case_images: PMC8504230_01
case_images: MRI images of DDLPS. Axial fat-saturated T2-weighted image (a) and coronal T2-weighted image (b) show a relatively well-defined pure fatty mass (white arrows), surrounding a non-fatty solid mass. DDLPS: dedifferentiated liposarcoma; MRI: magnetic resonance imaging.
case_images: 10.1177_20587384211048565-fig1.jpg
case_images: PMC8504230_01_10.1177_20587384211048565-fig1.jpg
case_images: fig1-20587384211048565
case_images: The MRI signal intensity for most of the mass was hyperintense on T1-weighted images and T2-weighted images (Figure 1(a)), with drop-out on MRI fat-suppressed sequence images (Figure 1(b)).
case_images: Gross appearance of DDLPS. The cross section of the WDLPS reveals yellow tissue, the high-grade DDLPS is fish flesh-colored, and the middle necrotic area is pale yellow; the low-grade DDLPS (white arrows) is gray-white, but the local area is grayish-brown. DDLPS: dedifferentiated liposarcoma; WDLPS: well-differentiated liposarcoma.
case_images: 10.1177_20587384211048565-fig2.jpg
case_images: PMC8504230_01_10.1177_20587384211048565-fig2.jpg
case_images: fig2-20587384211048565
case_images: There was a clear boundary between brown tumor foci near the capsule and other gray-white or fish flesh-colored tumor foci (Figure 2).
case_images: Histologic analysis of dedifferentiated liposarcoma specimens. (a) Typical well-differentiated liposarcoma of the adipocytic/lipoma-like type (hematoxylin-eosin stain; x100). (b) High-grade dedifferentiated liposarcoma demonstrates high cellularity, pleomorphism, and marked cellular atypia (hematoxylin-eosin stain; x100). (c) and (d) Transition from low-grade dedifferentiation with inflammatory myofibroblastic tumor-like features to high-grade dedifferentiation with undifferentiated pleomorphic sarcoma features (hematoxylin-eosin stain; c x40). The boundary (white arrows) between them is clear (hematoxylin-eosin stain; d x20). (e) and (f) Transition from low-grade dedifferentiation with fibromatosis-like features to high-grade dedifferentiation with undifferentiated pleomorphic sarcoma features (hematoxylin-eosin stain; ex40). The boundary (white arrows) between them is clear (hematoxylin-eosin stain; f x20).
case_images: 10.1177_20587384211048565-fig3.jpg
case_images: PMC8504230_01_10.1177_20587384211048565-fig3.jpg
case_images: fig3-20587384211048565
case_images: Most of the solid nodule were high-grade pleomorphic undifferentiated sarcomas with extensive tumor necrosis, and the tumor cells had obvious atypia and active mitotic images (about 50/50 high-power microscopic field; HPF) (Figure 3(b)). The low-grade DDLPS were located near the capsule of the solid nodule; histologically, they were inflammatory myofibroblastic tumor-like (Figure 3(c)) and fibromatosis-like features. Most of the tumor cells were spindle-shaped and had slight atypia, with pleomorphic tumor cells occasionally seen (Figure 3(e)). The low-grade DDLPS with multiple foci can be seen, which suddenly transits to the high-grade DDLPS (Figure 3(d) and (f)).
case_images: Fluorescence in situ hybridization of the MDM2 gene. FISH analysis confirmed MDM2 gene amplification (clustering of red signals) in the nuclei of atypical cells. FISH: fluorescence in situ hybridization.
case_images: 10.1177_20587384211048565-fig4.jpg
case_images: PMC8504230_01_10.1177_20587384211048565-fig4.jpg
case_images: fig4-20587384211048565
case_images: Fluorescence in situ hybridization (FISH) analysis showed the presence of MDM2 gene amplification (Figure 4).