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Liposarcomas with mixed well-differentiated and pleomorphic features: a clinicopathologic study of 12 cases.
[pleomorphic liposarcoma]
Pleomorphic
liposarcoma
(
PL
)
is
an
undifferentiated
pleomorphic
sarcoma
containing
pleomorphic
lipoblasts
.
PL
almost
always
arises
de
novo
without
an
associated
low
-grade
precursor
lesion
[
eg
,
well-differentiated
liposarcoma
(
WDL
)
]
.
We
have
,
however
,
observed
rare
cases
of
PL
,
which
arose
in
association
with
WDL
and
have
studied
these
cases
to
define
their
clinicopathologic
features
and
their
nosologic
relationship
to
other
forms
of
liposarcoma
.
Cases
were
retrieved
from
our
consultation
archives
and
from
review
of
cases
treated
surgically
at
Mayo
Clinic
.
Selected
tumors
were
tested
for
MDM
2
/
CPM
amplification
by
fluorescence
in
situ
hybridization
when
tumor
blocks
were
available
.
Twelve
tumors
were
identified
,
occurring
in
7
men
and
5
women
(
mean
age
59
y
,
range
:
35
-
84
y
)
.
Sites
of
origin
included
the
retroperitoneum
(
7
)
,
scrotum
(
2
)
,
buttock
(
2
)
,
and
abdominal
cavity
(
1
)
.
Tumors
consisted
predominately
of
typical
WDL
,
with
an
"
abrupt
"
transition
to
pleomorphic
spindle
cell
sarcoma
containing
pleomorphic
lipoblasts
.
MDM
2
/
CPM
amplification
was
present
in
10
of
11
(
91
%
)
cases
,
all
of
which
consisted
chiefly
of
PL
in
the
studied
blocks
.
Follow-up
information
was
available
for
7
of
7
patients
with
a
postresection
interval
of
>
12
months
(
range
:
14
-
165
mo
,
mean
44
mo
)
.
Four
of
these
7
patients
are
currently
alive
without
disease
(
mean
follow-up
duration
,
38
mo
)
.
Of
the
remaining
3
patients
,
1
died
of
progressive
disease
29
months
after
diagnosis
,
1
suffered
lung
metastases
and
local
recurrence
60
and
84
months
after
diagnosis
,
respectively
,
and
was
alive
with
unresectable
disease
165
months
after
diagnosis
,
and
1
died
14
months
after
diagnosis
,
of
unrelated
causes
.
The
5
patients
with
a
postoperative
follow-up
duration
of
<
12
months
are
without
evidence
of
disease
.
We
conclude
that
PL
arising
in
WDL
is
a
rare
phenomenon
.
The
presence
of
MDM
2
/
CPM
amplification
in
the
PL
component
of
mixed
WDL
/
PL
suggests
that
a
subset
of
PL
may
arise
through
tumor
progression
of
WDL
or
may
represent
a
"
transitional
"
or
partially
differentiated
step
toward
classic
DL
.
Diseases
Validation
Diseases presenting
"tumor progression"
symptom
carcinoma of the gallbladder
cholangiocarcinoma
dedifferentiated liposarcoma
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
hodgkin lymphoma, classical
liposarcoma
pleomorphic liposarcoma
severe combined immunodeficiency
von hippel-lindau disease
waldenström macroglobulinemia
well-differentiated liposarcoma
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