Giant atypical lipomatous tumors of the thigh: a case series

Edoardo Ipponi; Michele Di Lonardo; Elena Bechini; Martina Cordoni; Fabio Cosseddu; Rodolfo Capanna; Lorenzo Andreani

doi:10.23750/abm.v94i5.14275

Giant atypical lipomatous tumors of the thigh: a case series

Authors

Edoardo Ipponi University of Pisa - Department of Orthopaedics and Trauma surgery https://orcid.org/0000-0003-2107-6357
Michele Di Lonardo University of Pisa - Department of Orthopaedics and Trauma surgery
Elena Bechini University of Pisa - Department of Orthopaedics and Trauma surgery
Martina Cordoni University of Pisa - Department of Orthopaedics and Trauma surgery
Fabio Cosseddu University of Pisa - Department of Orthopaedics and Trauma surgery https://orcid.org/0000-0003-3416-7071
Rodolfo Capanna University of Pisa - Department of Orthopaedics and Trauma surgery https://orcid.org/0000-0001-7904-1267
Lorenzo Andreani University of Pisa - Department of Orthopaedics and Trauma surgery https://orcid.org/0000-0002-8268-6987

DOI: https://doi.org/10.23750/abm.v94i5.14275

Keywords:

Atypical Lipomatous Tumor, ALT, Thigh, Liposarcoma Lipoma-Like, Resection, Lipoma

Abstract

Background and aim: Atypical Lipomatous Tumors (ALTs) are low-grade locally aggressive soft tissue tumors. Deep large sized ALTs of the thigh can cause significant functional impairment due to their mass effect. Surgical resection, which is the treatment of choice for these lesions, can be a though procedure, especially if the neoplasm comes in proximity with noble structures such as large sized arteries or nerves. The aim of our study is to assess risks and effectiveness of surgical resection, evaluating complications, local recurrences and post-operative functionality.

Methods: We evaluated all the giant ALT (larger diameter of 10 cm or more) of the thigh that received surgery in our institution between 2017 and 2022. Each patient’s personal data and tumor size were evaluated. The quality of surgical margins was analyzed. MRI scans were performed both pre-operatively and during patients’ follow-up. Lower limb’s functional status was assessed using the MSTS score before and after surgery. Intra-operative and post-operative complications were recorded, as well as local recurrences.

Results: Twentythree cases were included in our study. Tumors’ mean major diameter was 19.1cm. The mean pre-operative MSTS score was 25.9. Only one case suffered from significant post-operative complications. Only 2 of our cases (8.7%) developed a local recurrence after surgery. The mean post-operative MSTS score was 29.1

Conclusions: A careful surgical resection can be effective in treating giant ALTs of the thigh in reason of good functional outcomes, low complications risks and reasonable local recurrence rates.

References

Burusapat C, Wongprakob N, Wanichjaroen N, Pruksapong C, Satayasoontorn K. Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma with Intramuscular Lipoma-Like Component of the Thigh. Case Rep Surg. 2020 Dec 12;2020:8846932. doi: 10.1155/2020/8846932.

Katenkamp K, Katenkamp D. Soft tissue tumors: new perspectives on classification and diagnosis. Dtsch Arztebl Int. 2009;106(39):632-636. doi:10.3238/arztebl.2009.0632.

Mascarenhas MRM, Mutti LA, Paiva JMG, Enokihara MMSES, Rosa IP, Enokihara MY. Giant atypical lipoma. An Bras Dermatol. 2017 Jul-Aug;92(4):546-549. doi: 10.1590/abd1806-4841.20174447.

Presman B, Jauffred SF, Kornø MR, Petersen MM. Low Recurrence Rate and Risk of Distant Metastases following Marginal Surgery of Intramuscular Lipoma and Atypical Lipomatous Tumors of the Extremities and Trunk Wall. Med Princ Pract. 2020;29(3):203-210. doi:10.1159/000503621.

Evans HL. Atypical lipomatous tumor, its variants, and its combined forms: a study of 61 cases, with a minimum follow-up of 10 years. Am J Surg Pathol. 2007;31(1):1-14. doi:10.1097/01.pas.0000213406.95440.7a.

Burusapat C, Wongprakob N, Wanichjaroen N, Pruksapong C, Satayasoontorn K. Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma with Intramuscular Lipoma-Like Component of the Thigh. Case Rep Surg. 2020;2020:8846932. Published 2020 Dec 12. doi:10.1155/2020/8846932

Rauh J, Klein A, Baur-Melnyk A, et al. The role of surgical margins in atypical Lipomatous Tumours of the extremities. BMC Musculoskelet Disord. 2018;19(1):152. Published 2018 May 17. doi:10.1186/s12891-018-2053-3

Murphy A, Williams J. Posterior interosseous nerve palsy caused by lipoma: A case report. Can J Plast Surg. 2009 Winter;17(4):e42-4.

McTighe S, Chernev I. Intramuscular lipoma: a review of the literature. Orthop Rev (Pavia). 2014;6(4):5618. Published 2014 Dec 16. doi:10.4081/or.2014.5618

Zhan H, Cao S, Gao T, et al. Giant atypical lipomatous tumor/well-differentiated liposarcoma affects lower limb activity: A case report. Medicine (Baltimore). 2019 Oct;98(42):e17619. doi: 10.1097/MD.0000000000017619.

Grimer RJ. Size matters for sarcomas! Ann R Coll Surg Engl. 2006 Oct;88(6):519-24. doi: 10.1308/003588406X130651.

Mashima E, Sawada Y, Nakamura M. Recent Advancement in Atypical Lipomatous Tumor Research. Int J Mol Sci. 2021 Jan 20;22(3):994. doi: 10.3390/ijms22030994.

Papanastassiou ID, Piskopakis A, Gerochristou MA, et al. Dedifferentiation of an atypical lipomatous tumor of the thigh - a 6 year follow-up study. J Musculoskelet Neuronal Interact. 2019 Mar 1;19(1):123-126.

Terzioglu A, Tuncali D, Yuksel A, Bingul F, Aslan G. Giant lipomas: a series of 12 consecutive cases and a giant liposarcoma of the thigh. Dermatol Surg. 2004;30(3):463-467. doi:10.1111/j.1524-4725.2004.30022.x.

Chan WP. Magnetic resonance imaging of soft-tissue tumors of the extremities: A practical approach. World J Radiol. 2013 Dec 28;5(12):455-9. doi: 10.4329/wjr.v5.i12.455.

Mannan K, Briggs TW. Soft tissue tumours of the extremities. BMJ. 2005 Sep 17;331(7517):590. doi: 10.1136/bmj.331.7517.590.

Asano Y, Miwa S, Yamamoto N, et al. A scoring system combining clinical, radiological, and histopathological examinations for differential diagnosis between lipoma and atypical lipomatous tumor/well-differentiated liposarcoma. Sci Rep. 2022;12(1):237. Published 2022 Jan 7. doi:10.1038/s41598-021-04004-1

Rauh J, Klein A, Baur-Melnyk A, et al. The role of surgical margins in atypical Lipomatous Tumours of the extremities. BMC Musculoskelet Disord. 2018 May 17;19(1):152. doi: 10.1186/s12891-018-2053-3.

Serpell JW, Chen RY. Review of large deep lipomatous tumours. ANZ J Surg. 2007;77(7):524-529. doi:10.1111/j.1445-2197.2007.04042.x.

Kito M, Yoshimura Y, Isobe K, et al. Clinical outcome of deep-seated atypical lipomatous tumor of the extremities with median-term follow-up study. Eur J Surg Oncol. 2015 Mar;41(3):400-6. doi: 10.1016/j.ejso.2014.11.044.

Tsukamoto S, Mavrogenis AF, Tanaka Y, Errani C. Imaging of Soft Tissue Tumors. Curr Med Imaging. 2021;17(2):197-216. doi:10.2174/1573405616666200713183400.

Aho JM, Nickerson TP, Thiels CA, Saint-Cyr M, Farley DR. Prevention of postoperative seromas with dead space obliteration: A case-control study. Int J Surg. 2016 May;29:70-3. doi: 10.1016/j.ijsu.2016.03.004.

Sun H, Lv L, Bai Y, et al. Nanotechnology-enabled materials for hemostatic and anti-infection treatments in orthopedic surgery. Int J Nanomedicine. 2018;13:8325-8338. Published 2018 Dec 6. doi:10.2147/IJN.S173063.

Andreani L, Del Chiaro A, Ipponi E, Di Sacco F, Caterino M, Capanna R. Use of Tranexamic Acid to Reduce PostOperative Bleeding in Orthopaedic Oncology. Acta Medica Lituanica. 2022; 29(2):275–283. doi: 10.15388/Amed.2022.29.2.17.

Crago AM, Brennan MF. Principles in Management of Soft Tissue Sarcoma. Adv Surg. 2015;49(1):107-122. doi:10.1016/j.yasu.2015.04.002

Vodanovich DA, M Choong PF. Soft-tissue Sarcomas. Indian J Orthop. 2018;52(1):35-44. doi:10.4103/ortho.IJOrtho_220_17

Gabriele L, Gariffo G, Grossi S, Ipponi E, Capanna R, Andreani L. Closed Incisional Negative Pressure Wound Therapy (ciNPWT) in Oncological Orthopedic Surgery: Preliminary Report. Surg Technol Int. 2021;38:451-454. doi:10.52198/21.STI.38.OS1429.