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A 71-year-old otherwise healthy woman presented with an enlarging, immobile, painless mass in her right gluteal area. She had no other associated symptoms. On examination, she had a large, palpable, nontender right gluteal mass. She had no neurovascular deficits. Results of laboratory studies were within normal limits. Computed tomography (CT) revealed an 11-cm heterogeneous lipomatous tumor involving the right gluteal musculature (Figure).
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B. Core needle biopsy of the lesion
Core needle biopsy should be performed to obtain tissue diagnosis. Incisional biopsy should be avoided and can complicate surgical and oncologic management.1 Surgical management should be deferred until a tissue diagnosis is made and preoperative workup is complete. Because this tumor is enlarging, larger than 5 cm, deep (subfascial), and heterogeneous, it should be considered malignant until proven otherwise. Repeat imaging is unnecessary and likely would be inadequate.
Liposarcomas are rare, often aggressive, malignancies that require surgical resection and multidisciplinary management. There are approximately 2400 new cases of liposarcoma diagnosed in the United States per year.2,3 Subtypes of liposarcoma include well-differentiated, dedifferentiated, myxoid, and pleomorphic. A well-differentiated liposarcoma of the extremity may also be referred to as an atypical lipomatous tumor.
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Corresponding Author: Fritz C. Eilber, MD, Division of Surgical Oncology, University of California, Los Angeles, 10833 Le Conte Ave, 54-140 CHS, Los Angeles, CA 90095 (firstname.lastname@example.org).
Published Online: April 5, 2019. doi:10.1001/jama.2019.3719
Conflict of Interest Disclosures: Dr Eilber reported serving as a member of the scientific advisory board of Certis Oncology. No other disclosures were reported.
Additional Contributions: We thank the patient for providing permission to share her information.
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