Mesenchymal tumors of the mediastinum.I. Tumors of fibrous tissue, adipose tissue, smooth muscle, and striated muscle

Pachter, M. Richard; Lattes, Raffaele

doi:10.1002/1097-0142(196301)16:1<74::aid-cncr2820160110>3.0.co;2-e

Cited by 59 publications

(16 citation statements)

References 54 publications

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“…In 1927, Edwards 3 described the first case of posterior mediastinal liposarcoma; since then, B40 cases of posterior mediastinal liposarcomas have been described in the English literature. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Many of the previously reported cases were described as part of large studies on mediastinal sarcomas before the advent of modern immunohistochemical (IHC) and molecular techniques. A few cases have been reported in the more recent literature based on modern diagnostic criteria and, in some instances, supported by ancillary studies.…”

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confidence: 99%

Liposarcomas of the posterior mediastinum: clinicopathologic study of 18 cases

et al. 2015

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Sarcomas of the posterior mediastinum are rare and correspond mostly to neurogenic tumors. We studied 18 cases of liposarcoma presenting in the posterior mediastinum; because of their unusual location, some of these tumors posed difficulties for diagnosis. There were 11 men and 7 women aged 29-87 years (mean: 57). The tumors were large lobulated masses ranging from 6 to 30 cm in greatest diameter (median: 15 cm). Symptoms included cough, dysphagia, and chest pain. Four patients were asymptomatic and the tumors were discovered incidentally on chest X-rays. Histologically, 10/18 (55%) cases were atypical lipomatous tumor/ well-differentiated liposarcoma, one of which harbored a smooth muscle component (lipoleiomyosarcoma); 3/18 (16%) were de-differentiated liposarcoma, one of which also harbored a smooth muscle component; 3/18 (16%) were myxoid/round cell liposarcoma; and 2/18 (11%) were pleomorphic liposarcoma. The cases of well-differentiated liposarcoma were mostly of the sclerosing type; however, five of them also showed prominent myxoid stroma closely resembling myxoid liposarcoma. Immunohistochemistry was performed in selected cases; 4/8 cases tested showed focal positivity for S-100 protein and 5/8 cases showed nuclear positivity for MDM-2. The three cases of myxoid liposarcoma were all negative for MDM2. Both cases of lipoleiomyosarcoma showed positivity for SMA and desmin in the smooth muscle component. FISH was performed in two cases of well-differentiated liposarcoma and high levels of amplification of MDM2 at 12q13-15 were observed; the CHOP translocation at 12q13.1-q13.2 was absent in both cases. Complete surgical excision was performed in 11 cases; however, negative surgical margins were achieved only in four. Clinical follow-up ranging from 1 to 192 months (median 28 months) was available for 13 patients. Two patients with myxoid/round cell liposarcoma died of tumor after 4 months and 3 years, respectively. Both had widely disseminated metastatic disease at the time of death. Six patients (6/10) with well-differentiated liposarcoma were alive and well with no evidence of disease (at 4, 7, 12, 15, and 25 months) and three (3/10) were alive with disease (at 3, 4, and 6 months). One patient with well-differentiated liposarcoma had multiple recurrences and a liver metastasis after 14 years; however, the patient was alive and well at 16 years. Five patients were lost to follow-up. In general, the biologic behavior of liposarcomas in the posterior mediastinum seems to correlate well with the histologic subtype and mirrors that of their counterpart in the retroperitoneum.

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confidence: 99%

Liposarcomas of the posterior mediastinum: clinicopathologic study of 18 cases

et al. 2015

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“…45 Primary liposarcomas of the mediastinum and thorax are very rare. 73,94 Although all liposarcoma subtypes have been reported in this anatomic location, 13,39,51 the majority of these reports predate the current morphologic and genetic classification of liposarcoma and lack genetic confirmation as to proper subtype. Herein we report a large clinicopathologic series of primary liposarcomas of the mediastinum collected from our institutional and consultation files over an approximately 60-year period using the current liposarcoma classification system and ancillary molecular genetic testing when appropriate.…”

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Liposarcomas of the Mediastinum and Thorax

Boland

Colby

Folpe

2012

American Journal of Surgical Pathology

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Liposarcoma rarely occurs in the mediastinum, and most reports predate the current genetically based classification system. We report the clinicopathologic and molecular genetic features of a series of thoracic liposarcomas identified over a 60-year period. Twenty-four confirmed cases were reclassified using the most recent World Health Organization classification. Fluorescent in situ hybridization for CPM amplification and/or DDIT3 rearrangement was performed on selected cases. The 24 cases occurred in 13 men and 11 women (mean age, 53 y; range, 15 to 73 y) and arose in all mediastinal compartments. All subtypes were encountered with 8 well-differentiated liposarcomas, 6 dedifferentiated liposarcomas (3 of 6 confirmed CPM+), 7 pleomorphic liposarcomas (2 of 7 confirmed CPM-, 1 of 7 confirmed DDIT3-), 2 myxoid liposarcomas, and 1 unclassifiable liposarcoma (CPM- and DDIT3-). Unusual histologic features included myxoid well-differentiated liposarcoma mimicking myxoid liposarcoma (2 cases), lipoleiomyosarcoma (1 case), dedifferentiated liposarcoma with "meningothelial"-like dedifferentiation, differentiated myxoid liposarcoma mimicking well-differentiated liposarcoma (CPM-), and pleomorphic liposarcoma with epithelioid and myxoid change. Follow-up information was available for 19 patients (mean, 55 mo; range, 8 to 252 mo). Outcome was strongly associated with histologic subtype, with death from disease occurring in 1 of 6 well-differentiated, 1 of 4 dedifferentiated, 5 of 7 pleomorphic, and 2 of 2 myxoid liposarcomas. The mediastinum shows a preponderance of uncommon subtypes and unusual morphologic variants. Correct classification has important implications, with most patients with well-differentiated/dedifferentiated liposarcoma having a protracted clinical course, in contrast to the more rapid disease progression seen in patients with myxoid and pleomorphic liposarcoma.

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“…A wide variety of benign and neoplastic conditions are known to occur in the mediastinum. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] FNAB is as accurate modality for distinguishing these conditions with low morbidity. 2 Although most FNABs from the mediastinum repre- sent epithelioid or lymphoreticular lesions, a smaller subset presents as lesions with spindle-cell morphologies.…”

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confidence: 99%

“…In this situation, clinical, pathologic, and radiologic findings 15 are necessary to reliably distinguish several entities. Possible entities that could produce similar mediastinal FNAB find- ings but not noted in this study include solitary fibrous tumor of the mediastinum, 9,10,22 fibromatosis, 3,16 and idiopathic fibrosing mediastinitis. 6 Differentiating these lesions can be difficult even with cell block preparations 22 or open surgical biopsy.…”

Section: Spindle-cell Lesions Of Mediastinummentioning

confidence: 99%

“…1,2 Although epithelial and lymphoreticular lesions are more common, the unusual spindle-cell lesions of the mediastinum represent a heterogeneous group of disorders that can potentially cause significant diagnostic difficulty. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] These lesions may be inflammatory conditions or benign or malignant neoplasms; therefore, FNAB may play a key role in patient management and outcome. There have only been a few reports discussing mediastinal spindle-cell lesions on FNAB.…”

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Spindle-cell lesions of the mediastinum: Diagnosis by fine-needle aspiration biopsy

et al. 1997

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Spindle cells seen in fine‐needle aspiration biopsy (FNAB) of the mediastinal lesions can be a component of a wide variety of benign and malignant conditions. Few of these conditions, however, are described in the FNA cytopathology literature. This review discusses the cytopathologic features, differential diagnoses, and potential pitfalls of a variety of lesions with a significant component of spindle cells encountered in mediastinal FNAB. The cytopathology files from four institutions were searched for cases of mediastinal FNAB containing a spindle‐cell component that was a key or predominant cytologic feature of the diagnostic specimen. The cytomorphologic features of these cases were analyzed, and their differential features are discussed. Of 196 mediastinal FNABs, 22 (11%) were lesions with significant spindle‐cell component: granulomatous inflammation (four); benign nerve sheath tumor (four); thymic cyst (two); spindle‐cell thymoma (two); large‐cell non‐Hodgkin's lymphoma with sclerosis (two); nodular sclerosing Hodgkin's disease (two); liposarcoma (two); spindle‐cell squamous carcinoma possibly arising in a teratoma (one); unspecified high‐grade sarcoma (one); spindle‐cell malignant melanoma (one); and nonspecific fibrous tissue (one). The cytologic features of each lesion were analyzed as an aid for accurate classification. These findings were correlated with radiologic and clinical information when available. The value of ancillary studies performed on aspirated material in selected cases was also reviewed. FNA of mediastinal lesions with significant spindle‐cell morphology represents an infrequent and heterogeneous group of entities that may pose significant diagnostic challenges. This review presents the salient cytopathologic features of various spindle‐cell lesions of the mediastinum with particular emphasis on differential diagnosis and pitfalls. The pathologist must use caution when interpreting these lesions and ancillary studies may be of significant value in selected cases. Diagn. Cytopathol. 1997;17:167–176. © 1997 Wiley‐Liss, Inc.

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Mesenchymal tumors of the mediastinum.I. Tumors of fibrous tissue, adipose tissue, smooth muscle, and striated muscle

Cited by 59 publications

References 54 publications

Liposarcomas of the posterior mediastinum: clinicopathologic study of 18 cases

Liposarcomas of the posterior mediastinum: clinicopathologic study of 18 cases

Liposarcomas of the Mediastinum and Thorax

Spindle-cell lesions of the mediastinum: Diagnosis by fine-needle aspiration biopsy

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