Abstract
Liposarcoma is the single most common soft tissue sarcoma accounting for up to 35 % of sarcomas. It represents a histologically diverse group of soft tissue tumors that demonstrate a wide range of imaging appearances with varied behavior patterns. Correspondingly, more aggressive histological subtypes often require management that includes a combination of surgery, chemotherapy, and radiation therapy. Distinguishing among liposarcoma subtypes has important therapeutic and prognostic implications. In this manuscript, we review the liposarcoma subtypes and their histologic and MRI findings, prognostic implications, and differential diagnostic considerations.
Similar content being viewed by others
References
Brennan MF, Antonescu CR, Moraco N, Singer S. Lessons learned from the study of 10,000 patients with soft tissue sarcoma. Ann Surg. 2014;260(3):416–21. discussion 21–2.
Fletcher C. WHO classification of tumours of soft tissue and bone. IARC. 2013:19–46.
Fiore M, Grosso F, Lo Vullo S, Pennacchioli E, Stacchiotti S, Ferrari A, et al. Myxoid/round cell and pleomorphic liposarcomas: prognostic factors and survival in a series of patients treated at a single institution. Cancer. 2007;109(12):2522–31.
Murphey M, Arcara LK, Fanburg-Smith J. From the archives of the AFIP: imaging of musculoskeletal liposarcoma with radiologic-pathologic correlation. Radiographics. 2005;25(5):1371–95.
Jones RL, Fisher C, Al-Muderis O, Judson IR. Differential sensitivity of liposarcoma subtypes to chemotherapy. Eur J Cancer. 2005;41(18):2853–60.
Kransdorf MJ, Bancroft LW, Peterson JJ, Murphey MD, Foster WC, Temple HT. Imaging of fatty tumors: distinction of lipoma and well-differentiated liposarcoma. Radiology. 2002;224(1):99–104.
Kransdorf MJ. Malignant soft-tissue tumors in a large referral population: distribution of diagnoses by age, sex, and location. AJR Am J Roentgenol. 1995;164(1):129–34.
Brisson M, Kashima T, Delaney D, Tirabosco R, Clarke A, Cro S, et al. MRI characteristics of lipoma and atypical lipomatous tumor/well-differentiated liposarcoma: retrospective comparison with histology and MDM2 gene amplification. Skelet Radiol. 2013;42(5):635–47.
Gaskin CM, Helms CA. Lipomas, lipoma variants, and well-differentiated liposarcomas (atypical lipomas): results of MRI evaluations of 126 consecutive fatty masses. AJR Am J Roentgenol. 2004;182(3):733–9.
O’Donnell PW, Griffin AM, Eward WC, Sternheim A, White LM, Wunder JS, et al. Can experienced observers differentiate between lipoma and well-differentiated liposarcoma using only MRI? Sarcoma. 2013;2013:982784.
Oliveira AM, Nascimento AG. Pleomorphic liposarcoma. Semin Diagn Pathol. 2001;18(4):274–85.
Bestic JM, Kransdorf MJ, White LM, Bridges MD, Murphey MD, Peterson JJ, et al. Sclerosing variant of well-differentiated liposarcoma: relative prevalence and spectrum of CT and MRI features. AJR Am J Roentgenol. 2013;201(1):154–61.
Gebhard S, Coindre JM, Michels JJ, Terrier P, Bertrand G, Trassard M, et al. Pleomorphic liposarcoma: clinicopathologic, immunohistochemical, and follow-up analysis of 63 cases: a study from the French Federation of Cancer Centers Sarcoma Group. Am J Surg Pathol. 2002;26(5):601–16.
Spillane AJ, Fisher C, Thomas JM. Myxoid liposarcoma—the frequency and the natural history of nonpulmonary soft tissue metastases. Ann Surg Oncol. 1999;6(4):389–94.
Fuglo HM, Maretty-Nielsen K, Hovgaard D, Keller JO, Safwat AA, Petersen MM. Metastatic pattern, local relapse, and survival of patients with myxoid liposarcoma: a retrospective study of 45 patients. Sarcoma. 2013;2013:548628.
Kilpatrick SE, Doyon J, Choong PF, Sim FH, Nascimento AG. The clinicopathologic spectrum of myxoid and round cell liposarcoma. A study of 95 cases. Cancer. 1996;77(8):1450–8.
O’Regan KN, Jagannathan J, Krajewski K, Zukotynski K, Souza F, Wagner AJ, et al. Imaging of liposarcoma: classification, patterns of tumor recurrence, and response to treatment. AJR Am J Roentgenol. 2011;197(1):W37–43.
Tateishi U, Hasegawa T, Beppu Y, Kawai A, Satake M, Moriyama N. Prognostic significance of MRI findings in patients with myxoid-round cell liposarcoma. AJR Am J Roentgenol. 2004;182(3):725–31.
Antonescu CR, Tschernyavsky SJ, Decuseara R, Leung DH, Woodruff JM, Brennan MF, et al. Prognostic impact of P53 status, TLS-CHOP fusion transcript structure, and histological grade in myxoid liposarcoma: a molecular and clinicopathologic study of 82 cases. Clin Cancer Res. 2001;7(12):3977–87.
Hasegawa T, Seki K, Hasegawa F, Matsuno Y, Shimodo T, Hirose T, et al. Dedifferentiated liposarcoma of retroperitoneum and mesentery: varied growth patterns and histological grades—a clinicopathologic study of 32 cases. Hum Pathol. 2000;31(6):717–27.
Henricks WH, Chu YC, Goldblum JR, Weiss SW. Dedifferentiated liposarcoma: a clinicopathological analysis of 155 cases with a proposal for an expanded definition of dedifferentiation. Am J Surg Pathol. 1997;21(3):271–81.
Weiss S, Goldblum J. Liposarcoma. In: Enzinger and Weiss’s soft tissue tumors. St Louis: Mosby; 2001.
Hornick JL, Bosenberg MW, Mentzel T, McMenamin ME, Oliveira AM, Fletcher CD. Pleomorphic liposarcoma: clinicopathologic analysis of 57 cases. Am J Surg Pathol. 2004;28(10):1257–67.
Peterson JJ, Kransdorf MJ, Bancroft LW, O’Connor MI. Malignant fatty tumors: classification, clinical course, imaging appearance and treatment. Skelet Radiol. 2003;32(9):493–503.
Pretell-Mazzini J, Barton Jr MD, Conway SA, Temple HT. Unplanned excision of soft-tissue sarcomas: current concepts for management and prognosis. J Bone Joint Surg Am. 2015;97(7):597–603.
Nikolaidis P, Silverman SG, Cibas ES, Vansonnenberg E, Rybicki FJ, Manola JB, et al. Liposarcoma subtypes: identification with computed tomography and ultrasound-guided percutaneous needle biopsy. Eur Radiol. 2005;15(2):383–9.
Ikoma N, Torres KE, Somaiah N, Hunt KK, Cormier JN, Tseng W, et al. Accuracy of preoperative percutaneous biopsy for the diagnosis of retroperitoneal liposarcoma subtypes. Ann Surg Oncol. 2015;22(4):1068–72.
Mavrogenis AF, Lesensky J, Romagnoli C, Alberghini M, Letson GD, Ruggieri P. Atypical lipomatous tumors/well-differentiated liposarcomas: clinical outcome of 67 patients. Orthopedics. 2011;34(12):e893–8.
Mussi CE, Daolio P, Cimino M, Giardina F, De Sanctis R, Morenghi E, et al. Atypical lipomatous tumors: should they be treated like other sarcoma or not? Surgical consideration from a bi-institutional experience. Ann Surg Oncol. 2014;21(13):4090–7.
Lahat G, Anaya DA, Wang X, Tuvin D, Lev D, Pollock RE. Resectable well-differentiated versus dedifferentiated liposarcomas: two different diseases possibly requiring different treatment approaches. Ann Surg Oncol. 2008;15(6):1585–93.
Azumi N, Curtis J, Kempson RL, Hendrickson MR. Atypical and malignant neoplasms showing lipomatous differentiation. A study of 111 cases. Am J Surg Pathol. 1987;11(3):161–83.
Kito M, Yoshimura Y, Isobe K, Aoki K, Momose T, Suzuki S, et al. Clinical outcome of deep-seated atypical lipomatous tumor of the extremities with median-term follow-up study. Eur J Surg Oncol. 2015;41(3):400–6.
Canter RJ, Borys D, Olusanya A, Li CS, Lee LY, Boutin RD, et al. Phase I trial of neoadjuvant conformal radiotherapy plus sorafenib for patients with locally advanced soft tissue sarcoma of the extremity. Ann Surg Oncol. 2014;21(5):1616–23.
Wang WL, Katz D, Araujo DM, Ravi V, Ludwig JA, Trent JC, et al. Extensive adipocytic maturation can be seen in myxoid liposarcomas treated with neoadjuvant doxorubicin and ifosfamide and pre-operative radiation therapy. Clin Sarcoma Res. 2012;2(1):25.
Di Giandomenico S, Frapolli R, Bello E, Uboldi S, Licandro SA, Marchini S, et al. Mode of action of trabectedin in myxoid liposarcomas. Oncogene. 2014;33(44):5201–10.
Evans HL. Liposarcomas and atypical lipomatous tumors: a study of 66 cases followed for a minimum of 10 years. Surg Pathol. 1988;1:41–54.
Nascimento AG. Dedifferentiated liposarcoma. Semin Diagn Pathol. 2001;18(4):263–6.
Eilber FC, Eilber FR, Eckardt J, Rosen G, Riedel E, Maki RG, et al. The impact of chemotherapy on the survival of patients with high-grade primary extremity liposarcoma. Ann Surg. 2004;240(4):686–95. discussion 95–7.
Griffin N, Khan N, Thomas JM, Fisher C, Moskovic EC. The radiological manifestations of intramuscular haemangiomas in adults: magnetic resonance imaging, computed tomography and ultrasound appearances. Skelet Radiol. 2007;36(11):1051–9.
Wild AT, Raab P, Krauspe R. Hemangioma of skeletal muscle. Arch Orthop Trauma Surg. 2000;120(3–4):139–43.
Yilmaz S, Kozakewich HP, Alomari AI, Fishman SJ, Mulliken JB, Chaudry G. Intramuscular capillary-type hemangioma: radiologic-pathologic correlation. Pediatr Radiol. 2014;44(5):558–65.
Nielsen GP, Dickersin GR, Provenzal JM, Rosenberg AE. Lipomatous hemangiopericytoma. A histologic, ultrastructural and immunohistochemical study of a unique variant of hemangiopericytoma. Am J Surg Pathol. 1995;19(7):748–56.
Craig WD, Fanburg-Smith JC, Henry LR, Guerrero R, Barton JH. Fat-containing lesions of the retroperitoneum: radiologic-pathologic correlation. Radiographics. 2009;29(1):261–90.
Rossi A, Incensati R. Bone tissue in adrenal myelolipoma: a case report. Tumori. 1998;84(1):90–3.
Gatcombe HG, Assikis V, Kooby D, Johnstone PA. Primary retroperitoneal teratomas: a review of the literature. J Surg Oncol. 2004;86(2):107–13.
Li F, Tian R, Yin C, Dai X, Wang H, Xu N, et al. Liposarcoma of the spermatic cord mimicking a left inguinal hernia: a case report and literature review. World J Surg Oncol. 2013;11:18.
Folpe AL, Weiss SW. Pleomorphic hyalinizing angiectatic tumor: analysis of 41 cases supporting evolution from a distinctive precursor lesion. Am J Surg Pathol. 2004;28(11):1417–25.
Subhawong TK, Subhawong AP, Montgomery EA, Fayad LM. Pleomorphic hyalinizing angiectatic tumor: imaging findings. Skelet Radiol. 2012;41(12):1621–6.
Lee SA, Chung HW, Cho KJ, Sung CK, Lee SH, Lee MH, et al. Encapsulated fat necrosis mimicking subcutaneous liposarcoma: radiologic findings on MR, PET-CT, and US imaging. Skelet Radiol. 2013;42(10):1465–70.
Grobmyer SR, Brennan MF. Predictive variables detailing the recurrence rate of soft tissue sarcomas. Curr Opin Oncol. 2003;15(4):319–26.
Grimer R, Judson I, Peake D, Seddon B. Guidelines for the management of soft tissue sarcomas. Sarcoma. 2010;2010:506182.
Casali PG, Jost L, Sleijfer S, Verweij J, Blay JY, Group EGW. Soft tissue sarcomas: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2008;19(2):ii89–93.
Leyvraz S, Jelic S, Force EGT. ESMO minimum clinical recommendations for diagnosis, treatment and follow-up of soft tissue sarcomas. Ann Oncol. 2005;16 Suppl 1:i69–70.
Issakov J, Soyfer V, Kollender Y, Bickels J, Meller I, Merimsky O. Liposarcoma in adult limbs treated by limb-sparing surgery and adjuvant radiotherapy. J Bone Joint Surg (Br). 2006;88(12):1647–51.
Sheah K, Ouellette HA, Torriani M, Nielsen GP, Kattapuram S, Bredella MA. Metastatic myxoid liposarcomas: imaging and histopathologic findings. Skelet Radiol. 2008;37(3):251–8.
Patel SR, Zagars GK, Pisters PW. The follow-up of adult soft-tissue sarcomas. Semin Oncol. 2003;30(3):413–6.
James SL, Davies AM. Post-operative imaging of soft tissue sarcomas. Cancer Imaging. 2008;8:8–18.
Cheney MD, Giraud C, Goldberg SI, Rosenthal DI, Hornicek FJ, Choy E, et al. MRI surveillance following treatment of extremity soft tissue sarcoma. J Surg Oncol. 2014;109(6):593–6.
Roberts C, Kransdorf M, Beaman BD. American College of Radiology ACR Appropriateness Criteria® : Follow-up of Malignant or Aggressive Musculoskeletal Tumors. Available at https://acsearch.acr.org/docs/69428/Narrative/. American College of Radiology. Accessed 1/2016.2015.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The author(s) declare that they have no competing interests.
Rights and permissions
About this article
Cite this article
Rizer, M., Singer, A.D., Edgar, M. et al. The histological variants of liposarcoma: predictive MRI findings with prognostic implications, management, follow-up, and differential diagnosis. Skeletal Radiol 45, 1193–1204 (2016). https://doi.org/10.1007/s00256-016-2409-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-016-2409-4