Marginal resection for patients with atypical lipomatous tumours of the extremities and trunk wall: a systematic review and meta-analysis

Kido, Akira; Kitagawa, Yasuyuki; Tsukushi, Satoshi; Iwata, Shintaro; Ishida, Yukako; Tsukamoto, Shinji; Kawai, Akira

doi:10.1093/jjco/hyab185

Cited by 3 publications

(1 citation statement)

References 13 publications

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“…They have suggested that wide resection is necessary to prevent local recurrence, dedifferentiation, and residual tumor. However, a recent systematic review revealed that the local recurrence rate was not significantly higher in the marginal resection group (32). A scheduled R1 marginal resection is easy because the tumor capsule is completely individualized.…”

Section: Managementmentioning

confidence: 98%

Biology and Management of Deep-seated Atypical Lipomatous Tumor of the Extremities

NISHIO,

NAKAYAMA,

CHIJIIWA

et al. 2023

Anticancer Res

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Adipocytic neoplasms are frequently encountered in clinical practice. Atypical lipomatous tumor (ALT) is a locally aggressive but non-metastasizing adipocytic neoplasm that primarily occurs in the proximal extremities of middleaged to older adults. Histologically, ALT is divided into adipocytic (lipoma-like), sclerosing and inflammatory subtypes. The sclerosing subtype is an unfavorable prognostic factor for local recurrence. ALT is characterized by supernumerary ring and/or giant rod chromosomes. These rings and giant markers invariably contain amplified sequences originating from the long arm of chromosome 12, including the MDM2 protooncogene (MDM2) and cyclin-dependent kinase 4 (CDK4) gene. MDM2 and/or CDK4 nuclear immunopositivity is present in most cases. Confidently differentiating deep-seated ALT from deep-seated ordinary lipoma is often difficult on imaging. Moreover, the sclerosing subtype may mimic a higher grade liposarcoma. Detection of MDM2 amplification by fluorescence in situ hybridization would be helpful diagnostically for ALT in more difficult cases. The standard treatment for deep-seated ALT is surgery. Although there is no consensus on the best surgical approach for deep-seated ALT of the extremities, the use of marginal resection is acceptable to preserve musculoskeletal function. This review provides an overview of the current knowledge on the clinical and imaging characteristics, pathogenesis, histopathology, and management of deep-seated ALT of the extremities.Adipocytic tumors are the most common mesenchymal neoplasms of the extremities and represent a biologically and histologically diverse group. Many of these tumors are atypical lipomatous tumor (ALT) or ordinary lipoma (1). ALT is a locally aggressive mesenchymal neoplasm composed entirely or in part of mature adipocytic proliferation demonstrating at least focal nuclear atypia in both adipocytes and stromal spindle cells. Deep-seated ALT of the extremities shows no potential for metastasis unless it undergoes dedifferentiation. ALT is characterized by the presence of supernumerary ring and/or giant rod chromosomes. These rings and giant markers are composed, exclusively or partly, of amplified 12q13-15 material, including the MDM2 proto-oncogene (MDM2) and cyclindependent kinase 4 (CDK4) gene (2). MDM2 amplification is considered to represent one of the earliest events in the formation of ALT (3). In our experience, distinguishing ALT from ordinary lipoma can be challenging based on preoperative imaging features alone, especially if they occur in deep anatomical sites. Surgery is the mainstay of treatment for ALT. However, there is no consensus regarding the best surgical treatment for deep-seated ALT of the extremities. This review highlights the clinical and imaging characteristics, pathogenesis, histopathology, and management of deep-seated ALT of the extremities. Clinical CharacteristicsALT can occur at any age but has a peak incidence in the fifth to seventh decades of life, with no sex predilection (3). It most frequently occur...

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Section: Managementmentioning

confidence: 98%

Biology and Management of Deep-seated Atypical Lipomatous Tumor of the Extremities

NISHIO,

NAKAYAMA,

CHIJIIWA

et al. 2023

Anticancer Res

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Histology-Tailored Approach to Soft Tissue Sarcoma

Gervais,

Basile,

Dulude

et al. 2024

Ann Surg Oncol

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Atypical Spindle Cell/Pleomorphic Lipomatous Tumor: A Review and Update

Nishio,

Nakayama,

Chijiiwa

et al. 2024

Cancers

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Atypical spindle cell/pleomorphic lipomatous tumor (ASCPLT) is a rare and recently described adipocytic neoplasm that primarily occurs in the subcutis of the limbs and limb girdles, particularly of middle-aged adults. It has locally recurrent potential if incompletely excised but no risk for distant metastasis. ASCPLT is histologically similar to spindle cell/pleomorphic lipoma and atypical lipomatous tumor and shows a mixture of atypical spindle cells, adipocytes, lipoblasts, floret-like multinucleated giant cells, and/or pleomorphic cells. It has been recently recognized that ASCPLT can undergo sarcomatous transformation. However, the biological significance of morphological sarcomatous transformation in ASCPLT remains uncertain. Immunohistochemically, the tumor cells show variable expression of CD34, S-100 protein, and desmin. Loss of nuclear Rb expression is observed in the majority of cases. ASCPLT lacks MDM2 gene amplification but can show RB1 gene deletion in a significant subset of cases. Complete surgical excision is the treatment of choice. This review provides an overview of the current knowledge on the clinicoradiological features, pathogenesis, histopathology, and treatment of ASCPLT. In addition, we will discuss the differential diagnosis of this new entity.

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Marginal resection for patients with atypical lipomatous tumours of the extremities and trunk wall: a systematic review and meta-analysis

Cited by 3 publications

References 13 publications

Biology and Management of Deep-seated Atypical Lipomatous Tumor of the Extremities

Biology and Management of Deep-seated Atypical Lipomatous Tumor of the Extremities

Histology-Tailored Approach to Soft Tissue Sarcoma

Atypical Spindle Cell/Pleomorphic Lipomatous Tumor: A Review and Update

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