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Atypical Lipomatous Tumors: Should They be Treated Like Other Sarcoma or Not? Surgical Consideration from a Bi-Institutional Experience

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

To identify the best surgical approach to atypical lipomatous tumors we reviewed 171 patients who underwent surgery at two sarcoma referral centers with different surgical policies.

Methods

Of the 151 patients (88 %) with primary tumors, 95 were treated at Institution A and 76 were treated at Institution B. At Institution A, a wide surgical resection, including a slight cuff of soft tissue around the mass, was adopted, which was defined as marginal resection (MR) according to the Enneking classification. At Institution B, a simple tumor resection (SR), according to the Enneking classification, was employed. En bloc surgical resection was the goal in both centers. The primary outcomes of the study were local recurrence-free survival (LRFS), incidence of secondary dedifferentiation at recurrence, and presence of residual tumor after re-excision.

Results

Sixteen patients (9 %) had local recurrence. The 10-year LRFS was 82 %. No cases of secondary dedifferentiation were observed. Residual tumor after re-excision was found in 46 % of cases. In univariate analysis, sclerosing subtype, tumor rupture, and SR were unfavorable prognostic factors for LRFS. Sclerosing subtype and tumor rupture were independent prognostic factors for LRFS in multivariate analysis. SR was significantly associated with tumor rupture.

Conclusions

Sclerosing subtype and tumor rupture are unfavorable prognostic factors for local recurrence. MR is associated with a lower risk of tumor rupture than SR. Neurovascular and major muscle resections are not necessary in principle. Re-excision after unplanned surgery is not always mandatory. A preoperative core needle biopsy could be useful in identifying the sclerosing subtype.

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Authors and Affiliations

  1. Department of Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy

    Chiara Erminia Mussi MD, Matteo Cimino MD, Luca Cozzaglio MD & Vittorio Quagliuolo MD

  2. Department of Surgery, Orthopaedic Institute Pini, Rozzano, Milan, Italy

    Primo Daolio MD, Fabio Giardina MD, Maria S. Bartoli MD & Stefano Bastoni MD

  3. Department of Oncology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy

    Rita De Sanctis MD

  4. Department of Statistics, Humanitas Clinical and Research Center, Rozzano, Milan, Italy

    Emanuela Morenghi MD

  5. Department of Pathology, Orthopaedic Institute Pini, Rozzano, Milan, Italy

    Antonina Parafioriti MD

  6. Department of Pathology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy

    Piergiuseppe Colombo MD

Authors
  1. Chiara Erminia Mussi MD
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  2. Primo Daolio MD
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  3. Matteo Cimino MD
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  4. Fabio Giardina MD
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  5. Rita De Sanctis MD
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  6. Emanuela Morenghi MD
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  7. Antonina Parafioriti MD
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  8. Maria S. Bartoli MD
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  9. Stefano Bastoni MD
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  10. Luca Cozzaglio MD
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  11. Piergiuseppe Colombo MD
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  12. Vittorio Quagliuolo MD
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Corresponding author

Correspondence to Chiara Erminia Mussi MD.

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Mussi, C.E., Daolio, P., Cimino, M. et al. Atypical Lipomatous Tumors: Should They be Treated Like Other Sarcoma or Not? Surgical Consideration from a Bi-Institutional Experience. Ann Surg Oncol 21, 4090–4097 (2014). https://doi.org/10.1245/s10434-014-3855-7

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  • DOI: https://doi.org/10.1245/s10434-014-3855-7

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