Liposarcoma diagnostic study of choice: Difference between revisions

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==Overview==
==Overview==
The definitive diagnosis of liposarcoma is made with biopsy, which also provides histopathological classification of the liposarcoma's sub-type.
The optimal method for [[diagnosis]] of liposarcoma is by [[biopsy]].  [[Biopsy]] also provides important [[Histopathology|histopathological]] information required to identify the sub-type of the liposarcoma.


==Diagnostic Study of Choice==
==Diagnostic Study of Choice==
===Study of Choice===
===Study of Choice===
Although imaging may be helpful in the diagnosis of liposarcoma, the optimal method for diagnosis of liposarcoma is by biopsy. Biopsy also provides important histopathological information required to identify the sub-type of the liposarcoma.
The optimal method for [[diagnosis]] of liposarcoma is by [[biopsy]]. [[Biopsy]] also provides important [[Histopathology|histopathological]] information required to identify the sub-type of the liposarcoma.


{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align=center
{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px" align="center"
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| valign="top" |
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! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Subtype}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Subtype}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Findings}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Findings}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Atypical Lipomatous Neoplasm (ALN)/Well-Differentiated Liposarcoma (WDL)
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Atypical lipomatous neoplasm (ALN)/Well-differentiated liposarcoma (WDL)
| style="padding: 5px 5px; background: #F5F5F5;" | 4 subtypes:<br>
| style="padding: 5px 5px; background: #F5F5F5;" | '''4 subtypes:'''<br>
*Lipoma-like<br>
*[[Lipoma]]-like<br>
*Sclerosing<br>
*[[Sclerosis|Sclerosing]]<br>
*Spindle cell<br>
*[[Spindle cell]]<br>
*Inflammatory<br>
*[[Inflammation|Inflammatory]]<br>
Multivacuolated lipoblasts and spindle cells with hyperchromatic nuclei are often observed.<br>Other findings include fibrotic areas and atypical stroma cells.
Multivacuolated lipoblasts and [[spindle cells]] with [[Hyperchromicity|hyperchromatic]] [[Cell nucleus|nuclei]] are often observed.<br>Other findings include [[Fibrosis|fibrotic]] areas and atypical [[stromal]] [[Cell (biology)|cells]].
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | De-differentiated Liposarcoma
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | De-differentiated liposarcoma
| style="padding: 5px 5px; background: #F5F5F5;" | Abrupt transition from a low-grade to a high-grade differentiation within the same mass of a well-differentiated liposarcoma.
| style="padding: 5px 5px; background: #F5F5F5;" | Abrupt transition from a low-grade to a high-grade differentiation within the same mass of a well-differentiated liposarcoma.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Myxoid liposarcoma
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Myxoid liposarcoma
| style="padding: 5px 5px; background: #F5F5F5;" |Multinodular mass with round cells and hyaluronic acid matrix.<br>High cellularity at the periphery and low cellularity at the center of the mass. Mitotic activity is normal and the nuclei are normochromatic.  
| style="padding: 5px 5px; background: #F5F5F5;" |[[Nodular|Multinodular]] mass with round [[Cell (biology)|cells]] and [[hyaluronic acid]] [[matrix]].<br>High [[Cell (biology)|cellularity]] at the periphery and low [[Cell (biology)|cellularity]] at the center of the mass. [[Mitosis|Mitotic]] activity is normal and the [[Cell nucleus|nuclei]] are [[Normochromic|normochromatic]].  
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Pleomorphic liposarcoma
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Pleomorphic liposarcoma
| style="padding: 5px 5px; background: #F5F5F5;" | Pleomorphic lipoblasts with hyperchromatic nuclei, acidophilic cytoplasm, and eosinophilic hyaline globules.<br>Spindle cells and multinucleated giant cells may be observed.  
| style="padding: 5px 5px; background: #F5F5F5;" | [[Pleomorphism|Pleomorphic]] lipoblasts with [[Hyperchromicity|hyperchromatic]] [[Cell nucleus|nuclei]], [[Acidophile|acidophilic]] [[cytoplasm]], and [[eosinophilic]] [[hyaline]] globules.<br>[[Spindle cells]] and [[multinucleated giant cells]] may be observed.  
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Mixed-type Liposarcoma
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Mixed-type liposarcoma
| style="padding: 5px 5px; background: #F5F5F5;" | Mixed features of myxoid, pleomorphic, and well-differentiated liposarcoma.  
| style="padding: 5px 5px; background: #F5F5F5;" | Mixed features of myxoid, [[Pleomorphism|pleomorphic]], and well-differentiated liposarcoma.  
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" colspan=2| <small>Table adapted from Fletcher CDM, Unni KK, Mertens F, eds. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Soft Tissue and Bone. Geneva:IARC Press; 2002<ref>{{cite book | last = Fletcher | first = Christopher | title = Pathology and genetics of tumours of soft tissue and bone | publisher = IARC Press | location = Lyon | year = 2002 | isbn = 9283224132 }}</ref> and Enzinger and Weiss's Soft Tissue Tumors , 6th Edition <ref>{{cite book | last = Goldblum | first = John | title = Enzinger and Weiss's soft tissue tumors | publisher = Saunders/Elsevier | location = Philadelphia, PA | year = 2014 | isbn = 978-0-323-08834-3 }}</ref> </small>
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" | <small>Table adapted from Fletcher CDM, Unni KK, Mertens F, eds. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Soft Tissue and Bone. Geneva:IARC Press; 2002<ref>{{cite book | last = Fletcher | first = Christopher | title = Pathology and genetics of tumours of soft tissue and bone | publisher = IARC Press | location = Lyon | year = 2002 | isbn = 9283224132 }}</ref> and Enzinger and Weiss's Soft Tissue Tumors , 6th Edition <ref>{{cite book | last = Goldblum | first = John | title = Enzinger and Weiss's soft tissue tumors | publisher = Saunders/Elsevier | location = Philadelphia, PA | year = 2014 | isbn = 978-0-323-08834-3 }}</ref> </small>
|-
|-
|}
|}


===Staging===
===Staging===
The staging of liposarcoma is based on the TNM classification, which includes primary tumor spread, [[lymph node]] involvement, and presence of [[metastasis]].
The [[Cancer staging|staging]] of liposarcoma is based on the [[TNM classification]], which includes primary [[tumor]] spread, [[lymph node]] involvement, and presence of [[metastasis]].


{|
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{| style="border: 0px; font-size: 90%; margin: 3px; width: 350px;" align="center"
|valign=top|
| valign="top" |
|+
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! style="background: #4479BA;" colspan=2 | {{fontcolor|#FFF|Primary Tumor (T)}}
! colspan="2" style="background: #4479BA;" | {{fontcolor|#FFF|Primary Tumor (T)}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; width: 50px;" | Tx
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; width: 50px;" | Tx
| style="padding: 5px 5px; background: #F5F5F5;; width: 300px;" | Tumor cannot be assessed.
| style="padding: 5px 5px; background: #F5F5F5;; width: 300px;" | [[Tumor]] cannot be assessed
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;"|T0
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" |T0
| style="padding: 5px 5px; background: #F5F5F5;" | No evidence of primary tumor.
| style="padding: 5px 5px; background: #F5F5F5;" | No evidence of primary [[tumor]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |T1
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |T1
| style="padding: 5px 5px; background: #F5F5F5;" | Tumor ≤ 5 cm
| style="padding: 5px 5px; background: #F5F5F5;" | [[Tumor]] ≤ 5 cm
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:T1a
:T1a
| style="padding: 5px 5px; background: #F5F5F5;" | Superficial tumor <small>(not invading the fascia)</small>
| style="padding: 5px 5px; background: #F5F5F5;" | [[Superficial (human anatomy)|Superficial]] [[tumor]] <small>(not invading the [[fascia]])</small>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:T1b
:T1b
| style="padding: 5px 5px; background: #F5F5F5;" | Deep tumor
| style="padding: 5px 5px; background: #F5F5F5;" | Deep [[tumor]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |T2
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |T2
| style="padding: 5px 5px; background: #F5F5F5;" | Tumor > 5 cm
| style="padding: 5px 5px; background: #F5F5F5;" | [[Tumor]] > 5 cm
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:T2a
:T2a
| style="padding: 5px 5px; background: #F5F5F5;" | Superficial tumor <small>(not invading the fascia)</small>
| style="padding: 5px 5px; background: #F5F5F5;" | [[Superficial (human anatomy)|Superficial]] [[tumor]] <small>(not invading the [[fascia]])</small>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:T2b
:T2b
| style="padding: 5px 5px; background: #F5F5F5;" | Deep tumor
| style="padding: 5px 5px; background: #F5F5F5;" | Deep [[tumor]]
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" colspan=2|<small> Retrieved from the National Cancer Institute. Adapted from AJCC: Soft tissue sarcoma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 291-8. <ref name="NCI"> {{cite web| url=http://www.cancer.gov/cancertopics/pdq/treatment/adult-soft-tissue-sarcoma/HealthProfessional/page3#Section_197| title= National Cancer Institute - Stage Information for Adult Soft Tissue Sarcoma}} </ref></small>
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |<small> Retrieved from the National Cancer Institute. Adapted from AJCC: Soft tissue sarcoma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 291-8. <ref name="NCI">{{cite web| url=http://www.cancer.gov/cancertopics/pdq/treatment/adult-soft-tissue-sarcoma/HealthProfessional/page3#Section_197| title= National Cancer Institute - Stage Information for Adult Soft Tissue Sarcoma}} </ref></small>
|}
|}
|
|
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| valign="top" |
{| style="border: 0px; font-size: 90%; margin: 3px; width: 350px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px; width: 350px;" align="center"
|valign=top|
| valign="top" |
|+
|+
! style="background: #4479BA;" colspan=2 | {{fontcolor|#FFF|Lymph Nodes (N)}}
! colspan="2" style="background: #4479BA;" | {{fontcolor|#FFF|Lymph Nodes (N)}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; width: 50px;" |NX
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; width: 50px;" |NX
| style="padding: 5px 5px; background: #F5F5F5;; width: 300px;" | Lymph nodes cannot be assessed.
| style="padding: 5px 5px; background: #F5F5F5;; width: 300px;" | [[Lymph node|Lymph nodes]] cannot be assessed
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |N0
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |N0
| style="padding: 5px 5px; background: #F5F5F5;" | No regional lymph node involvement.
| style="padding: 5px 5px; background: #F5F5F5;" | No regional [[lymph node]] involvement
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |N1
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |N1
| style="padding: 5px 5px; background: #F5F5F5;" |Regional lymph node involvement.
| style="padding: 5px 5px; background: #F5F5F5;" |Regional [[lymph node]] involvement  
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" colspan=2|<small> Retrieved from the National Cancer Institute. Adapted from AJCC: Soft tissue sarcoma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 291-8. <ref name="NCI"> {{cite web| url=http://www.cancer.gov/cancertopics/pdq/treatment/adult-soft-tissue-sarcoma/HealthProfessional/page3#Section_197| title= National Cancer Institute - Stage Information for Adult Soft Tissue Sarcoma}} </ref></small>
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |<small> Retrieved from the National Cancer Institute. Adapted from AJCC: Soft tissue sarcoma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 291-8. <ref name="NCI">{{cite web| url=http://www.cancer.gov/cancertopics/pdq/treatment/adult-soft-tissue-sarcoma/HealthProfessional/page3#Section_197| title= National Cancer Institute - Stage Information for Adult Soft Tissue Sarcoma}} </ref></small>
|}
|}
{| style="border: 0px; font-size: 90%; margin: 3px; width: 350px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px; width: 350px;" align="center"
|valign=top|
| valign="top" |
|+
|+
! style="background: #4479BA;" colspan=2 | {{fontcolor|#FFF|Metastasis (M)}}
! colspan="2" style="background: #4479BA;" | {{fontcolor|#FFF|Metastasis (M)}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; width: 50px;" | M0
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; width: 50px;" | M0
| style="padding: 5px 5px; background: #F5F5F5;; width: 300px;" | No distant metastasis
| style="padding: 5px 5px; background: #F5F5F5;; width: 300px;" | No distant [[metastasis]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |M1
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |M1
| style="padding: 5px 5px; background: #F5F5F5;" | Distant metastasis
| style="padding: 5px 5px; background: #F5F5F5;" | Distant [[metastasis]]
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" colspan=2|<small> Retrieved from the National Cancer Institute. Adapted from AJCC: Soft tissue sarcoma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 291-8. <ref name="NCI"> {{cite web| url=http://www.cancer.gov/cancertopics/pdq/treatment/adult-soft-tissue-sarcoma/HealthProfessional/page3#Section_197| title= National Cancer Institute - Stage Information for Adult Soft Tissue Sarcoma}} </ref></small>
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |<small> Retrieved from the National Cancer Institute. Adapted from AJCC: Soft tissue sarcoma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 291-8. <ref name="NCI">{{cite web| url=http://www.cancer.gov/cancertopics/pdq/treatment/adult-soft-tissue-sarcoma/HealthProfessional/page3#Section_197| title= National Cancer Institute - Stage Information for Adult Soft Tissue Sarcoma}} </ref></small>
|}
|}
|}
|}


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| style="background: #4479BA; font-weight: bold; width: 100px;" | {{fontcolor|#FFF|Stages}}
| style="background: #4479BA; font-weight: bold; width: 100px;" | {{fontcolor|#FFF|Stages}}
Line 158: Line 158:
| style="padding: 5px 5px; background: #F5F5F5;" | Any grade
| style="padding: 5px 5px; background: #F5F5F5;" | Any grade
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" colspan=5|<small> Retrieved from the National Cancer Institute. Adapted from AJCC: Soft tissue sarcoma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 291-8.<ref name="NCI"> {{cite web| url=http://www.cancer.gov/cancertopics/pdq/treatment/adult-soft-tissue-sarcoma/HealthProfessional/page3#Section_197| title= National Cancer Institute - Stage Information for Adult Soft Tissue Sarcoma}} </ref></small>
| colspan="5" style="padding: 5px 5px; background: #F5F5F5;" |<small> Retrieved from the National Cancer Institute. Adapted from AJCC: Soft tissue sarcoma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 291-8.<ref name="NCI">{{cite web| url=http://www.cancer.gov/cancertopics/pdq/treatment/adult-soft-tissue-sarcoma/HealthProfessional/page3#Section_197| title= National Cancer Institute - Stage Information for Adult Soft Tissue Sarcoma}} </ref></small>
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Latest revision as of 15:37, 28 May 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Sabawoon Mirwais, M.B.B.S, M.D.[2]

Overview

The optimal method for diagnosis of liposarcoma is by biopsy. Biopsy also provides important histopathological information required to identify the sub-type of the liposarcoma.

Diagnostic Study of Choice

Study of Choice

The optimal method for diagnosis of liposarcoma is by biopsy. Biopsy also provides important histopathological information required to identify the sub-type of the liposarcoma.

Subtype Findings
Atypical lipomatous neoplasm (ALN)/Well-differentiated liposarcoma (WDL) 4 subtypes:

Multivacuolated lipoblasts and spindle cells with hyperchromatic nuclei are often observed.
Other findings include fibrotic areas and atypical stromal cells.

De-differentiated liposarcoma Abrupt transition from a low-grade to a high-grade differentiation within the same mass of a well-differentiated liposarcoma.
Myxoid liposarcoma Multinodular mass with round cells and hyaluronic acid matrix.
High cellularity at the periphery and low cellularity at the center of the mass. Mitotic activity is normal and the nuclei are normochromatic.
Pleomorphic liposarcoma Pleomorphic lipoblasts with hyperchromatic nuclei, acidophilic cytoplasm, and eosinophilic hyaline globules.
Spindle cells and multinucleated giant cells may be observed.
Mixed-type liposarcoma Mixed features of myxoid, pleomorphic, and well-differentiated liposarcoma.
Table adapted from Fletcher CDM, Unni KK, Mertens F, eds. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Soft Tissue and Bone. Geneva:IARC Press; 2002[1] and Enzinger and Weiss's Soft Tissue Tumors , 6th Edition [2]

Staging

The staging of liposarcoma is based on the TNM classification, which includes primary tumor spread, lymph node involvement, and presence of metastasis.

Primary Tumor (T)
Tx Tumor cannot be assessed
T0 No evidence of primary tumor
T1 Tumor ≤ 5 cm
T1a
 Superficial tumor (not invading the fascia)
T1b
 Deep tumor
T2 Tumor > 5 cm
T2a
 Superficial tumor (not invading the fascia)
T2b
 Deep tumor
Retrieved from the National Cancer Institute. Adapted from AJCC: Soft tissue sarcoma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 291-8. [3]
Lymph Nodes (N)
NX Lymph nodes cannot be assessed
N0 No regional lymph node involvement
N1 Regional lymph node involvement
Retrieved from the National Cancer Institute. Adapted from AJCC: Soft tissue sarcoma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 291-8. [3]
Metastasis (M)
M0 No distant metastasis
M1 Distant metastasis
Retrieved from the National Cancer Institute. Adapted from AJCC: Soft tissue sarcoma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 291-8. [3]
Stages Primary Tumor (T) Lymph Node (N) Metastasis (M) Histopathological Grading
Stage IA T1a, T1b N0 M0 Low grade
Stage IB T2a, T2b N0 M0 Low grade
Stage IIA T1a, T1b N0 M0 High grade
Stage IIB T2a, T2b N0 M0 High grade
Stage III Any T N0, N1 M0 High grade
Stage IV Any T Any N M1 Any grade
Retrieved from the National Cancer Institute. Adapted from AJCC: Soft tissue sarcoma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 291-8.[3]

References

  1. ↑ Fletcher, Christopher (2002). Pathology and genetics of tumours of soft tissue and bone. Lyon: IARC Press. ISBN 9283224132.
  2. ↑ Goldblum, John (2014). Enzinger and Weiss's soft tissue tumors. Philadelphia, PA: Saunders/Elsevier. ISBN 978-0-323-08834-3.
  3. ↑ 3.0 3.1 3.2 3.3 "National Cancer Institute - Stage Information for Adult Soft Tissue Sarcoma".


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