대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Pleomorphic liposarcoma

Radiologic Findings

Figs 1-4. Chest CT shows an ovoid mass measuring approximately 4.3cm in the right anterior chest wall. The mass demonstrates heterogeneous enhancement. There is no internal calcification, and there is no definite bone erosion or destruction.

Brief Review

After undifferentiated pleomorphic sarcoma, liposarcoma is the most common malignant soft-tissue chest wall tumor. In the World Health Orga-nization classification system, the most commontypes of liposarcomas are described: well differentiated, dedifferentiated, myxoid, pleomorphic, and mixed. The different subtypes of liposarcoma can be thought of as a spectrum from least to most differentiated. The more differentiated the tumor, the more fat it contains and the less aggressive it is. Conversely, the more undifferentiated tumors have less or sometimes no fat and are more aggressive.
The most aggressive form of liposarcoma, the pleomorphic subtype, is the least common and appears as a heterogeneous soft-tissue mass on CT and MR images. These are aggressive high-grade sarcomas with a high incidence of recurrence and metastasis. On CT and MRI, the imaging appearance of pleomorphic liposarcoma is a well-circumscribed mass containing little or no fat. The MRI appearance is similar to other aggressive soft-tissue sarcomas, often showing internal hemorrhage and necrosis. Given that 62%–75% of pleomorphic liposarcomas contain no fat, differentiating them from other soft-tissue sarcomas is difficult.

References

1. Mansour J, Joseph J, et al. Diagnostic and imaging approaches to chest wall lesions. Radiographics 2022;42:359-378.
2. O'Regan KN, Jagannathan J, Krajewski K, et al. Imaging of liposarcoma: classification, patterns of tumor recurrence, and response to treatment. AJR Am J Roentgenol 2011;197:W37-W43.

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