Liposarcoma Clinical Presentation

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 20, 2012
 

History

Liposarcomas are most commonly found in the extremities; in the retroperitoneum; and, less often, in the head and neck area. These tumors are most likely to arise from deep-seated, well-vascularized structures than from submucosal or subcutaneous fat.

Liposarcomas of all subtypes can occur in the cutis and the subcutis; however, their primary occurrence in the skin is rare. Clinically, all cases of liposarcomas in the skin tend to grow in an exophytic manner, presenting as either dome-shaped or polypoid lesions. In all patients, the neoplasm is centered in the dermis, and it has a minimal tendency to grow downward into the underlying subcutaneous adipose tissue.

Most patients with liposarcoma have no symptoms until the tumor is large and impinges on neighboring structures, causing tenderness, pain, or functional disturbances. In the retroperitoneal area, where liposarcoma is detected at a late stage, the tumor may grow to a substantial size, weighing several pounds at the time of diagnosis. In general, liposarcoma grows silently, and the patient's estimation of the clinical duration is often unreliable. The patient eventually becomes aware of a swelling or a mass and reports this finding to the physician.

Patients may report the following:

  • Associated episode of trauma to the region containing the mass
  • Painful swelling (occurs in one third of cases for as long as 6 mo)
  • Decreased function (ie, range of motion)
  • Numbness
  • Enlargement of varicose veins
  • Fatigue
  • Abdominal pain
  • Weight loss
  • Nausea
  • Vomiting
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Physical

The 3 most common locations of involvement are the thighs, the retroperitoneum, and the inguinal region.

Liposarcoma usually appears as a well-circumscribed palpable mass as large as 10 cm in diameter. The mass tends to grow slowly over time. The lesion is commonly not tender on palpation. Diffuse abdominal enlargement may be observed in patients with retroperitoneal disease. Liposarcoma that resembles a skin tag has been reported but is an exceptionally rare event.[6]

Fascial compartmentalization may cause liposarcomas to have awkward discoid and fusiform shapes rather than smooth, round forms. Thus, liposarcoma can appear with an array of clinical morphologies and manifestations. Other aspects to note on physical examination are neurologic involvement and lymphadenopathy.

Pleomorphic liposarcoma is both uncommon and rarely occurs in the skin and subcutis.[7] They are most often located on an extremity, trunk, and head and neck and more often involve the subcutaneous, less so the subcutis or dermis.

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Causes

No well-established causative factor has been identified, although trauma has been implicated.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Matthew J Trovato, MD  Fellow, Division of Plastic Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Disclosure: Nothing to disclose.

Santiago A Centurion, MD  Staff Physician, Department of Dermatology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey

Santiago A Centurion, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Jacek C Szepietowski, MD, PhD  Professor, Vice-Head, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University; Director of the Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Poland

Disclosure: Stiefel GSK Company Salary Employment; Orfagen Consulting fee Consulting; Maruho Consulting fee Consulting; Astellas Consulting fee Consulting; Abbott Consulting fee Consulting; Leo Pharma Consulting fee Consulting

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD  Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology

Disclosure: Amgen Honoraria Consulting; Celgene Honoraria Safety Monitoring Committee

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Antonescu CR. The role of genetic testing in soft tissue sarcoma. Histopathology. Jan 2006;48(1):13-21. [Medline].

  2. Binh MB, Sastre-Garau X, Guillou L, et al. MDM2 and CDK4 immunostainings are useful adjuncts in diagnosing well-differentiated and dedifferentiated liposarcoma subtypes: a comparative analysis of 559 soft tissue neoplasms with genetic data. Am J Surg Pathol. Oct 2005;29(10):1340-7. [Medline].

  3. Skubitz KM, Cheng EY, Clohisy DR, Thompson RC, Skubitz AP. Differential gene expression in liposarcoma, lipoma, and adipose tissue. Cancer Invest. 2005;23(2):105-18. [Medline].

  4. Tayal S, Classen E, Bemis L, Robinson WA. C-kit expression in dedifferentiated and well-differentiated liposarcomas; immunohistochemistry and genetic analysis. Anticancer Res. May-Jun 2005;25(3B):2215-20. [Medline].

  5. Vocks E, Worret WI, Burgdorf WH. Myxoid liposarcoma in a 12-year-old girl. Pediatr Dermatol. Mar-Apr 2000;17(2):129-32. [Medline].

  6. Paredes BE, Mentzel T. Atypical Lipomatous Tumor/"Well-Differentiated Liposarcoma" of the Skin Clinically Presenting as a Skin Tag: Clinicopathologic, Immunohistochemical, and Molecular Analysis of 2 Cases. Am J Dermatopathol. Feb 24 2011;[Medline].

  7. 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;[Medline].

  8. Mustacchio V, Cabibi D, Minervini MI, Barresi E, Amato S. A diagnostic trap for the dermatopathologist: granulomatous reactions from cutaneous microimplants for cosmetic purposes. J Cutan Pathol. Mar 2007;34(3):281-3. [Medline].

  9. Gonçales ES, Almeida AS, Soares S, Oliveira DT. Silicone implant for chin augmentation mimicking a low-grade liposarcoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Apr 2009;107(4):e21-3. [Medline].

  10. Nascimento AF, Bertoni F, Fletcher CD. Epithelioid variant of myxofibrosarcoma: expanding the clinicomorphologic spectrum of myxofibrosarcoma in a series of 17 cases. Am J Surg Pathol. Jan 2007;31(1):99-105. [Medline].

  11. Chan WY, McHenry ID, Carter LM, Reall G, Wales CJ. Gingival liposarcoma: an unusual polyp. Br J Oral Maxillofac Surg. Mar 2008;46(2):150-1. [Medline].

  12. McElderry J, McKenney JK, Stack BC. High-grade liposarcoma metastatic to the gingival mucosa: case report and literature review. Am J Otolaryngol. Mar-Apr 2008;29(2):130-4. [Medline].

  13. Olaleye O, Fu B, Moorthy R, Lawson C, Black M, Mitchell D. Left supraclavicular spindle cell lipoma. Int J Otolaryngol. 2010;2010:942152. [Medline].

  14. 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. [Medline].

  15. 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. Nov 2006;33(11):1290-5. [Medline].

  16. Weaver J, Rao P, Goldblum JR, Joyce MJ, Turner SL, Lazar AJ, et al. Can MDM2 analytical tests performed on core needle biopsy be relied upon to diagnose well-differentiated liposarcoma?. Mod Pathol. May 21 2010;[Medline].

  17. Jones RL, Fisher C, Al-Muderis O, Judson IR. Differential sensitivity of liposarcoma subtypes to chemotherapy. Eur J Cancer. Dec 2005;41(18):2853-60. [Medline].

  18. 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. [Medline].

  19. Dalal KM, Antonescu CR, Singer S. Diagnosis and management of lipomatous tumors. J Surg Oncol. Mar 15 2008;97(4):298-313. [Medline].

  20. 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. [Medline].

  21. Hogg ME, Wayne JD. Atypical lipomatous tumor/well-differentiated liposarcoma: what is it?. Surg Oncol Clin N Am. Apr 2012;21(2):333-40. [Medline].

  22. 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;[Medline].

  23. Turcotte RE, Ferrone M, Isler MH, Wong C. Outcomes in patients with popliteal sarcomas. Can J Surg. Feb 2009;52(1):51-5. [Medline].

  24. Tebes S, Cardosi R, Hoffman M. Liposarcoma complicating pregnancy. Gynecol Oncol. Dec 2001;83(3):610-2. [Medline].

  25. Allen PW, Strungs I, MacCormac LB. Atypical subcutaneous fatty tumors: a review of 37 referred cases. Pathology. May 1998;30(2):123-35. [Medline].

  26. Azumi N, Curtis J, Kempson RL, Hendrickson MR. Atypical and malignant neoplasms showing lipomatous differentiation. A study of 111 cases. Am J Surg Pathol. Mar 1987;11(3):161-83. [Medline].

  27. Dei Tos AP, Mentzel T, Fletcher CD. Primary liposarcoma of the skin: a rare neoplasm with unusual high grade features. Am J Dermatopathol. Aug 1998;20(4):332-8. [Medline].

  28. Deyrup AT, Weiss SW. Grading of soft tissue sarcomas: the challenge of providing precise information in an imprecise world. Histopathology. Jan 2006;48(1):42-50. [Medline].

  29. Enzinger FM, Weiss SW. Liposarcoma. In: Enzinger and Weiss's Soft Tissue Tumors. 3rd ed. Mosby-Year Book; 1995.

  30. Evans HL. Liposarcomas and atypical lipomatous tumors. A study of 66 cases followed for a minimum of 10 years. Surg Pathol. 1988;1:41.

  31. Fleishman JS, Schwartz RA. Hibernoma: ultrastructural observations. J Surg Oncol. Aug 1983;23(4):285-9. [Medline].

  32. Guillén DR, Cockerell CJ. Cutaneous and subcutaneous sarcomas. Clin Dermatol. May-Jun 2001;19(3):262-8. [Medline].

  33. Mathew R, Morgan MB. Dermal atypical lipomatous tumor/well-differentiated liposarcoma obfuscated by epidermal inclusion cyst: a wolf in sheep's clothing?. Am J Dermatopathol. Aug 2006;28(4):338-40. [Medline].

  34. Matushansky I, Hernando E, Socci ND, et al. A developmental model of sarcomagenesis defines a differentiation-based classification for liposarcomas. Am J Pathol. Apr 2008;172(4):1069-80. [Medline].

  35. McCormick D, Mentzel T, Beham A, Fletcher CD. Dedifferentiated liposarcoma. Clinicopathologic analysis of 32 cases suggesting a better prognostic subgroup among pleomorphic sarcomas. Am J Surg Pathol. Dec 1994;18(12):1213-23. [Medline].

  36. Mentzel T. Cutaneous lipomatous neoplasms. Semin Diagn Pathol. Nov 2001;18(4):250-7. [Medline].

  37. Mentzel T. [Lipomatous tumors of the skin and soft tissue. New entities and concepts]. Pathologe. Nov 2000;21(6):441-8. [Medline].

  38. Nemanqani D, Mourad WA, Akhtar M, et al. Liposarcoma: A clinicopathological study of 73 cases diagnosed at King Faisal Specialist Hospital and Research Centre. Ann Saudi Med. Jul-Aug 1999;19(4):299-303. [Medline].

  39. Reis-Filho JS, Milanezi F, Soares MF, Fillus-Neto J, Schmitt FC. Intradermal spindle cell/pleomorphic lipoma of the vulva: case report and review of the literature. J Cutan Pathol. Jan 2002;29(1):59-62. [Medline].

  40. Uenotsuchi T, Imafuku S, Moroi Y, Urabe K, Furue M. Large subcutaneous liposarcoma arising from the chest wall. Eur J Dermatol. Jan-Feb 2005;15(1):43-5. [Medline].

  41. Weitzner S, Kornblum S. Subcutaneous liposarcoma of forearm. Am Surg. Mar 1972;38(3):176-8. [Medline].

 
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