Analysis of dedifferentiated liposarcomas emphasizing the diagnostic dilemmas
Introduction: Dedifferentiated liposarcoma (DDLPS) is defined as a progression of well-differentiated liposarcoma (WDLPS) to another nonlipogenic sarcoma. Since a variety of heterologous sarcomas can be encountered in dedifferentiation, clinical dilemmas arise. The present study analyzed the role of...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Thieme Medical and Scientific Publishers Pvt. Ltd.
2020-01-01
|
| Series: | Indian Journal of Medical and Paediatric Oncology |
| Subjects: | |
| Online Access: | http://www.ijmpo.org/article.asp?issn=0971-5851;year=2020;volume=41;issue=1;spage=39;epage=46;aulast=Lali |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849703128109154304 |
|---|---|
| author | Bhagat Singh Lali Hema Kini Shrijeet Chakraborti Jyoti Kini Pooja K Suresh |
| author_facet | Bhagat Singh Lali Hema Kini Shrijeet Chakraborti Jyoti Kini Pooja K Suresh |
| author_sort | Bhagat Singh Lali |
| collection | DOAJ |
| description | Introduction: Dedifferentiated liposarcoma (DDLPS) is defined as a progression of well-differentiated liposarcoma (WDLPS) to another nonlipogenic sarcoma. Since a variety of heterologous sarcomas can be encountered in dedifferentiation, clinical dilemmas arise. The present study analyzed the role of clinicopathologic and immunohistochemical (IHC) features in the diagnosis of DDLPS and its differentiation from mimics. Materials and Methods: A retrospective and prospective study was conducted wherein all cases of liposarcoma from 2012 to 2017 were reviewed. DDLPS cases were identified among pleomorphic lesions. Clinical and histopathological details for these cases were retrieved from medical records section and department archives. Histomorphology and immunohistochemistry (MDM2, S100, and Ki-67) were analyzed for these cases. Results: Among 37 cases of liposarcomas reviewed, DDLPS was diagnosed in 12 cases (32.4%). Mean age of the patients was 54.3 years with equal gender distribution (M:F =1:1.2). Two patients had recurrent tumors. Most were retroperitoneal (58.3%) with mean duration of symptoms being 8.7 months. Mean tumor dimension was 17.5 cm. High-grade dedifferentiated component was most common (83.3%) with only one case each (8.3%) of low-grade and homologous dedifferentiation. Undifferentiated pleomorphic sarcoma was the frequent nonlipogenic sarcoma. MDM2 overexpression was detected in 100%, focal S100 positivity seen in 66.6%, and mean Ki-67 labeling index was 24. Conclusion: DDLPS exhibits aggressive clinical behavior. Adequate sampling, correlation to clinical details, demonstration of transition from WDLPS to DDLPS aid in narrowing the differentials. Immunostaining with MDM2 helps in definite categorization and S100 highlights lipoblasts, when they are not easily identifiable. MDM2, CDK4, and p16 IHC panel is recommended in all cases and fluorescence in situ hybridization analysis where IHC is noncontributory. |
| format | Article |
| id | doaj-art-0f7cb7ccb8ca45b2a1ba379b221b456e |
| institution | DOAJ |
| issn | 0971-5851 0975-2129 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Indian Journal of Medical and Paediatric Oncology |
| spelling | doaj-art-0f7cb7ccb8ca45b2a1ba379b221b456e2025-08-20T03:17:24ZengThieme Medical and Scientific Publishers Pvt. Ltd.Indian Journal of Medical and Paediatric Oncology0971-58510975-21292020-01-01411394610.4103/ijmpo.ijmpo_129_19Analysis of dedifferentiated liposarcomas emphasizing the diagnostic dilemmasBhagat Singh LaliHema KiniShrijeet ChakrabortiJyoti KiniPooja K SureshIntroduction: Dedifferentiated liposarcoma (DDLPS) is defined as a progression of well-differentiated liposarcoma (WDLPS) to another nonlipogenic sarcoma. Since a variety of heterologous sarcomas can be encountered in dedifferentiation, clinical dilemmas arise. The present study analyzed the role of clinicopathologic and immunohistochemical (IHC) features in the diagnosis of DDLPS and its differentiation from mimics. Materials and Methods: A retrospective and prospective study was conducted wherein all cases of liposarcoma from 2012 to 2017 were reviewed. DDLPS cases were identified among pleomorphic lesions. Clinical and histopathological details for these cases were retrieved from medical records section and department archives. Histomorphology and immunohistochemistry (MDM2, S100, and Ki-67) were analyzed for these cases. Results: Among 37 cases of liposarcomas reviewed, DDLPS was diagnosed in 12 cases (32.4%). Mean age of the patients was 54.3 years with equal gender distribution (M:F =1:1.2). Two patients had recurrent tumors. Most were retroperitoneal (58.3%) with mean duration of symptoms being 8.7 months. Mean tumor dimension was 17.5 cm. High-grade dedifferentiated component was most common (83.3%) with only one case each (8.3%) of low-grade and homologous dedifferentiation. Undifferentiated pleomorphic sarcoma was the frequent nonlipogenic sarcoma. MDM2 overexpression was detected in 100%, focal S100 positivity seen in 66.6%, and mean Ki-67 labeling index was 24. Conclusion: DDLPS exhibits aggressive clinical behavior. Adequate sampling, correlation to clinical details, demonstration of transition from WDLPS to DDLPS aid in narrowing the differentials. Immunostaining with MDM2 helps in definite categorization and S100 highlights lipoblasts, when they are not easily identifiable. MDM2, CDK4, and p16 IHC panel is recommended in all cases and fluorescence in situ hybridization analysis where IHC is noncontributory.http://www.ijmpo.org/article.asp?issn=0971-5851;year=2020;volume=41;issue=1;spage=39;epage=46;aulast=Lalidedifferentiatedliposarcomamdm2sarcoma |
| spellingShingle | Bhagat Singh Lali Hema Kini Shrijeet Chakraborti Jyoti Kini Pooja K Suresh Analysis of dedifferentiated liposarcomas emphasizing the diagnostic dilemmas Indian Journal of Medical and Paediatric Oncology dedifferentiated liposarcoma mdm2 sarcoma |
| title | Analysis of dedifferentiated liposarcomas emphasizing the diagnostic dilemmas |
| title_full | Analysis of dedifferentiated liposarcomas emphasizing the diagnostic dilemmas |
| title_fullStr | Analysis of dedifferentiated liposarcomas emphasizing the diagnostic dilemmas |
| title_full_unstemmed | Analysis of dedifferentiated liposarcomas emphasizing the diagnostic dilemmas |
| title_short | Analysis of dedifferentiated liposarcomas emphasizing the diagnostic dilemmas |
| title_sort | analysis of dedifferentiated liposarcomas emphasizing the diagnostic dilemmas |
| topic | dedifferentiated liposarcoma mdm2 sarcoma |
| url | http://www.ijmpo.org/article.asp?issn=0971-5851;year=2020;volume=41;issue=1;spage=39;epage=46;aulast=Lali |
| work_keys_str_mv | AT bhagatsinghlali analysisofdedifferentiatedliposarcomasemphasizingthediagnosticdilemmas AT hemakini analysisofdedifferentiatedliposarcomasemphasizingthediagnosticdilemmas AT shrijeetchakraborti analysisofdedifferentiatedliposarcomasemphasizingthediagnosticdilemmas AT jyotikini analysisofdedifferentiatedliposarcomasemphasizingthediagnosticdilemmas AT poojaksuresh analysisofdedifferentiatedliposarcomasemphasizingthediagnosticdilemmas |