去分化脂肪肉瘤合并脂肪瘤样高分化脂肪肉瘤:30例临床病理研究,特别关注高分化和去分化成分的混合模式:对高分化脂肪肉瘤和去分化脂肪肉瘤现有亚分类重新分组的建议
Dedifferentiated liposarcoma with lipoma-like well-differentiated liposarcoma: clinicopathological study of 30 cases, with particular attention to the comingling pattern of well- and dedifferentiated components: a proposal for regrouping of the present subclassification of well-differentiated liposarcoma and dedifferentiated liposarcoma.
作者信息
Iwasa Yoko, Nakashima Yasuaki
机构信息
Izumi Municipal Hospital, Osaka, Japan.
出版信息
Int J Surg Pathol. 2013 Feb;21(1):15-21. doi: 10.1177/1066896912449040. Epub 2012 Jun 6.
Dedifferentiated liposarcoma (DDL) is defined as nonlipogenic sarcoma, with an abrupt transition from coexisting well-differentiated liposarcoma (WDL). However, intermingled transition in a mosaic pattern between WDL and DDL is not infrequently encountered. Here, the authors review clinicopathological features of 30 cases of DDL associated with lipoma-like WDL. Histological examination revealed 20 tumors that showed an abrupt transition between WDL and DDL. Among these, 13 tumors showed high-grade spindle-cell sarcoma having histological features of unclassified malignant fibrous histiocytoma (MFH)-like sarcoma (high-grade DDL [HDDL]). The remaining 7 tumors showed moderate cellular spindle-cell proliferation with mild nuclear atypia and scant mitotic figures (low-grade DDL [LDDL]). The other 10 tumors showed intermingled transition between WDL and DDL. The interface between these 2 components overlapped, resulting in frequent occurrence of a lipogenic spindle-cell component (comingling DDL). Based on the cellularity and nuclear atypia of the spindle-cell components, there were 7 comingling HDDLs and 3 comingling LDDLs. The histology of comingling LDDL simulated an admixture of spindle-cell liposarcoma and LDDL, and distinction from each other was practically difficult. The histology of comingling HDDL simulated pleomorphic liposarcoma. Follow-up data, available for 23 patients (median, 39 months), showed that 2 patients died of tumor (both had HDDL), and 1 patient died of unrelated disease; 8 patients were alive with recurrent or metastatic diseases (3 HDDLs, 3 LDDLs, and 2 comingling HDDLs). Statistical analysis by Fisher's exact test showed no correlation between histological subtypes (HDDL and LDDL, and typical DDL and comingling DDL).
去分化脂肪肉瘤(DDL)被定义为非脂肪生成性肉瘤,与并存的高分化脂肪肉瘤(WDL)有突然的转变。然而,WDL和DDL之间呈镶嵌样的混合过渡并不少见。在此,作者回顾了30例与脂肪瘤样WDL相关的DDL的临床病理特征。组织学检查显示,20个肿瘤在WDL和DDL之间有突然转变。其中,13个肿瘤表现为具有未分类恶性纤维组织细胞瘤(MFH)样肉瘤组织学特征的高级别梭形细胞肉瘤(高级别DDL [HDDL])。其余7个肿瘤表现为中等细胞密度的梭形细胞增生,核异型性轻度,有丝分裂象稀少(低级别DDL [LDDL])。另外10个肿瘤在WDL和DDL之间表现为混合过渡。这两个成分之间的界面重叠,导致脂肪生成性梭形细胞成分(混合性DDL)频繁出现。根据梭形细胞成分的细胞密度和核异型性,有7个混合性HDDL和3个混合性LDDL。混合性LDDL的组织学表现类似梭形细胞脂肪肉瘤和LDDL的混合,实际很难相互区分。混合性HDDL的组织学表现类似多形性脂肪肉瘤。23例患者(中位随访时间39个月)的随访数据显示,2例患者死于肿瘤(均为HDDL),1例患者死于非相关疾病;8例患者有复发或转移性疾病存活(3例HDDL,3例LDDL,2例混合性HDDL)。Fisher精确检验的统计分析显示,组织学亚型(HDDL和LDDL,以及典型DDL和混合性DDL)之间无相关性。