Dedifferentiated Liposarcoma With Inflammatory Myofibroblastic Tumor-like Features

The dedifferentiated component of dedifferentiated liposarcoma shows wide histologic variation including tumors with heterologous differentiation. Myofibroblastic differentiation has been recognized in dedifferentiated liposarcoma. However, tumors closely resembling inflammatory myofibroblastic tumor have not. We report the clinicopathologic, immunohistochemical, and molecular finding in 6 cases of dedifferentiated liposarcoma with inflammatory myofibroblastic tumor-like features treated at our institution. The tumors occurred mostly in middle age or elderly men, involved mostly the inguinal/scrotal region or retroperitoneum, and behaved aggressively. Microscopically, the dedifferentiated component closely resembled or, if taken out of context, was indistinguishable from inflammatory myofibroblastic tumor. All 3 major patterns seen in inflammatory myofibroblastic tumor (myxoid, cellular, and hypocellular fibrous) were represented. Areas resembling nodular fasciitis or desmoid fibromatosis were frequent findings. One tumor had heterologous osseous differentiation. In 4 tumors the inflammatory myofibroblastic tumor-like areas were diffuse, whereas in 2 they were combined with noninflammatory myofibroblastic tumor-like high-grade sarcoma. Five tumors stained for smooth muscle actin or desmin, none stained for ALK-1, 5 stained for MDM2, and 5 had amplified MDM2 by fluorescence in situ hybridization. Well-differentiated liposarcomatous components were present in every tumor. All patients developed locally recurrent or metastatic disease. At last follow-up 2 patients had died of disease and 2 were alive with disease. Dedifferentiated liposarcoma can have prominent inflammatory myofibroblastic tumor-like features, a finding that further expands its histologic spectrum. Awareness of this finding can prevent one from misdiagnosing dedifferentiated liposarcoma as inflammatory myofibroblastic tumor, a much less aggressive neoplasm.