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What Does The Following Histopathology Report Indicate?
Question: XXXXPatient Details
Name : XXXXX
Gender : Female
Age : 61 years 11 months
Weight on 22nd January 2015 : 68.7 kgs (before surgery)
Weight on 14th February 2015 : 64.7 kgs (after surgery)
Height : 5' 3"
Children : 4 Daughters, 1 Son, (Age of eldest child : 42 years, yougest child age : 35 years)-all normal deliveries
She can walk, work and do household work in good manner without much problems
Patient History
From 1994 till 2010
hysterectomy done 1994 due to fibroid uterus.
Patient of hypertension since last 15 years (Blood pressure is under control due to medication.)
Patient of thyroid and cholesterol (both well under control).
Year 2011
On 25/12/2011 patient complained of severe abdominal pain, nausea, vomiting, uneasiness – admitted to hospital – administered inj. Zenflox, Rantec, Dynapar –IV, Tab. Rabium DSR 1-0-1 and discharged next day i.e. 26-12-11 at own request.
Advised :
Adv. CBS, SGPT, USG Abdomen
Adv. Repeat SOS USG, PPBS and urine complete
USG Abdomen concluded : Hepathomegaly with fatty change with minimum ascitis (of or relating to or resulting from an abnormal accumulation of protein and electrolyte rich fluid in the peritoneal cavity) – SGPT = 20 U/L
Year 2012 - 2014
She had feeling of mild abdominal pain very occasionally for last 2 years but since she did not feel it on continuous basis she felt that it could be due to acidity. On 5th December 2014 - during casual blood tests carried out through one laboratory her lipase was detected abnormal as 71.3 U/I as against reference range of 5.6 – 51.3. Referred to family physician who advised USG Abdomen.
27th December 2014 - USG Abdomen concluded: LARGE ILL-DEFINED INTRAPERITONEAL HYPOECHOIC SOL IN RIGHT SIDE OF ABDOMEN FROM RHC REGION TO RIF. IT SHOWS POOR VASCULARITY – POSSIBILITY OF LIPOMATOUS LESION APPEARS MOST LIKELY – adv. CT SCAN
29th December 2014 - MDCT of abdomen and pelvis carried out , suggested – EXTENSIVE ABNORMAL LIPOMATOSIS INVOLVING ALMOST COMPLETE RIGHT ABDOMINAL CAVITY - ? NATURE. NO EVIDENT HEPATIC INFILTRATION, FREE FLUID OR ADENOPATHY SEEN. Referred to oncologist (Dr - A)
30th December 2014 - CT guided biopsy carried out on suggestion of Dr - A – Fluid material specimen processed for block at pathology laboratory and microscopic examination concluded LIPOMATOUS TUMOR, RIGHT RETROPERITONEUM. WELL DIFFERENTIATED LIPOMA LIKE LIPOSARCOMA MOST LIKELY IN THIS LOCATION.
30th December 2014 - Oncologist (Dr - A) opined it to be liposarcoma.
3rd January 2015 - As a second opinion - Consulted another Oncologist (Dr - B) who mentioned that he will review slide and block of biopsy done by Dr - A. His histopathology review mentioned A SMALL FRAGMENT OF MATURE FIBRO ADIPOSE TISSUE; INADEQUATE FOR A DEFINITIVE OPINION. Dr - B suggested another biopsy at his place.
5th January 2015 - USG guided truecut biopsy carried out by (Dr - B) from right sided retroperitoneal lesion - and his Histopathology report revealed possibility of a typical lipomatous tumor / well differentiated liposarcome likely. He suggested to get PET CT scan done.
8th January 2015 - PET-CT CARRIED OUT – FINDINGS : NON-FDG CONCENTRATING LIPOMATOSIS INVOLVING ABDOMINO-PELVIC CAVITY ON RIGHT SIDE - NO EVIDENCE OF METABOLICALL ACTIVE DISEASE ELSEWHERE IN THE BODY.
9th January 2015 - Dr B suggested for surgery - RADICAL RESECTION OF LIPOMETOUS TUMOR
10th January - Both Dr A and Dr B are surgeons. We decided to get opinion of separate histopathological specialist before getting ready for surgery. Hence we sent Blocks and slides of first and second Biopsy (done by Dr - A and Dr - B) to a histopathology specialst Dr - C.
13th January report of Dr - C mentioned following :
Review of Dr - A's sample - Biopsy reveals mature adipose tissue
Review of Dr - B's sample - Biopsy reveals infarcted fat with dystrophic calcifications
If both biopsies are representative of the lesion, this is a lipomatous tumor showing fact necrosis. However, there is no evidence of it being a liposarcoma.
22th January 2015 - PATIENT ADMITTED TO Dr B's hospital AND ON 23-01-15 SURGERY CARRIED OUT FOR RADICAL RESECTION OF LIPOMETOUS TUMOR. Tumor was sent to Dr - B's lab for further analysis. Approximate weight of tumor was around 1.2 kg. We have tumor image captured. If you need we can provide.
27th January 2015 - PATIENT DISCHARGED IN HAEMODYNAMICALLY STABLE CONDITION with advice to follow-up for dressing, soft diet, all liquids, coconut water twice a day.
2nd February patient complained of mild pain – N.A.D. – Mild collection in suture line found – cleaned.
4th February 2015 - Histopathology report from Dr - B's lab shows impression : well differentiated liposarcoma / a typical lipomatous tumor.
10th February 2015 - Patient complained pain and hence USG local part (Screening) carried out at Dr - B's place which revealed FOCAL ILL DEFINED NODULARITY DEEPLY ALONG THE ABDOMINAL SCAR WITH FAT STRANDING AND PROBE TENDERNESS – PoSSIBILITY OF INFLAMATORY ETIOLOGY SUGGETING FOLLOW-UP.
10th February 2015 - Block and Slides of extracted tumor preserved at Dr B's place were sent for review to Dr - C (histopathology specialist)
14th February 2015 - Review by Dr C says following -
Microscopy:
Gigantic Lipoma
The thick fibrous septae show histiocytes and lymphoplasmacytic infilterate.
Foci of fat necrosis and dystrophic calcification are noted
Impression
Right abdominal intraperitoneal SOL : Gigantic Lipoma
Questions :
What should we infer based no Dr C's histopathology review of 14th February 2015?
Is this information sufficient to tell us whether the said tumor is Lipoma (benign) or Liposarcoma (Malignant one) ? If yes, what is it, benign or malignant?
If it is benign what would you suggest as next course of treatment ?
If it is Malignant what would you suggest as next course of treatment ?
If above information is insufficient in order to decide about the nature of tumor what else needs to be done to understand its nature (considering the fact that tumor is not preserved now)
What should we infer about remarks based on USG local part (Screening) carried out on 10th February 2015 by Dr - B? Is this something to be concerned of OR not ?
Note :- We have all the physical as well as digital copies of CT scan, PET CT scan, Biopsy reports, Surgery reports, histopathology reports and slides+blocks of biopsies done by Dr A and Dr B (including biopsy of whole tumor after the surgery done by Dr - B.)
Name : XXXXX
Gender : Female
Age : 61 years 11 months
Weight on 22nd January 2015 : 68.7 kgs (before surgery)
Weight on 14th February 2015 : 64.7 kgs (after surgery)
Height : 5' 3"
Children : 4 Daughters, 1 Son, (Age of eldest child : 42 years, yougest child age : 35 years)-all normal deliveries
She can walk, work and do household work in good manner without much problems
Patient History
From 1994 till 2010
hysterectomy done 1994 due to fibroid uterus.
Patient of hypertension since last 15 years (Blood pressure is under control due to medication.)
Patient of thyroid and cholesterol (both well under control).
Year 2011
On 25/12/2011 patient complained of severe abdominal pain, nausea, vomiting, uneasiness – admitted to hospital – administered inj. Zenflox, Rantec, Dynapar –IV, Tab. Rabium DSR 1-0-1 and discharged next day i.e. 26-12-11 at own request.
Advised :
Adv. CBS, SGPT, USG Abdomen
Adv. Repeat SOS USG, PPBS and urine complete
USG Abdomen concluded : Hepathomegaly with fatty change with minimum ascitis (of or relating to or resulting from an abnormal accumulation of protein and electrolyte rich fluid in the peritoneal cavity) – SGPT = 20 U/L
Year 2012 - 2014
She had feeling of mild abdominal pain very occasionally for last 2 years but since she did not feel it on continuous basis she felt that it could be due to acidity. On 5th December 2014 - during casual blood tests carried out through one laboratory her lipase was detected abnormal as 71.3 U/I as against reference range of 5.6 – 51.3. Referred to family physician who advised USG Abdomen.
27th December 2014 - USG Abdomen concluded: LARGE ILL-DEFINED INTRAPERITONEAL HYPOECHOIC SOL IN RIGHT SIDE OF ABDOMEN FROM RHC REGION TO RIF. IT SHOWS POOR VASCULARITY – POSSIBILITY OF LIPOMATOUS LESION APPEARS MOST LIKELY – adv. CT SCAN
29th December 2014 - MDCT of abdomen and pelvis carried out , suggested – EXTENSIVE ABNORMAL LIPOMATOSIS INVOLVING ALMOST COMPLETE RIGHT ABDOMINAL CAVITY - ? NATURE. NO EVIDENT HEPATIC INFILTRATION, FREE FLUID OR ADENOPATHY SEEN. Referred to oncologist (Dr - A)
30th December 2014 - CT guided biopsy carried out on suggestion of Dr - A – Fluid material specimen processed for block at pathology laboratory and microscopic examination concluded LIPOMATOUS TUMOR, RIGHT RETROPERITONEUM. WELL DIFFERENTIATED LIPOMA LIKE LIPOSARCOMA MOST LIKELY IN THIS LOCATION.
30th December 2014 - Oncologist (Dr - A) opined it to be liposarcoma.
3rd January 2015 - As a second opinion - Consulted another Oncologist (Dr - B) who mentioned that he will review slide and block of biopsy done by Dr - A. His histopathology review mentioned A SMALL FRAGMENT OF MATURE FIBRO ADIPOSE TISSUE; INADEQUATE FOR A DEFINITIVE OPINION. Dr - B suggested another biopsy at his place.
5th January 2015 - USG guided truecut biopsy carried out by (Dr - B) from right sided retroperitoneal lesion - and his Histopathology report revealed possibility of a typical lipomatous tumor / well differentiated liposarcome likely. He suggested to get PET CT scan done.
8th January 2015 - PET-CT CARRIED OUT – FINDINGS : NON-FDG CONCENTRATING LIPOMATOSIS INVOLVING ABDOMINO-PELVIC CAVITY ON RIGHT SIDE - NO EVIDENCE OF METABOLICALL ACTIVE DISEASE ELSEWHERE IN THE BODY.
9th January 2015 - Dr B suggested for surgery - RADICAL RESECTION OF LIPOMETOUS TUMOR
10th January - Both Dr A and Dr B are surgeons. We decided to get opinion of separate histopathological specialist before getting ready for surgery. Hence we sent Blocks and slides of first and second Biopsy (done by Dr - A and Dr - B) to a histopathology specialst Dr - C.
13th January report of Dr - C mentioned following :
Review of Dr - A's sample - Biopsy reveals mature adipose tissue
Review of Dr - B's sample - Biopsy reveals infarcted fat with dystrophic calcifications
If both biopsies are representative of the lesion, this is a lipomatous tumor showing fact necrosis. However, there is no evidence of it being a liposarcoma.
22th January 2015 - PATIENT ADMITTED TO Dr B's hospital AND ON 23-01-15 SURGERY CARRIED OUT FOR RADICAL RESECTION OF LIPOMETOUS TUMOR. Tumor was sent to Dr - B's lab for further analysis. Approximate weight of tumor was around 1.2 kg. We have tumor image captured. If you need we can provide.
27th January 2015 - PATIENT DISCHARGED IN HAEMODYNAMICALLY STABLE CONDITION with advice to follow-up for dressing, soft diet, all liquids, coconut water twice a day.
2nd February patient complained of mild pain – N.A.D. – Mild collection in suture line found – cleaned.
4th February 2015 - Histopathology report from Dr - B's lab shows impression : well differentiated liposarcoma / a typical lipomatous tumor.
10th February 2015 - Patient complained pain and hence USG local part (Screening) carried out at Dr - B's place which revealed FOCAL ILL DEFINED NODULARITY DEEPLY ALONG THE ABDOMINAL SCAR WITH FAT STRANDING AND PROBE TENDERNESS – PoSSIBILITY OF INFLAMATORY ETIOLOGY SUGGETING FOLLOW-UP.
10th February 2015 - Block and Slides of extracted tumor preserved at Dr B's place were sent for review to Dr - C (histopathology specialist)
14th February 2015 - Review by Dr C says following -
Microscopy:
Gigantic Lipoma
The thick fibrous septae show histiocytes and lymphoplasmacytic infilterate.
Foci of fat necrosis and dystrophic calcification are noted
Impression
Right abdominal intraperitoneal SOL : Gigantic Lipoma
Questions :
What should we infer based no Dr C's histopathology review of 14th February 2015?
Is this information sufficient to tell us whether the said tumor is Lipoma (benign) or Liposarcoma (Malignant one) ? If yes, what is it, benign or malignant?
If it is benign what would you suggest as next course of treatment ?
If it is Malignant what would you suggest as next course of treatment ?
If above information is insufficient in order to decide about the nature of tumor what else needs to be done to understand its nature (considering the fact that tumor is not preserved now)
What should we infer about remarks based on USG local part (Screening) carried out on 10th February 2015 by Dr - B? Is this something to be concerned of OR not ?
Note :- We have all the physical as well as digital copies of CT scan, PET CT scan, Biopsy reports, Surgery reports, histopathology reports and slides+blocks of biopsies done by Dr A and Dr B (including biopsy of whole tumor after the surgery done by Dr - B.)
Brief Answer:
Correct histopathology report is key.
Detailed Answer:
Hi.
Thank you for your detailed description, it really helps. At this point, I do not need any report copies or films.
Your problem as I see it, entirely rests upon the differentiation between lipoma and liposarcoma, as the further course of action will depend completely upon this differentiation.
So, firstly, the standard of the laboratory used by Dr B and that of Dr C is something that only you can tell. If both the laboratories are equally reputed and standardized, then the confusion exists and you will have to send the blocks to an even better lab. For this, there are 2 options. First, you can go to a reputed Government Cancer Hospital. If you are located in XXXXXXX you can go to Tata Memorial Hospital, XXXXXXX The 2nd option is to send the blocks to a private lab of repute, like Onquest/Quest/Core diagnostics for second opinion. Ensure please, that they also do Immunohistochemistry (IHC) on the blocks. This is an additional test that will help confirm the diagnosis.
If either of the labs are of sufficient repute as compared to the ones I have already mentioned, then we will go by the report of the better reputed lab. This should answer your 1st and 4th questions.
Now, if it is a lipoma, then there is nothing more to be done, except routine follow up. He will need to show to the oncologist and get an USG abdomen done every 3 months initially, prolonging the interval between follow ups as time passes.
If it is a liposarcoma, then he will have to undergo further treatment in the form of radiotherapy in view of the large size and location of the tumor. This is an approximately 6 week treatment with daily sittings. He does not need chemotherapy. He will need lifelong follow up thereafter.
As to the recent USG showing a nodule near the scar, it does not appear to be anything sinister and is most likely an infected collection and should subside with antibiotics.
I hope I have answered all your queries. If there are any more, I will be happy to answer them.
Take care.
Correct histopathology report is key.
Detailed Answer:
Hi.
Thank you for your detailed description, it really helps. At this point, I do not need any report copies or films.
Your problem as I see it, entirely rests upon the differentiation between lipoma and liposarcoma, as the further course of action will depend completely upon this differentiation.
So, firstly, the standard of the laboratory used by Dr B and that of Dr C is something that only you can tell. If both the laboratories are equally reputed and standardized, then the confusion exists and you will have to send the blocks to an even better lab. For this, there are 2 options. First, you can go to a reputed Government Cancer Hospital. If you are located in XXXXXXX you can go to Tata Memorial Hospital, XXXXXXX The 2nd option is to send the blocks to a private lab of repute, like Onquest/Quest/Core diagnostics for second opinion. Ensure please, that they also do Immunohistochemistry (IHC) on the blocks. This is an additional test that will help confirm the diagnosis.
If either of the labs are of sufficient repute as compared to the ones I have already mentioned, then we will go by the report of the better reputed lab. This should answer your 1st and 4th questions.
Now, if it is a lipoma, then there is nothing more to be done, except routine follow up. He will need to show to the oncologist and get an USG abdomen done every 3 months initially, prolonging the interval between follow ups as time passes.
If it is a liposarcoma, then he will have to undergo further treatment in the form of radiotherapy in view of the large size and location of the tumor. This is an approximately 6 week treatment with daily sittings. He does not need chemotherapy. He will need lifelong follow up thereafter.
As to the recent USG showing a nodule near the scar, it does not appear to be anything sinister and is most likely an infected collection and should subside with antibiotics.
I hope I have answered all your queries. If there are any more, I will be happy to answer them.
Take care.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Hello Doctor,
Thank you for your response.
Dr B - is XXXXXXX Oncology associates from XXXXXXX It is affiliated with HCG (HEALTH CARE GLOBAL) cancer center and histopathology report of HCG has come from its subsidiary Triesta Sciences. Triesta Sciences claims to be largest network of CAP and NABL accredited high end oncology diagnostic laboratory service provider in the country. www.triesta.com
Dr C - is Dr XXXXXXX XXXXXXX Borges from SRL diagnostic Ltd XXXXXXX Here is link to their COE for histopathology:(http://www.srlworld.com/article/8/21/coe-for-histopathology.html).
It seems that Dr XXXXXXX Borges also worked at Tata Memorial Hospital for sometime (http://iapp-pune.org/pdf/CV-Anita-Borges.pdf)
In view of given information, I request your considered opinion to go ahead with.
1) Whether we should get slides + block reviewed by Tata Memorial along with Immunohistochemistry (IHC) reports ? OR
2) should we rely on Dr B's or Dr C's report (Please refer information below)?
--4th February 2015 - Histopathology report from Dr - B's lab shows impression : well differentiated liposarcoma / a typical lipomatous tumor
--14th February 2015 - Review by Dr C says following -
Microscopy:
Gigantic Lipoma
The thick fibrous septae show histiocytes and lymphoplasmacytic infilterate.
Foci of fat necrosis and dystrophic calcification are noted
Impression
Right abdominal intraperitoneal SOL : Gigantic Lipoma
3) Also can you help us understand the meaning of Dr C's final review dated 14th February 2015 shared above.
Thank you very much
Thank you for your response.
Dr B - is XXXXXXX Oncology associates from XXXXXXX It is affiliated with HCG (HEALTH CARE GLOBAL) cancer center and histopathology report of HCG has come from its subsidiary Triesta Sciences. Triesta Sciences claims to be largest network of CAP and NABL accredited high end oncology diagnostic laboratory service provider in the country. www.triesta.com
Dr C - is Dr XXXXXXX XXXXXXX Borges from SRL diagnostic Ltd XXXXXXX Here is link to their COE for histopathology:(http://www.srlworld.com/article/8/21/coe-for-histopathology.html).
It seems that Dr XXXXXXX Borges also worked at Tata Memorial Hospital for sometime (http://iapp-pune.org/pdf/CV-Anita-Borges.pdf)
In view of given information, I request your considered opinion to go ahead with.
1) Whether we should get slides + block reviewed by Tata Memorial along with Immunohistochemistry (IHC) reports ? OR
2) should we rely on Dr B's or Dr C's report (Please refer information below)?
--4th February 2015 - Histopathology report from Dr - B's lab shows impression : well differentiated liposarcoma / a typical lipomatous tumor
--14th February 2015 - Review by Dr C says following -
Microscopy:
Gigantic Lipoma
The thick fibrous septae show histiocytes and lymphoplasmacytic infilterate.
Foci of fat necrosis and dystrophic calcification are noted
Impression
Right abdominal intraperitoneal SOL : Gigantic Lipoma
3) Also can you help us understand the meaning of Dr C's final review dated 14th February 2015 shared above.
Thank you very much
Brief Answer:
block review and IHC at Tata Memorial Hospital
Detailed Answer:
Hi.
Both these laboratories I would consider to be of equal reputation and level of standardization. However, in the oncology community, they are not considered to be the final word. Dr. XXXXXXX Borges did work previously at Tata Memorial, but it is not necessary that she goes through all the slides and blocks of all patients at her present lab.
Anyways, the only way to conclusively settle the confusion is to take the slides and blocks to Tata Memorial Hospital and also get immunohistochemistry done there. That will settle the diagnosis once and for all.
As to the report by Dr C's lab, all the terms that have been used, i.e. fibrous septa, histiocytes, lymphoplasmacytic infiltrate, fat necrosis, dystrophic calcification, are present in the normal human body and their presence does not signify malignancy or cancer. They are also seen in benign tumors like lipoma. Hence their final diagnosis of lipoma.
Hope that answers all your queries. If there are no more, please rate the answer and close the thread.
Take care.
block review and IHC at Tata Memorial Hospital
Detailed Answer:
Hi.
Both these laboratories I would consider to be of equal reputation and level of standardization. However, in the oncology community, they are not considered to be the final word. Dr. XXXXXXX Borges did work previously at Tata Memorial, but it is not necessary that she goes through all the slides and blocks of all patients at her present lab.
Anyways, the only way to conclusively settle the confusion is to take the slides and blocks to Tata Memorial Hospital and also get immunohistochemistry done there. That will settle the diagnosis once and for all.
As to the report by Dr C's lab, all the terms that have been used, i.e. fibrous septa, histiocytes, lymphoplasmacytic infiltrate, fat necrosis, dystrophic calcification, are present in the normal human body and their presence does not signify malignancy or cancer. They are also seen in benign tumors like lipoma. Hence their final diagnosis of lipoma.
Hope that answers all your queries. If there are no more, please rate the answer and close the thread.
Take care.
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
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