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Dedifferentiated liposarcoma and pleomorphic liposarcoma: a comparative study of cytomorphology and MDM2/CDK4 expression on fine-needle aspiration.
[dedifferentiated liposarcoma]
Dedifferentiated
liposarcoma
(
DDLPS
)
and
pleomorphic
liposarcoma
(
PLPS
)
are
distinct
high
-grade
liposarcomas
.
DDLPS
is
a
nonlipogenic
sarcoma
characterized
by
amplification
of
MDM
2
and
CDK
4
.
PLPS
is
a
high
-grade
sarcoma
containing
lipoblasts
,
characterized
by
a
complex
karyotype
and
a
more
aggressive
clinical
course
.
Rarely
,
DDLPS
shows
lipogenic
differentiation
,
mimicking
PLPS
.
The
cytomorphologic
features
of
DDLPS
and
PLPS
and
the
utility
of
ancillary
studies
have
not
been
systemically
analyzed
.
Cytologic
preparations
of
25
DDLPS
and
13
PLPS
,
all
histologically
confirmed
,
were
retrospectively
reviewed
along
with
clinical
and
cytogenetic
data
.
Sample
cellularity
,
vascular
architecture
,
background
material
,
predominant
cell
morphology
,
quality
of
the
cytoplasm
,
and
nuclear
pleomorphism
were
compared
for
both
tumor
types
.
Immunohistochemistry
for
MDM
2
and
CDK
4
was
performed
on
cell
blocks
and
/
or
core
needle
biopsies
.
Fine-needle
aspirate
smears
from
both
DDLPS
and
PLPS
were
variably
cellular
,
composed
of
cellular
clusters
and
noncohesive
cells
.
Abundant
myxoid
stroma
was
present
in
∼
25
%
of
DDLPS
and
PLPS
cases
,
whereas
branching
curvilinear
vessels
were
more
common
in
DDLPS
than
in
PLPS
(
7
of
25
versus
2
of
13
)
.
Tumors
were
composed
of
predominantly
spindled
(
18
of
25
DDLPS
versus
3
of
13
PLPS
)
or
epithelioid
cells
(
7
of
25
DDLPS
versus
6
of
13
PLPS
)
.
Pleomorphic
cells
were
predominant
in
3
PLPS
,
and
were
frequent
in
both
(
13
of
25
DDLPS
versus
10
of
13
PLPS
)
.
The
cytoplasm
was
mostly
fibrillary
and
often
vacuolated
in
both
entities
.
Other
features
included
necrosis
,
mitoses
,
and
a
prominent
inflammatory
infiltrate
.
The
main
cytologic
differences
were
the
presence
of
marked
pleomorphism
,
abundant
lipoblasts
,
and
cells
with
microvacuolated
cytoplasm
in
most
PLPS
.
A
total
of
24
(
96
%
)
and
20
(
80
%
)
cases
of
DDLPS
expressed
MDM
2
and
CDK
4
,
respectively
,
whereas
none
of
the
PLPS
expressed
both
markers
.
Six
DDLPS
tested
showed
ring
or
giant
marker
chromosomes
and
/
or
MDM
2
amplification
by
fluorescence
in
situ
hybridization
;
2
PLPS
had
complex
karyotypes
.
DDLPS
and
PLPS
exhibit
variable
and
occasionally
overlapping
cytologic
features
.
The
presence
of
lipoblasts
,
cells
with
microvacuolated
cytoplasm
,
and
marked
pleomorphism
are
more
suggestive
of
PLPS
,
but
these
characteristics
can
be
present
in
DDLPS
.
Coexpression
of
MDM
2
and
CDK
4
distinguishes
DDLPS
from
PLPS
.
Diseases
Validation
Diseases presenting
"main cytologic differences"
symptom
dedifferentiated liposarcoma
pleomorphic liposarcoma
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