Atypical Lipomatous Tumor
This specimen was handled by a colleague of mine. It came from a 66 year old man that had the tumor gradually grow for about a year reaching around 30+ cm in widest dimension. I never got to see the slides when it came out and just serendipitously stopped by the lab when this was being grossed.
Atypical Lipomatous Tumor are malignant mesenchymal neoplasms that are well differentiated. When the phrase well differentiated is mentioned, just think of neoplastic cells looking close to as normal as they can be but with noticeable flaws unlike their moderate to poorly differentiated counterparts where it can become a challenge to identify what type of cells or lineage you're looking at.
While this case had only mild atypia and no mitotic activity, the sheer size and possibility of just not sampling the areas that contain obvious signs of malignancy may not have been sampled. One can extensively section several parts and still not "hit" the hotspot. A differential for this case is a large lipoma but those tend to be smaller and hitting beyond the > 10cm size raises suspicion of malignancy or at least progression to malignancy.
I had one case of Atypical lipomatous tumor recently and it grossly didn't look like this. These things are aggressive and malignant but early detection and excision tends to do keep the possibility of metastasis low. It's problematic if they grew at the peritoneum, spermatic cords or mediastinum. My case was from a 44 year old male.
I didn't get to take a pic of the slide but you aren't missing much if you refer to this image
Those cells with a weird shape instead of the regular round to ovoid looking cells are the tumor cells.
Bad prognostic factors include length of time the tumor was left to grow, signs of dedifferentiation (loss of recognizable features that indicates maturation), and resection margins being positive (means some parts of the tumor weren't successfully removed).
If you made it this far reading, thank you for your time.
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Wow a big one! So did u guys also got some lymph nodes from the patient as well?
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For the 1st case, no, the procedure was only wide excision biopsy since the tumor was located superficial to the shoulder area. The second case (mine) was taken from the mediastinum, if there were any near identifiable lymph nodes it would likely but sentinel lymph node biopsy wasn't indicated as it was believed to be lipoma pre operatively.
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That is one juicy specimen!
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Quite hard to fix due to the fat too. Fatty specimens are like blessing or a curse depending on one's cutting schedule. If you are swamped with work and need a breather, you can take the measurements and do small incisions to let the formalin seep in then cut it the next day. But if you got plans on a weekend and just don't want to obligate yourself to comeback for grossing this, then it becomes a curse. Same sentiment with breasts and colon specimens.
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Damn, that's a literal weight on the shoulder. Was it a dysfunctional public healthcare system that made him wait so long that it became huge or just patient reluctance?
The 1st case is a mix of negligence to self and healthcare system. The guy lived in the provinces where there isn't an accessible diagnostic center or specialist center to cater to his surgical needs. When the term atypical is used, I think of the case as more than half the time it's a precursor to actual malignancy but there is still a chance that the morphological can just be triggered by something as benign as inflammation and it goes away on its own. The resection margins for this one was negative for tumor so if his metastatic workup shows no spread, he'll just be put into monitoring phase.