Rozental Tamara D, Khoury Lisa D, Donthineni-Rao Rakesh, Lackman Richard D
Orthopaedic Oncology Service, Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
Clin Orthop Relat Res. 2002 May(398):203-11. doi: 10.1097/00003086-200205000-00029.
Atypical lipomatous tumors occur predominantly in middle-aged patients and often present as painless, slow-growing masses in the extremities. The clinical outcomes of surgically treated superficial or deep atypical lipomas of the extremities were reviewed. Thirty-one patients were included in this study. There were 16 men and 15 women, with an average age of 57 years (range, 32-87 years). The mean followup was 7 years (range, 1-28.8 years). Twenty-five tumors occurred in the lower extremity and six in the upper extremity. Sixteen patients (52%) had a recurrence at an average of 4.7 years after resection. Twelve (39%) patients required additional surgical procedures to treat their tumor. Occurrence of a deep lesion and positive margins at the time of the initial surgery correlated closely with the rate of recurrence and need for additional surgical treatment. Dedifferentiation to high-grade liposarcoma developed in four (13%) patients. Atypical lipomas have a high propensity for local recurrence and a potential for malignant dedifferentiation. Patients with atypical lipomas require careful evaluation, complete surgical excision when possible, and close clinical followup extending beyond 5 years.
非典型脂肪瘤主要发生于中年患者，常表现为四肢无痛性、生长缓慢的肿块。我们回顾了手术治疗四肢浅表或深部非典型脂肪瘤的临床结果。本研究纳入了31例患者。其中男性16例，女性15例，平均年龄57岁（范围32 - 87岁）。平均随访时间为7年（范围1 - 28.8年）。25个肿瘤发生在下肢，6个在上肢。16例患者（52%）在切除术后平均4.7年复发。12例（39%）患者需要额外的手术来治疗肿瘤。初次手术时深部病变的出现和切缘阳性与复发率及额外手术治疗的需求密切相关。4例（13%）患者发生去分化为高级别脂肪肉瘤。非典型脂肪瘤有较高的局部复发倾向和恶性去分化的可能性。非典型脂肪瘤患者需要仔细评估，尽可能完整手术切除，并进行超过5年的密切临床随访。
