J Cutan Pathol 2014: 41: 907–915 © 2014 John Wiley & Sons A/S.

doi: 10.1111/cup.12428 Published by John Wiley & Sons Ltd

John Wiley & Sons. Printed in Singapore
Journal of
Cutaneous Pathology

Primary subcutaneous myxoid

liposarcoma: a clinicopathologic
review of three cases with molecular
confirmation and discussion of the
differential diagnosis‡
Background: Myxoid liposarcoma typically presents as a Darya Buehler1,† , Trent B.
deep-seated mass in the lower extremity of adults. Presentation as Marburger2,3,† and Steven D.
a primary subcutaneous tumor is rare. Here we discuss Billings2,3
clinicopathologic characteristics of three such cases and their 1
differential diagnosis to alert dermatopathologists to this unusual Department of Pathology, University of
Wisconsin School of Medicine and Public
clinical presentation of a potentially aggressive entity. Health, Madison, WI, USA ,
2
Methods: Cases of myxoid liposarcoma were retrieved from Department of Pathology, Cleveland Clinic,
archives and consultation files. Inclusion required location above Cleveland, OH, USA , and
3
Department of Dermatology, Cleveland
the subcutaneous fascia with no evidence of a metastatic origin. Clinic, Cleveland, OH, USA
Clinicopathologic features were retrospectively reviewed. † Both authors contributed equally to this
Fluorescence in situ hybridization for DDIT3 (CHOP ) gene manuscript.
rearrangement was performed on all cases. ‡ This work was presented at the 50th Annual

Results: The tumors affected young adults (two males and one Meeting of The American Society of
female, mean 36 years, range 32–40 years). No prior history of Dermatopathology, Washington, DC. 10/12/2013.
myxoid liposarcoma or deep soft tissue mass was identified. The
tumors occurred in the foot, thigh and hand. All demonstrated
multilobular architecture with abundant myxoid stroma,
prominent branching capillary vascular network and lipoblastic
differentiation. No dermal involvement was seen. Round cell
features were identified in one case and represented <5% of the
tumor. All patients remain disease-free following local excision
only at 6, 8 and 13 months.
Conclusions: Myxoid liposarcoma can rarely present as a primary
subcutaneous mass and should be considered in the differential
diagnosis of cutaneous myxoid tumors in adults.

Keywords: DDIT3, liposarcoma, myxoid, round cell liposarcoma,

subcutaneous
Steven D. Billings, MD,
Buehler D, Marburger TB, Billings SD. Primary subcutaneous Department of Pathology, Cleveland Clinic, 9500
myxoid liposarcoma: a clinicopathologic review of three cases Euclid Avenue, L25 Cleveland, OH 44195, USA
with molecular confirmation and discussion of the differential Tel: 216-444-2826
Fax: +1 216 445 6967
diagnosis‡ . e-mail: billins@ccf.org
J Cutan Pathol 2014; 41: 907–915. © 2014 John Wiley & Sons A/S.
Published by John Wiley & Sons Ltd Accepted for publication June 15, 2014

907
Buehler et al.
Myxoid liposarcoma is one of the four main
liposarcoma subtypes recognized by the 2013
World Health Organization (WHO) classifica-
tion,1 the other ones being atypical lipomatous
tumor/well-differentiated liposarcoma, dediffer-
entiated liposarcoma and pleomorphic liposar-
coma. Myxoid liposarcoma represents approxi-
mately 5% of all soft tissue sarcomas and about
one third to one half of all liposarcomas.1 – 3 It
primarily affects younger adults, with a peak inci-
dence during the fifth decade but is also the most
common liposarcoma subtype to occur in the
pediatric population.4 Myxoid liposarcoma clas-
sically involves the deep soft tissue of the lower
extremity (75%), especially the medial thigh and
popliteal region, is a well-circumscribed, multin-
odular gelatinous mass on gross examination.2
Histopathologically, classic myxoid liposar-
coma is a relatively circumscribed, lobular
neoplasm composed of bland fusiform or
spindled mesenchymal cells and univacuo-
lated or multivacuolated lipoblasts, set in a
prominent myxoid matrix containing a rich
plexiform capillary network. Purely myxoid
tumors are hypocellular but tend to have rela-
tively enhanced cellularity at the periphery of
the nodules. Pooling of stromal mucin can often
be appreciated creating a lymphangioma-like
or ‘pulmonary edema’-like growth pattern.1,2,5
A recent study highlighted a striking diver-
sity of morphologic patterns in this tumor,
including previously unrecognized nested and
island patterns.6 This morphologic diversity can
complicate the diagnosis, especially in small
biopsy specimens. The very limited utility of
immunohistochemical studies in the diagno-
sis of myxoid liposarcoma only adds to the
diagnostic challenge.
High-grade myxoid liposarcoma (formerly
referred to as round cell liposarcoma) demon-
strates hypercellular areas composed of sheets
of primitive round cells, which obscure the cap-
illary vasculature and display a greater degree
of nuclear atypia and mitotic activity than their
well-differentiated counterpart. Although the
percentage of round cell differentiation nec-
essary for the diagnosis of high-grade myxoid
liposarcoma was a subject to debate for some
time, it is currently accepted that it should
comprise >5% of tumor cells.1 Both the myx-
oid and round cell components demonstrate
reciprocal chromosomal translocations, t(12;16)
(q13;p11) resulting in a FUS/DDIT3 fusion
protein (seen in >90% of cases7 ) or t(12;22)
(q13;q22) resulting in a EWSR1/DDIT3 fusion
protein.8 These gene rearrangements can be
908
reliably demonstrated by fluorescent in situ
hybridization (FISH) on paraffin tissue utilizing
dual color break apart rearrangement probes.9
Myxoid liposarcoma has a potential for local
recurrence and metastatic spread. The risk
of metastasis parallels the amount of round
cell component.10 – 15 Myxoid liposarcomas are
unique among sarcomas in their propensity for
metastasis to soft tissue, body cavities and bone
before lung metastases develop.10,12,14 – 16 Treat-
ment of myxoid liposarcoma primarily includes
complete surgical excision as there is a high con-
cordance between a negative margin status, local
recurrence and disease-specific survival.10,12,14,17
Neoadjuvant or postoperative radiation therapy
has been used very successfully in this tumor.18
Chemotherapy is usually reserved for patients
with metastatic, locally advanced and/or unre-
sectable disease. Myxoid liposarcoma has shown
a unique sensitivity to trabectedin.19
A superficial presentation of myxoid liposar-
coma is uncommon. Primary superficial myx-
oid liposarcomas comprise from 1 to 20% of all
myxoid liposarcomas3,10,15,18,20 and their presen-
tation in the dermis and upper subcutaneous
layer is exceptionally rare.21,22 Given the variety
of more common myxoid tumors found in these
locations, a superficial presentation of myxoid
liposarcoma could represent a significant diag-
nostic challenge. The biologic behavior of these
tumors in superficial locations is not completely
understood. Herein, we report the clinicopatho-
logic characteristics of three such cases with
molecular confirmation and review the differen-
tial diagnosis of myxoid liposarcoma in order to
raise awareness of this rare potentially aggressive
entity.
Materials and methods
The study was approved by the institutional
review board. Cases diagnosed as myxoid liposar-
coma were retrieved from our archives and con-
sultation files. Inclusion required that cases arise
in superficial tissues above the subcutaneous
fascia with no evidence of a metastatic origin.
Clinicopathologic features were retrospectively
reviewed. Treatment and clinical course charac-
teristics were obtained from patient files and con-
tributing physicians.
FISH for DDIT3 (CHOP ) gene rearrange-
ment was performed on interphase nuclei in
formalin-fixed, paraffin-embedded tissue secti-
ons as previously described9 using DDIT3
(12q13) Dual Color, Break Apart Rearrange-

ment Probe (Abbott Molecular/Vysis, Des
Plaines, IL, USA).
Results
Clinical features
The clinical findings are summarized in Table 1.
The tumors presented as subcutaneous masses in
adult patients (two males and one female, mean
age 36 years, range 32–40 years). The tumors
ranged in size from 1.7 to 3.8 cm in greatest
dimension. No evidence of prior history of myx-
oid liposarcoma or unrecognized primary or syn-
chronous lesions in deep soft tissue was identi-
fied on clinical exam or imaging studies. This
argues against the possibility that these repre-
sented metastases from an underlying occult pri-
mary tumor. No examples of superficial metas-
tases from deeper primary tumors were identi-
fied within our archives and consultation files.
All tumors involved the extremities with location
in the foot, thigh and hand. The clinical course
prior to diagnosis was known in one case (Case
1), where the patient reported first noticing the
lesion roughly 6 years prior to presentation, as a
‘pea-sized’ somewhat mobile mass on his left foot
(Fig. 1B). The clinical impression in all three
cases was that of a benign soft tissue lesion, pos-
sibly a complex ganglion (Case 1) or a nerve
sheath tumor or nodular fasciitis (Case 3).
Microscopic features
All three tumors presented as well-circumscribed
masses in the superficial subcutis (Fig. 1A,B).
Dermal involvement was not identified. Patho-
logically, all tumors demonstrated the charac-
teristic features of myxoid liposarcoma includ-
ing: a multilobular architecture with abundant
myxoid stroma, a prominent branching capillary
vascular network and lipoblastic differentiation
(Fig. 2A–D). Areas of increased cellularity with
round cell features were identified in one case
(Case 1), representing <5% of the tumor volume
(Fig. 3). Necrosis was not identified.
Fluorescence in situ hybridization
DDIT3 (CHOP ) gene rearrangements were
demonstrated in all three tumors via FISH
utilizing DDIT3 (12q13) as illustrated in Fig. 4.
Outcome
Treatment and follow up data is presented in
Table 2. The patient in Case 1 underwent fore-
foot amputation with negative margins, and is
Primary subcutaneous myxoid liposarcoma
currently alive with no evidence of disease at
6 months follow up. The patient in Case 2 under-
went a re-excision with negative margins and is
alive with no evidence of disease at 13 months.
Neither patient received radiation or chemother-
apy. The treatment details beyond the initial exci-
sion with negative margins are not available for
Case 3; however, the patient is alive and free of
disease at 8 months follow up.
Discussion
Myxoid liposarcoma is generally regarded as a
neoplasm arising in the deep soft tissues of
extremities. Primary superficial myxoid liposar-
comas are very uncommon, ranging from 1 to
20% of all cases in various series. However,
many studies do not specify the location of the
tumor with respect to fascial planes. In our
practice, these three cases of superficial myx-
oid liposarcoma comprised <2% of all primary
myxoid/round cell liposarcomas, diagnosed dur-
ing the past 20 years at our institution. There-
fore, the objective of this study was to alert der-
matopathologists to this rare scenario and dis-
cuss the differential diagnosis with more com-
mon myxoid cutaneous neoplasms.
The clinical presentations in our cases were
similar to the deep-seated myxoid liposarcomas
reported in the literature, except that two of the
three cases were located at acral sites, a relatively
uncommon location for this tumor type. Der-
mal involvement was not identified in any of our
cases, which is in keeping with vanishingly rare
reports of this phenomenon in the literature.
Although dermal involvement is not specifically
addressed in most large contemporary series of
myxoid liposarcoma, a bona fide dermal myx-
oid liposarcoma was identified in only 1 of 671
consecutive liposarcoma cases (0.2%) in a major
soft tissue consultation practice.21 It is unclear
whether dermis represents a biologically dis-
advantageous location for myxoid liposarcoma
given its predilection to grow in fat-containing
sites, at least in the setting of metastatic disease.15
However, the rarity of dermal involvement may
be used as a diagnostic aid in separating myx-
oid liposarcoma from other cutaneous myxoid
tumors.
From the cytoarchitectural standpoint, all
three cases demonstrated classic features of
myxoid liposarcoma, with short, spindled cells
loosely distributed in myxoid stroma contain-
ing prominent plexiform vasculature. When
a tumor with this appearance presents as a
deep-seated mass, the diagnosis of myxoid
909
Buehler et al.

Table 1. Clinicopathologic profiles of the three cases reviewed in this study

Round cell FNCLCC

Patient Age/sex Location Size (cm) component grade (1–3) AJCC stage DDIT3 FISH

1 40/M Left foot 3.8 <5% 1 pT1a Positive

2 37/F Right hand 1.7 None 1 pT1a Positive
3 32/M Right thigh 2 None 1 pT1a Positive

F, female; FISH, fluorescence in situ hybridization; M, male; FNCLCC, Fédération Nationale des Centres de Lutte Contre le Cancer; AJCC, American
Joint Committee on Cancer.

Fig. 1. A) A magnetic resonance image (MRI) of Patient 3 shows a well-circumscribed tumor in the subcutis with a clear plane
of tissue between the tumor and the fascia. B) Gross image of the resection from Patient 1 demonstrating a well-circumscribed
gelatinous tumor centered in the subcutis and abutting the overlying dermis of the forefoot.

liposarcoma is usually straightforward. However,
when encountered in a subcutaneous location,
myxoid liposarcoma can be easily confused with
other, more common dermal and subcutaneous
tumors containing prominent myxoid stroma.
Perhaps the most important differential diag-
nosis in this context is with the myxoid variant
of dermatofibrosarcoma protuberans (DFSP).
Myxoid DFSP is defined by the presence of
myxoid stromal change in >50% of the tumor23
and on occasion, can be nearly entirely myx-
oid. Clinically, these tumors often occur on the
extremities of young adult patients. Microscop-
ically, myxoid DFSP shows striking similarity to
myxoid liposarcoma as this is also a relatively
hypocellular tumor composed of short spindle or
stellate cells distributed loosely in a prominently
myxoid stroma, which may contain delicate
vasculature (Fig. 5A,B). The most helpful fea-
ture to distinguish myxoid DFSP from myxoid
liposarcoma is the presence of a conventional
storiform component, with an infiltrative edge
entrapping subcutaneous adipocytes in a dif-
fuse, honeycomb-like pattern. This conventional
storiform component can be identified, even
if focally, in up to 70% of myxoid DFSP cases
according to large series.23 Univacuolated and
multivacuolated lipoblasts are uncharacteristic
of myxoid DFSP but must be distinguished from
entrapped mature adipocytes. The capillary vas-
cular network of myxoid liposarcoma is typically
richer and more uniformly distributed than that
seen in myxoid DFSP. As mentioned above, the
involvement of the dermis, a prominent feature
in DFSP, appears to be very rare in superficial
myxoid liposarcoma. Nuclear atypia and mitotic
activity are not particularly helpful in distin-
guishing these entities as both myxoid DFSP
and myxoid liposarcoma have relatively bland
nuclear features and very low mitotic activity.
Immunohistochemical staining for CD34 can
be helpful as most myxoid liposarcomas are
negative for this marker while most DFSPs,
including the myxoid variant, are diffusely pos-
itive for CD34. The pitfall in this context lies
in mistaking CD34-positive dermal fibroblasts
for tumor cells. Therefore, in a particularly
challenging case, FISH or molecular testing
for DDIT3 (specific for myxoid liposarcoma)
and/or the COL01A-PDGFB (specific for DFSP)
gene rearrangements may be employed.
Another diagnostic dilemma in evaluation of
a superficial myxoid liposarcoma is distinguish-
ing it from myxofibrosarcoma, which also classi-
cally presents as a subcutaneous, lobulated mass
in patients in their sixth and seventh decades of
life. Several features can help to distinguish myx-
ofibrosarcoma from myxoid liposarcoma. Myx-
ofibrosarcoma characteristically has an exten-
sively infiltrative, multinodular growth pattern
and a greater degree of nuclear pleomorphism,
which can be appreciated at low power, even in

910
 Primary subcutaneous myxoid liposarcoma

A B

C D

Fig. 2. A) Myxoid liposarcoma demonstrating a circumscribed myxoid neoplasm centered in the subcutis. The overlying dermis is
intact (×14). B) Multi-lobular appearance of myxoid liposarcoma. Condensation of cells at the periphery of the lobules is evident
(×40). C) Myxoid liposarcoma composed of uniform, comma-shaped cells with dark chromatin, distributed in uniformly myxoid
stroma containing delicate branching capillary vasculature (×200). D) Lipoblastic differentiation was prominent in superficial
myxoid liposarcomas in our series (×200).

Table 2. Treatment and outcomes of the three cases reviewed in this study

Patient Age/sex Location Treatment* Follow-up (months) Outcome

1 40/M Left foot Forefoot Amputation 6 ANED

2 37/F Right hand Re-excision with no residual tumor 13 ANED
3 32/M Right thigh Unknown 8 ANED

ANED, alive no evidence of disease; F, female; M, male.

*Represents definitive treatment past the initial, diagnostic biopsy or excision.

low-grade tumors (Fig. 5C,D). The vessels of myx-
ofibrosarcoma are larger and coarser with char-
acteristic perivascular condensation of the tumor
cells. One can encounter cells with intracyto-
plasmic vacuoles containing mucin (so-called
pseudolipoblasts) in myxofibrosarcoma; but true
lipoblastic differentiation is not seen in this
entity. The high-grade component of myxofi-
brosarcoma typically has the appearance of pleo-
morphic sarcoma but may have epithelioid cells
that resemble carcinoma or melanoma. This is
in contrast to the small round blue cell appear-
ance of high grade (round cell) liposarcoma. A
pleomorphic sarcoma component is exception-
ally rare in myxoid liposarcoma (unpublished
observations). DDIT3 gene rearrangement is not
seen in myxofibrosarcoma.
Low-grade fibromyxoid sarcoma may arise in
the superficial locations24 and thus enter the
differential diagnosis of myxoid liposarcoma.
In contrast to the latter, low-grade fibromyxoid
sarcoma demonstrates alternating fibrous and
myxoid zones and a more whorling/storiform
arrangement of spindle cells. The vasculature
may be prominent in myxoid zones but is coarser
and unevenly distributed, forming characteristic
arcades. A high-grade counterpart of low-grade
fibromyxoid sarcoma is sclerosing epithelioid
fibrosarcoma, which is composed of cords of
epithelioid cells embedded in a hyalinized

911
Buehler et al.
Fig. 3. Distinct nodules of high grade myxoid liposarcoma
demonstrating round cell morphology (right) were present
adjacent to well-differentiated areas with prominent lipoblastic
differentiation (left) in the tumor from Patient 1. These high
grade/round cell areas represented <5% of the tumor volume
(×100).
Fig. 4. Fluorescence in situ hybridization (FISH) for DDIT3
(CHOP ) utilizing a dual color break apart rearrangement
probe set demonstrating separation of the green and red
signals (arrow) indicating rearrangement of one copy of the
DDIT3 gene region.
stroma. Although a cord-like pattern of myxoid
liposarcoma mimicking sclerosing epithelioid
fibrosarcoma has been described,6 it is typically
seen in association with traditional myxoid
liposarcoma. In challenging cases, immunohis-
tochemical staining for EMA, MUC425 and/or
FISH studies for DDIT3 gene rearrangement
are helpful in distinguishing these entities. It
should be noted that myxoid liposarcoma and
low-grade fibromyxoid sarcoma share FUS gene
rearrangement. Thus, this alone cannot serve as
a definitive test to distinguish these tumors.
912
Benign fibroblastic tumors with myxoid stroma
are commonly encountered by dermatopathol-
ogists including myxoma, angiomyxoma and
superficial acral fibromyxoma. However, these
are rarely confused with myxoid liposarcoma.
Myxoma and angiomyxoma are far less cellu-
lar tumors that lack the plexiform capillary vas-
cular network and lipoblasts of myxoid liposar-
coma. In superficial angiomyxoma, the vessels
are elongated, arcing thin-walled vessels, often
with perivascular neutrophilic aggregates. Pre-
dominantly myxoid examples of superficial acral
fibromyxoma may be confused with myxoid
liposarcoma as both tumors will show spin-
dled cells loosely suspended in myxoid vascu-
lar stroma. However, superficial acral fibromyx-
oma typically has alternating myxoid and cellu-
lar zones, more prominent spindling and a fas-
cicular arrangement of the tumor cells. CD34 is
positive in superficial acral fibromyxomas and is
generally negative in myxoid liposarcomas.
In our own experience and that of others,20,26
myxoid liposarcoma can be confused with dif-
fusely myxoid examples of spindle cell lipoma.
In addition to being fat-poor, these tumors often
feature prominent branching capillary vascula-
ture (Fig. 5E,F). The presence of eosinophilic
ropey collagen fibers, the shape of the spin-
dle cells, diffuse CD34 immunoreactivity and
predilection for upper back/neck area in an
older age group will help distinguish spindle cell
lipoma from myxoid liposarcoma.
Finally, several subtypes of nerve sheath tumors
encountered by dermatopathologists can have
prominent myxoid stroma. Dermal nerve sheath
myxoma (neurothekeoma) and myxoid perineu-
rioma are rarely confused with myxoid liposar-
coma as their appearance is quite distinctive.
Myxoid neurofibromas, on the other hand, may
resemble myxoid liposarcoma (Fig. 5G,H). Myx-
oid neurofibromas are more spindled in appear-
ance and composed of cells with hyperchro-
matic, wavy nuclei and more amphophilic cyto-
plasm. The presence of bundles of collagen sep-
arating the tumor cells and intralesional axons is
helpful, although the latter may only be identi-
fied by immunohistochemical staining for neu-
rofilament protein. The vasculature in myxoid
neurofibromas is sparse and when present, is
less branching and more uneven in size and dis-
tribution. Most neurofibromas show some S100
immunoreactivity while the mononuclear com-
ponent of myxoid liposarcoma is typically neg-
ative for this marker. S100 can be positive in
lipoblasts in myxoid liposarcoma.
 Primary subcutaneous myxoid liposarcoma

A B

C D

E F

G H

Fig. 5. A) Myxoid dermatofibrosarcoma protuberans composed of spindled to stellate tumor cells infiltrating into the subcutaneous
fat. The tumor lacks a regular plexiform vasculature and lipoblasts. B) Higher power image of myxoid dermatofibrosarcoma
protuberans demonstrating spindled to stellate tumor cells. The vasculature may be composed of delicate capillaries, but the
plexiform vasculature of myxoid liposarcoma is typically absent. C) Myxofibrosarcoma has a coarser curvilinear vasculature. D)
The tumor cells of myxofibrosarcoma have more atypia and pleomorphism than those seen in myxoid liposarcoma. E) Myxoid
variants of spindle cell lipoma can resemble myxoid liposarcoma, but spindle cell lipomas typically have mature adipocytes and a
stereotypical clinical presentation. F) Myxoid variants of spindle cell lipoma have the characteristic wiry to ropy collagen of spindle
cell lipoma. They may have delicate capillaries but typically not in a plexiform pattern. G) Myxoid neurofibromas have a random
arrangement of wavy spindled cells, but usually have some of the fine collagenous stroma typical of neurofibroma. The vasculature
lacks the plexiform pattern of myoid liposarcoma. H) The tumor nuclei of neurofibroma are wavy in contrast to the round fusiform
nuclei of myxoid liposarcoma.

913
Buehler et al.

The clinical importance of recognizing a
superficial myxoid liposarcoma is twofold. First,
myxoid liposarcoma is unique among soft tissue
sarcomas in that it has a predilection to metasta-
size to soft tissues, bone and body cavities, often
prior to pulmonary involvement.10,12,14,16 Thus,
identification of a superficial myxoid liposar-
coma should prompt an appropriate clinical
investigation, potentially including examina-
tion/imaging of the lower limbs, to ensure the
absence of occult, deep-seated primary tumor.
Second, myxoid liposarcoma is a potentially
aggressive sarcoma, which should be completely
excised and well sampled to determine the pres-
ence of high grade (round cell) areas. The latter
remains the main adverse prognostic factor in
this disease, however, a variety of other parame-
ters have been suggested, albeit inconsistently, to
negatively affect outcomes including: older age,
tumor size, local recurrence,10,15 necrosis,10,12
p53,12 AXL tyrosine kinase,15 and p27kip127
expression. Even in the absence of these factors,
pure myxoid liposarcomas may be associated
with a substantial (10–20%) risk of systemic
metastasis.14,15 In our series, all three patients
had superficial, low-grade myxoid liposarcoma
and remain free of disease at 6, 8 and 13 months
follow up. A lengthy pre-operative duration
(6 years) was seen on one of our cases. The
prognostic significance of superficial location
in this disease remains unclear, as many series
that include superficial myxoid liposarcomas do
not specifically evaluate outcomes based on this
parameter. In large series by Hoffmann et al.15
and Fiore et al.,14 superficial location did not
seem to play a role in disease-specific survival in
myxoid liposarcoma. However, the latter study
also included pleomorphic liposarcomas, which
too may arise in the subcutis based on this and
other large series.28 In contrast, most studies con-
vincingly demonstrate that the status of negative
margin plays a significant role in the prognosis
of myxoid liposarcoma.12,14 The advantageous
clinical course in our patients could be related
to the amenability of these superficial tumors
to complete surgical excision, although the
relatively short follow up time precludes firm
conclusions about prognosis of these lesions.
In summary, myxoid liposarcoma is a poten-
tially aggressive sarcoma that can rarely present
as a primary superficial subcutaneous mass.
Thus, myxoid liposarcoma should be considered
in the differential diagnosis of subcutaneous
myxoid tumors in adults. The presence of
characteristic microscopic features and demon-
stration of DDIT3 rearrangement confirm the
diagnosis of myxoid liposarcoma and allow reli-
able differentiation from a variety of potential
mimics.

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