Dedifferentiated liposarcoma

Definition

A malignant tumour consisting of both well differentiated liposarcoma and a transformed non-lipogenic component.

Epidemiology

Dedifferentiation is much more common in retroperitoneal well differentiated liposarcoma than in those occurring in the limbs. 90% of cases are primary, 10% of instances of dedifferentiation occur in recurrences.

Radiology

Imaging shows both lipomatous and non-lipomatous components.

Macroscopic appearances

Usually a fatty tumour with discrete solid non-fatty dedifferentiated areas.

Histopathology

The transition from well differentiated liposarcoma to dedifferentiated areas is usually abrupt but may be gradual. The dedifferentiated component is usually high grade, MFH-like pleomorphic sarcoma or myxofibrosarcoma. Less often the dedifferentiated areas are low grade non-lipogenic tumour. Heterologous elements include myogenic, osteosarcomatous, chondrosarcomatous and angiosarcomatous components and are present in 5-10% of cases. A meningiothelial-like concentric pattern has been described, associated with ossification.

Immunohistochemistry

Identifies heterologous elements.

Cytogenetics

There are ring or giant marker chromosome, as seen in well differentiated liposarcoma. The complex karyotypic abnormalities seen in pleomorphic liposarcoma are not seen.

Differential diagnosis

High grade sarcomas not arising by dedifferentiation of liposarcoma.

Prognosis

The prognosis is better than that for other high grade sarcomas. Overall, 40% recur locally, but almost all retroperitoneal cases eventually recur. 15-20% show distant metastases. The extent of the dedifferentiated areas and the presence of heterologous elements does not affect prognosis. The prognostic significance of microscopic foci of dedifferentiation is uncertain. Dedifferentiated liposarcoma may recur as well differentiated liposarcoma.

References

World Health Organization Classification of Tumours, Tumours of Soft Tissues and Bone, IARC Press 2002.

 

This page last revised 4.2.2006.

©SMUHT/PW Bishop