Liposarcoma Clinical Presentation

Updated: Mar 18, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Presentation

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. Myxoid liposarcoma is usually evident as a deep-seated mass in the lower extremity of adults, but it may be less commonly be first evident as a primary subcutaneous mass. [15]

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 Examination

The three 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. [16]

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. [14] 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. It may be evident as a painless pedunculated pink papulonodule. [17]

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Complications

A case report describes liposarcoma complicating pregnancy. [18] A myxoid liposarcoma was described in a psoriatic patient on adalimumab. [19] A tumor-to-tumor metastasis of a prostatic adenocarcinoma metastasizing to a myxoid liposarcoma has been described, a most unusual coincidence. [20]

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