Mediastinal liposarcoma

Case contributed by Dr Yune Kwong

Presentation

Incidental finding

Patient Data

Age: 65-70 years
Gender: Male
X-ray

Abnormal mediastinal mass deviating trachea to the left.

CT

Mixed fatty/solid mass in the anterior mediastinum, extending to the neck. Deviation of the trachea.

Nuclear medicine

Mild uptake only in the solid components of the anterior mediastinal mass.

HISTOPATHOLOGY: MACROSCOPIC DESCRIPTION:
Right neck plus mediastinal mass: A smooth encapsulated, lobulated mass is inked with silver  nitrate and serially sliced. The cut surface is yellow tan, soft and lobulated. Areas of haemorrhage or necrosis are not seen. Involvement of the capsule macroscopically is not identified
MICROSCOPIC DESCRIPTION:
Sections of demonstrate a tumour composed predominantly of adipocytes. Throughout the tumour there are background areas of fibrosis and collagen,scattered within which  there  are  atypical  cells. The atypical cells are characterised by nuclear enlargement and irregularity and some multinucleate forms are identified. These cells have a small amount of ampophilic cytoplasm, with no striations evident.  The mitotic rate is not elevated.  Rare lipoblasts are present. Immunoperoxidase staining is negative for actin and  desmin  and  shows  patchy positivity with CD34.
DIAGNOSIS: Right neck plus mediastinal mass: Well-differentiated liposarcoma (lipoma-like).

Case Discussion

The differential for a fat-containing mediastinal mass includes mediastinal lipomatosis, tumours arising from fat (lipoma, liposarcoma, hibernoma) and tumours containing fat (teratoma, thymolipoma).

Liposarcomas present more commonly in the anterior than posterior mediastinum. They are usually large and can infiltrate the mediastinum. Patients typically are middle-aged and present with dyspnoea or chest pain. Well differentiated liposarcomas have large amounts of fat as well as soft tissue, as in this case (lack of PET uptake suggested low-grade tumour pre-operatively). High-grade liposarcomas do not have significant amounts of fat.

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Case information

rID: 32453
Case created: 27th Nov 2014
Last edited: 22nd Aug 2017
System: Chest
Inclusion in quiz mode: Included

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