Citation, DOI, disclosures and article data
Citation:
Knipe H, Silverstone L, Anan R, et al. Lipoma vs well-differentiated liposarcoma. Reference article, Radiopaedia.org (Accessed on 13 Mar 2025) https://doi.org/10.53347/rID-68800
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 favor 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 favor well-differentiated liposarcoma include 1-3:
- size >10 cm 4-6
- 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 favor lipoma include 1-3:
- size <10 cm 4-6
- percentage fat >75%
- no or few thin (<2 mm) septa
- no or minimal enhancement
- no or minimal high T2 signal foci
- subcutaneous location
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1. Kransdorf M, Bancroft L, Peterson J, Murphey M, Foster W, Temple H. Imaging of Fatty Tumors: Distinction of Lipoma and Well-Differentiated Liposarcoma. Radiology. 2002;224(1):99-104. doi:10.1148/radiol.2241011113 - Pubmed
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2. Gaskin C & Helms C. Lipomas, Lipoma Variants, and Well-Differentiated Liposarcomas (Atypical Lipomas): Results of MRI Evaluations of 126 Consecutive Fatty Masses. AJR Am J Roentgenol. 2004;182(3):733-9. doi:10.2214/ajr.182.3.1820733 - Pubmed
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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. doi:10.1148/rg.255055106 - Pubmed
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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. doi:10.1186/s12891-015-0491-8 - Pubmed
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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. doi:10.1016/j.jamcollsurg.2013.06.003 - Pubmed
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6. Bird J, Morse L, Feng L et al. Non-Radiographic Risk Factors Differentiating Atypical Lipomatous Tumors from Lipomas. Front Oncol. 2016;6:197. doi:10.3389/fonc.2016.00197 - Pubmed
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