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Skeletal Radiol. 2018 Jun;47(6):877-882. doi: 10.1007/s00256-017-2866-4. Epub 2018 Jan 23.

Mosaic-pattern dedifferentiation in liposarcoma and chondrosarcoma: imaging features of an uncommon form of dedifferentiation.

Author information

1
Department of Radiology, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA.
2
Department of Radiology, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA. kransdorf.mark@mayo.edu.
3
Department of Orthopedic Surgery, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA.
4
Center for Musculoskeletal Care, Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 1450 Chapel Street, New Haven, CT, 06511, USA.
5
Department of Laboratory Medicine and Pathology, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA.

Abstract

The term "dedifferentiation" was classically used in sarcoma pathology to refer to tumors in which a high-grade, undifferentiated sarcoma, or a high-grade sarcoma showing heterologous differentiation, arises from a pre-existing neoplasm of borderline or low-grade malignancy. The best recognized examples of this include dedifferentiated liposarcoma, arising from atypical lipomatous tumor/well-differentiated liposarcoma, and dedifferentiated chondrosarcoma, arising from grade 1 hyaline chondrosarcoma of bone. In the overwhelming majority of cases, this dedifferentiated, high-grade sarcoma presents as a macroscopically visible mass, adjacent to and clearly distinct from the pre-existing low-grade lesion. It is less well appreciated that dedifferentiation may also occur in a so-called "mosaic pattern,' in which the high-grade component is intimately admixed with elements of the precursor lesion, forming only microscopically apparent foci. This mosaic or co-mingling pattern of dedifferentiation is also reflected in the MR imaging appearance. In contrast to the classic pattern of dedifferentiation in which there are two distinct juxtaposed masses with different signal intensities and enhancement patterns, such changes are not seen in mosaic dedifferentiation. The imaging features of this pattern of dedifferentiation have not been described. In this report we describe the imaging features of two patients with mosaic pattern dedifferentiation, one with liposarcoma and one with chondrosarcoma. In both cases the precursor lesion was correctly diagnosed by pre-biopsy imaging, but the presence of high-grade sarcoma was not recognized.

KEYWORDS:

Chondrosarcoma; Co-mingling; Dedifferentiation; Liposarcoma; MR imaging; Mosaic; Neoplasm

PMID:
29362843
DOI:
10.1007/s00256-017-2866-4
[Indexed for MEDLINE]

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