What is the role of biopsy in the diagnosis of liposarcoma?

Updated: Mar 18, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Preoperative biopsy is important in planning therapy. [30] The diagnostic procedure of choice for liposarcoma is open biopsy. With superficial, small, fatty tumors, excisional biopsy is recommended for diagnosis. In large (>3 cm) and deep tumors, diagnosis and treatment may involve open incisional biopsy followed by definitive resection.

Fine-needle aspiration or biopsy should be followed by histologic and immunohistochemical examination. Adjunctive tests for MDM2 (murine double minute 2) may be helpful to distinguish liposarcoma from benign fatty neoplasms, but cutaneous and subcutaneous pleomorphic liposarcoma is less likely to demonstrate amplification. [31, 32] Immunohistochemical examination aids in excluding other sarcomas. Lipid staining may be helpful, although Sudan black or oil red O stains are generally insufficient for diagnosis. Helpful stains include the following:

  • S-100 - Positive results in fat cells and lipoblasts

  • Alpha-1-antitrypsin - Positive results in malignant fibrous histiocytomas

  • Desmin - Positive results in leiomyosarcomas

  • Myoglobin - Positive results in rhabdomyosarcomas

  • Adipophilin stain to document lipid content in the cytoplasm of the neoplastic cells using formalin-fixed paraffin-embedded issue [33]

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