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Weekly Chest CasesArchive of Old Cases

Case No : 755 Date 2012-04-16

  • Courtesy of Ji Eun Park, Sung Shine Shim, Yookyung Kim / Ewha Womans University Mokdong Hospital
  • Age/Sex 62 / F
  • Chief Complaintmediastinal mass on chest simple radiograph
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7

Figure 1. Initial.

Diagnosis With Brief Discussion

Diagnosis
Well differentiated mediastinal liposarcoma
Radiologic Findings
Initial chest radiograph demonstrates upper mediastinal widening with increased opacity at the level of aortic arch. Follow up chest PA after 45 months shows slightly progressed mediastinal widening. CT scan (mediastinal window) shows a fatty lesion with mass effect on superior vena cava and on the aortic arch. There is also increased volume of the mass at the same level of follow up chest CT. The mass composes largely of fatty tissue and some fine nodules and minimal streaky soft tissue portion.
Brief Review
Primary mediastinal liposarcomas are rare tumors that arise in the anterior and posterior mediastinum with relatively equal frequency. Less than 5% of liposarcomas arise in the mediastinum. Similar to primary retroperitoneal liposarcomas, mediastinal liposarcomas are most common in adults and are most often well differentiated.
The predominant finding of mediastinal liposarcoma on conventional chest radiography is a widened mediastinum. Deviation of the trachea and vessels may be apparent. On CT and MR imaging, mediastinal liposarcomas appear as inhomogeneous fatty masses that vary in appearance depending on the amount of soft tissue and fibrous bands in the tumor.
Well-differentiated liposarcomas or atypical lipomas are low-grade lesions containing a large amount of fat, usually more than 75%of their volume. They are difficult to confidently differentiate from benign lipomas. Fibrous septa may be broader and more nodular than those seen in lipomas. These tumors often recur if only marginally excised but do not metastasize.
Currently, the overall distribution of liposarcoma arising at all sites is 45% to 50% well-differentiated liposarcomas, 30% to 35% myxoid liposarcomas, 15% to 20% dedifferentiated liposarcomas, and 5% are pleomorphic liposarcomas. Overall, prognosis correlates with tumor subtype, as rapid tumor recurrence and metastatic disease were more common in patients with dedifferentiated and pleomorphic subtypes, whereas patients with well-differentiated tumors rarely recur or metastasize.
References
1) Munk PL, Lee MJ, Janzen DL, et al. Lipoma and liposarcoma: evaluation using CT and MR imaging. AJR 1997;169:589-594
2) Hahn HP, Fletcher CD. Primary mediastinal liposarcoma: clinicopathologic analysis of 24 cases. Am J Surg Pathol. 2007 Dec;31(12):1868-74.
3) Munden RF, Nesbitt JC, Kemp BL, et al. Primary liposarcoma of the mediastinum. AJR 2000 Nov;175(5):1340
Keywords
mediastinum, malignant tumor,

No. of Applicants : 122

▶ Correct Answer : 30/122,  24.6%
  • - Goa Medical College , India Paresh Desai
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - CHRU lille , France manuel toledano
  • - Samsung medical center , Korea (South) Hyun Su Kim
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - All India Institute of medical sciences , India Justin Moses
  • - , Korea (South) park ji hoon
  • - CHU Poitiers , France CHAN paul
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - XiangYa hospital , China Xia Yu
  • - fmmc , India subas kandimalla
  • - HIA Legouest - METZ , France Alban Gervaise
  • - Japanese Red Cross Society Himeji Hospital , Japan Yuichiro Kanie
  • - UWO , Canada S Lee
  • - Kyung Hee University Medical center , Korea (North) Myung You
  • - Asan Medical Center , Korea (South) Ji Eun Kim
  • - Asan medical center , Korea (South) Sang Young Oh
  • - MUHC , Canada Nesreen Abourokbah
  • - Seoul National University Hospital , Korea (South) YongSub Song
  • - IRSA , France, Metropolitan BIGOT
  • - Jikei medical school third hospital , Japan Hirokazu Ashida
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - CLCC , France nicolas gautier
  • - National Taiwan University Hospital , Taiwan Li-Ta Keng
  • - Azienda Ospedaliera San Gerardo , Italy Gabriele DAndrea
  • - Private sector , Greece Vasilios Tzilas
  • - Bupyong Serim Hospital , Korea (South) Hee Seok Choi
▶ Correct Answer as Differential Diagnosis : 31/122,  25.4%
  • - Montreal , Canada Drago Le King
  • - Korea University Guro Hospital , Korea (South) Kyungwon Doo
  • - GM InHospital , Korea (South) Ju Won Lee
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Cincinnati Childrens Hospital Medical Center , United States mantosh rattan
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - McGill University Health Center , Canada Alexandre Semionov
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - All India Institute of Medical Sciences , India Jitesh Ahuja
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Korea university , Korea (South) Kun Woo Kang
  • - Asan Medical Center , Korea (South) Hye Jeon Hwang
  • - SEVERANCE HOSPITAL , Korea (South) HAESUNG YOON
  • - Fukuyama city hospital , Japan Ryotaro Kishi
  • - Centre Hospitalier Lyon Sud , France matthieu ROUSSET
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - chungbuk national university hospital , Korea (South) soojung lee
  • - Chungbuk univertisy hospital , Korea (South) Soohyun Lee
  • - bmcri , India sanjeev choudri
  • - Iwate Medical University , Japan Akio Akahane
  • - Hopital du Sacre Coeur , Canada Andrea Ojanguren
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Hanyang university medical center , Korea (South) YOONAH SONG
  • - NASA SCANS , India RAKESH BHATIA
  • - shengjing hospital china medical university , China yue yong
▶ Semi-Correct Answer : 1/122,  0.8%
  • - MANIPAL UNIVERSITY , India ABHILASHA JAURA
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