Lipogenic tumours Flashcards Preview

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Flashcards in Lipogenic tumours Deck (12):
1

What is a lipoma?

  • A common benign tumour of Mature fat 
  • maybe subcutaneous, extramuscular or intramuscular
  • M>F
  • pts 40-60 yrs
  • develops in sedentary individuals
  • location
    • superficial/Subcutaneous common
    • upper back/thigh/buttocks/shoulder/arm
    • deep in thigh/shoulders/arms
    • 5-10% multiple lesions
  • Prognosis
    • size plateaus after initial growth

2

Describe the classification of lipomas?

  • Spindle cell lipoma
    • Males, 45-65
  • Pleomorphic lipoma
    • middle ages pts
  • Angiolipoma
    • unique that Painful when palpated
    • small nodules in upper arm
  • Intermuscular lipoma
    • symptomatic often require marginal resection
  • Hiberonoma- see pic
    • tumour of brown fat
    • young pts 20-40

A image thumb
3

What are the symptoms of a lipoma?

  • Painless mass that been present for a long time
    • angiolipoma exception

O/E

  • Palpable, mobile, painless lesion

4

What is seen on imaging of a lipoma?

  • Xray
    • radiolucent lesion in the soft tissues
    • mineralisation should raise concerns of synovial cell carcinoma
  • CT
    • lesion akin to subcutaneous fat
  • MRI
    • Homogenous signal intenisty matches adipose tissue on all images sequencing
    • high signal T1
    • low (dark) T2 and STIR
    • dx often made so biopsy often not required

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5

What is the tx of lipoma?

Non operative

  • Observation only
    • painless & MRi confirms dx

Operative

  • Marginal resection
    • symptomatic lesions
    • mass rapidly growing
    • spindle cell/pleomorphic lipomas tx w marginal resection

6

What is the complication of lipomas?

  • Local Reoccurance
  • <5%

7

What is a liposarcoma?

  • A Heterogenous class of sarcomas with differentation towards adipose tissue
    • the lipoblast ( signal ring type cell) is hallmark
  • 2nd most common form of soft tissue sarcoma in adults
  • lipomas not predisposition to liposarcomas
  • 50-80yrs
  • M>F
  • occur deep fascia
  • Lower extremity> upper extremity
  • common in retroperitoneum
  • genetics
    • myxoid liposarcoma- translocation (12,16)

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8

What is the malignancy potential with liposarcomas?

  • Correlates w grade/subtype
  • low grade met rate <1%
  • Intermediate ( myxoid) met rate 10-30%
  • High grade met rate >50%

9

What is the prognosis of  liposarcomas?

  • well differentiated exhibit <10 local recurrence rates and <1% chance of mets & almost complete survival
  • w appropriate tx, intermediate & high grade liposarcomas show -20% risk of local recurrence but they exhibit 5 years survival between 25-50%

10

Describe the types of  liposarcomas?

  • All from primitive mesenchymal cells
  • Well differentiated
  • Myxoid
    • most common 50% liposarcomas
  • Round cell
  • Pleomorphic
  • Dedifferentiated

11

What is see on imaging of  liposarcomas?

  • xrays
    • may show calciifcation/ossification in well differentiated  liposarcomas
  • MRI
    • well differentiated similar to lipomas- T1 Bright, dark T2
    • high grade - see pic
      • T1 Dark- due to <10% of fat in lesion
      • T2 Bright
  • Ct Chest/abdo/pelvis- esp in myxoid  liposarcomas as tendency to met to areas outside lungs- retroperitoneal 

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12

What is the tx of  liposarcomas?

  • Operative
    • marginal resection without radiotherapy
      • well differentiatied  liposarcomas
      • low risk of recurrence, met extremely rare
    • Wide surgical resection with adjuvant radiotherapy
      • for ​intermediate/high grade  liposarcomas
      • radiation reduces local recurrence
      • chemo may benefit some pts
      • myxoid  liposarcomas w >10% round cells have high likelyhood of mets