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Atypical appearance of lipomatous tumors on MR images: high signal intensity with fat-suppression STIR sequences.

Lipomatous tumors generally have signal characteristics that allow them to be diagnosed with great accuracy by means of magnetic resonance imaging. These tumors usually have signal intensities similar to those of subcutaneous fat on both T1- and T2-weighted spin-echo images. Previous reports have not, to the authors' knowledge, described the appearance of lipomatous tumors on images obtained with a short-inversion-time inversion-recovery (STIR) sequence, which can be used to suppress signal from fat. Three lipomatous tumors (two liposarcomas and one lipoma) with signal characteristics unlike those of normal subcutaneous fat at all pulse sequences are presented.

Adult↗

Intra-abdominal metastases from soft tissue sarcoma.

OBJECTIVE: To define the clinical features and prognosis of patients with abdominal metastasis from primary soft tissue sarcoma (STS) at other sites. METHODS: All patients with abdominal metastasis from STS were identified from the Royal Marsden Hospital Sarcoma Unit prospective database from January 1990 to July 2001. RESULTS: Nineteen patients developed abdominal metastasis out of a cohort of 2127 patients (0.9%) evaluated during the study interval. The median age was 49 (19-71) years. The median time to abdominal metastasis from diagnosis of the primary was 27 (8-91) months. The presenting complaints were incomplete intestinal obstruction (n = 5), abdominal pain (n = 4), mass (n = 2), gastrointestinal bleed (n = 2), urinary obstruction (n = 2), anorexia (n = 1), and abdominal distension (n = 1). Emergency laparotomy was done for perforative peritonitis (n = 2), intussusception (n = 2), and bleed in spleen (n = 1). Two patients were asymptomatic. The common histologies were myxoid liposarcoma (n = 6) and leiomyosarcoma (n = 4). The median follow-up of survivors post metastasis was 12 months. Abdominal metastatectomy was performed in 16 patients, 3 of these patients had abdominal recurrences. The 1- and 2-year overall disease specific survival for the 19 patients was 66% (SE = 11%) and 43% (SE = 13%) with a median survival of 13 months (95% CI = 11.8-14.7). Metastasectomy was associated with slight improved median post-metastasis survival (33 months vs. 8 months for unresected patients). CONCLUSIONS: Although abdominal metastasis is rare, vigilance is warranted. Symptomatic patients should be examined and investigated thoroughly for metastases. Surgery is the treatment of choice for patients with an acute presentation; however, survival is dismal.

Abdominal Neoplasms↗

Magnetic resonance imaging of bone and soft tissue tumors: early experience in 31 patients compared with computed tomography.

In 31 patients with 21 soft tissue and 10 bone tumors, magnetic resonance imaging (MRI) and computed tomography (CT) were equally effective in delineating the margins of most soft tissue tumors, and the margins of bone tumors from fat and adjacent normal bone. However, MRI was superior to CT in delineating bone tumors from adjacent muscle, and in showing the relationships to bone of the deep margins of some soft tissue tumors. This was true because the quality of CT images around thick cortical bone often was severely degraded by streak artifact, which does not occur in MRI. Excellent anatomic detail was achieved on MRI by spin echo pulse sequences with short repetition times. Bone tumors were delineated best by spin echo 1000/30 images, and soft tissue tumors by spin echo 1000/30 or inversion recovery images.

Bone Neoplasms↗

Perioperative fractionated high-dose rate brachytherapy for malignant bone and soft tissue tumors.

PURPOSE: To investigate the viability of perioperative fractionated HDR brachytherapy for malignant bone and soft tissue tumors, analyzing the influence of surgical margin. METHODS AND MATERIALS: From July 1992 through May 1996, 16 lesions of 14 patients with malignant bone and soft tissue tumors (3 liposarcomas, 3 MFHs, 2 malignant schwannomas, 2 chordomas, 1 osteosarcoma, 1 leiomyosarcoma, 1 epithelioid sarcoma, and 1 synovial sarcoma) were treated at the Osaka University Hospital. The patients' ages ranged from 14 to 72 years (median: 39 years). Treatment sites were the pelvis in 6 lesions, the upper limbs in 5, the neck in 4, and a lower limb in 1. The resection margins were classified as intracapsular in 5 lesions, marginal in 5, and wide in 6. Postoperative fractionated HDR brachytherapy was started on the 4th-13th day after surgery (median: 6th day). The total dose was 40-50 Gy/7-10 fr/4-7 day (bid) at 5 or 10 mm from the source. Follow-up periods were between 19 and 46 months (median: 30 months). RESULTS: Local control rates were 75% at 1 year and 48% in 2 years, and ultimate local control was achieved in 8 (50%) of 16 lesions. Of the 8 uncontrolled lesions, 5 (63%) had intracapsular (macroscopically positive) resection margins, and all the 8 controlled lesions (100%) had marginal (microscopically positive) or wide (negative) margins. Of the total, 3 patients died of both tumor and metastasis, 3 of metastasis alone, 1 of tumor alone, and 7 showed no evidence of disease. Peripheral nerve palsy was seen in one case after this procedure, but no infection or delayed wound healing caused by tubing or irradiation has occurred. CONCLUSION: Perioperative fractionated HDR brachytherapy is safe, well tolerated, and applicable to marginal or wide surgical margin cases.

Adolescent↗

The evolution of techniques for reconstruction of full-thickness cheek defects.

Our experience with 20 full-thickness cheek reconstruction in 17 patients over the past 27 years is presented. The evolution of techniques for management of full-thickness cheek defects reflects our gradual appreciation of the longitudinal artery concept within axial and musculocutaneous flap units. During the 1950s, defects were managed by random flaps. Popularization of the forehead flap and introduction of the medially based deltopectoral flap during the 1960s heralded the current application of axial flaps. The 1970s saw an explosion of new techniques, including the musculocutaneous flaps and microvascular free tissue transfers, based on the longitudinal vessel concept. A method simultaneously employing the pectoralis major musculocutaneous flap for intraoral lining and the deltopectoral flap for external coverage has been described. A modification of the latissimus dorsi free flap to allow a one-stage watertight closure of large full-thickness cheek defects has been outlined. Our challenge for the 1980s lies in the improvement of techniques to reanimate the reconstructed cheek.

Adolescent↗

Electron microscopy of fine needle aspiration biopsy from soft tissue tumors.

The value of electron microscopy as an adjunct to fine needle aspiration cytology in the preoperative diagnosis of soft tissue tumors was studied in 22 cases. In 19 of these, the aspirated material obtained was adequate for electron microscopy analysis. The aspiration procedure did not damage the cells, and the aspirates were well suited to electron microscopic examination. In many cases this examination enhanced the precision of diagnosis and subclassification. This was the case in two intramuscular myxomas diagnosed as myxoid liposarcomas with light microscopy and in two sarcomalike squamous cell carcinomas diagnosed as polymorphous sarcomas in the ordinary smears.

Adult↗

CT and MR imaging of primary cardiac malignancies.

Primary cardiac malignancies are rare tumors that are difficult to diagnose clinically. Different primary cardiac malignancies may have different clinical, morphologic, and radiologic features and intracardiac locations. Angiosarcoma is the most common primary cardiac malignancy. It tends to occur in the right atrium and involve the pericardium. Because of its tendency to hemorrhage, angiosarcoma often demonstrates areas of increased signal intensity with T1-weighted sequences. Undifferentiated sarcomas typically occur in the left atrium and have variable epidemiologic and radiologic features. Rhabdomyosarcoma is the most common primary cardiac malignancy in children and is more likely than other primary cardiac sarcomas to involve the valves. Primary cardiac osteogenic sarcoma almost always occurs in the left atrium and frequently demonstrates calcification. Certain features (eg, broad base of attachment, origin at a site other than the atrial septum) help differentiate this tumor from left atrial myxoma. Leiomyosarcoma favors the left atrium and tends to invade the pulmonary veins and mitral valve. Fibrosarcoma also tends to occur in the left atrium and is often necrotic. Liposarcoma is very rare and usually manifests as a large, infiltrating mass. Foci of macroscopic fat are occasionally seen. Primary cardiac lymphoma occurs more commonly in immunocompromised patients, frequently involves the pericardium, and, unlike other primary cardiac malignancies, may respond to chemotherapy. The advent of cross-sectional imaging has allowed earlier detection of primary cardiac malignancies as well as more accurate diagnosis and characterization.

Calcinosis↗

[Perineo-scrotal liposarcoma. Apropos of 3 cases].

The authors report 3 rare cases of liposarcoma occurring in the perineal or paratesticular regions. They review literature data concerning this particular form of soft tissue sarcoma and emphasize on prognosis which depends mainly on its histo-pathologic type.

Adolescent↗

Myxoid liposarcoma of the oral cavity: case report and review of the literature.

Liposarcomas very rarely affect the oral cavity; in such cases the cheek is typically involved. Differential diagnosis between lipoma and other sarcomas is sometimes challenging because the macroscopic and histological features may be difficult to distinguish. Neoplasms with the morphology of lipoma should always receive a careful postoperative histopathologic evaluation. Complete surgical excision is the most effective treatment. We present a case of myxoid liposarcoma of the cheek, together with a literature review of intraoral liposarcomas reported during the last 60 years.

Gingival Neoplasms↗

Retroperitoneal sarcomas: grade and survival.

BACKGROUND: The survival of patients with retroperitoneal sarcomas depends on the feasibility of complete resection and the grade of the tumor. HYPOTHESIS: A high rate of complete resection, wide rather than local excision when feasible, and a policy of prompt reoperation for local recurrence all improve survival. METHODS: A review of 130 consecutive patients with retroperitoneal soft tissue sarcomas (1977-2001). RESULTS: The complete resectability rate was 95%, being 99% (78/79) for the primary tumors and 90% (46/51) for tumors referred with local recurrence. Local recurrence after complete resection occurred in 41% (32/79) of those with primary tumors and in 61% (31/51) of those referred with local recurrence (P =.06). The local recurrence rate was 63% after local excision and 39% after wide resection (P =.02). Of 83 patients with relapse, 37 (45%) were rendered surgically disease free. The estimated 5-year (10-year in parentheses) survival from the first surgery at our center was 65% (56%) for patients with primary tumors and 53% (34%) for patients referred with local recurrence (P =.23). For the primary tumors, the 5- and 10-year survival rates were 70% and 60%, respectively, after wide resection and 47% and 39%, respectively, after local excision (P =.04). For the primary tumors, the 5-year survival was 92%, 54%, and 48% for grades I, II, and III, respectively (P =.02). For those referred with local recurrence, the figures were 76%, 45%, and 19% for grades I, II, and III, respectively (P<.001). CONCLUSIONS: A high resectability rate (95%) is possible in retroperitoneal sarcomas. The survival estimates are similar to those following resection of extremity soft tissue sarcomas given an effective reoperation policy for local recurrences. Wide resection lowers the local recurrence and improves survival significantly. Survival varies significantly according to the grade of the tumor.

Adolescent↗

Hyperthermic isolated regional perfusion of the limb with carboplatin.

AIMS: To investigate the feasibility of hyperthermic isolated regional perfusion (HIRP) with carboplatin in the management of locally recurrent and/or intransit metastases of melanoma or locally advanced soft tissue sarcoma. METHODS: Three patients, two with locally advanced melanoma and one with a low-grade liposarcoma of the lower extremity, were treated with HIRP under mild hyperthermia (39-40 degrees C) with 125 mg carboplatin/l perfused limb volume. RESULTS: No systemic toxicity was observed. Local toxicity consisted of post-perfusion oedema present in all three patients which resolved within 2 weeks. Clinically, a persistent local neuropathy was observed in all three patients, two of which were confirmed by electromyogram and nerve conduction study. Severe motor-sensory neuropathy was located mainly in the peroneal and sural nerves of the perfused limbs. Pharmacokinetic parameters of the carboplatin showed a higher concentration of carboplatin in the skin compared to the muscle. The two melanoma patients showed a complete response but developed local recurrences within 1.5 years after perfusion. The third patient underwent a delayed excision of the sarcoma 8 weeks after perfusion which revealed 50% viable tumour. One of the melanoma patients and the sarcoma patient died from lung metastases 56 and 31 months post-perfusion treatment, respectively. The other melanoma patient is alive 95+ months post-perfusion treatment. CONCLUSIONS: The local neurotoxicity observed did not warrant further research of carboplatin in HIRP.

Aged↗

Immunohistochemical detection of EWS and FLI-1 proteinss in Ewing sarcoma and primitive neuroectodermal tumors: comparative analysis with CD99 (MIC-2) expression.

The molecular analysis of the t(11;22) rearrangement involving EWS/FLI-1 genes is likely to be of diagnostic value in Ewing sarcoma (ES) and primitive neuroectodermal tumors (PNET). The objective of the current study was to analyze the immunohistochemical expression of the EWS and FLI-1 proteins in a group of small round-cell tumors (SRCT) to determine their specificity and relevance in their differential diagnosis. Forty-eight cases-10 conventional ES, 4 large-cell ES, 5 PNET, 9 neuroblastomas (NB), 6 undifferentiated synovial sarcomas (SS), 5 rhabdomyosarcomas (RB), 5 non-Hodgkin lymphomas (NHL), 1 round-cell liposarcoma, and 3 mesenchymal chondrosarcomas-were analyzed. Immunocytochemistry was performed on paraffin sections after the LSAB method and antigen retrieval using ethylenediaminetetraacetic acid buffer (pH 6). Primary antibodies included FLI-1 (C-19), EWS (N-18), EWS (C-19), and CD99 (MIC-2). As expected, CD-99 expression was found in 100% of ES/PNET cases, in 2 cases of RB, 2 SS, and 1 NHL. FLI-1 protein was observed as nuclear staining in 16 cases of ES/PNET (84%) and in 4 cases of NHL, 2 NB, and 3 SS. Normal endothelial cells and lymphocytes also were positive. EWS expression (both proteins N-18 and C-19) was detected not only in 95% of ES/PNET cases but also in more than 50% of cases from the other tumoral types (4 of 9 and 7 of 9 NB, 5 of 6 and 6 of 6 SS, 3 of 5 and 5 of 5 RB, and 2 of 5 and 3 of 5 NHL, respectively). Whereas EWS expression does not appear specific for ES/PNET, analysis of FLI-1 expression together with CD-99 is a powerful marker for ES/PNET and important factors in the differential diagnosis of SRCT.

12E7 Antigen↗

Evidence for fetal antigen in human sarcoma.

A common antigen (S(2)), initially thought to be uniquely associated with human sarcomas, has been found to be widely distributed in patients with other tumors as well. Absorption studies with human embryonic tissues suggest that S(2) may be a fetal antigen. The presence of antibody to S(2) in patients with tumors and in their relatives implies a propensity in these individuals for cellular dedifferentiation which may be a prerequisite for malignant transformation.

Antibodies, Neoplasm↗