Liposarcoma: what is it, symptoms, treatment, prognosis, pictures
Liposarcoma is among the malignant tumors, originating in the adipose tissue. Among patients dominated by older men, and in children it occurs very rarely. Incidence peaks at age 50-60 years.
The tumor prevalence is in second place after a cm, meeting approximately three cases per million people. Geographical patterns as explicit relationships to particular external conditions in the appearance of the tumor is not seen.
The basis of liposarcoma are lipoplasty – immature cells of connective tissue origin, and the tumor is in the extremities, in the retroperitoneum, buttocks. Very rarely it can be found in other parts of the body – the heart or even the brain.
The behavior of the tumor is determined by the degree of differentiation of its cells, activity of growth, localization. Differentiated varieties are characterized by better prognosis than the highly malignant, giving a greater percentage of recurrence and early metastases.
Causes and types of liposarcoma
Question the cause of liposarcoma is still open, but the researchers were able to prove the possible Association of several factors with tumor. It is believed that liposarcoma of the soft tissues may contribute to injury, ionizing radiation, which could take place many years ago, as well as carcinogens (asbestos).
There has been speculation about a possible malignancy lipoma is one of the most benign human tumor. Such cases are extremely rare, but in order to prevent large lipomas should be removed. In addition, observed the relationship between liposarcoma and neurofibromatosis. Perhaps these diseases have shared genetic mechanisms, which remain unsolved.
The basis of liposarcoma are lipoplasty – undifferentiated cells, containing fat and resembling immature cells of adipose tissue, which coexist in the tissue neoplasm with well formed lipocytes. A tumor with good vascular network, and growing to the periphery, forming a kind of capsule with a high differentiation of cellular elements. Low-differentiated liposarcoma prone to invasive growth with a penetration and destruction of surrounding tissue, without clear boundaries.
Externally, the tumor looks like a more or less explicit educational or unlimited infiltration, tissue it resembles fish meat, unstructured, gray or yellowish. Possible areas of necrosis and hemorrhage.
The most frequent localisation of liposarcoma is the thigh, the shoulder, then the retroperitoneal region, groin, knee joint. Very rarely it is found in the Breasts, the tissues of the head, neck, hands and feet. Liposarcoma located in the subcutaneous fat layer, and deeper between the muscle fibers, fascia, ligaments. The tumor is able to grow into bones, the elements of the joints.
Histologic varieties of liposarcomas are isolated in accordance with the characteristics of the structure and behavior of lipoblasts. Type of neoplasm determines its clinical course and prognosis.
- Vysokomehanizirovannoe, consisting mainly of Mature cells, usually affecting the elderly that reside in body cavities or deep soft tissues. These tumors often recur but rarely metastasize, therefore characterized by a relatively benign course.
- Myxoid liposarcoma is composed of Mature lipocytes and lipoblasts surrounded studnational substance with an abundance of blood vessels. Characteristic of the Mature age, is located on the limbs tend to give relapses, but metastases are rare.
- Round-cell variety – refers to nizkoeffektivnyj types of liposarcoma consists of cells, round shape, little resembling fat.
- Pleodorina sarcoma is a poorly-differentiated type, contains cells of fusiform or round shape.
- Undifferentiated liposarcoma consists of two components – a high and a low degree of differentiation, which can be traced in different parts of the tumor.
Symptoms of liposarcoma
When high-grade tumor, and in the case of the initial stages of nizkoeffektivnyj liposarcoma symptoms is small or non-existent. With increasing size, it is possible to test tumor formation. Liposarcomas can reach 20 cm in size, the tumor is usually solitary or in dense or elastic node uneven texture, without clear boundaries. In rare cases diagnosed multiple growth.
Symptoms of liposarcoma appear when the tumor grows surrounding tissue, bone, compresses nerves and blood vessels. The most common symptom is pain. About a fifth of all liposarcoma is embedded in the bone or compresses the nerve endings, and patients complain of intense pain at the site of the lesion.
Liposarcomas of the large size deformed limbs or joints, caused by disorders of blood flow in thrombosis, thrombophlebitis, severe swelling, ischemia with difficulty of blood circulation. The damage to major nerves is fraught with paresis and paralysis, disturbance of sensation.
Liposarcoma of the retroperitoneal space has no bright symptoms. Patients experience a strange feeling of stretching in the abdomen, feeling of heaviness, but the pain, as such, for a long time there, so to specify complaints is problematic. When retroperitoneal liposarcoma reaches a significant amount, starts to feel the pain, the stomach increases, there are signs of compression of the abdominal organs – dyspepsia, constipation, heartburn, bitter taste in the mouth, etc.
Far advanced stage of the disease manifested General symptoms of intoxication, the body temperature rises, increasing weakness, lost appetite, the patient loses weight. In the growth of liposarcoma, the skin may become hot, bluish, perhaps the appearance of varicose veins.
Liposarcoma, malignant neoplasm can metastasize. Usually the dressing of tumor cells occurs through the blood vessels, and among target organs – lungs, brain, kidneys, bones, liver. By lymphogenous metastasis occurs in isolated cases.
Diagnosis and treatment of liposarcoma
Diagnosis of liposarcoma begins with a survey, clarify the nature of the complaints and inspection of the alleged site of neoplasm growth. The most informative instrumental method of diagnostics of MRI believe, but for final confirmation of the diagnosis of biopsy (needle, incisional).
If you suspect the presence of metastases in the abdominal organs, the patient is sent for an ultrasound. Lung metastases rule out by x-ray, bone – scintigraphy.
Video: liposarcoma of the thigh
The main method of treatment of liposarcomas – surgical, which can be supplemented with radiation and chemotherapy. Removal of the tumor is performed in the cancer hospital in compliance with the rules for preventing the spread of malignant cells in the operative field and blood vessels. As with all types of malignant neoplasias, it is important to make the operation very considerably, with the capture of surrounding healthy tissues.
Surgical treatment without chemotherapy and radiation is possible with high-grade tumors, but subject to excise it completely. If during the operation difficulties, and fragments of neoplasia remained in the tissues, it is shown re-intervention.
Depending on the volume produced:
Conserving surgery after the tumor is removed, the surrounding tissue, muscle, fascia, the limb or joint is still intact;
Removal of the liposarcoma can be quite traumatic, especially when large sizes. If it grows between the muscles, they are excised together with the tumor site. When there is no clear boundary between the neoplastic field and surrounding structures, and liposarcoma located in the extremities, the surgeon is forced to make a very crippling amputation and assertequal.
In the case of rapid growth of tumors and presence of metastases, surgery is complemented with the appointment of chemotherapy and irradiation in a dose of 40-70 Gy. Radiotherapy is indicated for recurrence and metastasis. Preoperative radiation therapy can help to reduce the amount of large liposarcoma, facilitating the work of the surgeon.
Among chemotherapeutic agents, is effective in liposarcoma, vincristine, doxorubicin, cyclophosphamide. Alone chemotherapy is used for inoperable liposarcoma as a palliative method allowing to improve the patient’s condition and to inhibit the growth and metastasis of tumors. High malignant liposarcoma requires the use of chemotherapy in the case if she had time to metastasize.
Liposarcoma applies to dangerous types of tumors with a high mortality rate. Even modern methods of treatment does not improve prognosis in many patients. The spread of the tumor into the surrounding tissue and early metastasis through the blood vessels contribute to the great frequency of relapses.
The most favorable variant of the tumor is considered vysokomehanizirovannoe the liposarcoma subcutaneous fat layer, which is not prone to local recurrence. She, being located in the spaces between the muscles, gives the recurrence in one third of patients, and with the growth in the retroperitoneal space, the probability of re-growth reaches 37%.
Distant metastases are found in almost half of patients, which is associated with the rapid spread of malignant cells through the blood vessels, which are very much in the subcutaneous tissue, and muscle. Again arisen the tumor is often characterized by a lower differentiation and, therefore, will grow faster and give secondary metastases, therefore, to deal with recurrences is very difficult and not always effective.
Life expectancy determines the type of the tumor. The most favorable in this respect is recognized vysokomehanizirovannoe and myxoid variants, in which five or more years is home to more than half of the patients, and complete cure can be achieved at least in one third. In children, liposarcoma is more favorable than in adults. Five-year survival in young patients up to 90%.