Liposarcoma diagnostic study of choice

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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 definitive diagnosis of liposarcoma is made with biopsy, which also provides histopathological classification of the liposarcoma's sub-type.

Diagnostic 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.

Subtype	Findings
Atypical Lipomatous Neoplasm (ALN)/Well-Differentiated Liposarcoma (WDL)	4 subtypes: Lipoma-like Sclerosing Spindle cell Inflammatory Multivacuolated lipoblasts and spindle cells with hyperchromatic nuclei are often observed. Other findings include fibrotic areas and atypical stroma 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 and Enzinger and Weiss's Soft Tissue Tumors , 6th Edition

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.

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. 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.

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.

References

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