Liposarcoma is the malignant form of lipoma and the second most common type of soft tissue sarcoma. It is a malignant tumor that grows on the fatty tissue. It is typically a huge bulky tumor that tends to have several smaller satellites that extends beyond the primary location of the tumor. Liposarcoma is normally found in adults in the 40 to 60 year age bracket and occur usually in the extremities or retroperitoneum. Like all other forms of sarcomas, occurrence of this disease is rare.
Liposarcoma is generally believed to originate from the mesenchymal cells. In histology, it is classified into 5 main forms;
- Well-differentiated – This is the most common type of the disease and accounts for about 50% of all known cases. Also known as atypical lipoma, this type has the highest volume of fat content. Well-differentiated liposarcoma is considered as low grade.
- Myxoid – This is the second most common type of the disease and is considered as intermediate grade.
- Round Cell or De-differentiated – This type of liposarcoma is aggressive and usually typified by frequent metastases and is considered as high grade.
- Pleomorphic – This is the least common form of the disease; is also aggressive and also comes with frequent metastases; also considered to be high grade.
- Mix – This is a combination of other types of the disease.
Prognosis and Treatment
The location and grade of the liposarcoma will determine the appropriate prognosis and treatment. Those affecting the extremities, more so when well-differentiated are lethargic but nevertheless tend to recur locally (happens in 0 – 69% of all incidences and goes even higher in cases of deep lesions).
High grade cases, particularly those of the retroperitoneum register bad prognosis, and the rate of recurrence ranges from 63% to 91%.
Surgical procedures are done with a wide local excision. This is responsible for some of the more successful outcomes of lesions in the extremities. Chemotherapy and radiotherapy are other forms of treatments used for treatment.
Liposarcoma usually manifests symptoms like, pain, painful swelling, numbness, fatigue, enlargement of varicose veins, reduction in the range of motion, nausea, vomiting, loss of weight, emaciation, pains in the abdominal area, compression of the kidney, and density of the ureter.
Radiographic Features of the Disease
- CT – in solid form: attenuation is greater than +20HU; if mixed: areas of less than -20HU and areas of more than +20HU; if pseudocystic: homogenous density in the range of -20HU and +20HU
- CT findings that favor liposarcoma from a lipoma – features include non-homogenous attenuation with proof of a considerable volume of soft tissues within the fat mass; poor definition of proximate structures; proof of invasion or penetration of mediastinal structures.
- MRI – As in the case of CT, MRI appearance also differs and depends on the grade and volume of the fat tissue. Low grade lesions or atypical lipomas are mostly made of a fat signal with thick septae, augmentation or proof of local intrusion. These characteristics are used to differentiate these from ordinary forms of lipoma. Often, the high grade lesions are without macroscopic fats and look the same as other sarcomas.
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