Differential Diagnosis of Lipoma and Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma by Cytological Analysis

2021 ◽  
Author(s):  
Kana Sugiyama ◽  
Kota Washimi ◽  
Shinya Sato ◽  
Toru Hiruma ◽  
Mai Sakai ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Detection Accuracy ◽  
Atypical Cell ◽  
Tissue Samples ◽  
Atypical Lipomatous Tumor ◽  
Lipomatous Tumor ◽  
Multinucleated Cells ◽  
Adipocytic Tumors ◽  
Atypical Cells ◽  
Well Differentiated

Abstract Background: Adipocytic tumors are the most common soft tissue tumors, with lipomas and atypical lipomatous tumor/well-differentiated liposarcomas (ALT/WDL) comprising the majority of cases. Preoperative differential diagnosis of lipoma or ALT/WDL can provide important information for decisions regarding treatment. We evaluated the cytological findings of 20 cases of lipoma and ALT/WDL.Methods: Fluorescence in situ hybridization (FISH) was performed on formalin-fixed paraffin-embedded specimens (FFPE) to examine mouse double minute 2 homolog (MDM2) amplification in all cases. Tissue samples were collected from the center of the surgical materials, stained with Papanicolaou, and evaluated for 12 cytological parameters by six cytotechnologists.Results: The findings regarding large atypical cells, multinucleated cells, and nuclear pleomorphism were highly concordant among the cytotechnologists and were associated with MDM2 amplification. Large atypical cells, considered a highly specific feature of ALT/WDL, were not observed in the lipoma cases. However, the sensitivity of the large atypical cell findings was not high (67%), and therefore, comprehensive evaluation of multinucleated cells and pleomorphism is crucial for predicting the diagnosis of ALT/WDL. FISH of MDM2 on Papanicolaou-stained specimens was performed in four cases. In two cases, the results were similar to those of MDM2 FISH performed on FFPE sections and were reproducible, whereas in two other cases, the signal could not be evaluated because of the strong background coloration. Conclusions: Cytology specimens may be useful for preoperative diagnosis of adipocytic tumors, particularly if the FISH conditions for Papanicolaou-stained specimens and the detection accuracy of MDM2 amplification can be improved.

scholarly journals A Scoring System Combining Clinical, Radiological, And Histopathological Examinations For Differential Diagnosis Between Lipoma And Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma

2021 ◽  
Author(s):  
Yohei Asano ◽  
Shinji Miwa ◽  
Norio Yamamoto ◽  
Katsuhiro Hayashi ◽  
Akihiko Takeuchi ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Differential Diagnosis ◽  
Diagnostic Accuracy ◽  
Predictive Factors ◽  
Scoring System ◽  
Regression Analyses ◽  
Multivariate Logistic Regression ◽  
Atypical Lipomatous Tumor ◽  
Lipomatous Tumor ◽  
Well Differentiated

Abstract This study evaluated the diagnostic accuracy of clinical, radiological, and histopathological examinations for differential diagnosis between atypical lipomatous tumor (ALT)/well-differentiated liposarcoma (WDLS) and lipoma, and aimed to develop a new combined scoring system for the preoperative diagnosis of ALT/WDLS. Eighty-nine ALT/WDLS and 56 lipomas were included and their clinical characteristics, magnetic resonance imaging (MRI) findings, histological findings by hematoxylin and eosin (HE) staining were investigated. Then, univariate and multivariate logistic regression analyses were performed for the findings, and a combined scoring system consisted of predictive factors of ALT/WDLS was developed. The univariate and multivariate logistic regression analyses revealed that tumor location (lower extremity), deep site, size (>11cm), thick septa (>2mm), enhancement of septa or nodular lesions, and lipoblasts were significantly different for the diagnosis of ALT/WDLS. We developed a combined scoring system based on the six predictive factors (total 0–16 points, the cutoff was 9 points). The area under the curve was 0.945, and sensitivity was 87.6% and specificity was 91.1% by the receiver operating characteristics curve. This combined scoring system does not require special equipment and reagents such as fluorescence in situ hybridization (FISH), and anyone can use it easily in many medical institutions with high diagnostic accuracy.

scholarly journals A scoring system combining clinical, radiological, and histopathological examinations for differential diagnosis between lipoma and atypical lipomatous tumor/well-differentiated liposarcoma

2021 ◽  
Author(s):  
Yohei Asano ◽  
Shinji Miwa ◽  
Norio Yamamoto ◽  
Katsuhiro Hayashi ◽  
Akihiko Takeuchi ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Differential Diagnosis ◽  
Predictive Factors ◽  
Scoring System ◽  
Regression Analyses ◽  
Multivariate Logistic Regression ◽  
Special Equipment ◽  
Atypical Lipomatous Tumor ◽  
Lipomatous Tumor ◽  
Well Differentiated

Abstract Background: Preoperative differential diagnosis between atypical lipomatous tumor (ALT)/well-differentiated liposarcoma (WDLS) and lipoma is important to determine the appropriate resection margin. However, since their radiological and histopathological findings are similar, it may be difficult to make a differential diagnosis. In this study, we evaluated the diagnostic accuracies of clinical, radiological, and histopathological examinations for diagnosing ALT/WDLS and developed a new combined scoring system.Methods: Eighty-nine ALT/WDLS and 56 lipomas were included and their clinical characteristics, magnetic resonance imaging (MRI) findings, histological findings by hematoxylin and eosin (HE) staining were investigated, and compared between ALT/WDLS and lipoma. Then, univariate analyses and multivariate logistic regression analyses were performed for the findings, and a combined scoring system consisted of predictive factors of ALT/WDLS was developed. Results: The univariate and multivariate logistic regression analyses revealed that tumor location (lower extremity), deep site, and size (>11cm), thick septa (>2mm), enhancement of septa or nodular lesions on MRI, and lipoblasts in HE staining were significantly different for the diagnosis of ALT/WDLS. Based on the six predictive factors, we developed a combined scoring system (total 0–16 points, the cutoff was 9 points). The mean score of ALT/WDLS was significantly higher than lipoma (11.9 vs. 5.6, p<0.0001). The area under the curve was 0.945, and sensitivity was 87.6% and specificity was 91.1% by the receiver operating characteristics curve.Conclusions: We developed a new combined scoring system based on comprehensive examinations that excluded examination which requires special equipment and reagents such as fluorescence in situ hybridization (FISH), and this can be used in many medical institutions. The diagnostic accuracy of ALT/WDLS was high and it may be useful for preoperative diagnosis and surgical plan.

“Fat-Rich” (Spindle Cell-Poor) Variant of Atypical Spindle Cell/Pleomorphic Lipomatous Tumor: Striking Mimic of “Classical” Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma

2019 ◽  
Vol 27 (8) ◽  
pp. 868-871 ◽  
Author(s):  
David Creytens ◽  
Thomas Mentzel ◽  
Liesbeth Ferdinande ◽  
Joost van Gorp ◽  
Jo Van Dorpe ◽  
...  
Keyword(s):  
Spindle Cell ◽  
Molecular Genetic ◽  
Low Grade ◽  
Tissue Mass ◽  
Atypical Lipomatous Tumor ◽  
Lipomatous Tumor ◽  
Multinucleated Cells ◽  
Pericytic Mimicry ◽  
Well Differentiated ◽  
The Right

We report the case of a “fat-rich” (spindle cell-poor) variant of an atypical spindle cell/pleomorphic lipomatous tumor in a 63-year-old female patient presenting with a firm, painless soft tissue mass on the right hip. Atypical spindle cell/pleomorphic lipomatous tumor is a very recently described low-grade adipocytic neoplasm, which occurs predominantly in adults with a predilection for the limbs and limb girdles. In the present case, the diagnosis of an atypical spindle cell/pleomorphic lipomatous tumor was challenging because the tumor was almost exclusively composed of an atypical adipocytic component (resembling “classical” atypical lipomatous tumor/well-differentiated tumor) with only very focal presence of the diagnostic atypical morphologic features (atypical spindle-shaped cells, floret-like multinucleated cells, and “bizarre” pleomorphic [multinucleated] cells). The possibility of a “classical” atypical lipomatous tumor/well-differentiated liposarcoma was ruled out by immunohistochemistry (lack of MDM2 expression and loss of Rb expression) and molecular genetic testing (no amplification of MDM2 and presence of monoallelic deletion of RB1). Another interesting morphologic observation in this case was the striking perivascular location of the atypical spindle/pleomorphic cells in some areas (so-called “pericytic mimicry”). To our knowledge, pericytic mimicry has not been reported in the setting of an atypical spindle cell/pleomorphic lipomatous tumor.

scholarly journals A scoring system combining clinical, radiological, and histopathological examinations for differential diagnosis between lipoma and atypical lipomatous tumor/well-differentiated liposarcoma

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Yohei Asano ◽  
Shinji Miwa ◽  
Norio Yamamoto ◽  
Katsuhiro Hayashi ◽  
Akihiko Takeuchi ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Differential Diagnosis ◽  
Diagnostic Accuracy ◽  
Predictive Factors ◽  
Scoring System ◽  
Regression Analyses ◽  
Multivariate Logistic Regression ◽  
Atypical Lipomatous Tumor ◽  
Lipomatous Tumor ◽  
Well Differentiated

AbstractThis study evaluated the diagnostic accuracy of clinical, radiological, and histopathological examinations for differential diagnosis between atypical lipomatous tumor (ALT)/well-differentiated liposarcoma (WDLS) and lipoma, and aimed to develop a new combined scoring system for the preoperative diagnosis of ALT/WDLS. Eighty-nine lipomas and 56 ALT/WDLS were included and their clinical characteristics, magnetic resonance imaging (MRI) findings, histological findings by hematoxylin and eosin (HE) staining were investigated. Then, univariate and multivariate logistic regression analyses were performed for the findings, and a combined scoring system consisted of predictive factors of ALT/WDLS was developed. The univariate and multivariate logistic regression analyses revealed that tumor location (lower extremity), deep site, size (> 11 cm), thick septa (> 2 mm), enhancement of septa or nodular lesions, and lipoblasts were significantly different for the diagnosis of ALT/WDLS. We developed a combined scoring system based on the six predictive factors (total 0–16 points, the cutoff was 9 points). The area under the curve was 0.945, and sensitivity was 87.6% and specificity was 91.1% by the receiver operating characteristics curve. This combined scoring system does not require special equipment and reagents such as fluorescence in situ hybridization (FISH), and anyone can use it easily in many medical institutions with high diagnostic accuracy.

Orbital Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma Masquerading as Pleomorphic Lipoma

2019 ◽  
Vol 35 (3) ◽  
pp. e76-e80 ◽  
Author(s):  
Kyle McKey ◽  
Paul J. L. Zhang ◽  
Carol L. Shields ◽  
Sara E. Lally ◽  
Ralph C. Eagle ◽  
...  
Keyword(s):  
Atypical Lipomatous Tumor ◽  
Lipomatous Tumor ◽  
Pleomorphic Lipoma ◽  
Well Differentiated

scholarly journals A Retrospective Study of Superficial Type Atypical Lipomatous Tumor

2020 ◽  
Vol 7 ◽  
Author(s):  
Emi Mashima ◽  
Yu Sawada ◽  
Natsuko Saito-Sasaki ◽  
Kayo Yamamoto ◽  
Shun Ohmori ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Tumor Size ◽  
Clinical Characteristics ◽  
Clinical Manifestations ◽  
Tumor Location ◽  
Atypical Lipomatous Tumor ◽  
Lipomatous Tumor ◽  
Physical Examinations ◽  
Superficial Type ◽  
Well Differentiated

Atypical lipomatous tumor (ALT) has been defined as a well-differentiated liposarcoma exhibiting a higher frequency of a local recurrence after surgical resection. ALT is mainly classified into deep type and superficial type. Compared with deep type ALT, superficial type ALT is rarely observed. One of the most important issues is that little has been known about superficial type ALT and it is not easy to predict the presence of superficial type ALT before surgical resection. To clarify the clinical manifestations of superficial type ALT, we examined 15 cases with superficial type ALT and 118 cases with benign lipoma, and analyzed their differences in clinical characteristics and the findings of MRI test. In clinical characteristics, the tumor size of superficial type ALT was significantly greater than that of benign lipoma, and superficial type ALT showed a significantly higher frequency of the tumor size of more than 4 cm. Superficial type ALT exhibited poor tumor mobility and hardness with elastic soft. In addition, a significantly higher frequency of tumor location of superficial type ALT was observed in extremities. Among tumor sites at the trunk, buttocks, and shoulder were high frequent location in superficial type ALT. In an MRI examination, superficial type ALT exhibited a significantly higher frequency of the septal structures compared with benign lipoma. The combinations of clinical characteristics, including physical examinations, MRI, and histological examinations, are helpful for the diagnosis of superficial type ALT.

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