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.^[20]

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

Complications

A case report describes liposarcoma complicating pregnancy.^[21]A myxoid liposarcoma was described in a psoriatic patient on adalimumab.^[22]A tumor-to-tumor metastasis of a prostatic adenocarcinoma metastasizing to a myxoid liposarcoma has been described, a most unusual coincidence.^[23]

Differential Diagnoses

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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. 2012 Mar 31. [QxMD MEDLINE Link].
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Buehler D, Marburger TB, Billings SD. Primary subcutaneous myxoid liposarcoma: a clinicopathologic review of three cases with molecular confirmation and discussion of the differential diagnosis. J Cutan Pathol. 2014 Dec. 41(12):907-15. [QxMD MEDLINE Link].
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Rodríguez-Cerdeira C, Neissa-Vasquez J, Carnero-Gregorio M, FiaÑo-Valverde C, Muñoz-Garzón V. Myxoid liposarcoma associated with adalimumab treatment: A case report. Mol Clin Oncol. 2019 Apr. 10 (4):454-456. [QxMD MEDLINE Link].
Miller V, Hoellwarth JS, Hankins ML, McGough R, Schoedel K. Tumor-to-Tumor Metastasis: Prostate Carcinoma Metastatic to Soft Tissue Sarcoma, a Previously Unreported Event. Int J Surg Pathol. 2020 Apr. 28 (2):196-199. [QxMD MEDLINE Link].
Monteiro EVE, Gaspar J, Paiva C, Correia R, Valente V, Coelho A, et al. Abdominal Actinomycosis misdiagnosed as liposarcoma. Autops Case Rep. 2020 Jan-Mar. 10 (1):e2020137. [QxMD MEDLINE Link].
Zubair M, Malik AA, Ali D, Farooq Q, Khokhar MI, Afzal MF. Giant lipoma of submandibular region; an unusual presentation. J Pak Med Assoc. 2021 Jan. 71 (1(A)):153-155. [QxMD MEDLINE Link].
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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. 2009 Apr. 107(4):e21-3. [QxMD MEDLINE Link].
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Chan WY, McHenry ID, Carter LM, Reall G, Wales CJ. Gingival liposarcoma: an unusual polyp. Br J Oral Maxillofac Surg. 2008 Mar. 46(2):150-1. [QxMD MEDLINE Link].
McElderry J, McKenney JK, Stack BC. High-grade liposarcoma metastatic to the gingival mucosa: case report and literature review. Am J Otolaryngol. 2008 Mar-Apr. 29(2):130-4. [QxMD MEDLINE Link].
Olaleye O, Fu B, Moorthy R, Lawson C, Black M, Mitchell D. Left supraclavicular spindle cell lipoma. Int J Otolaryngol. 2010. 2010:942152. [QxMD MEDLINE Link].
Young R, Snow H, Hendry S, Mitchell C, Slavin J, Schlicht S, et al. Correlation between percutaneous biopsy and final histopathology for retroperitoneal sarcoma: a single-centre study. ANZ J Surg. 2020 Feb 16. [QxMD MEDLINE Link].
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Media Gallery

Computed tomography (CT) scan of a left thigh shows a huge mass (arrows) with predominant fat attenuation. The central soft-tissue component (asterisk) and thick, internal septations are consistent with liposarcoma.

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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Coauthor(s)

Santiago A Centurion, MD Dermatologist, Dermatology Associates of Central NJ

Santiago A Centurion, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, American Society of Dermatopathology, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

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, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: Biogen US (Adjudicator for study entry cutaneous lupus erythematosus); Priovant (Adjudicator for entry into a dermatomyositis study); IQVIA (Serono - adjudicator for a study of cutaneous LE) <br/>Received honoraria from UpToDate for author/editor; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for these trust accounts for: Stocks held in various trust accounts: Allergen; Amgen; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble;; Celgene; Gilead; CVS; Walgreens; Bristol-Myers Squibb.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

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: Received consulting fee from Orfagen for consulting; Received consulting fee from Maruho for consulting; Received consulting fee from Astellas for consulting; Received consulting fee from Abbott for consulting; Received consulting fee from Leo Pharma for consulting; Received consulting fee from Biogenoma for consulting; Received honoraria from Janssen for speaking and teaching; Received honoraria from Medac for speaking and teaching; Received consulting fee from Dignity Sciences for consulting; .

Acknowledgements

Matthew J Trovato, MD Fellow, Division of Plastic Surgery, Rutgers New Jersey Medical School

Disclosure: Nothing to disclose.