Lipoma vs well-differentiated liposarcoma

Changed by Francis Deng, 12 Feb 2020

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There a number of features that can help distinguish between lipoma and well-differentiated liposarcoma. This article relates to superficial well-differentiated liposarcomas that typically occur in the extremities, also known as atypical lipomatous tumors, and not retroperitoneal liposarcoma.

Epidemiology

Demographic factors that favour well-differentiated liposarcoma are age >60 years and male sex 1

Radiographic features

MRI

MRI can have 100% sensitivity for the diagnosis of well-differentiated liposarcomas, however, has a low positive predictive value due to overlap of imaging features with benign lipoma variants 2. Features that favour well-differentiated liposarcoma 1-3:

  • size >10 cm4-6
  • percentage fat <75%
  • thick or nodular (>2 mm) septa
  • nodular/globular areas
  • prominent high T2 signal foci
  • prominent enhancement
  • associated non-adipose mass
  • lower limb location
  • intramuscular location

Features that favour lipoma 1-3:

  • size <10 cm4-6
  • percentage fat >75%
  • no or few thin (<2 mm) septa
  • no or minimal enhancement
  • no or minimal high T2 signal foci
  • subcutaneous location
  • -<p>There a number of features that can help <strong>distinguish between lipoma and well-differentiated liposarcoma</strong>. This article relates to superficial well-differentiated liposarcomas that typically occur in the extremities, and not <a href="/articles/retroperitoneal-liposarcoma-2">retroperitoneal liposarcoma</a>.</p><h4>Epidemiology</h4><p>Demographic factors that favour well-differentiated <a href="/articles/liposarcoma">liposarcoma</a> are age &gt;60 years and male sex <sup>1</sup>. </p><h4>Radiographic features</h4><h5>MRI</h5><p>MRI can have 100% sensitivity for the diagnosis of well-differentiated liposarcomas, however, has a low positive predictive value due to overlap of imaging features with <a href="/articles/benign-lipoma-variants">benign lipoma variants</a> <sup>2</sup>. Features that favour well-differentiated liposarcoma <sup>1-3</sup>:</p><ul>
  • -<li>size &gt;10 cm</li>
  • +<p>There a number of features that can help <strong>distinguish between lipoma and well-differentiated liposarcoma</strong>. This article relates to superficial well-differentiated liposarcomas that typically occur in the extremities, also known as <strong>atypical lipomatous tumors</strong>, and not <a href="/articles/retroperitoneal-liposarcoma-2">retroperitoneal liposarcoma</a>.</p><h4>Epidemiology</h4><p>Demographic factors that favour well-differentiated <a href="/articles/liposarcoma">liposarcoma</a> are age &gt;60 years and male sex <sup>1</sup>. </p><h4>Radiographic features</h4><h5>MRI</h5><p>MRI can have 100% sensitivity for the diagnosis of well-differentiated liposarcomas, however, has a low positive predictive value due to overlap of imaging features with <a href="/articles/benign-lipoma-variants">benign lipoma variants</a> <sup>2</sup>. Features that favour well-differentiated liposarcoma <sup>1-3</sup>:</p><ul>
  • +<li>size &gt;10 cm <sup>4-6</sup>
  • +</li>
  • -<li>size &lt;10 cm</li>
  • +<li>size &lt;10 cm <sup>4-6</sup>
  • +</li>

References changed:

  • 3. Murphey M, Arcara L, Fanburg-Smith J. From the Archives of the AFIP: Imaging of Musculoskeletal Liposarcoma with Radiologic-Pathologic Correlation. Radiographics. 2005;25(5):1371-95. <a href="https://doi.org/10.1148/rg.255055106">doi:10.1148/rg.255055106</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/16160117">Pubmed</a>
  • 4. Nagano S, Yokouchi M, Setoguchi T et al. Differentiation of Lipoma and Atypical Lipomatous Tumor by a Scoring System: Implication of Increased Vascularity on Pathogenesis of Liposarcoma. BMC Musculoskelet Disord. 2015;16(1):36. <a href="https://doi.org/10.1186/s12891-015-0491-8">doi:10.1186/s12891-015-0491-8</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25879189">Pubmed</a>
  • 5. Fisher S, Baxter K, Staley C et al. The General Surgeon's Quandary: Atypical Lipomatous Tumor Vs Lipoma, Who Needs a Surgical Oncologist? J Am Coll Surg. 2013;217(5):881-8. <a href="https://doi.org/10.1016/j.jamcollsurg.2013.06.003">doi:10.1016/j.jamcollsurg.2013.06.003</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24074812">Pubmed</a>
  • 6. Bird J, Morse L, Feng L et al. Non-Radiographic Risk Factors Differentiating Atypical Lipomatous Tumors from Lipomas. Front Oncol. 2016;6:197. <a href="https://doi.org/10.3389/fonc.2016.00197">doi:10.3389/fonc.2016.00197</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27713864">Pubmed</a>
  • 3. Mark D. Murphey, Lynn K. Arcara, Julie Fanburg-Smith. Imaging of Musculoskeletal Liposarcoma with Radiologic-Pathologic Correlation1. (2005) RadioGraphics. 25 (5): 1371-95. <a href="https://doi.org/10.1148/rg.255055106">doi:10.1148/rg.255055106</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/16160117">Pubmed</a> <span class="ref_v4"></span>

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