Abstract
BackgroundAdipocytic tumors are the most common soft tissue tumors, with lipomas and atypical lipomatous tumor/well‐differentiated liposarcomas (ALT/WDL), which comprise most cases. Preoperative differential diagnosis of lipoma or ALT/WDL can provide important information for decisions regarding treatment. We evaluated the cytological findings of 20 cases of lipoma and ALT/WDL.MethodsFluorescence in situ hybridization (FISH) was performed on formalin‐fixed paraffin‐embedded specimens (FFPE) to examine mouse double minute 2 homolog (MDM2) amplification in all cases. Tissue samples were collected from the center of the surgical materials, stained with Pap, and evaluated for 12 cytological parameters by six cytotechnologists.ResultsThe findings regarding large atypical cells, multinucleated cells, and nuclear pleomorphism were highly concordant among the cytotechnologists and were associated with MDM2 amplification. Large atypical cells, considered a highly specific feature of ALT/WDL, were not observed in lipoma cases. However, the sensitivity of the large atypical cell findings was not high (67%); therefore, comprehensive evaluation of multinucleated cells and pleomorphism is crucial for predicting ALT/WDL diagnosis. FISH of MDM2 on Pap‐stained specimens was performed in four cases. In two, the results were similar to those of MDM2 FISH performed on FFPE sections and were reproducible, whereas in the other two, the signal could not be evaluated because of the strong background coloration.ConclusionsCytology specimens may be useful for the preoperative diagnosis of adipocytic tumors, particularly if the FISH conditions for Pap‐stained specimens and the detection accuracy of MDM2 amplification can be improved.
Highlights
Adipocytic tumors are the most common soft tissue tumors, with lipomas and atypical lipomatous tumor/well-differentiated liposarcomas (ALT/WDL) comprising the majority of cases
Cytology specimens may be useful for preoperative diagnosis of adipocytic tumors, if the Fluorescence in situ hybridization (FISH) conditions for Papanicolaou-stained specimens and the detection accuracy of mouse double minute 2 homolog (MDM2) amplification can be improved
Each CT estimated the histological type of the lipoma or ALT/WDL based on the cytological findings
Summary
Adipocytic tumors are the most common soft tissue tumors, with lipomas and atypical lipomatous tumor/well-differentiated liposarcomas (ALT/WDL) comprising the majority of cases. Preoperative differential diagnosis of lipoma or ALT/WDL can provide important information for decisions regarding treatment. Adipocytic tumors are the most common soft tissue tumors and mostly comprise lipomas and atypical lipomatous tumor/well-differentiated liposarcomas (ALT/WDL). ALT/WDL can become highly malignant by dedifferentiation or recurrence, thereby making it important to differentiate them from lipomas, which are benign tumors, for appropriate treatment and for determining the follow-up period after tumor resection.[1] The mouse double minute 2 homolog (MDM2) protein suppressively regulates TP53, a tumor suppressor gene. We compared the cytological features of lipoma and ALT/WDL and used the cytological findings for their differential diagnosis. We performed FISH to examine MDM2 amplification in cytological specimens and to evaluate the usefulness of cytology for differential diagnosis of adipocytic tumors
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