Yoav Morag1,2, Corrie Yablon1,2, Monica Kalume Brigido1,2, Jon Jacobson1,2, David Lucas3,4. 1. Department of Radiology, University of Michigan Hospitals, Taubman Center 2910F, SPC 5326, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5326, USA. 2. Department of Pathology, University of Michigan Hospitals, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5326, USA. 3. Department of Radiology, University of Michigan Hospitals, Taubman Center 2910F, SPC 5326, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5326, USA. yoavm@umich.edu. 4. Department of Pathology, University of Michigan Hospitals, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5326, USA. yoavm@umich.edu.
Abstract
OBJECTIVE: Describe the imaging appearance of well-differentiated liposarcoma with myxoid stroma (WDLMS) and correlate with histopathology. MATERIALS AND METHODS: A keyword search of the institution medical records was performed from 1 January 2000 to 30 June 2017. The histopathology slides of cases identified in this fashion were then reviewed by a pathologist. Additional cases were prospectively collected from extramural referrals and tumor boards. Diagnostic imaging studies of pathologically proven cases of WDLMS were then reviewed in consensus and correlated with pathology. RESULTS: Ten cases of pathologically proven WDLMS were identified (7 men, 3 women, ages 26-81). Tumor location included the retroperitoneum (n = 5), thigh (n = 4), and the shin (n = 1). Nine patients had macroscopic fat on imaging. The nonlipomatous components had a variable appearance, including septal, nodular, and lacelike patterns. Two cases included two distinct areas that were predominantly myxoid or lipomatous ("bi-morphic"). One tumor had no macroscopic fat on imaging. On CT, the nonlipomatous nodular components were hypodense/had hypodense areas. On MRI, the nodular components had intermediate/bright T2W signal. Interval nonlipomatous nodular growth was identified in 3 cases. CONCLUSION: WDLMS may present on imaging as a mass with variable morphology and amounts of nonlipomatous components. Histopathological diagnosis of WDLMS is challenging and imaging correlation may be helpful, as this tumor may have ≥50% fatty volume, may have a myxoid nodular component or bi-morphic appearance, or may be located in the retroperitoneum, features that are unusual for myxoid liposarcoma. WDLMS with a nodular component cannot be distinguished from dedifferentiated liposarcoma based on imaging alone.
OBJECTIVE: Describe the imaging appearance of well-differentiated liposarcoma with myxoid stroma (WDLMS) and correlate with histopathology. MATERIALS AND METHODS: A keyword search of the institution medical records was performed from 1 January 2000 to 30 June 2017. The histopathology slides of cases identified in this fashion were then reviewed by a pathologist. Additional cases were prospectively collected from extramural referrals and tumor boards. Diagnostic imaging studies of pathologically proven cases of WDLMS were then reviewed in consensus and correlated with pathology. RESULTS: Ten cases of pathologically proven WDLMS were identified (7 men, 3 women, ages 26-81). Tumor location included the retroperitoneum (n = 5), thigh (n = 4), and the shin (n = 1). Nine patients had macroscopic fat on imaging. The nonlipomatous components had a variable appearance, including septal, nodular, and lacelike patterns. Two cases included two distinct areas that were predominantly myxoid or lipomatous ("bi-morphic"). One tumor had no macroscopic fat on imaging. On CT, the nonlipomatous nodular components were hypodense/had hypodense areas. On MRI, the nodular components had intermediate/bright T2W signal. Interval nonlipomatous nodular growth was identified in 3 cases. CONCLUSION: WDLMS may present on imaging as a mass with variable morphology and amounts of nonlipomatous components. Histopathological diagnosis of WDLMS is challenging and imaging correlation may be helpful, as this tumor may have ≥50% fatty volume, may have a myxoid nodular component or bi-morphic appearance, or may be located in the retroperitoneum, features that are unusual for myxoid liposarcoma. WDLMS with a nodular component cannot be distinguished from dedifferentiated liposarcoma based on imaging alone.
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