The management of deep-seated, lowgrade lipomatous lesions

Al-Ani, Zeid; Fernando, M. A.; Wilkinson, V.; Kotnis, Nikhil

doi:10.1259/bjr.20170725

Cited by 7 publications

(5 citation statements)

References 32 publications

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“…For masses located in the deep soft tissues and the retro-peritoneum, most authors agree that 10 cm is a reasonable cut-off for suspecting ALT/WDLPS. 26,27 In this study, there is a difference in the average size between the eligible lipomas and the diagnosed cases of liposarcomas (15.10 cm vs. 18.70 cm); however, this study demonstrates that size should not be used as the sole basis for reflex testing with MDM2 and p16 IHC. Most of the eligible cases, even though they measure more than 10 cm, demonstrated no or minimal atypia and cell size heterogeneity.…”

Section: Size As Basis For the Immunohistochemical Evaluation Of Adipocytic Tumorsmentioning

confidence: 64%

Immunohistochemical Expression of MDM2 and p16 in Adipocytic Neoplasms Measuring Ten Centimeters or more in Diameter among Filipino Patients in a Public Tertiary Hospital from 2017 to 2019

Masalunga¹,

Rivera²,

Carnate³

2021

PJP

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Introduction.A size of more than 10 cm suggests that a soft tissue tumor might be malignant. Pertinent ancillary diagnostic testing, such as immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH), may be done to confirm the diagnosis. Several studies have shown that size may be a useful criterion in determining which tumors are candidates for further molecular testing. MDM2 and p16 are IHC markers for atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDLPS).Objectives. The primary objective of this study is to determine the proportion of tumors signed out as "lipomas" from 2017 to 2019, and measuring at least 10 cm, that express MDM2 and p16 on IHC and warrant revision as ALT/WDLPS.Methodology. This is a descriptive, retrospective cohort study in which all lipomas from 2017 to 2019 that measured at least 10 cm were included. The size, age of the patient, and location of each tumor were documented. The slides of all eligible cases were reviewed and immunohistochemically stained for MDM2 and p16. For each case, the intensity and immunoreactivity of each stain were assessed using a modified, four-tier scoring system. Fisher's exact test was used to determine if a significant number of tumors expressed MDM2 or p16.Results. Thirty (30) cases satisfied the inclusion and exclusion criteria. The average size of these tumors is 15.10 cm. There is no sex predilection. The most common location of these tumors is the extremities. None of the tumors expressed MDM2, and only one case was p16-positive. The case positive for p16 also showed cytologic atypia and variability in cell size, resulting in the revision of its diagnosis from lipoma to atypical lipomatous tumor. The rate of diagnosis revision after slide review and IHC studies is 3.33%. Conclusion.None of the adipocytic tumors that measured at least 10 cm in diameter and were signed out as lipomas was MDM2 positive, and only one case was p16-positive. Thus, morphology remains the cornerstone in the diagnosis of adipocytic tumors. Careful microscopic evaluation is necessary to establish the diagnosis of malignancy in these tumors. Ancillary tests should only be considered in cases where the pathologic features are equivocal.

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Section: Size As Basis For the Immunohistochemical Evaluation Of Adipocytic Tumorsmentioning

confidence: 64%

Immunohistochemical Expression of MDM2 and p16 in Adipocytic Neoplasms Measuring Ten Centimeters or more in Diameter among Filipino Patients in a Public Tertiary Hospital from 2017 to 2019

Masalunga¹,

Rivera²,

Carnate³

2021

PJP

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“…Moreover, lesion size >10 cm, presence of nodular or globular enhancing soft-tissue components, and thickened septae (>3 mm) favor a diagnosis of LS over lipoma. 5,15 MRI shows high signal intensity on T1-and intermediate signal intensity on T2-weighted images with the loss of signal on fat-suppressed images corresponding to areas of fat.…”

Section: Liposarcomamentioning

confidence: 99%

“…The lesions are hypo-or isointense to liver parenchyma on T1-weighted imaging and markedly hyperintense on T2-weighted imaging with brisk enhancement on post-contrast images (►Fig. 15). About 80% of cases show the characteristic uniform high signal intensity on T2-weighted images (light bulb sign); the presence of internal hemorrhage may reduce T2 signal intensity in the remaining cases.…”

Section: Paragangliomamentioning

confidence: 99%

Solid Primary Retroperitoneal Masses in Adults: An Imaging Approach

Gulati

Swarup

Kumar

2022

Indian J Radiol Imaging

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Mass lesions in the retroperitoneal space may be primary or secondary. Primary retroperitoneal mass lesions are relatively uncommon as compared to pathology that arises secondarily from retroperitoneal organs. These may be solid or cystic lesions. The overlapping imaging features of various solid primary retroperitoneal tumors make the diagnosis difficult, and hence, histopathology remains the mainstay of diagnosis. This paper provides a brief review of the anatomy of the retroperitoneal space and provides an algorithmic approach based on cross-sectional imaging techniques to narrow down the differential diagnosis of solid primary retroperitoneal masses encountered in the adult population.

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“…In this case, the patient's foot drop was presumed to be due to peroneal nerve compression and leg muscle atrophy. Despite their benign nature, giant lipomas also have a risk of malignant transformation to liposarcoma and warrant at minimum a biopsy for further evaluation [5]. For patients willing to undergo surgery, wide margin excision is a preferred treatment option [5].…”

mentioning

confidence: 99%

“…Despite their benign nature, giant lipomas also have a risk of malignant transformation to liposarcoma and warrant at minimum a biopsy for further evaluation [5]. For patients willing to undergo surgery, wide margin excision is a preferred treatment option [5]. However, with giant lipomas, the risk of recurrence remains, and patients should undergo continued surveillance following surgical intervention to assess for relapse [2,3].…”

mentioning

confidence: 99%

Radiographic presentation of a multi-compartmental atypical giant lipoma of the lower extremity

Patel¹,

Krishnan²,

Desai³

2022

J Clin Images Med Case Rep

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A 61-year-old female with no significant past medical history presented with painless progressive left lower extremity weakness and foot drop resulting in altered gait over the course of two years prior to seeking care. Examination revealed a hypertrophied left lower extremity, steppage gait, and 1 out of 5 strength with left ankle dorsiflexion. Initial x-ray of the affected ankle was unremarkable.

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The management of deep-seated, lowgrade lipomatous lesions

Cited by 7 publications

References 32 publications

Immunohistochemical Expression of MDM2 and p16 in Adipocytic Neoplasms Measuring Ten Centimeters or more in Diameter among Filipino Patients in a Public Tertiary Hospital from 2017 to 2019

Immunohistochemical Expression of MDM2 and p16 in Adipocytic Neoplasms Measuring Ten Centimeters or more in Diameter among Filipino Patients in a Public Tertiary Hospital from 2017 to 2019

Solid Primary Retroperitoneal Masses in Adults: An Imaging Approach

Radiographic presentation of a multi-compartmental atypical giant lipoma of the lower extremity

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