Retroperitoneal Sarcoma
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《新英格兰医药杂志》
To the Editor: In our opinion, the mass described as a myxoid liposarcoma and shown in the January 29 Images in Clinical Medicine1 is not an example of that entity but, rather, an atypical lipomatous tumor (well-differentiated liposarcoma) with secondary myxoid features. These two tumor types differ considerably on topographic, gross, microscopical, molecular genetic, and prognostic grounds, and their distinction is therefore of importance.
Juan Rosai, M.D.
Silvana Pilotti, M.D.
Istituto Nazionale Tumori
20133 Milan, Italy
References
Napolitano LM. Retroperitoneal sarcoma. N Engl J Med 2004;350:493-493.
The author and colleagues reply: We agree with Drs. Rosai and Pilotti that the clinical behavior of liposarcoma closely reflects its histologic type, so that the identification of the histologic subtype is very important for both prognosis and therapy. In this case, pathological examination of tissue from the initial resection provided the grounds for the diagnosis of myxoid liposarcoma, which was confirmed by the Armed Forces Institute of Pathology. The pathological findings on examination of the recurrent retroperitoneal sarcoma also confirmed the diagnosis of myxoid liposarcoma. In addition to myxoid areas, the specimen had areas with morphologic features of low-grade (well-differentiated) liposarcoma, but the overall morphologic findings were most consistent with the general category of myxoid liposarcoma. We did not confirm this diagnosis by cytogenetic analysis.
Rosai and Pilotti's opinion was based on the small photograph of a histologic section that was provided with the case report, which may not have been fully representative of myxoid liposarcoma. However, our pathology department staff had the opportunity to review multiple areas of the very large tumor at the initial surgery and in the recurrent tumor.
Lena M. Napolitano, M.D.
Dong H. Lee, M.D.
Baltimore Veterans Affairs Medical Center
Baltimore, MD 21201
Andrew Borkowski, M.D.
Tampa Veterans Affairs Medical Center
Tampa, FL 33612
Juan Rosai, M.D.
Silvana Pilotti, M.D.
Istituto Nazionale Tumori
20133 Milan, Italy
References
Napolitano LM. Retroperitoneal sarcoma. N Engl J Med 2004;350:493-493.
The author and colleagues reply: We agree with Drs. Rosai and Pilotti that the clinical behavior of liposarcoma closely reflects its histologic type, so that the identification of the histologic subtype is very important for both prognosis and therapy. In this case, pathological examination of tissue from the initial resection provided the grounds for the diagnosis of myxoid liposarcoma, which was confirmed by the Armed Forces Institute of Pathology. The pathological findings on examination of the recurrent retroperitoneal sarcoma also confirmed the diagnosis of myxoid liposarcoma. In addition to myxoid areas, the specimen had areas with morphologic features of low-grade (well-differentiated) liposarcoma, but the overall morphologic findings were most consistent with the general category of myxoid liposarcoma. We did not confirm this diagnosis by cytogenetic analysis.
Rosai and Pilotti's opinion was based on the small photograph of a histologic section that was provided with the case report, which may not have been fully representative of myxoid liposarcoma. However, our pathology department staff had the opportunity to review multiple areas of the very large tumor at the initial surgery and in the recurrent tumor.
Lena M. Napolitano, M.D.
Dong H. Lee, M.D.
Baltimore Veterans Affairs Medical Center
Baltimore, MD 21201
Andrew Borkowski, M.D.
Tampa Veterans Affairs Medical Center
Tampa, FL 33612