Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, UK.
Department of Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, UK.
Br J Radiol. 2021 Jun 1;94(1122):20201403. doi: 10.1259/bjr.20201403. Epub 2021 May 20.
To determine the incidence and diagnostic relevance of non-fatty 'solid appearing' components within lipomatous tumours of the trunk and extremity.
Retrospective review of patients referred to a specialist musculoskeletal oncology service over a 12-month period with a lipomatous trunk or extremity soft tissue tumour. The presence and morphology (solitary/multifocal; homogeneous/heterogeneous; well-defined/poorly defined) of non-fatty components was recorded based on MRI and compared with the final histological diagnosis.
213 patients with 217 lipomatous tumours were included, 119 (55.9%) males and 94 (44.1%) females with mean age of 54.6 years (range 7-93 years). Seventy-seven (35.5%) lesions arose superficial to the fascia and 139 (64.1%) deep, while a single case involved both compartments. Mean maximal tumour dimension was 94.9 mm (range 12-288 mm). Non-fatty 'solid appearing' components were identified in 28 (12.9%) cases, of which eight were solitary and 20 were multifocal, six had homogeneous SI and 22 had heterogeneous SI, and eight had well-defined margins, while 20 had poorly defined margins. Histological diagnosis was available in 20 of the tumours containing non-fatty components, 16 of which were benign, two intermediate grade and two malignant (a dedifferentiated liposarcoma and a myxoid liposarcoma). The commonest diagnosis was spindle cell lipoma, which accounted for 10 of 20 (50%) cases with confirmed histology.
Non-fatty components are identified in ~13% of trunk and extremity lipomatous tumours. The majority of such lesions are benign lipoma variants, most commonly spindle cell lipoma.
Solid non-fatty components are identified in approximately 13% of lipomatous tumours referred to a specialist sarcoma service. Despite the concern that these may represent dedifferentiated liposarcomas, high-grade tumours were seen in only two cases, the commonest diagnosis being a spindle cell lipoma.
确定躯干和四肢脂肪瘤中存在非脂肪性“实性”成分的发生率和诊断相关性。
回顾性分析了 12 个月内因躯干或肢体软组织脂肪瘤就诊于专业肌肉骨骼肿瘤服务的患者。根据 MRI 记录非脂肪成分的存在和形态（单发/多发；均匀/不均匀；边界清楚/边界不清），并与最终的组织学诊断进行比较。
共纳入 213 例 217 个脂肪瘤患者，男 119 例（55.9%），女 94 例（44.1%），平均年龄 54.6 岁（范围 7-93 岁）。77 例（35.5%）病变位于筋膜浅层，139 例（64.1%）位于深层，1 例同时累及两个部位。最大肿瘤直径的平均值为 94.9mm（范围 12-288mm）。在 28 例（12.9%）病例中发现了非脂肪性“实性”成分，其中 8 例为单发，20 例为多发，6 例 SI 均匀，22 例 SI 不均匀，8 例边界清楚，20 例边界不清。20 个含有非脂肪成分的肿瘤中有 20 个获得了组织学诊断，其中 16 个为良性，2 个为中级，2 个为恶性（一个去分化脂肪肉瘤和一个黏液样脂肪肉瘤）。最常见的诊断是梭形细胞脂肪瘤，在 20 例经组织学证实的病例中占 10 例（50%）。
在躯干和肢体脂肪瘤中约有 13%存在非脂肪成分。此类病变大多数为良性脂肪瘤变异，最常见的是梭形细胞脂肪瘤。
在转介至肉瘤专科服务的脂肪瘤中约有 13%存在实性非脂肪成分。尽管人们担心这些可能代表去分化脂肪肉瘤，但在仅有的 2 例高级别肿瘤中，最常见的诊断是梭形细胞脂肪瘤。
