10.1245/ASO.2004.03.058
Annals of Surgical Oncology 11:78-84 (2004)
© 2004 Society of Surgical Oncology
Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma of the Extremity and Trunk Wall: Importance of Histological Subtype With Treatment Recommendations
David A. Kooby, MD,
Cristina R. Antonescu, MD,
Murray F. Brennan, MD and
Samuel Singer, MD
From the Departments of Surgery (DAK, MFB, SS) and Pathology (CRA), Memorial Sloan-Kettering Cancer Center, New York, New York.
Correspondence: Address correspondence and reprint requests to: Samuel Singer, MD, Memorial Sloan-Kettering Cancer Center, Department of Surgery, H1210, 1275 York Ave., New York, NY 10021; Fax: 646-422-2300; E-mail: singers{at}mskcc.org
 |
ABSTRACT
|
|---|
Background: This study defines the behavior and classification of atypical lipomatous tumors (ALT) and well-differentiated liposarcomas (WDLS) of the extremity and trunk.
Methods: A total of 91 well-differentiated lipomatous tumors of the extremity and trunk were identified from a soft tissue tumor database between July 1982 and June 2001. A soft tissue pathologist, blinded to prior diagnosis and clinical outcome, reviewed histology. Those composed predominantly of mature adipose tissue with scattered atypical stromal cells and scant lipoblasts or fibrosis were ALTs. Tumors with lipoblasts but <25% fibrosis were termed lipoma-like WDLS, and those with 
25% fibrosis were identified as sclerosing WDLS. Clinical factors were analyzed to assess effects on local recurrence–free survival (LRFS).
Results: Histological review identified 34 ALTs and 57 WDLSs. Of the WDLSs, 29 were lipoma-like and 28 were sclerosing. Five-year and 10-year LRFS were 100% ± 0% and 78% ± 9%, respectively. Factors evaluated were age, sex, tumor site, tumor size, histology, presentation status, margin status, and adjuvant radiotherapy. Positive resection margins and sclerosing histology were associated with reduced LRFS. Dedifferentiation was observed in three tumors (3%).
Conclusions: Lipoma-like WDLSs and ALTs share similar histological features and favorable behavior. Margin-positive sclerosing WDLSs have a 10-year LRFS of only 17% and should undergo function-preserving re-excision when possible, or adjuvant radiotherapy.
Key Words: Atypical lipomatous tumor • Well-differentiated liposarcoma • Soft tissue sarcoma • Dedifferentiated liposarcoma • Local recurrence
|
INTRODUCTION
|
|---|
Lipomatous neoplasms account for approximately 50% of soft tissue tumors and thus are commonly encountered by surgeons and pathologists. They can occur in any part of the body, and they range from simple benign lipomas that require no intervention to potentially lethal, high-grade pleomorphic liposarcomas that require multidisciplinary management. The term well-differentiated liposarcoma (WDLS) has been used to describe nonmetastasizing low-grade lipomatous neoplasms with a propensity for local recurrence.1 Most authors agree that the sarcoma label is appropriate when these lesions are found in the retroperitoneum. Opinion is divided, however, when these tumors are located in the extremity or abdominal wall; some experts2–4 advocate the term atypical lipomatous tumor (ALT; aka atypical lipoma), and others5–7 are in favor of maintaining the sarcoma status. Proponents of the term ALT cite the favorable outcome after resection and the almost negligible effect on patient survival, whereas advocates of the term WDLS point to reports demonstrating a high incidence of local recurrence and potential for tumor dedifferentiation and metastasis.8,9
Dating back to 1962, the modern histological classification of liposarcoma has included the category of WDLS,10 but it was not until 1974 that the term ALT was introduced.11 Since then, these labels have been assigned to lesions on the basis of an array of conflicting criteria, including microscopic appearance, tumor location, and personal bias. Karyotyping has consistently demonstrated the presence of ring and long marker chromosomes composed of an amplified chromosomal region 12q13–15 in both ALT and WDLS,12,13 suggesting that these lesions are members of the same category within the classification scheme. The recent World Health Organization classification of tumors of soft tissue and bone grouped these lesions into one category, "atypical lipomatous tumor/well-differentiated liposarcoma," demonstrating the confusion surrounding existing terminology.14
These lesions can be subclassified as lipoma-like or sclerosing on the basis of the degree of collagen-containing hyperchromatic stromal cells present.15 Lipoma-like lesions are more common in extremity and truncal sites, but sclerosing tumors can also be found in these locations.16 Although a few reports have examined the importance of histological subtyping of these tumors, results have been inconclusive because of small sample size and heterogeneity in tumor specifics and patient information.
This study reviews a large number of patients with well-differentiated lipomatous lesions of the extremity and trunk wall treated at a single institution over 20 years. It correlates careful histological analysis with clinicopathologic information to define factors predictive of local recurrence and dedifferentiation.
|
MATERIALS AND METHODS
|
|---|
All patients treated for soft tissue sarcoma at Memorial Sloan-Kettering Cancer Center (MSKCC) between July 1, 1982, and December 31, 2001, were entered onto a prospectively maintained database. All lesions of the extremity and trunk wall that carried the diagnosis of ALT or WDLS were evaluated in this study. Extremity lesion sites (including the groin) were categorized as upper or lower, and lesions of the trunk wall were categorized as chest wall, abdominal wall, or back. Only ALTs deep to the fascia were studied, to preclude evaluation of truly benign lipomas; however, superficial WDLSs were included. Retroperitoneal, visceral, and head and neck lesions were excluded from this study, because their deep central location and more aggressive biology often results in mortality from repeated local recurrence. Patient, tumor, and treatment factors were analyzed for prognostic significance. Histological review was correlated with clinicopathologic features. The end points for this study were local recurrence–free survival (LRFS) and the incidence of tumor dedifferentiation.
A soft-tissue pathologist blinded to histological diagnosis and clinical outcome reviewed archived slides. In most cases, a section was made for each cubic centimeter of tumor (i.e., a 15 x 15 cm tumor had 15 sections to review). Fatty tumors containing mature adipocytes that contained occasional irregular hyperchromatic nuclei and rare or absent lipoblasts were designated ALT. Those lesions with lipoblasts and minimal fibrosis (<25% of low-powered fields) were labeled lipoma-like WDLS. Specimens with lipoblasts and significant fibrosis (25%) were identified as sclerosing WDLS (Fig. 1). Inflammatory and spindle cell subtypes were excluded from the analysis. Lesions with regions of high-grade, nonlipogenic sarcoma arising within a fatty tumor or in the bed of a previously resected well-differentiated lipomatous tumor were identified as dedifferentiated liposarcoma (Fig. 2). Correlation to clinical outcome was assigned after histological reclassification.
View larger version (111K):
[in this window]
[in a new window]
|
FIG. 1. Photomicrographs demonstrating histological differences between atypical lipomatous tumors (A) (high power), lipoma-like well-differentiated liposarcomas (B) (high power), and sclerosing well-differentiated liposarcomas (C) (low power). Atypical lipomatous tumors are characterized by the presence of rare atypical cells within mature fat. Lipoma-like liposarcomas have lipoblasts (arrowheads) but minimal to no sclerosing areas. Sclerosing liposarcomas have lipoblasts and significant sclerosing regions (*).
|
|
View larger version (197K):
[in this window]
[in a new window]
|
FIG. 2. Low-power photomicrograph demonstrating the features of a dedifferentiated liposarcoma. The top two thirds represents the high-grade, nonlipogenic dedifferentiated sarcoma. The bottom third shows features of sclerosing well-differentiated liposarcoma.
|
|
Patient, tumor, and treatment factors were reviewed for the 91 patients. These included age, sex, tumor site (extremity or trunk wall), tumor size, tumor depth (superficial or deep to the fascia), presentation status (primary or recurrent lesion), procedure performed (radical or marginal resection), use of radiotherapy (XRT), and microscopic margin status (positive or negative as determined at the original histological evaluation). Clinical data were correlated to reclassified histological diagnoses, and LRFS and the incidence of dedifferentiation were determined. Patient data were coded by study identification numbers, and before analysis, these data were stripped of all identifiers to maintain patient confidentiality, in accordance with our institutional review board.
Statistical analyses were performed with SPSS statistical software, version 10.0 for Windows (SPSS Inc., Chicago, IL). Statistical significance was defined as P < .05. Fisher’s exact test was used to evaluate differences between categorical variables, and two-way analysis of variance was used for continuous variables. LRFS was calculated by the method of Kaplan and Meier.17 Univariate analysis was performed with the log-rank test.18
|
RESULTS
|
|---|
Patient Population
From July 1982 through December 2001, 4884 patients underwent resection for soft tissue sarcoma at MSKCC. Of these, 891 (18%) patients had a histological diagnosis of liposarcoma, and 138 liposarcomas were well differentiated; 51 of these were located in the extremity and trunk wall.
An additional 79 patients underwent resection of indeterminate, intramuscular lipomatous soft tissue tumors. Of these, 40 were designated as ALTs by our pathologists. The study population consisted of the 51 WDLSs and the 40 ALTs, for a total of 91 cases.
Histological Reclassification
After histological review, 13 (33%) of the 40 cases designated as ALTs were reclassified as lipoma-like WDLS, and 7 (14%) of the 51 WDLSs were reclassified as ALTs. The final count consisted of 34 ALTs and 57 WDLSs. Of the 57 WDLSs, 29 (51%) were categorized as lipoma-like and 28 (49%) as sclerosing. Overall, 22% (20 of 91 cases) were reclassified from their original diagnosis. No case originally identified as an ALT was reclassified as a sclerosing WDLS.
Association Between Histology and Local Recurrence
Table 1 lists the patient, tumor, and treatment factors evaluated and their breakdown by histology. The average age for patients with ALT was significantly younger than that of patients with WDLS (53 ± 12 years vs. 60 ± 14 years; P = .03). Most patients were male (62%). Extremity tumors were more common than trunk tumors (90% vs. 10%). The average tumor size (largest dimension) was equivalent for ALTs and WDLSs (16 cm). Six (11%) WDLSs were superficial to the fascia, and all remaining tumors were deep.
Most patients presented with primary lesions (n = 71; 78%), and this was similar for ALTs and WDLSs. Marginal resections (n = 63; 69%) were more common than wide excisions (n = 28; 31%) for both histologies, because these were large tumors that were often close to major neurovascular structures. Microscopic margin status was found to be positive in 38 cases (42% of the entire population). Positive margins were seen equally among ALTs and WDLS (38% vs. 44%; P = .6). Adjuvant XRT was administered to 16 patients (18% of the entire group), 15 of whom had WDLS (P = .001). The one patient with ALT who received XRT had a 25-cm buttock lesion that was originally thought to be a WDLS.
The median follow-up time for the 91 patients was 47 months (range, 12–222 months). The overall LRFS was 100% at 5 years and 78% at 10 years. No patient experienced a recurrence before 5 years, and the range was 60 to 120 months. Only five patients developed local recurrences after treatment at MSKCC, and their data are listed in Table 2. Table 3 lists the univariate analysis of factors that potentially affect LRFS. No significant differences in 10-year LRFS were observed by tumor site (extremity vs. trunk; P = .7), tumor size (<15 vs. 15 cm; P = .9), tumor depth (superficial vs. deep; P = .6), presentation (primary vs. recurrent; P = .2), procedure (wide excision vs. marginal resection; P = .07), use of XRT (no vs. yes; P = .3), or tumor histology (ALT vs. WDLS; P = .2).
Margin status and histological subtype carried statistically significant associations with the development of local recurrence. Patients who had positive microscopic resection margins had a 10-year LRFS of 53% ± 16%, compared with 100% ± 0% for patients with negative resection margins (P = .01; Fig. 3). Patients with sclerosing tumors had a 10-year LRFS of 56% ± 15%, compared with 100% ± 0% for patients with nonsclerosing tumors (ALTs and lipoma-like WDLSs; P = .01; Fig. 4). All patients in this series who experienced local recurrence had sclerosing tumors and positive microscopic margins. The 10-year LRFS for patients with sclerosing WDLS and microscopic positive margins was 17% ± 15%. Multivariate analysis could not be performed on this population, because events (local recurrences) were limited.
View larger version (14K):
[in this window]
[in a new window]
|
FIG. 3. Local recurrence–free survival by histological subtype. The 28 patients with sclerosing tumors (broken line) were more likely to develop local recurrence than the 63 patients with nonsclerosing lesions (solid line; P = .01; log-rank test).
|
|
View larger version (13K):
[in this window]
[in a new window]
|
FIG. 4. Local recurrence-free survival by microscopic margin status. The 38 patients with positive resection margins (broken line) were more likely to develop local recurrence than the 53 patients with negative margins (solid line; P = .01; log-rank test).
|
|
Dedifferentiation
Three patients developed dedifferentiated liposarcoma, and their data are listed in Table 4. All were young women (aged 34–40 years) with extremity lesions ranging from 3 to 18 cm in the longest dimension. Two lesions originally presented as WDLSs and were identified as having undergone dedifferentiation at first recurrence (at 5 and 12 years), and the other case was that of a WDLS with foci of incipient dedifferentiation noted at initial evaluation. Currently, one of these patients is alive with disease, and two are without evidence of disease.
|
DISCUSSION
|
|---|
Classification of well-differentiated lipomatous neoplasms of the extremity and trunk wall remains confusing and controversial, because experts are divided on the question of their true malignant potential. The World Health Organization uses the combined term "atypical lipomatous tumor/well-differentiated liposarcoma" in their recently published manual on soft tissue tumors,14 further illustrating this indecision. Our study attempted to clarify classification of these lesions through pairing histological review and subtyping with clinical behavior in a large number of cases diagnosed and treated at a single institution.
The term atypical lipoma was introduced in 197411 but did not gain momentum until the late 1970s and early 1980s. In a critical evaluation of histology and clinical behavior, Evans et al.3 described a group of low-grade lipomatous tumors that had enlarged mature adipocytes with atypical, hyperchromatic nuclei located in the subcutis, extremity, or abdominal wall musculature or retroperitoneum. They observed that the nine subcuticular lesions did not recur after resection, whereas most (9 of 13) intramuscular lesions did (Table 5). None of these patients died of disease, but many of them required multiple operations, and two were alive with disease at the time of publication. The authors believed that the term atypical lipoma was appropriate for extremity lesions because they were unlikely to result in metastases or mortality. Patients with retroperitoneal lesions were less fortunate, because five of eight cases recurred locally, and three patients died of disease. This group concluded that the clinical behavior of these lesions was location dependent and that retroperitoneal lesions should still maintain the sarcoma label because of their poor prognosis. Several subsequent reviews have confirmed this finding.3,5–8
View this table:
[in this window]
[in a new window]
|
TABLE 5. Summary of published reports on well-differentiated lipomatous tumors (excluding lesions in the retroperitoneum and viscera)a
|
|
Opinion remains divided regarding lesions outside the retroperitoneum, with some in favor of softening the name to atypical lipoma4,6 while others are in favor of maintaining the sarcoma label.5,7 Table 5 provides a summary of published reports on well-differentiated lipomatous tumors (ALTs and WDLSs) of the extremity and abdominal wall. Retroperitoneal, visceral, head and neck, and miscellaneous tumors have been removed from the totals, and local recurrence, dedifferentiation, metastasis, and disease-specific death are reported. This information is clearly stated in some articles and less clearly in others. Sample size reflects only lesions that fit our descriptions of ALTs (deep to fascia) and WDLSs. Terminology refers to the final label recommended by the respective authors. Note that percentages are provided as crude rates, because Kaplan-Meier data are not reported. Local recurrence ranged from 15% to 52%, and the incidence of dedifferentiated liposarcoma varied from 0% to 19%. Metastasis and disease-specific death were exceedingly rare events.
We report a lower incidence of local recurrence than was shown in these studies. The LRFS in this study was 100% at 5 years and 78% at 10 years for the entire cohort. One explanation for this finding is our aggressive management of inadequately treated primary tumors. Fifteen cases operated on elsewhere had close or positive microscopic resection margins and underwent planned re-excision to improve local control. Seventeen patients (16 WDLS) in this study received adjuvant XRT. Although the benefits of re-excision and XRT are not clear for this subset of patients, this proactive approach to initial suboptimal therapy may have translated into fewer recurrences.
Another explanation for the lower recurrence rate we report could be our limited follow-up time, because our data suggest that recurrence is a late event in this disease. We reported our follow-up from the time of first operation at Memorial Hospital; thus, patients presenting with local recurrence who were initially treated elsewhere (n = 20) were compared with patients who had initial primary tumor resections (n = 71) at MSKCC. Although this approach limits follow-up time and ignores recurrences that occurred before treatment at out institution, it allows for better homogeneity in diagnosis, management, and data accrual. Other studies relied on patient memory of previous tumors to lengthen follow-up. We observed no difference in recurrence rates between patients whose first MSKCC operation was for their primary lesion and those who presented with a recurrence.
A primary end point of this study was to examine how histological appearance influenced clinical behavior in well-differentiated lipomatous tumors outside the retroperitoneum. Enzinger and Weiss19 were the first to categorize these tumors as lipoma-like or sclerosing. Lipoma-like lesions resemble lipomas with mature adipocytes, occasional irregularly shaped cells, and hyperchromatic, atypical nuclei. Lipoblasts are present in variable degrees, and scant fibrous septa are present, dividing the tumor into irregular lobules.19 The sclerosing variant is reportedly less common in the extremity. It shows features similar to those of lipoma-like lesions within a background matrix of dense fibrosis consisting of eosinophilic collagen fibrils. Previous reports have examined histological subtype, but commentary on the relationship to clinical behavior is scant. Azumi et al.6 suggested that sclerosing retroperitoneal tumors are more likely to recur than lipoma-like lesions, but these authors made no comment on extremity and truncal lesions in this regard. Lucas et al.7 also subclassified lesions by histological appearance by using lipoma-like and sclerosing categories but did not report on the relationship of histological subtype to clinical behavior.
All five local recurrences that we observed occurred in patients with sclerosing tumors and positive resection margins (Table 3). The minimum time to recurrence was 5 years. Only one patient (case 2) developed metastatic disease (to the lung) but is doing well in follow-up. Nonsclerosing tumors did not recur in this series, even when resection margins were positive (n = 9), suggesting that these lesions are less aggressive. The significance of these findings, however, requires confirmation with longer follow-up, because the median time to local recurrence in this series (69 months; range, 60–120 months) exceeds the median follow-up time (47 months; range, 12–222 months).
The term dedifferentiated liposarcoma was coined by Evans et al.3 and was used to describe focal poorly differentiated regions within a WDLS lesion. These regions may resemble malignant fibrous histiocytoma or another undifferentiated component that does not fit any clear-cut classification. There is variability in reporting the incidence of dedifferentiation. Weiss and Rao5 found this process to be time dependent (range, 2–18 years) and not site specific, as was previously reported. In this regard, our median follow-up time of 47 months may limit our conclusions on this point, because all recurrences occurred at 60 months after resection. The three cases in our study are shown in Table 5. They were all in young women with sclerosing extremity lesions. In one instance, incipient dedifferentiation was a de novo event, and in the other two cases, dedifferentiation occurred 5 and 12 years after the original resection.
In summary, our findings identified two factors that were significantly associated with an increased risk of local recurrence after resection of well-differentiated lipomatous neoplasms of the extremity and trunk wall: positive microscopic resection margin and sclerosing histology. Dedifferentiation was a rare event (seen in 3% of patients in the present series), and metastases and disease-specific death were even less common, although longer follow-up (>10 years median follow-up time) may influence these findings.
We conclude that ALTs and lipoma-like WDLSs in the extremity and trunk wall are synonymous terms that are associated with similar clinical outcome. Their management should include complete function-preserving excisions with clean margins when possible. Re-excision or the addition of adjuvant XRT in cases in which microscopic margins are positive is unlikely to provide significant benefit, because the recurrence rate for this subset is low. Those well-differentiated lipomatous lesions in the extremity and trunk with significant sclerosing areas should be approached with a function-preserving wide excision with 1-cm margins, when possible. If clean margins are achieved, this constitutes definitive therapy, and XRT is unnecessary. In cases of sclerosing WDLS in which the margins are microscopically positive because of the proximity of adjacent neurovascular structures, adjuvant external beam XRT should be considered.
|
ACKNOWLEDGMENTS
|
|---|
The acknowledgments are available online in the full-text version at www.annalssurgicaloncology.org. They are not available in the PDF version.
The authors thank Monica Cha and Allison Samaniego for their assistance and meticulous data acquisition. Supported by grant T32 CA 09501 from the National Institutes of Health.
|
FOOTNOTES
|
|---|
Classification of low-grade lipomatous neoplasms of the deep soft tissues remains confusing to surgeons and pathologists. This study correlates clinicopathologic features with histology in a large cohort of extremity and truncal atypical lipomatous tumors and well-differentiated liposarcomas treated and followed up at a single institution.
Received for publication March 8, 2003.
Accepted for publication August 25, 2003.
|
REFERENCES
|
|---|
- Brennan MF. Diagnosis and Management of Soft Tissue Sarcoma. London: Martin Dunitz, 2002: 21–54.
- Kindblom LG, Angervall L, Fassina AS. Atypical lipoma. APMIS 1982; 90: 27–36.
- Evans HL, Soule EH, Winkelmann RK. Atypical lipoma, atypical intramuscular lipoma, and well-differentiated retroperitoneal liposarcoma: a reappraisal of 30 cases formerly classified as well-differentiated liposarcoma. Cancer 1979; 43: 574–84.[CrossRef][Medline]
- Rozental TD, Khoury LD, Donthineni-Rao R, Lackman RD. Atypical lipomatous masses of the extremities: outcome of surgical treatment. Clin Orthop 2002; 203–11.
- Weiss SW, Rao VK. Well-differentiated liposarcoma (atypical lipoma) of deep soft tissue of the extremities, retroperitoneum, and miscellaneous sites. A follow-up study of 92 cases with analysis of the incidence of "dedifferentiation." Am J Surg Pathol 1992; 16: 1051–8.[Medline]
- Azumi N, Curtis J, Kempson RL, Hendrickson MR. Atypical and malignant neoplasms showing lipomatous differentiation. A study of 111 cases. Am J Surg Pathol 1987; 11: 161–83.[CrossRef][Medline]
- Lucas DR, Nascimento AG, Sanjay BK, Rock MG. Well-differentiated liposarcoma. The Mayo Clinic experience with 58 cases. Am J Clin Pathol 1994; 102: 677–83.[Medline]
- Henricks WH, Chu YC, Goldblum JR, Weiss SW. Dedifferentiated liposarcoma: a clinicopathological analysis of 155 cases with a proposal for an expanded definition of dedifferentiation. Am J Surg Pathol 1997; 21: 271–81.[CrossRef][Medline]
- Mentzel T. Biological continuum of benign, atypical, and malignant mesenchymal neoplasms—does it exist? J Pathol 2000; 190: 523–5.[CrossRef][Medline]
- Enzinger F, Wolf RF. Liposarcoma. A study of 103 cases. Virchows Arch A Pathol Anat Histol 1962; 335: 367–88.
- Kindblom LG, Angervall L, Stener B, Wickbom I. Intermuscular and intramuscular lipomas and hibernomas. A clinical, roentgenologic, histologic, and prognostic study of 46 cases. Cancer 1974; 33: 754–62.[CrossRef][Medline]
- Fletcher CD, Akerman M, Dal Cin P, et al. Correlation between clinicopathological features and karyotype in lipomatous tumors. A report of 178 cases from the Chromosomes and Morphology (CHAMP) Collaborative Study Group. Am J Pathol 1996; 148: 623–30.[Abstract]
- Rubin BP, Fletcher CD. The cytogenetics of lipomatous tumours. Histopathology 1997; 30: 507–11.[CrossRef][Medline]
- Fletcher CDM, Unni KK, Mertens F, eds. Pathology and Genetics of Tumors of Soft Tissue and Bone. Oxford: Oxford University Press, 2002: 35–9.
- Weiss SW. Lipomatous tumors. Monogr Pathol 1996; 38: 207–39.[Medline]
- Mentzel T, Fletcher CD. Lipomatous tumours of soft tissues: an update. Virchows Arch 1995; 427: 353–63.[Medline]
- Kaplan TL, Meier S. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457–81.[CrossRef]
- Peto R, Peto J. Asymptomatically efficient rank invariant test procedures. J R Stat Soc A 1972; 135: 185–206.
- Enzinger F, Weiss SW. Soft Tissue Tumors. St. Louis: Mosby, 1988: 346–82.
This article has been cited by other articles:
|
|
|
|
 
S. Singer, N. D. Socci, G. Ambrosini, E. Sambol, P. Decarolis, Y. Wu, R. O'Connor, R. Maki, A. Viale, C. Sander, et al.
Gene Expression Profiling of Liposarcoma Identifies Distinct Biological Types/Subtypes and Potential Therapeutic Targets in Well-Differentiated and Dedifferentiated Liposarcoma
Cancer Res.,
July 15, 2007;
67(14):
6626 - 6636.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. L. CRIBB, W. P. COOL, D. J. FORD, and D. C. MANGHAM
Giant Lipomatous Tumours of the Hand and Forearm
J Hand Surg Eur Vol.,
October 1, 2005;
30(5):
509 - 512.
[Abstract]
[Full Text]
[PDF]
|
|
|
TOP
ABSTRACT
INTRODUCTION
