Azumi N, Curtis J, Kempson R L, Hendrickson M R
Am J Surg Pathol. 1987 Mar;11(3):161-83. doi: 10.1097/00000478-198703000-00001.
One-hundred-eleven cases of histopathologically atypical or malignant lipomatous lesions in the somatic soft tissue and retroperitoneum were studied. These consisted of 48 differentiated fatty neoplasms of the somatic soft tissues (DFT-S), 21 fatty neoplasms of the retroperitoneum (DFT-R), 33 myxoid liposarcomas from various sites and nine pleomorphic liposarcomas. DFT-S were defined as lipomatous lesions composed of mature fat and containing atypical stromal cells or lipoblasts. In the somatic soft tissues, this group included lesions that would be classified using published criteria as "atypical lipoma", "pleomorphic lipoma", "well-differentiated lipoma-like liposarcoma", and "sclerosing liposarcoma". All of the DFT-R met previously published criteria for "well differentiated liposarcoma" or "sclerosing liposarcoma". We found no consistent histologic differences between the DFT-S and DRT-R. No pure "round cell" liposarcomas were encountered although many myxoid liposarcomas had "round cell" areas. Follow-up data were available in 80 cases (72%) with a mean follow-up period of over 7 years. Among the DFT-S there were no uncontrollable recurrences, distant metastases, or tumor-related deaths. The depth of the neoplasm correlated with the tendency for local recurrence; no neoplasms primary in the subcutis recurred; 29% of the tumors recurred when they originated in the deep soft tissues or within the muscle. None of the recurrent tumors demonstrated "dedifferentiation." DFT-R had a recurrence rate of 67% and, although there were no distant metastases, nine patients (43%) died of tumor. Five retroperitoneal tumors dedifferentiated but did not metastasize. In light of this experience, we believe that the term "atypical lipoma" is warranted for the DFT-S and "well differentiated liposarcoma" is an appropriate label for the DFT-R. The overall mean survival for the 52 cases of liposarcoma (excluding DFT-S) was 13.6 years. The mean survival in "well differentiated liposarcoma" (11.25 years) was between that for myxoid liposarcoma (16.25 years) and that for pleomorphic liposarcoma (7 years). Six patients (29%) with myxoid liposarcoma developed local recurrences and 6 patients (29%) developed distant metastases and died. Metastasis was always associated with a round cell (or pleomorphic) component with increased numbers of mitotic figures in either the primary tumor or a local recurrence.
对111例发生于体壁软组织和腹膜后的组织病理学表现为非典型性或恶性的脂肪性病变进行了研究。这些病变包括48例体壁软组织的分化型脂肪性肿瘤（DFT-S）、21例腹膜后的脂肪性肿瘤（DFT-R）、33例来自不同部位的黏液样脂肪肉瘤和9例多形性脂肪肉瘤。DFT-S被定义为由成熟脂肪组成且含有非典型性间质细胞或脂肪母细胞的脂肪性病变。在体壁软组织中，该组病变包括按照已发表标准可分类为“非典型脂肪瘤”“多形性脂肪瘤”“高分化脂肪瘤样脂肪肉瘤”和“硬化性脂肪肉瘤”的病变。所有DFT-R均符合先前发表的“高分化脂肪肉瘤”或“硬化性脂肪肉瘤”的标准。我们发现DFT-S和DFT-R之间没有一致的组织学差异。尽管许多黏液样脂肪肉瘤有“圆形细胞”区域，但未遇到单纯的“圆形细胞”脂肪肉瘤。80例（72%）有随访数据，平均随访时间超过7年。在DFT-S中，没有不可控制的复发、远处转移或肿瘤相关死亡。肿瘤深度与局部复发倾向相关；皮下原发性肿瘤无复发；起源于深部软组织或肌肉内的肿瘤有29%复发。复发性肿瘤均未出现“去分化”。DFT-R的复发率为67%，尽管没有远处转移，但9例患者（43%）死于肿瘤。5例腹膜后肿瘤发生去分化但未转移。根据这一经验，我们认为DFT-S采用“非典型脂肪瘤”这一术语是恰当的，而DFT-R采用“高分化脂肪肉瘤”这一名称是合适的。52例脂肪肉瘤（不包括DFT-S）的总体平均生存期为13.6年。“高分化脂肪肉瘤”的平均生存期（11.25年）介于黏液样脂肪肉瘤（16.25年）和多形性脂肪肉瘤（7年）之间。6例（29%）黏液样脂肪肉瘤患者发生局部复发；6例（29%）发生远处转移并死亡。转移总是与原发性肿瘤或局部复发中具有增多有丝分裂象的圆形细胞（或多形性）成分相关。
