Management Algorithm for Atypical Lipomatous Tumours: A Retrospective Case Series

Area of Science:

• Oncology
• Radiology
• Pathology

Background:

• Atypical lipomatous tumours (ALTs), also known as low-grade well-differentiated liposarcomas (WDLs), present diagnostic challenges due to complex radiological and histological features.
• The current nomenclature for ALTs may underestimate their potential for local recurrence, necessitating a clear management strategy.

Purpose of the Study:

• To evaluate the clinical, radiological, and histological characteristics of atypical lipomatous tumours.
• To develop and propose a management algorithm for differentiating ALTs from benign lipomas.

Main Methods:

• A retrospective analysis of a prospectively maintained database from Tallaght University Hospital (2013-2019).
• Inclusion of patients with atypical lipomatous tumours, detailing demographics, tumour characteristics, radiological findings, treatment, and recurrence data.

Main Results:

• Out of 607 lipomatous tumours resected, 40 lesions in 37 patients were classified as ALTs.
• The mean age of ALT patients was 56.15 years, with the lower limb being the most common location.
• Three patients (7.5%) experienced local recurrence requiring re-operation; two patients (5%) needed pre-operative angio-embolisation.

Conclusions:

• Distinguishing atypical lipomatous tumours from lipomas is crucial for appropriate patient management.
• MRI findings, including increased intratumoural vascularity and septation, may indicate malignant potential in adipocytic tumours.
• A proposed management algorithm can assist in stratifying subcutaneous lesions.