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LETTER TO THE EDITOR
Year : 2016  |  Volume : 12  |  Issue : 1  |  Page : 424-426

Mixed type retroperitoneal liposarcoma-combination of myxoid and well-differentiated type


1 Department of Pathology, College of Medicine and Sagore Dutta Hospital, Kolkata, India
2 Department of Pathology, Bankura Sammilani Medical College, Bankura, West Bengal, India

Date of Web Publication13-Apr-2016

Correspondence Address:
Subrata Pal
Gobindanagar, Kenduadihi, Bankura, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.172590

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How to cite this article:
Pal S, Sengupta S, Bose K, Jana S. Mixed type retroperitoneal liposarcoma-combination of myxoid and well-differentiated type. J Can Res Ther 2016;12:424-6

How to cite this URL:
Pal S, Sengupta S, Bose K, Jana S. Mixed type retroperitoneal liposarcoma-combination of myxoid and well-differentiated type. J Can Res Ther [serial online] 2016 [cited 2019 Nov 17];12:424-6. Available from: http://www.cancerjournal.net/text.asp?2016/12/1/424/172590



Sir,

Liposarcomas are malignant adipocytic tumors constituting about 20% of soft tissue sarcomas.[1] Morphologically, these are classified into well-differentiated, de-differentiated, myxoid, round cell, pleomorphic, and mixed type.[2] Mixed type liposarcomas represent combined features of the myxoid/round cell and well-differentiated/de-differentiated liposarcoma or features of the myxoid/round cell/pleomorphic subtype.[3] Mixed type liposarcomas are infrequent occurring in elderly patients preferably in retroperitonium and intraabdominal space.[3] Mixed liposarcomas create conceptual problems in the management protocols due to histological diversity and lack of well-established guidelines.[4]

A 57-year-old lady was admitted in surgery ward with complaints of gradually increasing abdominal girth and diffuses abdominal pain for 2 months associated with the symptoms of anorexia, dyspepsia and weight loss. On abdominal examination, a large solid mass was palpable at right lumber and para-umbilical area. A computed tomography (CT) scan of the abdomen showed a large heterogeneous soft tissue mass present at retroperitoneal area compressing abdominal contents to both flanks [Figure 1] without any invasion.
Figure 1: Computed tomography of abdomen showing solid heterogeneous mass at retroperitonium

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All hematological and biochemical tests were unremarkable except mild anemia (hemoglobin - 9.5 gm/dl). Laparotomy was performed, and mass was excised. On gross examination, it was a large, soft and solid mass measuring 30 cm × 22 cm × 18 cm. On cut section, two distinct zones were identified yellowish homogeneous and grayish, tan gelatinous areas separated by thin fibrous tissue [Figure 2]. On microscopy, yellowish areas showed proliferation of adipocytes with occasional presences of uni/multi vacuolated lipoblasts. Sections from tan-colored area revealed admixture of round cells and oval to spindle cells in myxoid stroma and prominent delicate branching blood vessels [Figure 3]. Occasional lipoblasts were found in the myxoid area. The adjoining area of two zones was composed of intervening fibrous tissue separating two different histological variants [Figure 4]. Histopathological diagnosis was mixed type retroperitoneal liposarcoma. The patient was further treated with six cycles of chemotherapy. Clinically, she was disease free after 1 year of follow-up.
Figure 2: Gross picture of the retroperitoneal mass (cut open) shows two distinct zones in the tumor - one area of yellowish lipomatous area and another area of tan colored myxoid area

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Figure 3: Photomicrograph shows many spindle cells and branching delicate blood vessels in the myxoid stroma, typical of myxoid liposarcoma (H and E, ×10 view)

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Figure 4: Microscopy shows two heterologous components in the same tumor - an area of atypical lipomatous tumor and another area of myxoid liposarcoma (H and E, ×10 view)

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Liposarcoma is the most common type of retroperitoneal sarcoma accounting 41% of retroperitoneal malignant mesenchymal tumors.[5] According to recent cytogenetic and immunohistochemical data, liposarcomas are classified into three types - well-differentiated/de-differentiated, myxoid/round cell and pleomorphic subtype. Myxoid liposarcoma is the most common variant though uncommon in retroperitoneal location.[1] In retroperitonium, well-differentiated liposarcoma is the most frequent subtype. Only 5% liposarcomas show an admixture of different histological subtypes in the same tumor.[4] Morphological heterogenecity of mixed type liposarcomas have been explained by different levels of maturation within a single developmental pathway of adipogenesis.[4] Clinical features are due to the compression of adjacent organs. CT scan and magnetic resonance imaging are the best preoperative investigations for evaluation. The histomorphological diversity of a mixed liposarcoma may cause misdiagnosis in cytology and small biopsy.[4] Multiple sections from different parts are necessary to avoid misdiagnosis.

Retroperitoneal liposarcomas have more propensity of local recurrence than distant metastasis.[5] Complete surgical removal with negative marginal status is the cornerstone of favorable prognosis and disease free survival.[5] Sometimes complete surgical removal is difficult and may require resection of involved organs.[4] The role of chemoradiation depends on components, completeness of resection, and differentiation of the tumor. Overall, 5 years survival rate in well-differentiated and myxoid liposarcoma exceeds 70%.

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Nil

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

1.
Akhoondinasab MR, Omranifard M. Huge retroperitoneal liposarcoma. J Res Med Sci 2011;16:565-7.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Chee CC, Essam G. A rare case of double mesenteric liposarcoma. Grand Rounds E Med 2011;11:98-102.  Back to cited text no. 2
    
3.
Choi YY, Kim YJ, Jin SY. Primary liposarcoma of the ascending colon: A rare case of mixed type presenting as hemoperitoneum combined with other type of retroperitoneal liposarcoma. BMC Cancer 2010;10:239.  Back to cited text no. 3
    
4.
Fletcher CD, Unni KK, Mertens F. World Health Organization classification of tumours. In: Pathology and Genetics of Tumours of Soft Tissue and Bone. Lyon, France: IARC Press; 2002. p. 35-46.  Back to cited text no. 4
    
5.
de Vreeze RS, de Jong D, Koops W, Nederlof PM, Ariaens A, Haas RL, et al. Oncogenesis and classification of mixed-type liposarcoma: A radiological, histopathological and molecular biological analysis. Int J Cancer 2011;128:778-86.  Back to cited text no. 5
    


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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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