July 14, 2017

Well-Differentiated Lipomatous Tumors: A Case Series (Video)

Soft tissue pathology service’s most common consult

In this case series, John Goldblum, MD, chairman of the Department of Pathology in Cleveland Clinic’s Robert J. Tomsich’s Pathology and Laboratory Medicine Institute and an expert in soft tissue tumor pathology, reviews three cases of soft tissue tumors. According to Dr. Goldblum, well-differentiated lipomatous tumors are the most common reason that clinicians consult the department’s soft tissue pathology service. “It’s a very common problem seen by all surgical pathologists,” he says, before offering an overview of Cleveland Clinic’s approach to identifying these legions through the lens of three typical cases.

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He illustrates how to distinguish among pleomorphic lipomas, well-differentiated liposarcomas (also known as atypical lipomatous tumors) and dedifferentiated liposarcomas. The first case is a 49-year-old male with an upper back mass, and Dr. Goldblum emphasizes that the multi-nucleated floret-like giant cells seen in the slide are suggestive of but not pathognomonic of pleomorphic lipomas.

The second case is a deep soft tissue mass from the thigh of a 65-year-old female. Dr. Goldblum notes the atypical hyperchromatic nuclei that lead him toward a diagnosis of well-differentiated liposarcoma. He also explains why he never looks for lipoblasts when examining a well-differentiated fatty tumor.

In this case series, John Goldblum, MD, chairman of the Department of Pathology in Cleveland Clinic’s Robert J. Tomsich’s Pathology and Laboratory Medicine Institute and an expert in soft tissue tumor pathology, reviews three cases of soft tissue tumors. According to Dr. Goldblum, well-differentiated lipomatous tumors are the most common reason that clinicians consult the department’s soft tissue pathology service. “It’s a very common problem seen by all surgical pathologists,” he says, before offering an overview of Cleveland Clinic’s approach to identifying these legions through the lens of three typical cases.

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He illustrates how to distinguish among pleomorphic lipomas, well-differentiated liposarcomas (also known as atypical lipomatous tumors) and dedifferentiated liposarcomas. The first case is a 49-year-old male with an upper back mass, and Dr. Goldblum emphasizes that the multi-nucleated floret-like giant cells seen in the slide are suggestive of but not pathognomonic of pleomorphic lipomas.

The second case is a deep soft tissue mass from the thigh of a 65-year-old female. Dr. Goldblum notes the atypical hyperchromatic nuclei that lead him toward a diagnosis of well-differentiated liposarcoma. He also explains why he never bothers to identify lipoblasts when examining a well-differentiated fatty tumor.

In the final case, he examines a large retroperitoneal mass from an elderly patient and highlights the importance of examining the slide’s periphery in order to identify any well-differentiated liposarcomatous components. Find out why Dr. Goldblum argues that the type of spindle cell sarcoma is inconsequential in this case in the video below:

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The accurate diagnosis, grading and staging of benign and malignant soft tissue neoplasms, as well as mesenchymal neoplasms of the skin and parenchymal organs, can be challenging. Cleveland Clinic’s soft tissue pathology service, led by Karen Fritchie, MD, offers consultations on some of the most difficult cases in soft tissue pathology as well as a fellowship program and continuing medical education opportunities for practicing pathologists.

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