Orthopedic Oncology cases liposarcoma

An 81-year-old female is brought to your office by her son. She has been treated for bilateral knee osteoarthritis for the past year by her primary care physician. A recent MRI was conducted and was concerning for an incidentally found 12-cm soft-tissue mass in her posterior thigh. She denies pain in this area but does admit to feeling a deep mass in the back of her thigh when she sits down. X-ray and MRI images are shown in Figure 8–29A and B.

 

 

Figure 8–29 A–B

 

Which soft-tissue sarcomas can exhibit areas of calcification?

1. Rhabdomyosarcoma and liposarcoma

2. Liposarcoma and synovial sarcoma

3. Fibrosarcoma and clear cell sarcoma

4. Malignant peripheral nerve sheath tumor and leiomyosarcoma

 

Discussion

The correct answer is (B). Liposarcoma and synovial sarcoma can show foci of calcification. In an elderly patient with a painless, enlarging soft tissue mass, areas of calcification on plain radiograph should raise suspicion for one of these two malignancies. Since liposarcoma is more common in this age group, this is the leading diagnosis for this patient based on imaging.

In addition to a standard chest CT, which of the following is an important study to include in staging workup of myxoid liposarcoma?

1. Lymph node biopsy

2. Head CT

3. Abdomen/pelvis CT

4. Renal function tests

 

Discussion

The correct answer is (C). Myxoid liposarcomas have metastatic patterns that can differ from other sarcomas and have a propensity to metastasize to the retroperitoneum. Therefore, staging for this tumor should include a CT scan of the abdomen and pelvis in addition to a CT of the chest.

If staging workup does not show any evidence of metastases, what is the most

appropriate treatment to recommend for the thigh lesion?

1. Chemotherapy and surgery, as these tumors are chemosensitive

2. Radiation only, as these tumors are extremely radiation-sensitive

3. Radiation and wide surgical resection

4. Chemotherapy and hip disarticulation

 

Discussion

The correct answer is (C). Wide surgical resection plus radiation is the treatment for large, deep extremity liposarcoma. If wide resection is not achievable, amputation can be considered. Due to the patients advanced age and the limited sensitivity of this tumor to chemotherapy, she is unlikely to benefit from chemotherapy.

After full laboratory and imaging workup, a biopsy is performed with image guidance. Pathology report confirms diagnosis of high-grade pleomorphic liposarcoma. It also reveals lesions in the lungs that are biopsied and shown to be metastasis. What stage does this represent, based on the American Joint Committee on Cancer (AJCC) Staging system for soft-tissue sarcoma?

1. III

2. IIA

3. IV

4. IIB

 

Discussion

The correct answer is (C). If distant metastases are present, this automatically categorizes the patient as stage IV. The presence of metastases is the most important prognostic factor in soft-tissue sarcoma staging. Other criteria important for AJCC staging include grade, size of the tumor, and regional lymph node involvement.

 

Objectives: Did you learn...?

 

 

Clinical and imaging features of liposarcoma? Staging evaluation of liposarcoma?

 

Treatment of liposarcoma?