Top

Published in:

Open Access 01-12-2018 | Research article

The role of surgical margins in atypical Lipomatous Tumours of the extremities

Authors: Jessica Rauh, Alexander Klein, Andrea Baur-Melnyk, Thomas Knösel, Lars Lindner, Falk Roeder, Volkmar Jansson, Hans Roland Dürr

Published in: BMC Musculoskeletal Disorders | Issue 1/2018

Abstract

Background

Atypical lipomatous tumours (ALT) are common adipocytic tumours. Due to their large size and deep-seated location, wide resection might result in severe functional deficits. The question which margins should be aimed is hence discussed controversially.

Methods

Forty consecutive patients underwent limb-sparing resections. Margins were defined as R0 (wide resection), R1 (marginal resection) or R2 if tumour was left. All patients were followed for evidence of local recurrence or remote metastases. Overall and recurrence-free survival was calculated.

Results

The mean age at the time of surgery was 61.9 years. The mean tumour diameter was 17 cm with no patient having metastatic disease. In 8 cases a wide (R0) resection, in 31 cases a marginal (R1) and in one patient a R2-resection was performed. The median follow-up time was 40 months. Four patients died due to causes that were not tumour-related. 3 (7.5%) patients (all R1) developed local recurrences. Two of our 3 recurrences in this series occurred in 6 already recurring cases. We observed no dedifferentiation of tumours and no metastatic disease.

Conclusions

ALT represents a comparatively common diagnosis in large deep-seated lesions of the extremities, especially in patients over 60 years. Marginal resection shows an acceptable rate of local recurrence. The risk of dedifferentiation as proven also in a metaanalysis of the English literature of the last 30 years is close to 1%, metastatic disease is exceedingly rare.

Evans HL, Soule EH, Winkelmann RK. Atypical lipoma, atypical intramuscular lipoma, and well differentiated retroperitoneal liposarcoma: a reappraisal of 30 cases formerly classified as well differentiated liposarcoma. Cancer. 1979;43(2):574–84.CrossRefPubMed

Kindblom LG, Angervall L, Stener B, Wickbom I. Intermuscular and intramuscular lipomas and hibernomas. A clinical, roentgenologic, histologic, and prognostic study of 46 cases. Cancer. 1974;33(3):754–62.CrossRefPubMed

Dei Tos AP, Pedeutour F. Atypical lipomatous tumour. In: BJA FCDM, Hogendoorn PCW, Mertens F, editors. WHO classification of Tumours of soft tissue and bone. Volume 4. Lyon: International Agency for Research on Cancer (IARC); 2013. p. 33–6.

Dei Tos AP. Liposarcoma: new entities and evolving concepts. Ann Diagn Pathol. 2000;4(4):252–66.CrossRefPubMed

Billing V, Mertens F, Domanski HA, Rydholm A. Deep-seated ordinary and atypical lipomas: histopathology, cytogenetics, clinical features, and outcome in 215 tumours of the extremity and trunk wall. J Bone Joint Surg Br Vol. 2008;90(7):929–33.CrossRef

Weiss SW, Rao VK. Well-differentiated liposarcoma (atypical lipoma) of deep soft tissue of the extremities, retroperitoneum, and miscellaneous sites. A follow-up study of 92 cases with analysis of the incidence of “dedifferentiation”. Am J Surg Pathol. 1992;16(11):1051–8.CrossRefPubMed

Chang DH, Ma H, Liao WC, Huang MH, Wu PS. Atypical Lipomatous tumors of the extremities and trunk wall-the first case series of Chinese population with 45 cases. Ann Plast Surg. 2016;76(Suppl 1):S8–S12.CrossRefPubMed

Yamamoto N, Hayashi K, Tanzawa Y, Kimura H, Takeuchi A, Igarashi K, Inatani H, Shimozaki S, Kitamura S, Tsuchiya H. Treatment strategies for well-differentiated liposarcomas and therapeutic outcomes. Anticancer Res. 2012;32(5):1821–5.PubMed

Gaskin CM, Helms CA. Lipomas, lipoma variants, and well-differentiated liposarcomas (atypical lipomas): results of MRI evaluations of 126 consecutive fatty masses. AJR Am J Roentgenol. 2004;182(3):733–9.CrossRefPubMed

10.

Panzarella MJ, Naqvi AH, Cohen HE, Damron TA. Predictive value of gadolinium enhancement in differentiating ALT/WD liposarcomas from benign fatty tumors. Skelet Radiol. 2005;34(5):272–8.CrossRef

11.

Chung WJ, Chung HW, Shin MJ, Lee SH, Lee MH, Lee JS, Kim MJ, Lee WK. MRI to differentiate benign from malignant soft-tissue tumours of the extremities: a simplified systematic imaging approach using depth, size and heterogeneity of signal intensity. Br J Radiol. 2012;85(1018):e831–6.CrossRefPubMedPubMedCentral

12.

Hosono M, Kobayashi H, Fujimoto R, Kotoura Y, Tsuboyama T, Matsusue Y, Nakamura T, Itoh T, Konishi J. Septum-like structures in lipoma and liposarcoma: MR imaging and pathologic correlation. Skelet Radiol. 1997;26(3):150–4.CrossRef

13.

Weaver J, Rao P, Goldblum JR, Joyce MJ, Turner SL, Lazar AJ, Lopez-Terada D, Tubbs RR, Rubin BP. Can MDM2 analytical tests performed on core needle biopsy be relied upon to diagnose well-differentiated liposarcoma? Mod Pathol. 2010;23(10):1301–6.CrossRefPubMed

14.

Kimura H, Dobashi Y, Nojima T, Nakamura H, Yamamoto N, Tsuchiya H, Ikeda H, Sawada-Kitamura S, Oyama T, Ooi A. Utility of fluorescence in situ hybridization to detect MDM2 amplification in liposarcomas and their morphological mimics. Int J Clin Exp Pathol. 2013;6(7):1306–16.PubMedPubMedCentral

15.

Binh MB, Sastre-Garau X, Guillou L, de Pinieux G, Terrier P, Lagace R, Aurias A, Hostein I, Coindre JM. MDM2 and CDK4 immunostainings are useful adjuncts in diagnosing well-differentiated and dedifferentiated liposarcoma subtypes: a comparative analysis of 559 soft tissue neoplasms with genetic data. Am J Surg Pathol. 2005;29(10):1340–7.CrossRefPubMed

16.

Errani C, Cocchi S, Ali N, Chehrassan M, Righi A, Gambarotti M, Mavrogenis AF, Vanel D, Donati D. Recurrence after marginal excision for atypical Lipomatous tumors versus lipomas of the extremities. Orthopedics. 2016;39(4):e610–4.CrossRefPubMed

17.

Mavrogenis AF, Lesensky J, Romagnoli C, Alberghini M, Letson GD, Ruggieri P. Atypical lipomatous tumors/well-differentiated liposarcomas: clinical outcome of 67 patients. Orthopedics. 2011;34(12):e893–8.CrossRefPubMed

18.

Kubo T, Sugita T, Shimose S, Arihiro K, Ochi M. Conservative surgery for well-differentiated liposarcomas of the extremities adjacent to major neurovascular structures. Surg Oncol. 2006;15(3):167–71.CrossRefPubMed

19.

Laurino L, Furlanetto A, Orvieto E, Dei Tos AP. Well-differentiated liposarcoma (atypical lipomatous tumors). Semin Diagn Pathol. 2001;18(4):258–62.PubMed

20.

Azumi N, Curtis J, Kempson RL, Hendrickson MR. Atypical and malignant neoplasms showing lipomatous differentiation. A study of 111 cases. Am J Surg Pathol. 1987;11(3):161–83.CrossRefPubMed

21.

Evans HL. Atypical lipomatous tumor, its variants, and its combined forms: a study of 61 cases, with a minimum follow-up of 10 years. Am J Surg Pathol. 2007;31(1):1–14.CrossRefPubMed

22.

Sommerville SM, Patton JT, Luscombe JC, Mangham DC, Grimer RJ. Clinical outcomes of deep atypical lipomas (well-differentiated lipoma-like liposarcomas) of the extremities. ANZ J Surg. 2005;75(9):803–6.CrossRefPubMed

23.

Bassett MD, Schuetze SM, Disteche C, Norwood TH, Swisshelm K, Chen X, Bruckner J, Conrad EU 3rd, Rubin BP. Deep-seated, well differentiated lipomatous tumors of the chest wall and extremities: the role of cytogenetics in classification and prognostication. Cancer. 2005;103(2):409–16.CrossRefPubMed

24.

Kooby DA, Antonescu CR, Brennan MF, Singer S. Atypical lipomatous tumor/well-differentiated liposarcoma of the extremity and trunk wall: importance of histological subtype with treatment recommendations. Ann Surg Oncol. 2004;11(1):78–84.CrossRefPubMed

25.

Lucas DR, Nascimento AG, Sanjay BK, Rock MG. Well-differentiated liposarcoma. The Mayo Clinic experience with 58 cases. Am J Clin Pathol. 1994;102(5):677–83.CrossRefPubMed

26.

Cassier PA, Kantor G, Bonvalot S, Lavergne E, Stoeckle E, Le Pechoux C, Meeus P, Sunyach MP, Vaz G, Coindre JM, et al. Adjuvant radiotherapy for extremity and trunk wall atypical lipomatous tumor/well-differentiated LPS (ALT/WD-LPS): a French sarcoma group (GSF-GETO) study. Annals Oncol. 2014;25(9):1854–60.CrossRef

27.

Kang J, Botros M, Goldberg S, Giraud C, Nielsen GP, Chen YL, Raskin K, Schwab J, Yoon SS, Hornicek FJ, et al. The use of radiation therapy in the management of selected patients with atypical lipomas. Sarcoma. 2013;2013:485483.CrossRefPubMedPubMedCentral

28.

Rozental TD, Khoury LD, Donthineni-Rao R, Lackman RD. Atypical lipomatous masses of the extremities: outcome of surgical treatment. Clin Orthop Relat Res. 2002;398:203–11.CrossRef

29.

Kito M, Yoshimura Y, Isobe K, Aoki K, Momose T, Suzuki S, Tanaka A, Sano K, Akahane T, Kato H. Clinical outcome of deep-seated atypical lipomatous tumor of the extremities with median-term follow-up study. Eur J Surg Oncol. 2015;41(3):400–6.CrossRefPubMed

30.

Cool P, Grimer R, Rees R. Surveillance in patients with sarcoma of the extremities. Eur J Surg Oncol. 2005;31(9):1020–4.CrossRefPubMed

31.

Zagars GK, Goswitz MS, Pollack A. Liposarcoma: outcome and prognostic factors following conservation surgery and radiation therapy. Int J Radiat Oncol Biol Phys. 1996;36(2):311–9.CrossRefPubMed

32.

Fisher SB, Baxter KJ, Staley CA 3rd, Fisher KE, Monson DK, Murray DR, Oskouei SV, Weiss SW, Kooby DA, Maithel SK, et al. The general Surgeon's quandary: atypical lipomatous tumor vs lipoma, who needs a surgical oncologist? J Am Coll Surg. 2013;217(5):881–8.CrossRefPubMedPubMedCentral

33.

Mussi CE, Daolio P, Cimino M, Giardina F, De Sanctis R, Morenghi E, Parafioriti A, Bartoli MS, Bastoni S, Cozzaglio L, et al. Atypical lipomatous tumors: should they be treated like other sarcoma or not? Surgical consideration from a bi-institutional experience. Ann Surg Oncol. 2014;21(13):4090–7.CrossRefPubMed

Title: The role of surgical margins in atypical Lipomatous Tumours of the extremities
Authors: Jessica Rauh
Alexander Klein
Andrea Baur-Melnyk
Thomas Knösel
Lars Lindner
Falk Roeder
Volkmar Jansson
Hans Roland Dürr
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2018
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-018-2053-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The role of surgical margins in atypical Lipomatous Tumours of the extremities

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Modified Robert Jones bandage can not reduce postoperative swelling in enhanced-recovery after primary total knee arthroplasty without intraoperative tourniquet: a randomized controlled trial

A case of bilateral revision total knee arthroplasty using distal femoral allograft–prosthesis composite and femoral head allografting at the tibial site with a varus-valgus constrained prosthesis: ten-year follow up

Periprosthetic tibial fractures in total knee arthroplasty – an outcome analysis of a challenging and underreported surgical issue

Re-infection rates and clinical outcomes following arthrodesis with intramedullary nail and external fixator for infected knee prosthesis: a systematic review and meta-analysis.

The use of bidirectional rapid reductor in minimally invasive treatment of bicondylar tibial plateau fractures: preliminary radiographic and clinical results

Clinical implications of fracture-associated vascular damage in extremity and pelvic trauma