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Presented by Dr. Pedram Argani and prepared by Dr. Jennifer Bynum
This is a retroperitoneal mass in a 42 year old female.
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1. Question
Week (619): Case 3
This is a retroperitoneal mass in a 42 year old female.
Correct
Answer: Inflammatory liposarcoma
Histology: The major component of the lesion submitted is a nodule of spindle cells with myxoid stroma associated with prominent capillary vasculature and chronic inflammation. The appearances at low power suggest a lymph node. On higher power inspection, one can appreciate atypical cells within the nodule. Surrounding this nodule, in the associated fat, one can appreciate the atypical cells that are diagnostic of well differentiated liposarcoma. Therefore, the nodule represents a lymphocyte rich nodule within this well differentiated liposarcoma, which is termed inflammatory liposarcoma. Atypical cells in both the nodule and outside the nodule demonstrate strong nuclear labeling for MDM2, supporting the above diagnosis.
Discussion: Sclerosing mesenteritis would lack the prominent cytologic atypia of the current case, and would not label for MDM2. Myxoid liposarcoma is suggested by the myxoid stroma and prominent capillary vasculature within the lymphoid nodule of the current case; however, myxoid liposarcomas lack prominent cytologic atypia and would not demonstrate the well differentiated component seen at the periphery of the lesion. Dedifferentiated liposarcoma would be higher grade and lack lipogenic differentiation, which is not true of any of the components of the current lesion.
Reference(s):
– Am J Surg Pathol 1997; 21:884-895.
– Am J Surg Pathol 1997; 21:518-527.Incorrect
Answer: Inflammatory liposarcoma
Histology: The major component of the lesion submitted is a nodule of spindle cells with myxoid stroma associated with prominent capillary vasculature and chronic inflammation. The appearances at low power suggest a lymph node. On higher power inspection, one can appreciate atypical cells within the nodule. Surrounding this nodule, in the associated fat, one can appreciate the atypical cells that are diagnostic of well differentiated liposarcoma. Therefore, the nodule represents a lymphocyte rich nodule within this well differentiated liposarcoma, which is termed inflammatory liposarcoma. Atypical cells in both the nodule and outside the nodule demonstrate strong nuclear labeling for MDM2, supporting the above diagnosis.
Discussion: Sclerosing mesenteritis would lack the prominent cytologic atypia of the current case, and would not label for MDM2. Myxoid liposarcoma is suggested by the myxoid stroma and prominent capillary vasculature within the lymphoid nodule of the current case; however, myxoid liposarcomas lack prominent cytologic atypia and would not demonstrate the well differentiated component seen at the periphery of the lesion. Dedifferentiated liposarcoma would be higher grade and lack lipogenic differentiation, which is not true of any of the components of the current lesion.
Reference(s):
– Am J Surg Pathol 1997; 21:884-895.
– Am J Surg Pathol 1997; 21:518-527.
