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Head and Neck Surgery

(0673) Liposarcoma in the Head and Neck: A Scoping Review

Monday, September 30, 2024
12:00 PM – 1:00 PM EDT
Has Audio
Disclosure(s):
Emily Montgomery, MD: No relevant relationships to disclose.
Esther Kim, MD: No relevant relationships to disclose.
Paul Wistermayer, MD: No relevant relationships to disclose.


Introduction: Atypical Lipomatous Tumors/Well-Differentiated Liposarcomas (ALT/WD-LPS) are rare neoplasms in the head and neck, often with considerable variance in workup and treatment between patients. We present a case study of liposarcoma and scoping review of the literature to identify current best practices in treatment of these tumors.

Methods: A healthy 47-year-old female presented with a 2-year history of an enlarging right neck mass. CT revealed a 2.1 x 2.0 x 5.1 cm well circumscribed mass abutting the submandibular gland. Initial histopathological examination after elective surgery suggested lipoma with cellular atypia. Additional molecular testing reclassified the tumor as ALT/WD-LPS with positive margins. Elective neck dissection was performed with pathologic analysis confirmed clear margins. A scoping review following PRISMA-ScR guidelines was performed on primary head and neck ALT/WD-LPS. 120 articles were reviewed, with 49 meeting inclusion criteria for discussion.

Results: Liposarcomas are rare–less than 1% of tumors in the head and neck region with proposed etiologies being idiopathic, genetic predisposition, and radiation exposure. Molecular investigations reveal mutations in INK4A, INK4B, TP53, and MDM2 amplification. Radiographic features favoring ALT/WD-LPS include size (> 10cm), fat composition, septations, and non-adipose areas. Surgical excision is recommended, but there are frequent limitations to achieving negative margins in the head and neck region. Prognostically, ALT/WD-LPS are known for high rates of locoregional recurrence but limited metastatic potential. Typical treatment includes complete surgical resection. Adjunct therapy is infrequently utilized, with emphasis placed on long term follow up.

Conclusions: Differentiating liposarcoma from lipoma often requires post-excision molecular analysis. Our study reviews the literature reporting primary head and neck ALT/WD-LPS and their treatment; complete tumor excision with negative margins is generally recommended due to high locoregional recurrence.

    Presenting Author(s)

  • Emily Montgomery, MD

    Resident
    Walter Reed National Military Medical Center
    Bethesda, Maryland, United States

    • Co-Author(s)

  • AY

    Alex Yang, MD

    Walter Reed National Military Medical Center, United States

  • GB

    Grace Baisden, MD

    Walter Reed National Military Medical Center, United States

  • DM

    David Millay, MD

    Resident Physician
    Walter Reed National Military Medical Center
    Gaithersburg, Maryland, United States

  • Esther Kim, MD

    Associate Professor of Surgery
    Alexander T. Augusta Military Medical Center
    Fort Belvoir, Virginia, United States

    • Senior Author(s)

  • PW

    Paul Wistermayer, MD

    Attending Surgeon
    Walter Reed National Military Medical Center
    Bethesda, Maryland, United States