Myxoid liposarcoma

Case contributed by Dr Imran Ahmad Khan

Presentation

Large painless swelling in left groin from 2 months.

Patient Data

Age: 40 years
Gender: Female
ultrasound

A large heterogeneous mass is seen in the left groin, located mainly in the subcutaneous plane superficial to the muscles. Margins are lobulated but well-defined. The mass has a whirled appearance. Internal cystic/necrotic spaces are seen. Low level of internal vascularity is seen. No calcifications are seen in the mass.

mri

A large multilobulated mass measuring 13 x 12 x 8 cm is seen at the inner aspect of the proximal left thigh extending up to the left side of the perineum. The mass is brightly hyperintense on T2 and STIR and shows multiple thin hypointense internal septae. The mass is of intermediate signal intensity on T1. A thin fat intensity rim is seen at the medial border of the cranial end of the mass, which is hyperintense on T1 and shows signal suppression of T1 fat sat. On post-contrast scans, intense inhomogeneous enhancement of the mass is seen. The mass is embedded predominantly within the subcutaneous tissues with no involvement of the muscles or the pelvic bones.

Multiple uterine fibroids are noted. 

A small dermoid cyst is noted in the right ovary.

Ultrasound guided biopsy

ultrasound

Ultrasound guided core needle biopsy.

Case Discussion

Ultrasound and MRI were inconclusive as to the exact nature of the mass. An atypical lipomatous tumor was suspected in view of a thin fat intensity rim at the medial margin of the upper end of the mass. Histopathological examination was recommended. 

An ultrasound-guided biopsy was done to decide on surgical management. The biopsy revealed a "low-grade myxomatous neoplasm".

Surgical excision was performed which showed a yellowish, multiloculated and friable tumor. The specimen was sent for histopathology.

The final histopathological diagnosis came as - "Myxoid liposarcoma, FNCLCC Grade 1, with maximum tumor dimension of 19cm (pT4).

Histologic Grade (French Federation of Cancer Centers Sarcoma Group [FNCLCC])

Grade 1 [sum score of 3 : differentiation(2), mitoses(1), necrosis(0)]".

Local radiation therapy was not given. The patient has been placed on follow up and is disease-free at three months post-surgery. However, there are high chances of relapse 5 and the patient would be taken for chemotherapy in case of recurrence. 

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