localized in the oral mucosa [11], while oral and salivary gland liposarcomas accounted for only 0.3% (18/5,435) of all liposarcomas diagnosed in the Armed Forces Institute of Pathology between 1970 and 2000 [8].…”

“…Although ALT/WDLS is the most common type of liposarcoma of the oral mucosa [1,[8][9][10]12], pertinent data are limited because most relevant publications have been in the form of either single case reports or small case series. In this study, three additional cases of oral ALT/WDLS are described and a review of the reported oral ALT/WDLS cases in the English language literature is also presented.…”

Fat-Containing Salivary Gland Tumors: A Review

“…Among two series of non-lymphoid mesenchymal salivary neoplasms reported from large centers or registries, liposarcoma was represented by a single case in the two studies (one myxoid liposarcoma and one pleomorphic liposarcoma) [34,44]. However, the parotid gland was the third most common site for liposarcoma of the oral and salivary gland region in the AFIP series of 18 patients reported by Fanburg-Smith et al [45] Histological subtypes of the four patients included in this latter study were well differentiated/lipoma-like (2), myxoid (1) and dedifferentiated (1) liposarcoma [45]. Rare cases of liposarcoma metastatic to the parotid gland have been reported and should be included in the differential diagnosis of liposarcoma at this unusual location [46].…”

Dedifferentiated Liposarcoma of the Deep (Paralaryngeal) Soft Tissue: Lessons Learnt from a Case with a Partly Deceptively Benign Appearing Dedifferentiated Component

“…Also Japanese authors have presented data on the lack of prognostic relevance of low-versus high-grade DDLS [21], but again, none of these cases were located in the head and neck area. That liposarcomas of the head and neck region may carry a less sinister prognosis than in the retroperitoneum is suggested by a study by Fanburg-Smith et al [27] who presented a series of 18 cases of LS (including well differentiated, myxoid and dedifferentiated subtypes) where no patients developed metastasis or died of disease.…”