Sclerosing variant of well-differentiated liposarcoma: relative prevalence and spectrum of CT and MRI features

The purpose of this study was to determine the relative prevalence of the sclerosing variant of well-differentiated liposarcoma at one institution and to elucidate the CT and MRI characteristics of this subtype of well-differentiated liposarcoma. A retrospective computerized search was conducted to calculate the relative prevalence of the sclerosing variant of well-differentiated liposarcoma among all well-differentiated liposarcoma subtypes at one institution. The MRI and CT features of a total of 19 cases of pathologically proven sclerosing variant of well-differentiated liposarcoma were evaluated (seven identified from the study institution database and 12 cases contributed by other institutions). The cases of a total of 36 patients with well-differentiated liposarcoma were identified in the pathology database; six (17%) cases had evidence of dedifferentiation. Seven (19%) cases of sclerosing variant of well-differentiated liposarcoma were identified. Of these, three (43%) had evidence of dedifferentiation. On images, the sclerosing variant of well-differentiated liposarcoma typically presented as a large (average, 16.6 cm) well-circumscribed heterogeneous mass most commonly situated in the retroperitoneum (58%). Sixteen of the 19 tumors evaluated (84%) had predominantly well-circumscribed margins. Tumor composition ranged from predominantly fatty to entirely devoid of macroscopic fat; only three (16%) were composed of more than 75% fat. Variable amounts of nonlipomatous elements were identified in all cases. Enhancement of these elements was evident at CT or MRI in all 14 cases in which enhancement could be reliably assessed. The sclerosing variant of well-differentiated liposarcoma should be included in the differential diagnosis of any well-circumscribed lipomatous mass containing variable amounts of nonlipomatous elements, particularly when located in the retroperitoneum. Unlike other subtypes of well-differentiated liposarcoma, the sclerosing variant is less likely to be composed predominantly of fat and may be associated with an increased propensity for dedifferentiation.