Liposarcoma 101: Everything a Pathologist Needs to Know
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- čas přidán 29. 07. 2020
- A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology).
How to diagnose and subtype Liposarcoma. Long video but has 100+ pics and tons of practical tips for correctly working up & diagnosing the major forms of liposarcoma (& a few mimics too). I left out a few esoteric or controversial entities/topics, but otherwise, this video is pretty much comprehensive for what a general pathologist would need to know about liposarcomas. I hope you enjoy!
Presented as a virtual lecture via Zoom app to the Asociación Colombiana de Patología (Asocolpat) in lieu of my scheduled in person presentation at their 2020 annual meeting (cancelled due to COVID-19), July 2020, Cali, Colombia. This video is dedicated to my good friend and colleague, Dr. Jaime Arturo Mejia, past president of Asocolpat: thank you for the invitation, Jaime!
HUGE thanks to Dr. Mónica Ruiz Ballón for translating and typing up a Spanish transcript of all 20,000+ words of my lecture so that there could be Spanish subtitles and to Dr. Jaime Arturo Mejía for editing the transcript! Muchas gracias! Spanish transcript (Traducción al Español) available here: kikoxp.com/posts/5190.
(ps - if anyone wants to type up the time stamps for each topic/entity and post it as a comment, I'll copy-paste it here and give you name credit!)
Overview of liposarcoma major subtypes/families:
Explanation of pleomorphic lipoblasts:
Lochkern:
(great paper about lochkern: pubmed.ncbi.nlm.nih.gov/15618...)
ALT/WDL:
Lipoma with fat necrosis:
Dedifferentiated liposarcoma:
Myxoid liposarcoma:
High grade ("round cell") myxoid liposarcoma:
Pleomorphic liposarcoma:
Please check out my Soft Tissue Pathology & Dermatopathology survival guide textbooks: bit.ly/2Te2haB
This video is geared towards medical students, pathology or dermatology residents, or practicing pathologists or dermatologists. Of course, this video is for educational purposes only and is not formal medical advice or consultation.
Presented by Jerad M. Gardner, MD. Please subscribe to my channel to be notified of new pathology teaching videos.
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A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology). Traducción al Español aqui: kikoxp.com/posts/5190.
I was treated for pleomorphic liposarcoma many years ago. I liked your presentation, and I found it understandable even though I'm not in the medical field. I especially appreciated the comment that an individual isn't a statistic. That thought helped me when going through the treatment. It's nice to hear a doctor say that out loud.
Thank you for this feedback. I deeply value the perspective of rare disease patients (discussed in my TED talk about working with rare cancer Facebook patient groups: czcams.com/video/9aQSmx0A7pg/video.html). I’m glad to hear you are well many years out after liposarcoma treatment. Best wishes for continued health and happiness. Jerad
How are you now??
@@Ambuj_kumar08 Doing okay after 18 years.
You take medicine now
@@tekperson is you take medicine now
Thank you alot for your vids. That amazing job you do always keeps me inspired. Sometimes my thoughts are just getting confused, fused and whatsoever, so basically after watching you, I finally can get that bone needed. Please, keep going!
Amazing video Dr. Gardner, I am rotating in soft tissue pathology and this has really helped me understand better liposarcoma. Thank you!
One video clarified most doubts about liposarcoma. Thanks a lot!
Overview of liposarcoma major subtypes/families: 0:00
Explanation of pleomorphic lipoblasts: 5:32
Lochkern: 10:36
(great paper about lochkern: pubmed.ncbi.nlm.nih.gov/15618...)
ALT/WDL: 14:05
Lipoma with fat necrosis: 39:51
Dedifferentiated liposarcoma: 45:02
Myxoid liposarcoma: 1:05:34
High grade ("round cell") myxoid liposarcoma: 1:28:12
Pleomorphic liposarcoma: 1:35:06
Thank you!!!
Respected sir your presentation on liposarcoma was an eye opener for me may god bless you
Excellent talk. Very clear and nicely presented. Thanks dr. Gardner
wonderful video packed with information. Thanks Dr Gardner
Absolutely outstanding professor, with lots of love & respect from Nepal. Seeing your vids and reading robbins , ah it feels good💜
God bless... I might have read theses chapters for 4-5 times...and always always have bunch of queries... Today got not only solved but also have chance to see so many slides .... Thank you for this .
Thank you. This comment made my day. I’m so happy I was able to help.
Dear sir you are doing great job for pathologists sitting in far flung areas
Fantastic lecture! Thank you so much Dr Gardner! 🙏🏻🙏🏻🙏🏻🙏🏻
Another fantastic teaching session, thank you so much
Superb description DR JERAD
Thanks for this amazing comprehensive video 👍👍👍
Very informative video! Thank you. Just recently been diagnosed with Well-differentiated Liposarcoma/Atypical lipomatous. Great work 👏👏👏
Thank you for the kind words. I’m sorry to hear of your diagnosis. There is a Facebook patient support group for liposarcoma. You might find it to be a helpful source of general info and support. Best wishes for healing and good health.
How did you get your diagnosis? Do you mind explaining the process? My doctors often blow me off thinking they're lipomas. Is there a big difference I should be aware of?
Thank you doing this. This is really helpful.
Fantastic and very helpful! Thank you!!
You are an amazing teacher. Thank you very much
Loving your videos, Jerad, you're amazing! Thanks a lot for the time you dedicate yourself to teach us! Best regards from Brazil!
Obs. I absolutely agree with you, I can't never see "chicken wire" pattern! kkkk ;)
Long but very nice talk. Thank you😊
Thank you for this Dr. Gardner
Thank you for this video I am having a proceedure done for Myoxid Liposarcoma stage 3, this month. Buttocks mass exhition with a lift.
Thank you very much from Korea. Your lectures are really helpful. Wonderful.
Kam sa ham ni da!
Amazing discussion Sir..
Excellent lecture. Thank you!
Fantastic presentation
Thanks for the explanation. I got a well differentiated Liposarcoma when I were 26 on my right thryroid gland, it was removed by a surgery. Now it recurs after 2 years, so I will have another surgery in the next 2 weeks. Hope it will go away permanantly afterward.
Thanks.Great lecture as usuall.Is it possible to have abstracts of your lectures as well?
Amazing! Thank you very much!
Dr. Gardner, I watched this video again and again, it's helping me everyday of my practice! Thank you very much!
By the way, I really want to learn how you deal with recently recognized entities of adipose tissue like: Atypical spindle cell lipomatous tumor and Myxoid pleomorphic liposarcoma. Will you have plans for these entities someday in the future?
Thank you! Those entities are a bit more complicated. I may address them one day but I think these are still evolving areas of understanding in soft tissue Pathology.
Very very useful video 👍 thank you very much 🙂
Loving your videos, Dr! Btw, what is the cut-off value when analyzing amplified cells using fluorescence microscope?
Slide review focusing on morphology would be great as well.
Excellent!
You are amazing, thanks a lot
You are terrific
Madhu Dewan, MD
Thanks ..very helpful
Thank you so much!
Thank you so much dr. Gardner for this amazing video! I have one question: how to differentiate Myxofibrosarcoma and myxoid pleomorphic liposarcoma? thank you
Lipoblasts are the key. Here’s my Myxofibrosarcoma 101 video: kikoxp.com/posts/4190
My husband (41) died on 9/15, 1 year and 3 months after diagnosis with dedifferentiated liposarcoma, though he was showing symptoms at least 1 year and 7 months ago. Shortly before he died, he had a below normal albumin level that was essentially ignored (because the nurses said he would likely receive a transfusion 4 days later anyway) and I can't help but wonder if that caused his death. Yes, he was in pain, but I know my husband and he would've continued suffering through the pain so he could be here for our 4-year-old son and for me. I'm glad he's not in pain anymore, but I know what he would've wanted. He also had a cough and was lethargic. All of this info was relayed to the nurses and they brushed it off as side effects of the chemo. I wish we had just taken him to the hospital immediately instead of trusting them.
I’m so sorry for your loss! Best wishes for peace and healing for your and your family.
Great talk! Thank you so much Dr Gardner. I have a question. What is the median survival time of liposarcoma? Do you have any idea Dr ?
It depends on multiple factors, most importantly which exact type of liposarcoma it is. Each type is totally different. Also depends to some extent on Anatomic site and size of tumor.
Lochkern actually means nuclear hole ;) Greetings from Germany! And thanks for these videos, absolutely golden for pathology residents I believe!
Thank you very much
Very helpful thanks
My dad had liposarcoma 30 years ago. The tumor was 18lbs.He lived 2 years. I had a sarcoma in my hip. They caught it early.
Thanks you very much
Thank you
Thank you for the great lecture .
It really helped! (from your korean fan😄).
감사합니다
Hi Dr. Gardner, My identical twin sister was diagnosed with Dedifferentiated LipoSarcoma after it's removal, which was thought to be angiolipoma on the kidney pre-surgery. She is very scared because the tumor was 9 lbs and managed to hit the pancreas and the diaphragm. The surgeon thinks he got all of it, but we're in a state of distrust since the true diagnosis was so off from the very beginning. She is 57 years old. Is it possible to set up a second opinion with you since you seem to know so much about Liposarcomas.
I am worried for the last years I've been having what feels like lumpy fatty tissue build up in the inner thighs, abdomen and chest area. I've asked doctors in the past and they said it's fatty tissue. I was told I have enlarged lymph nodes in my chest and groin. I've seen an Oncologist/Hematologist then a Surgeon who did a biopsy along with other Doctors. A biopsy was done on my left Auxiliary Lymph Node and nothing suspicious was seen. I continue to have these things and the doctors never could say what I have. I've had all kinds of crazy symptoms for years. My doctor said my C diff was normal and I didn't have unexplained weight loss or night sweats so he wasn't too worried. I am wondering do Sarcomas or anything I should be worried about always show up in bloodwork? What would you say I should have the doctor's check ?
Lochkern would translate in english as nucleus with a hole in it, like nuclear hole, not lake. Regarding the pronunciation, it's more like loh, the sound "ch" produces is like a cat hissing, and the "e" in "kern" is pronounced more like in the english word "let". This is not in any way meant as a reproach or anything 😁 just pointing out the correct meaning and pronunciation, as I know you are open to stuff like this, Dr. Gardner. And, of course, thank you for your amazing contribution to pathology education!
Thank you for teaching me!
What would cause myxoid changes in a foot w/ "synovial cysts"? Also with mottling on the skin with temperature changes? 🧐🤔 And Fibrocartliagous coalition with fluid signal synovial sheath w/subcortical cysts of inferior navicular bone?
Any guesses?
Can ultrasound determine benign lipoma vs a pleomorphic sarcoma lump located on the subcutaneous tissue?
Thank you
Could CD34 help with differentiating spindle cell/pleomorphic lipoma and ALT/WDL as well?
It was so informative and helpful. But kindly use a dark colour pointer during slides pictures..
about 2.5 months ago I noticed a small lump in my buttock and it was tender to the touch and a little squooshie. Now I have bumps and masses that are spreading down my thighs, hips and buttocks. Im agonizing over what it might be and my insurance does not take effect for 20 days. Im truly afraid I have some fast spreading liposarcoma and dont know what to do. I dont feel sick or dizzy but am beside myself seeing the spread and having to wait for insurance to be diagnosed. Any guidance?
Definitely see your doctor (ideally a dermatologist) as soon as possible, but in the meantime, try not to worry too much. There are lots and lots of other benign things that can cause lumps and bumps. Angiolipoma, for example, often presents as multiple painful lumps on the arms or legs. And there are regular lipomas (benign fatty tumors that are totally unrelated to liposarcoma) and many many other possibilities. Your doctor can help figure out what it is, and they can do a biopsy to allow for pathologist to examine the tissue microscopically if feel that is indicated.I can't figure out what your diagnosis is just from this description, of course, but I will point out that I have seen many liposarcomas, but I've never seen one present as multiple bumps and masses spreading down the legs like you describe. Liposarcoma usually presents as a single large deep mass, and if and when it spreads, it spreads to the lungs usually. So try to be at peace while waiting to see your doctor and not lose sleep. Best wishes for everything to work out well and for your continued health.
you made a wonderful lecture! may I ask a question: can well-dif liposarcoma have osteosarcoma component as heterogeneous differentiation?
I don’t think so. Heterologous bone, yes. But if it has true osteosarcoma component, that would mean dedifferentiated liposarcoma to me.
@@JMGardnerMD I have a case with well-dif liposarcoma component, osteosarcoma component but no pleomorphic high grade area. what do you think?
Thank you Dr.Gardner. May i know is there a difference between lipoblast and pleomorphic lipoblast? is there anything like atypical lipoblast?
I don’t use “atypical lipoblast” as a specific term although I think a lipoblast with atypia would basically be the same thing as a pleomorphic lipoblast in my mind. Some lipoblasts (like the tiny signet ring lipoblasts in myxoid liposarcoma) do not have atypia or pleomorphism.
@@JMGardnerMD Thanks very much for the reply. Your videos are very helpful.
Loch actually means Hole in german, thank you
Ah thx!
Once I've seen needle core biopsies from a retroperitoneal mass, which showed an atypical spindle cell proliferation with a cellularity comparable to 1:03:38.. CISH showed MDM2 amplification.. however I think I found only 1 mitosis in all of the cores, even though there was not a hint of lipogenic differentiation, that was quite confusing :D
Yes some cases are in between well diff and Dediff and those are a struggle for all of us!
What is main difference between Lipoma and Liposarcoma? i got a soft movable lump which is nonpainful from one month it is 1 inch and not growing
My gp looked at mine i have a hx of breast and colon and skin cancer. Mine is about 1 inch in diameter it moves undernthe skin i got am referral to have it looked at but no appointments available for a while. It was concerning duee to history.
Can you help me ,my father has diagnosed dedifferentiated liposarcom high gradus 3.He did resection,we are in croatia,it is very rare case,he is in pain,also removed kidney and small part of liver
34 centimeter and 6 kilogram weight
My husband (41) died on 9/15, 1 year and 3 months after diagnosis, though he was showing symptoms at least 1 year and 7 months ago. I hope your father is still alive. If he is, I highly encourage you to try, as much as you can, to spend time with him outside of caregiving. Also, keep an eye on his levels after labs. My husband had a below normal albumin level that was essentially ignored (because the nurses said he would likely receive a transfusion 4 days later anyway) and I can't help but wonder if that caused his death. Yes, he was in pain, but I know my husband and he would've continued suffering through the pain so he could be here for our 4-year-old son and for me. He also had a cough and was lethargic. All of this info was relayed to the nurses and they brushed it off as side effects of the chemo. I wish we had just taken him to the hospital immediately instead of trusting them.
I have just under 10 random lumps in the fat cells in my thighs and my doctors tend to blow me off, but I want to be checked. How can I get my doctor to take it seriously enough to do some testing?
Go see your dermatologist and tell them you understand it is likely nothing but you are still worried and would feel better to have some of the masses sampled and reviewed microscopically by a pathologist. FYI multiple small lumps in the thigh is unlikely to be anything serious but having a biopsy reviewed by a pathologist can help put everyone’s mind at ease.
@@JMGardnerMD thank you
Very interesting. I have an almost 3 cm hard mass that goes deep in the posterior L side of my cervical neck area. MRI with and without contrast determined it is an atypical lipoma with suspiciousness to be a Liposarcoma. I really wished they would of defined that it was a Lipoma, but it isn't. They told me to due surgical consultation about atypical lipoma vs liposarcoma. Once removed; then proceed to a pathologist. I'm younger than 40 =(
I’ve got a 3 inch by 3 inch lump on my left oblique area and multiple smaller ones around my back and many of my lymph nodes are very inflamed from my neck to my thighs and my gp has completely ignored them saying they are probably just cysts but even so I’d like to get them properly checked and with covid I can’t even get ahold of her so i don’t even know what to do no doctors in my town are taking patients lmfao
I’m sorry to hear this. But don’t get too worried just yet. A small superficial liposarcoma in a person under 40 is extremely rare. And there are other benign fatty things (like spindle cell lipoma and hibernoma) that can mimic liposarcoma on radiology studies. The only way to know the diagnosis for sure is to have the mass biopsied or excised so it can be examined by a pathologist. Sometimes uncommon variants of fatty tumors Can be difficult to diagnose for a pathologist. In that case, a second opinion from an expert pathologist may be helpful. Please be sure to see your surgeon and discuss all of this with him or her. But in the meantime try not to be too worried. Wait until the pathology results come back to see what the final answer is. Please keep me updated and let me know what the results show. If I can help with explaining the pathology report, I would be happy to do so. You can reach me via email at JMGardnerMD at gmail.com. Best wishes for a benign diagnosis and good health.
Hi Catherine Arroyo, how about your right now? I got result liposarcoma on my left shoulder, and I'm younger than 40, can I have some information from your? Thank your!
Can a well differentiated liposarcoma occur in visceral organs?
They don’t usually arising WITHIN a visceral organ, but they often surround and infiltrate into organs. I’ve seen well differentiated/dedifferentiated liposarcoma of retroperitoneum grow through the wall of the colon, surround the kidney, and infiltrate into the pancreas.
Thank you sir
What about Myxofibrosarcoma?
Myxofibrosarcoma 101 video: kikoxp.com/posts/4190
Tengo liposarcoma desdiferenciado retroperitoneal y nadie me ayuda, lo dije en agosto 2020,tenia 5,6cm.Ahora mas de 20 y es enorme como un embarazo de 5 meses. Y nadie me quiere operar😢😢😢😢😢😢😢😢😢😢😢😢
👍🏾👍🏾👍🏾👍🏾👍🏾👍🏾👍🏾👍🏾👍🏾👍🏾
Hey, I have a lump in my upper right abdomen. It feels hard when I touch it and it is mostly flat near the surface.
When I first noticed it 4 years ago it was small like 1.5cm by 1.5cm ish and now it grew to approximately 3.5cm in length and 2cm in width kinda in a asymetrical shape of an oval.
Could it be a liposarcoma or somthing else? Cause I dont think it's a lipoma since it's not soft and it's not on the common place for lipomas(back, arms, shoulders, neck) But is for liposarcoma (abdomen, legs, arm)
Did you get it checked out ?
Thank you very much
Thank you