Wednesday, July 27, 2011

liposarcoma contd..

It was a great experience for me as i ventured into a feared area to excise a large low grade malignant tumour. All credit goes to Dr.Juyal, Dr.Babar, Dr.Manpreet, Dr.Om and Dr.Ujjawal for the support. The staff did a fantastic job in providing the logistic support ast hey always do.

Please view the rest of the snaps and some more.

Low grade myxoid liposarcoma of popliteal fossa












Myxoid / round cell liposarcoma


Myxoid and round cell liposarcoma represent a single entity, characterized by a morphologic spectrum from pure myxoid lesions (low-grade) to pure round cell tumors (high-grade) and sharing a t(12;16) or rarely t(12;22) translocation. These tumors account for approximately 35 to 50% of liposarcomas. Clinically, myxoid liposarcoma affects adults in their 3rd to 5th decades. Most tumors are located in the limbs, with a predilection for the thigh and popliteal fossa. Myxoid liposarcoma virtually never occurs in the retroperitoneum.
Myxoid liposarcoma is usually very well circumcribed. It is composed of monomorphic, primitive fusiform or stellate cells, lacking significant nuclear atypia. The prominent meshwork of delicate, thin-walled capillaries (" crow’s feet " or " chicken wire " pattern) is highly distinctive. The presence of acellular " mucin pools " is another helpful clue. Small univacuolated lipoblasts are commonly found in subcapsular areas.
The " round cell " component represents cellular areas composed of uniform round or spindle cells with larger nuclei. Mitoses are more frequently found. The typical vascular network may be obscured in particularly cellular lesions.
Tumor cells of both myxoid and round cell components may be positive for S100 protein in approximately 30-50% of cases.
Pure myxoid liposarcoma is a low-grade tumor which only rarely metastasize. In contrast, round cell liposarcoma is a high grade lesion, with a high metastatic rate. Metastases develop in the lung but also, characteristically, in the retroperitoneum and pleural cavities, or in soft tissues.
As it is exceedingly rare in the retroperitoneum, the identification of myxoid liposarcoma in this location should prompt a careful search for a primary tumor in the limbs.
The amount of round cells (or cellular areas) necessary to classify these tumors as intermediate grade is still debated but every lesion containing more than 10% of cellular areas should be reagarded with caution in terms of prognosis.
The main differential diagnosis of myxoid liposarcoma is myxofibrosarcoma, which has thicker curvilinear vessels, and shows a greater degree of nuclear atypia (table 3). Lipoblastoma may be virtually indistinguishable from myxoid liposarcoma and practically a " myxoid liposarcoma " under the age of 5 years is actually a lipoblastoma. Extraskeletal myxoid chondrosarcoma lacks the prominent vascularity of myxoid liposarcoma. Lesions containing abundant mature adipocytes may be confused with well-differentiated liposarcoma or even myxolipoma.
Round cell liposarcoma must be differentiated with metastatic carcinoma, melanoma, lymphoma, or even Ewing’s sarcoma. The correct diagnosis is suggested by the presence of myxoid areas and by the typical plexiform vascular pattern, which can be highlighted by immunostains for CD31 or CD34. S100 protein staining may also help to identify lipoblasts.

Saturday, July 2, 2011

shoulder paper

guys check out the publication