Serpell Jonathan W, Chen Richard Y Y
Breast, Endocrine Surgery and Surgical Oncology Unit, Frankston Hospital, and Department of Surgery, Monash University, Melbourne, Victoria, Australia.
ANZ J Surg. 2007 Jul;77(7):524-9. doi: 10.1111/j.1445-2197.2007.04042.x.
Lipomatous tumours comprise a range of diagnoses. There are controversies regarding the histopathological diagnosis, nomenclature, diagnostic method, surgical management, roles of radiotherapy and the risk of metastasis, local recurrence and dedifferentiation. This study describes our experience with such tumours.
Retrospective review of 224 soft tissue tumours from the Senior Author's (J. W. S.) database identified 28 patients with deep lipomatous tumours. Clinical features and outcomes were studied with median follow up of 1.5 years.
Eleven deep lipomas, six deep atypical lipomas, four well-differentiated (lipoma-like) liposarcomas, three well-differentiated liposarcomas and four liposarcomas were studied. Preoperative diagnosis was established by image-guided core biopsy in 20 patients, excisional biopsy in 6, incisional biopsy in 1 and fine-needle aspiration in 1. All patients diagnosed with deep lipoma and deep atypical lipoma underwent marginal excision. The median size of the excised tumour was 11 cm. Recurrence occurred in three deep atypical lipomas and one liposarcoma. Dedifferentiation occurred in one deep atypical lipoma, which transformed into a liposarcoma. None had metastasis or died of metastatic malignancy.
Large deep lipomatous tumours are uncommon and although they do not tend to metastasize, they not infrequently recur locally. Hence their local treatment to prevent local recurrence is important. Key aspects in achieving a complete, but marginal resection of the deep atypical lipoma and the well-differentiated lipoma-like liposarcoma is accurate preoperative diagnosis with core biopsy and accurate imaging to assess deep unsuspected extensions of the tumour.
脂肪性肿瘤包含一系列诊断类型。在组织病理学诊断、命名、诊断方法、手术管理、放疗作用以及转移、局部复发和去分化风险等方面存在争议。本研究描述了我们对这类肿瘤的经验。
对资深作者（J.W.S.）数据库中的224例软组织肿瘤进行回顾性分析，确定28例深部脂肪性肿瘤患者。研究临床特征和结局，中位随访时间为1.5年。
研究了11例深部脂肪瘤、6例深部非典型脂肪瘤、4例高分化（脂肪瘤样）脂肪肉瘤、3例高分化脂肪肉瘤和4例脂肪肉瘤。20例患者通过影像引导下的粗针活检进行术前诊断，6例通过切除活检，1例通过切开活检，1例通过细针穿刺抽吸进行诊断。所有诊断为深部脂肪瘤和深部非典型脂肪瘤的患者均接受了边缘性切除。切除肿瘤的中位大小为厘米。3例深部非典型脂肪瘤和1例脂肪肉瘤出现复发。1例深部非典型脂肪瘤发生去分化，转变为脂肪肉瘤。无一例发生转移或死于转移性恶性肿瘤。
大型深部脂肪性肿瘤并不常见，虽然它们一般不会发生转移，但局部复发并不少见。因此，预防局部复发的局部治疗很重要。实现对深部非典型脂肪瘤和高分化脂肪瘤样脂肪肉瘤进行完整但边缘性切除的关键在于通过粗针活检进行准确的术前诊断以及通过准确的影像学检查评估肿瘤深部未被怀疑的扩展情况。
