Abstract:

Pleomorphic liposarcoma (PL), the least common type of liposarcoma, is generally found in the deep soft tissues. Here we present an 81-year-old man who presented with a 3-year history of a slowly enlarging polypoid leg nodule. The lesion was bothersome, so he initially removed it with a pair of scissors; it regrew in about 3 months. He was then evaluated in clinic and noted to have a large exophytic nodule with a verrucous-appearing surface on the posterior-inferior thigh. Grossly, the lesion measured 3.5 cm and was pale pink and lobulated with a broad stalk. Histologically, the polyp showed a highly cellular stroma populated by predominantly spindled pleomorphic cells with scattered lipogenic differentiation. Numerous lipoblastic cells and atypical mitotic figures were identified. The tumor was negative for MDM2 amplification by fluorescence in-situ hybridization. The tumor was transected through the mid-dermis, so the extent and circumscription could not be initially assessed, although the tumor appeared poorly circumscribed and dissected into dermal collagen. The patient was diagnosed with pleomorphic liposarcoma, grade 2. Although the possibility of a larger, underlying soft tissue mass was entertained, PET and CT scan revealed only a small, ill-defined focus of residual tumor in the superficial posterior thigh and no deeper involvement or evidence of metastases. The remaining tumor was resected and revealed a 2 cm, poorly circumscribed residual tumor involving the dermis and superficial subcutis. Superficial PL cases are quite rare, and polypoid cases even more so. In our case, a majority of the tumor volume actually resided in the exophytic portion of the lesion.

Financial Disclosure:
No current or relevant financial relationships exist.

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Eric Morgan, MD