- 期刊
A Well-Differentiated "Lipoma-Like" Liposarcoma Arising in a Recurrent Intramuscular Lipoma-A Case Report and Review of Literature
源自復發性肌內脂肪瘤之分化良好似脂肪瘤之惡性脂肪肉瘤－病例報告及文獻回顧
摘要
肌內脂肪瘤佔脂肪瘤中之極為少數，但不同於表淺的脂肪瘤，其復發的機會相對較高，尤其是浸潤型肌內脂肪瘤。其較易復發主要是因為切除範圍不易拿捏，可能造成切除不完全的情形。另外要考慮是否在反覆復發的過程中產生了惡性變化，儘管機率非常的低。臨床上，對於形態較大，反覆復發，位於深部的脂肪組織腫瘤，需與分化良好之惡性脂肪肉瘤作區分。組織學上，分化良好之惡性脂肪肉瘤可進一步區分為三類：(1)“似脂肪瘤”型態(2)發炎型態(3)硬化型態，而其中又以“脂肪瘤”型態最為常見。其病理特徵是在成熟的脂肪細胞中呈現非典型深染的核，伴隨周圍夾雜著梭狀細胞的纖維組織。除了病理切片外，目前藉由影像學的發展及研究，有助於鑑別診斷肌內脂肪瘤及分化良好之惡性脂肪肉瘤。在臨床治療方面，肌內脂肪瘤及分化良好之惡性脂肪肉瘤皆建議廣泛性切除。在此我們提出一例分化良好“似脂肪瘤”之惡性脂肪肉瘤源自復發性肌內脂肪瘤的病例報告，一名四十二歲男性病患因左大腿反覆復發的肌內脂肪瘤，在過去十年接受了四次腫瘤切除手術，此次再度因為左大腿復發之腫瘤而入院。最後證實為分化良好“似脂肪瘤”之惡性脂肪肉瘤。本文將關於這兩類腫瘤在臨床和病理學上的特徵加以討論，並回顧相關的文獻資料作一整理。
關鍵字
無資料並列摘要
Intramuscular lipoma and well-differentiated liposarcoma are hardly differentiated both clinically and histologically. Intramuscular lipoma is benign but easy to recur. Well-differentiated liposarcoma is regarded as low grade malignancy. It does not metastasize but may recur after surgery and in some rare cases de-differentiate to a high-grade sarcoma. Malignant transformation of well-differentiated liposarcoma in a preexisting lipoma is rare and only a few cases have been reported previously. Wide resection is the treatment of choice for both tumors to minimize the potential risk of recurrence. Histologically, three variants of well-differentiated liposarcoma can be distinguished and the ”lipoma-like” variant is the most common. We presented a 42-year-old male patient of left thigh well-differentiated liposarcoma which was diagnosed as recurrent intramuscular lipoma for four times over the past 10 years. Wide excision was performed and pathology revealed well-differentiated ”lipoma-like” liposarcoma. The pathological characteristics and management are described and the previous literatures are reviewed.
延伸閱讀
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