대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 941 Date 2015-11-09

  • Courtesy of Hee Kang / Kosin University Gospel Hospital
  • Age/Sex 46 / M
  • Chief ComplaintAbnormal finding detected on routine follow-up chest radiograph
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Diagnosis With Brief Discussion

Diagnosis
Pulmonary metastases from pleomorphic liposarcoma
Radiologic Findings
On the chest radiograph, multiple round nodular opacities are seen in the periphery of both lungs. The chest CT scans reveal multiple, variable sized well-defined round nodules in the peripheral portion of both lung parenchyma. The multiple nodules have very low attenuation, less than -30 Hounsfield Unit in CT number on both pre- and post-contrast enhancement scans which suggests that the lesions are containing fat.
The patient has undergone a surgical resection of a tumor in the left thigh which was diagnosed with a pleomorphic liposarcoma one year ago. The multiple pulmonary nodules were newly developed on regular follow-up chest radiograph.
Brief Review
Liposarcoma, representing the single most common type of soft tissue sarcoma, includes three biological types; myxoid (ML), pleomorphic (PL) and dedifferentiated liposarcoma (DDL). Pleomorphic liposarcoma (PL) is a high-grade sarcoma showing histological evidence of adipocytic differentiation and represents the rarest variant of liposarcoma. The PL has a tendency to involve the lungs more than any other organs in their spread, in contrast to ML, which favors extrapulmonary sites. It has shorter interval to pulmonary and extrapulmonary metastasis than other liposarcomas.
The morphologic features of metastatic liposarcoma to the lung seem diverse but usually within the spectrum of the histologic type of the primary tumor. The tumor outline was well circumscribed without infiltrating tumor cells at the periphery, and the protruding nests of tumor cells were covered by reactive alveolar epithelium. The changes were interpreted as a sign of a relatively slower tumor growth, thereby permitting some reaction from surrounding tissue. But the metastatic foci of liposarcoma might differ in histologic features from the primary tumor like other tumors and often are more cellular with fewer lipoblasts or even nonlipogenic. The evaluation of these metastatic tumors is confounded by therapy-related changes precluding the estimation of true cellularity and cytologic appearance of neoplastic cells.
References
1. Nicolas M, Moran CA, Suster S., Pulmonary metastasis from liposarcoma: a clinicopathologic and immunohistochemical study of 24 cases. Am J Clin Pathol. 2005 Feb;123(2):265-75.
2. Apostolou G, Biteli M, Chatzipantelis P., Cytopathological diagnosis of metastatic pleomorphic liposarcoma in the lung: a report of a case correlated with the histopathology of the primary tumour. Diagn Cytopathol. 2009 Sep;37(9):667-70.
Keywords
Lung, Malignant tumor,

No. of Applicants : 84

▶ Correct Answer : 7/84,  8.3%
  • - Osaka Rosai Hospital , Japan Hiromitsu Sumikawa
  • - Armed Forces Seoul Hospital , Korea (South) Eui Jin Hwang
  • - CHU Poitiers , France CHAN paul
  • - chungbuk national university hospital , Korea (South) soojung lee
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Santosh hospital,Bengaluru , India Pravin Mahadevappa
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
▶ Correct Answer as Differential Diagnosis : 29/84,  34.5%
  • - Daejin Medical Center Bundang Jesaeng General Hospital , Korea (South) Donghwan Kim
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - chp st martin , France Mariotte benoit
  • - Juntendo University Hospital , Japan Akifumi Hagiwara
  • - GHICL , France manuel toledano
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - CHRU Lille , France Paul Lebert
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - University of Tsukuba Hospital , Japan Hiroaki Takahashi
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Kyungpook national university , Korea (South) Chungeun Lim
  • - Avrasya Hospital , Turkey Murat Ulusoy
  • - McGill University Health Center , Canada Alexandre Semionov
  • - the first affiliatited hospital of nanjing medical univercity , China Hai Xu
  • - Asan Medical Center , Korea (South) Jooae Choe
  • - Saitama-Sekishinkai Hosptal , Japan Mihoko Yamazaki
  • - Ajou University Hospital , Korea (South) Seulgi You
  • - , Korea (South) BAEK YOOLIM
  • - chungbuk university hospital , Korea (South) Hyeonmi Ryu
  • - chungbuk national university hospital , Korea (South) lee jung hwan
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - , Korea (South)
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Okinawa Kyodo Hospital , Japan Shoko Iraha
  • - NASA SCANS , India RAKESH BHATIA
  • - IRSA La Rochelle , France Denis Chabassiere
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - Ajou University Hospital , Korea (South) Young Keun Sur
▶ Semi-Correct Answer : 6/84,  7.1%
  • - Himeji Redcross Hospital , Japan Soichiro Okamoto
  • - Hopital du Sacre Coeur , Canada Andrea Ojanguren
  • - �stanbul , Turkey Ayhan Yilmaz
  • - Goa Medical College , India Paresh Desai
  • - medical university of isfahan , Iran pouya akbari
  • - Chonnam national university hospital , Korea (South) INSOO JANG
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