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Liposarcoma

Liposarcoma is a rare malignancy of fat cells. It occurs especially in the retroperitoneal tissues and the thigh.

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Presentation

The following are the signs and symptoms of liposarcoma:

Pain
  • After these therapies, bone pain persisted and bone scintigraphy showed increased activity in L4, T11, and T12 vertebrae. Zoledronic acid was added to trabectedin treatment.[ncbi.nlm.nih.gov]
  • Depending on where the tumor is, you may have any of the following: Chest pain Trouble swallowing or weight loss Trouble urinating or pain while urinating Pain and swelling in the area of your tumor Coughing or trouble speaking and breathing Decreased[disabled-world.com]
  • Many people do not feel sick or have pain.[medicinenet.com]
Swelling
  • A man with left scrotal swelling felt to represent inguinal hernia underwent computed tomography scan for reported bleeding after prostate biopsy.[ncbi.nlm.nih.gov]
  • Initially the swellings were smaller in size, but gradually increased in size over a period of one year and thereafter the size of the swellings remained constant. On local examination, four swellings were seen in the groin area ( fig. 1) .[edoj.org.eg]
  • This pressure may cause pain, swelling, or disrupt the function of nearby organs, such as the lungs, liver, or other abdominal organs. Causes A liposarcoma in the legs may cause swelling.[medicalnewstoday.com]
Weight Loss
  • Abstract We present a rare case of a big oesophageal liposarcoma causing dysphagia and weight loss in a 75-year-old patient.[ncbi.nlm.nih.gov]
  • In addition, individuals with liposarcoma may experience abdominal pain and cramps, nausea, vomiting, weight loss, fatigue, vomiting blood and appearance of blood in stools.[symptoma.com]
  • Retroperitoneal tumors may present themselves with signs of weight loss and emaciation and abdominal pain. These tumors may also compress the kidney or ureter leading to kidney failure.[disabled-world.com]
Fatigue
  • Liposarcoma Symptom Fatigue Fatigue can be described as the lack of energy and motivation (both physical and mental). This is different than drowsiness, a term that describes the need to sleep.[medicinenet.com]
  • A-84-year-old male was a consult to our Emergency Department with symptoms of a terrible general fatigue, abdominal pain, and vomiting. Abdominal ultrasonography and computed tomography (CT) revealed probable intussusception.[ncbi.nlm.nih.gov]
  • In addition, individuals with liposarcoma may experience abdominal pain and cramps, nausea, vomiting, weight loss, fatigue, vomiting blood and appearance of blood in stools.[symptoma.com]
Leg Swelling
  • Liposarcomas, like all sarcomas, are rare. [3] Signs and symptoms [ edit ] Left leg swelling caused by underlying liposarcoma Patients usually note a deep-seated mass in their soft tissue.[en.wikipedia.org]
Abdominal Pain
  • A-84-year-old male was a consult to our Emergency Department with symptoms of a terrible general fatigue, abdominal pain, and vomiting. Abdominal ultrasonography and computed tomography (CT) revealed probable intussusception.[ncbi.nlm.nih.gov]
  • In addition, individuals with liposarcoma may experience abdominal pain and cramps, nausea, vomiting, weight loss, fatigue, vomiting blood and appearance of blood in stools.[symptoma.com]
  • Retroperitoneal tumors may present themselves with signs of weight loss and emaciation and abdominal pain. These tumors may also compress the kidney or ureter leading to kidney failure.[disabled-world.com]
Vomiting
  • In addition, individuals with liposarcoma may experience abdominal pain and cramps, nausea, vomiting, weight loss, fatigue, vomiting blood and appearance of blood in stools.[symptoma.com]
  • A 73-year-old male patient was seen in May 1995 in the Ear, Nose and Throat (ENT) Department, Clinica Modelo de Morón, with intermittent dysphagia and dyspnoea due to recurrent vomiting.[ncbi.nlm.nih.gov]
Nausea
  • The second patient had symptoms of upper abdominal discomfort combined with nausea and anorexia. Several palpable masses were found with endoscopy. Endoscopic submucosal dissection was the treatment used, and the postoperative course was uneventful.[ncbi.nlm.nih.gov]
  • In addition, individuals with liposarcoma may experience abdominal pain and cramps, nausea, vomiting, weight loss, fatigue, vomiting blood and appearance of blood in stools.[symptoma.com]
  • However, symptoms and signs may include the following, depending on the location of the tumor : Painful swelling and/or a lump developing under the skin Numbness Fatigue Abdominal pain Chest pain Urinary difficulties Swallowing difficulties Nausea Vomiting[medicinenet.com]
Abdominal Mass
  • It is clear that our patient presented all the signs and symptoms specific for these tumors due to the size of the abdominal mass.[wjso.biomedcentral.com]
  • Dedifferentiated liposarcoma of the retroperitoneum in a 67-year-old man who presented with an enlarging abdominal mass. (a) Abdominal radiograph from a barium enema study shows a large abdominal mass that displaces opacified bowel to the left.[pubs.rsna.org]
  • View larger version (171K) Fig. 4 — 51-year-old woman who presented with abdominal mass.[ajronline.org]
Blood in Stool
  • In addition, individuals with liposarcoma may experience abdominal pain and cramps, nausea, vomiting, weight loss, fatigue, vomiting blood and appearance of blood in stools.[symptoma.com]
  • […] in stool When to see a doctor Make an appointment with your doctor if you have any persistent signs or symptoms that worry you.[mayoclinic.org]
Palpitations
  • A 61-year-old woman presented with melaena, epigastric discomfort and palpitations. Upper endoscopy revealed a submucosal tumour at the posterior gastric fundus with an actively bleeding ulcer on the top.[ncbi.nlm.nih.gov]
Long Arm
  • arm of chromosome 12; (2) myxoid and round cell (poorly differentiated myxoid) liposarcoma, characterized in most cases by a reciprocal translocation t(12;16)(q13;p11); and (3) pleomorphic liposarcoma, characterized by complex karyotypes.[ncbi.nlm.nih.gov]
Diplopia
  • She remained asymptomatic for 2 years following surgery, after which she abruptly developed diplopia with right lateral gaze. There were no symptoms of raised intracranial pressure or impaired vision.[ncbi.nlm.nih.gov]
Subcutaneous Mass
  • The patient was hospitalized in our department for tumour recurrence in June 2012, and a subcutaneous mass around 2 3 cm with medium hardness and poor mobility in the inner side of the right thigh near groin could be palpated.[orthopedics.imedpub.com]
  • Most superficial lipomas are small and they are only very rarely greater than 10cm in size. 4a 4b Figure 4: T1 and FSE T2-weighted sagittal images in a 63 year-old with swelling palmar to the index and long fingers reveal a lobulated subcutaneous mass[radsource.us]
  • The single benign lesion that could be mistaken for PLS is pleomorphic lipoma, but the latter typically arises as a well-circumscribed subcutaneous mass in the posterior neck, upper shoulders or back of middle-aged males ( 20 ).[nature.com]
  • (a, b) Coronal T1-weighted (500/20) (a) and axial T2-weighted (2500/90) (b) MR images show a largely lipomatous subcutaneous mass (*) with prominent thick and nodular septa (arrows).[pubs.rsna.org]
Neck Swelling
  • The patient presented with a right sided neck swelling associated with pain and shortness of breath upon lying down.[ncbi.nlm.nih.gov]
Neck Swelling
  • The patient presented with a right sided neck swelling associated with pain and shortness of breath upon lying down.[ncbi.nlm.nih.gov]
Kidney Failure
  • These tumors may also compress the kidney or ureter leading to kidney failure. Diagnosis The diagnosis is established by histologic examination of the tissue, i.e., biopsy or excision.[oncologica.com]
  • These tumors may also compress the kidney or ureter leading to kidney failure. Histological patterns vary from round cell, myxoid, well differentiated, and pleomorphic type.[curesarcoma.org]
  • These tumors may also compress the kidney or ureter, leading to kidney failure.[en.wikipedia.org]
  • They can also cause kidney failure due to the tumor putting pressure on the kidneys or ureter. Diagnosis & Treatment The first step to diagnosing liposarcoma is to have a physical exam done by a physician.[knowcancer.com]
  • These tumors may also compress the kidney or ureter leading to kidney failure.[disabled-world.com]
Scrotal Mass
  • Computed tomography scan revealed a 15-cm extratesticular left scrotal mass containing both fat and soft tissue components, raising concern for dedifferentiated liposarcoma.[ncbi.nlm.nih.gov]

Workup

A physical exam of the lump forms the primary basis of diagnosis of liposarcoma. Lumps that are 5cm or larger, are deep seated, and fixed to the structures are candidates for further examination. Following physical examination of the lump, imaging studies such as MRI, CT scan and X-ray are done. MRI being the most reliable in differentiating normal fat from lipomatous tumors in liposarcoma [6]. Positron emission tomography (PET) with FDG uptake imaging may improve risk assessment compared to traditional staging methods [7].

In addition, biopsy of the mass is suggested which is done either through needle biopsy or surgical biopsy. Based on the test results and location of the tumor, the treatment plan is chalked out. The use of cytogenetics in the diagnosis of cutaneous lipomatous tumors may be helpful especially in the identification of chromosomal abnormalities [8].

Pericardial Effusion
  • We present the case of a 47-year-old woman diagnosed with a large mediastinal mass with intrapericardial invasion and massive pericardial effusion; biopsies showed a mediastinal liposarcoma.[ncbi.nlm.nih.gov]

Treatment

Surgery usually forms the first line of treatment for individuals with liposarcoma. This is however, the method of choice only when the cancer has not spread to other parts of the body. In this procedure, the tumor along with a part of the healthy tissue is surgically removed to avoid the spread of the cancer. In majority of the cases, the affected limb can be spared by only removing the tumor. However, 5% of the cases may require limb amputation to completely eradicate the cancer from the body. In atypical cutaneous liposarcoma, removal by liposuction has been ardently described [9].

Tumors that develop in the abdomen cannot be completely removed and therefore in such situations a combination of methods has to be employed. Surgery along with radiation therapy is used in such cases. Radiation therapy at the site of surgery reduces the rate of recurrence of the tumor in about 80 – 90% cases.

Radiation therapy can also be administered prior to the surgical procedures to shrink the size of the tumor. However, this causes a delay in healing of the surgical wounds. Depending on the site and nature of the tumor various treatment methods are employed.

The role of chemotherapy in treatment of liposarcoma is still not well understood. But it is still recommended in conditions when the disease has spread to other parts of the body. How far the method would help in arresting the growth is yet to be analyzed and confirmed. Combination therapy with radiotherapy and chemotherapy has been found to be effective in treating high grade liposarcoma [10].

Prognosis

Prognosis of the disease condition greatly depends on location of the tumor and its extent of spread to other areas of the body [2]. With surgical removal of the tumor, chances of recurrence exist and are higher for those tumors that are deep seated compared to the superficial ones. Liposarcoma located in the extremities heralds a good prognosis [3]. The well differentiated type and the myxoid type of liposarcoma have 5 year survival rate of 100% and 88% respectively [4]. However, high grade lesions have a poor prognosis with high rates of recurrence. The rate of 5 year survival period varies based on the type of liposarcoma.

Complications

The most common and obvious complication of liposarcoma is the spread of the malignant tumor to other parts of the body. Therefore, early diagnosis of the disease followed by prompt treatment is utmost necessary to arrest the spread of the tumor to other vital organs. If such a condition is not prevented then it can cause life threatening complications.

Etiology

The exact factor that is causing liposarcoma is not known. There have been instances where patients have reported to develop a tumor after an accident or injury. However, there are no evidences that suggest development of liposarcoma from trauma. Also, such type of cancers is not known to stem from benign lipomas.

Epidemiology

Liposarcoma is amongst the 50 types of sarcoma known to affect thousands of individuals across the globe. Such a type of sarcoma was first described in the year 1980 by Virchow. Liposarcoma affects about 2.5 million individuals across the globe. It is the most common form of soft tissue sarcoma accounting for about 17% of all soft tissues sarcomas.

It has also been estimated that liposarcoma strikes more commonly the male population. Incidence of mortality for individuals with high grade liposarcoma is very high. Liposarcoma have been recorded to occur in young adults and teenagers, while those occurring in children are relatively rare [1].

Sex distribution
Age distribution

Pathophysiology

Liposarcoma is a form of lipogenic tumor that affects the deep layer of connective tissues. It occurs due to chromosomal abnormalities that create fusion proteins leading to development of cancer cells. Chromosomal abnormality of band 12q13 is known to play foul in the causation of liposarcomas.

Prevention

Cancer cannot be prevented; however the spread of the disease can be arrested with prompt diagnosis and initiation of the treatment. The recurrence of liposarcoma post treatment can be prevented by regular follow up with the doctors and checkups. Routine checkup becomes a part of life for patients surviving liposarcoma. MRI and CT scan of the original location is done in addition to X-rays of other areas to study metastasis.

Summary

Liposarcoma is a type of cancer of fat cells that occurs in the deep layers of the connective tissues. It can occur in any part of the body, but the most common areas are the abdomen and thigh regions. It mostly affects the adults in the age group of 40 to 60 years. In children usually teenagers fall prey to such a disease condition.

Liposarcoma is of four types differentiated on the nature of the malignant tumor cells. Treatment involves surgical procedures to remove the tumor cells. In addition, radiation and chemotherapy may also be required to arrest the growth of the tumor cells.

Patient Information

Definition

Liposarcoma is cancer of the fatty tissues and it majorly strikes areas of the lower extremities. It is a type of soft tissue sarcoma that primarily affects the adults and in rare cases children. Liposarcoma is divided into 4 different categories based on the nature and grade of the tumor cells.

Cause

The exact cause behind the abnormal development of cells in the fatty tissues is yet to be figured out. However, chromosomal defect is the one which is known to play foul in the causation of liposarcoma.

Symptoms

The lump forms beneath the skin and is firm to touch and is attached to the structures. In addition, individuals with liposarcoma may experience abdominal pain and cramps, nausea, vomiting, weight loss, fatigue, vomiting blood and appearance of blood in stools.

Diagnosis

Careful examination of the lump is the primary diagnosis of liposarcoma. In addition, CT scan and MRI of the lump are done to further analyze the nature of the tumor. Biopsy is required to understand the nature of the tumor.

Treatment

The treatment for liposarcoma depends on the extent of spread of the tumor and its original location. Surgery is employed when the tumor has not spread to other parts. A combination of radiation therapy and surgery may be done in certain cases.

References

Article

  1. Vocks E, Worret WI, Burgdorf WH. Myxoid liposarcoma in a 12-year-old girl. Pediatr Dermatol. Mar-Apr 2000; 17(2):129-32.
  2. Oda Y, Yamamoto H, Takahira T, et al. Frequent alteration of p16(INK4a)/p14(ARF) and p53 pathways in the round cell component of myxoid/round cell liposarcoma: p53 gene alterations and reduced p14(ARF) expression both correlate with poor prognosis. J Pathol. Dec 2005; 207(4):410-21.
  3. Hogg ME, Wayne JD. Atypical lipomatous tumor/well-differentiated liposarcoma: what is it? Surg Oncol Clin N Am. Apr 2012; 21(2):333-40.
  4. Nishida Y, Tsukushi S, Nakashima H, Ishiguro N. Clinicopathologic Prognostic Factors of Pure Myxoid Liposarcoma of the Extremities and Trunk Wall. Clin Orthop Relat Res. May 25 2010.
  5. Gardner JM, Dandekar M, Thomas D, Goldblum JR, Weiss SW, Billings SD, et al. Cutaneous and Subcutaneous Pleomorphic Liposarcoma: A Clinicopathologic Study of 29 Cases With Evaluation of MDM2 Gene Amplification in 26. Am J Surg Pathol. Mar 31 2012
  6. Lee YM, Chung HW, Shin MJ, Lee SH, Kim SS, Lee JS, Kim MJ. Musculoskeletal magnetic resonance imaging suggesting the possibility of liposarcoma: correlation between radiologists' certainty of diagnosis and pathology results. J Comput Assist Tomogr. 2011; 35(4):512-6 (ISSN: 1532-3145)
  7. Brenner W, Eary JF, Hwang W, Vernon C, Conrad EU. Risk assessment in liposarcoma patients based on FDG PET imaging. Eur J Nucl Med Mol Imaging. 2006; 33(11):1290-5 (ISSN: 1619-7070)
  8. Brandal P, Bjerkehagen B, Heim S. Rearrangement of chromosomal region 8q11-13 in lipomatous tumours: correlation with lipoblastoma morphology. J Pathol. Feb 2006; 208(3):388-94
  9. Sharma PK, Janniger CK, Schwartz RA, Rauscher GE, Lambert WC. The treatment of atypical lipoma with liposuction. J Dermatol Surg Oncol. Apr 1991; 17(4):332-4
  10. Dalal KM, Antonescu CR, Singer S. Diagnosis and management of lipomatous tumors. J Surg Oncol. Mar 15 2008; 97(4):298-313.

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Last updated: 2019-07-11 22:26