Skip to main content
SpringerLink
Log in

Mosaic-pattern dedifferentiation in liposarcoma and chondrosarcoma: imaging features of an uncommon form of dedifferentiation

  • Case Report
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

The term “dedifferentiation” was classically used in sarcoma pathology to refer to tumors in which a high-grade, undifferentiated sarcoma, or a high-grade sarcoma showing heterologous differentiation, arises from a pre-existing neoplasm of borderline or low-grade malignancy. The best recognized examples of this include dedifferentiated liposarcoma, arising from atypical lipomatous tumor/well-differentiated liposarcoma, and dedifferentiated chondrosarcoma, arising from grade 1 hyaline chondrosarcoma of bone. In the overwhelming majority of cases, this dedifferentiated, high-grade sarcoma presents as a macroscopically visible mass, adjacent to and clearly distinct from the pre-existing low-grade lesion. It is less well appreciated that dedifferentiation may also occur in a so-called “mosaic pattern,’ in which the high-grade component is intimately admixed with elements of the precursor lesion, forming only microscopically apparent foci. This mosaic or co-mingling pattern of dedifferentiation is also reflected in the MR imaging appearance. In contrast to the classic pattern of dedifferentiation in which there are two distinct juxtaposed masses with different signal intensities and enhancement patterns, such changes are not seen in mosaic dedifferentiation. The imaging features of this pattern of dedifferentiation have not been described. In this report we describe the imaging features of two patients with mosaic pattern dedifferentiation, one with liposarcoma and one with chondrosarcoma. In both cases the precursor lesion was correctly diagnosed by pre-biopsy imaging, but the presence of high-grade sarcoma was not recognized.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Goldblum JR, Folpe AL, Weiss SW. Liposarcoma. Enzinger & Weiss’s soft tissue tumors. 6th ed. Philadelphia: Elsevier; 2014. p. 484–523.

    Google Scholar 

  2. Dahlin DC, Beabout JW. Dedifferentiation of low-grade chondrosarcomas. Cancer. 1971;28(2):461–6.

    Article  CAS  PubMed  Google Scholar 

  3. Evans HL. Liposarcoma: a study of 55 cases with a reassessment of its classification. Am J Surg Pathol. 1979;3(6):507–23.

    Article  CAS  PubMed  Google Scholar 

  4. Fleming GF, Heimann PS, Stephens JK, Simon MA, Ferguson MK, Benjamin RS, et al. Dedifferentiated chordoma. Response to aggressive chemotherapy in two cases. Cancer. 1993;72(3):714–8.

    Article  CAS  PubMed  Google Scholar 

  5. Fukuda T, Ohnishi Y. Histological and immunohistochemical observations of dedifferentiated leiomyosarcoma of the uterus. Acta Pathol Jpn. 1991;41(6):466–72.

    CAS  PubMed  Google Scholar 

  6. Thway K, Hayes A, Ieremia E, Fisher C. Heterologous osteosarcomatous and rhabdomyosarcomatous elements in dedifferentiated solitary fibrous tumor: further support for the concept of dedifferentiation in solitary fibrous tumor. Ann Diagn Pathol. 2013;17(5):457–63.

    Article  PubMed  Google Scholar 

  7. Agaimy A, Specht K, Stoehr R, Lorey T, Markl B, Niedobitek G, et al. Metastatic malignant melanoma with complete loss of differentiation markers (undifferentiated/dedifferentiated melanoma): analysis of 14 patients emphasizing phenotypic plasticity and the value of molecular testing as surrogate diagnostic marker. Am J Surg Pathol. 2016;40(2):181–91.

    PubMed  Google Scholar 

  8. Kransdorf MJ, Meis JM, Jelinek JS. Dedifferentiated liposarcoma of the extremities: imaging findings in four patients. AJR Am J Roentgenol. 1993;161(1):127–30.

    Article  CAS  PubMed  Google Scholar 

  9. Meis JM, Dorfman HD, Nathanson SD, Haggar AM, Wu KK. Primary malignant giant cell tumor of bone: “dedifferentiated” giant cell tumor. Mod Pathol. 1989;2(5):541–6.

    CAS  PubMed  Google Scholar 

  10. Elgar F, Goldblum JR. Well-differentiated liposarcoma of the retroperitoneum: a clinicopathologic analysis of 20 cases, with particular attention to the extent of low-grade dedifferentiation. Mod Pathol. 1997;10(2):113–20.

    CAS  PubMed  Google Scholar 

  11. 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.

    Article  CAS  PubMed  Google Scholar 

  12. Dodd LG. Update on liposarcoma: a review for cytopathologists. Diagn Cytopathol. 2012;40(12):1122–31.

    Article  PubMed  Google Scholar 

  13. Iwasa Y, Nakashima Y. Dedifferentiated liposarcoma with lipoma-like well-differentiated liposarcoma: clinicopathological study of 30 cases, with particular attention to the comingling pattern of well- and dedifferentiated components: a proposal for regrouping of the present subclassification of well-differentiated liposarcoma and dedifferentiated liposarcoma. Int J Surg Pathol. 2013;21(1):15–21.

    Article  PubMed  Google Scholar 

  14. Eustace S, Baker N, Lan H, Wadhwani A, Dorfman D. MR imaging of dedifferentiated chondrosarcoma. Clin Imaging. 1997;21(3):170–4.

    Article  CAS  PubMed  Google Scholar 

  15. Ippolito V, Brien EW, Menendez LR, Mirra JM. Case report 797: “dedifferentiated” lipoma-like liposarcoma of soft tissue with focal transformation to high-grade “sclerosing” osteosarcoma. Skelet Radiol. 1993;22(8):604–8.

    Article  CAS  Google Scholar 

  16. Littrell LA, Wenger DE, Wold LE, Bertoni F, Unni KK, White LM, et al. Radiographic, CT, and MR imaging features of dedifferentiated chondrosarcomas: a retrospective review of 174 de novo cases. Radiographics. 2004;24(5):1397–409.

    Article  PubMed  Google Scholar 

  17. Murphey MD, 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.

    Article  PubMed  Google Scholar 

  18. Tsuchiya H, Tomita K, Yasutake H, Takagi Y, Ueda Y, Kadoya M. Maffucci’s syndrome combined with dedifferentiated chondrosarcoma. Arch Orthop Trauma Surg. 1991;110(5):269–72.

    Article  CAS  PubMed  Google Scholar 

  19. Murphey MD, Walker EA, Wilson AJ, Kransdorf MJ, Temple HT, Gannon FH. From the archives of the AFIP: imaging of primary chondrosarcoma: radiologic-pathologic correlation. Radiographics. 2003;23(5):1245–78.

    Article  PubMed  Google Scholar 

  20. Mitchell AD, Ayoub K, Mangham DC, Grimer RJ, Carter SR, Tillman RM. Experience in the treatment of dedifferentiated chondrosarcoma. J Bone Jt Surg Br. 2000;82(1):55–61.

    Article  CAS  Google Scholar 

  21. Dalal KM, Kattan MW, Antonescu CR, Brennan MF, Singer S. Subtype specific prognostic nomogram for patients with primary liposarcoma of the retroperitoneum, extremity, or trunk. Ann Surg. 2006;244(3):381–91.

  22. Weiss SW, Rao VK. Well-differentiated liposarcoma (atypical lipoma) of deep soft tissue of the extremities, retroperitoneum, and miscellaneous sites. A follow-up study of 92 cases with analysis of the incidence of “dedifferentiation.” Am J Surg Pathol. 1992;16(11):1051–58.

  23. Mercuri M, Picci P, Campanacci L, Rulli E. Dedifferentiated chondrosarcoma. Skeletal Radiol. 1995;24(6):409-16.

Download references

Acknowledgements

We would like to thank Andrew L. Folpe, MD, Mayo Clinic, Rochester, MN, for his assistance in the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA

    Kevin Taylor & Mark J. Kransdorf

  2. Department of Orthopedic Surgery, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA

    Adam J. Schwartz

  3. Center for Musculoskeletal Care, Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 1450 Chapel Street, New Haven, CT, 06511, USA

    Mary I. O’Connor

  4. Department of Laboratory Medicine and Pathology, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA

    Matthew A. Zarka

Authors
  1. Kevin Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark J. Kransdorf
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Adam J. Schwartz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mary I. O’Connor
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthew A. Zarka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark J. Kransdorf.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Taylor, K., Kransdorf, M.J., Schwartz, A.J. et al. Mosaic-pattern dedifferentiation in liposarcoma and chondrosarcoma: imaging features of an uncommon form of dedifferentiation. Skeletal Radiol 47, 877–882 (2018). https://doi.org/10.1007/s00256-017-2866-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-017-2866-4

Keywords

Search

Navigation