Highlights
- •With upfront marginal resection of truncal or extremities atypical lipomatous tumors/well-differentiated liposarcomas, overall local recurrence rate of 1.4% and reoperation rate of 1.1% were achieved.
- •When tumors showed MDM2 amplification, local recurrence rate of 6.1% was found as opposed to 0.8% in tumors with no MDM2 amplification.
- •There was no dedifferentiation or metastasis found with local recurrence.
Abstract
Introduction
Well-differentiated liposarcomas (WDLS) are low-grade lipomatous tumors with low malignant
potential. Previous review identified controversy on whether upfront wide resection
is necessary when they occur on the trunk or the extremities. MDM2 amplification is
a genetic mutation typically present in WDLS and absent in benign lipomas (BL). We
aimed to study the influence of MDM2 status on the management/recurrences of lipomatous
tumors in the trunk or the extremities.
Methods
All patients with lipomatous tumors with MDM2 testing in the Province of Alberta between
2015 and 2020 were identified from the Cancer Cytogenetics Laboratory dataset. High
grade sarcomas, retroperitoneal, head/neck, or groin tumors were excluded. Primary
outcome measures including MDM2 status, surgical margin, local recurrence, reoperation
rate, dedifferentiation, and metastasis were abstracted from chart review. Descriptive
statistics were used to analyse treatment patterns and recurrence rates according
to MDM2 status.
Results
Total of 764 charts were retrieved, and 282 were included for analysis. 33 showed
MDM2 amplification (11.7%), and 2 of them had local recurrence (6.1%). Two patients
with recurrent tumors underwent limb-salvaging reoperation (6.1%), but no dedifferentiation
or metastasis was seen.
Conclusion
Findings in this study confirmed the benign behaviour of truncal/extremities lipomas
with no MDM2 amplification. Given we found a 6.1% recurrence rate in MDM2 amplified
tumors, a prolong follow up of this subset of patients is warranted. Overall, regardless
of the MDM2 status, we believe an initial marginal excision is a reasonable surgical
approach as recurrences are rare, and they can be managed with re-excision when they
occur.
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Article info
Publication history
Published online: April 04, 2022
Accepted:
March 28,
2022
Received in revised form:
February 24,
2022
Received:
November 4,
2021
Identification
Copyright
Crown Copyright © 2022 Published by Elsevier Inc. All rights reserved.
