Mentzel T, Fletcher C D
Department of Histopathology, St. Thomas's Hospital, London, UK.
Virchows Arch. 1995;427(4):353-63. doi: 10.1007/BF00199383.
This review summarizes the clinicopathological features of recently characterized variants of lipomatous tumours of soft tissue, attempts to deal with some difficult conceptual issues relating to adipocytic neoplasms and aims to provide an update on cytogenetic aspects of fatty tumours. Myolipoma is a rare benign neoplasm, occurring most frequently in adults in the deep soft tissue of the abdomen or retroperitoneum, and is composed of irregularly admixed mature adipose and smooth muscle tissues. Chondroid lipoma represents an unusual benign lesion occurring mainly in adult females subcutaneously or in deep soft tissue; it is easily mistaken for myxoid liposarcoma or extraskeletal myxoid chondrosarcoma. Spindle-cell liposarcoma is a variant of well-differentiated liposarcoma quite commonly found in subcutaneous tissue of the shoulder region and upper limbs and is composed of relatively bland-appearing spindle cells mixed with a well-differentiated liposarcomatous component. Recently there has been considerable debate about classification of lipomatous tumours. The term atypical lipoma was proposed for a group of well-differentiated non-metastasizing liposarcomas arising in surgically amenable soft tissues and for deep-seated atypical adipocytic neoplasms that show variation in adipocytic size and atypical stromal cells but lack lipoblasts. However, these neoplasms recur repeatedly and may dedifferentiate and thereby acquire metastatic potential. We use the diagnosis atypical lipoma with caution and propose to use the terms well-differentiated liposarcoma and atypical lipoma interchangeably. The relationship between myxoid and round-cell liposarcoma, which constitutes the morphological spectrum of a single entity, has been clarified but there remain considerable problems in defining likely clinical behaviour. The recent advances in cytogenetic characterization and classification of lipomatous tumours, which is already proving to be of diagnostic importance, are reviewed, and the genetic importance of the distinct chromosomal translocation in myxoid/round cell liposarcoma is briefly discussed.
本综述总结了近期所明确的软组织脂肪性肿瘤变体的临床病理特征，试图解决一些与脂肪细胞性肿瘤相关的棘手概念问题，并旨在提供脂肪性肿瘤细胞遗传学方面的最新信息。肌脂肪瘤是一种罕见的良性肿瘤，最常见于成人腹部或腹膜后的深部软组织，由不规则混合的成熟脂肪组织和平滑肌组织组成。软骨样脂肪瘤是一种不常见的良性病变，主要发生于成年女性的皮下或深部软组织；它很容易被误诊为黏液样脂肪肉瘤或骨外黏液样软骨肉瘤。梭形细胞脂肪肉瘤是高分化脂肪肉瘤的一种变体，常见于肩部和上肢的皮下组织，由外观相对温和的梭形细胞与高分化脂肪肉瘤成分混合而成。最近，关于脂肪性肿瘤的分类存在相当大的争议。“非典型脂肪瘤”这一术语被用于一组发生于手术可及软组织的高分化、不转移的脂肪肉瘤，以及深部非典型脂肪细胞性肿瘤，这些肿瘤显示脂肪细胞大小不一和非典型间质细胞，但缺乏脂肪母细胞。然而，这些肿瘤会反复复发，并可能去分化从而获得转移潜能。我们谨慎使用非典型脂肪瘤这一诊断，并建议可互换使用高分化脂肪肉瘤和非典型脂肪瘤这两个术语。黏液样和圆形细胞脂肪肉瘤之间的关系已得到阐明，它们构成单一实体的形态学谱，但在确定可能的临床行为方面仍存在相当多的问题。本文综述了脂肪性肿瘤细胞遗传学特征和分类方面的最新进展，这已被证明具有诊断重要性，并简要讨论了黏液样/圆形细胞脂肪肉瘤中独特染色体易位的遗传学意义。
