Pleural liposarcoma mimicking carcinoma in pleural effusion cytology: a case report

Our plain-English summary of Pleural liposarcoma mimicking carcinoma in pleural effusion cytology: a case report, by A.F. Dagli, S. Pehlivan, M.R. Ozercan (Acta Cytologica, 2010).

The study

• Authors: A.F. Dagli, S. Pehlivan, M.R. Ozercan
• Journal: Acta Cytologica
• Published: 2010;54(4):601-4
• Type of article: Case report
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Primary pleural liposarcoma is extremely rare, and its most common subtype is the myxoid subtype. To the best of our knowledge, the number of cases reported up to now is <20. It is primarily a disease ofindividuals 50 years of age and it is more common in men. It has no specific symptoms except for cough and chest pain.

Case: A 56-year-old female presented complaining of chest pain and dyspnea for 4 months. An increase in homogeneous density on the left hemithorax, from the apex to basal area, with blurring of the borders of the heart and the diaphragm, was revealed by lung radiography. Thoracic computed tomography revealed a diffuse pleural effusion causing compressive atelectasis at the base of the left hemithorax. Cytologic examination of the pleural fluid demonstrated tumoral cells forming papillary structures with complex branching and fine fibrovascular core. The tumor cells were relatively uniform and had vacuolar cytoplasm with hyperchromatic nuclei. Upon finding CA-125 positive in the immunocytochemical examination, the case was reported as "consistent with malignancy, possibility of ovarian origin, cannot be excluded". As the gynecologic examination was normal, exploratory thoracotomy was performed to take a biopsy. The case was diagnosed as liposarcoma (myxoid type) by histopathologic examination.

Conclusion: Cytologic diagnosis of pleural liposarcoma is difficult due to its rarity and resemblance to malignant mesothelioma. Cytologic properties of liposarcoma in pleural fluid should be well known and considered in the differential diagnosis.

In plain English

This case report, by pathologists at Firat University in Elazig, Turkey, described one 56-year-old woman who had chest pain and shortness of breath for 4 months. Imaging showed fluid around her left lung (a pleural effusion). Tumor cells in the fluid formed branching, finger-like (papillary) clusters. Lab stains for thrombomodulin, calretinin, HBME-1 and CA15-3 were negative, while CA-125 was positive, so the fluid was reported as consistent with cancer, with a possible ovarian origin not ruled out. A gynecologic examination found nothing, so surgeons opened the chest and took a biopsy. The pleural surface was lined by benign mesothelial cells, and the tumor beneath it, which stained positive for S-100 and vimentin, was diagnosed as myxoid-type liposarcoma. The authors concluded that pleural liposarcoma is hard to diagnose from fluid because it is rare and mimics malignant mesothelioma, and that its features in fluid should be well known. They noted that how CA-125 stains in pleural liposarcomas is not yet known. The article does not mention asbestos.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report
• Who was studied: One 56-year-old woman with chest pain and shortness of breath (dyspnea) for 4 months, reported by the Department of Pathology, Firat University, Elazig, Turkey; dates of care are not stated
• Main results:
  • In the pleural fluid, tumor cells formed papillary structures with complex branching; the cells were relatively uniform, with vacuolar cytoplasm and hyperchromatic nuclei
  • On immunocytochemistry of the fluid, the tumor cells were negative for thrombomodulin, calretinin, HBME-1 and CA15-3 and positive for CA-125; the case was reported as consistent with malignancy, possibly of ovarian origin
  • Gynecologic examination showed no pathology, so exploratory thoracotomy was performed and a biopsy was taken
  • On biopsy, the pleural surface was lined by benign mesothelial cells, with a myxoid tumor containing occasional lipoblasts beneath it
  • In the biopsy tissue, the tumor cells were negative for thrombomodulin, calretinin, HBME-1, pancytokeratin, EMA and CD 36 and positive for S-100 and vimentin; the patient was diagnosed with myxoid-type liposarcoma
• The authors' conclusion: The authors concluded that the cell features of pleural liposarcoma should be well known and considered in diagnosis, because it is rare, hard to diagnose and mimics malignant mesothelioma
• Limitations the authors state:
  • The authors noted that how CA-125 stains in pleural liposarcomas is not yet known

Topics

Medical terms in this study, explained in our Lexicon: Carcinoma, Pleural Effusion, Cytology, Dyspnea, Hemithorax, Diaphragm, Atelectasis, CA-125.

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