title: Skeletal metastases in myxoid liposarcoma: an unusual pattern of distant spread.
abstract: BACKGROUND
  Myxoid liposarcoma (MLS), the second most common subtype of liposarcoma, occurs predominantly in the extremities of young adults and has a disproportionately high tendency to metastasize to unusual soft tissue locations, before disseminated spread or pulmonary metastases. Anecdotal evidence, mainly supported by isolated case reports, suggests that a subset of these patients also develop bone metastasis, especially within the spine, which was previously under-appreciated.
  
  
  METHODS
  In this study we investigate the incidence of osseous metastases in a well annotated sarcoma database and correlate this endpoint with clinicopathologic and molecular findings.
  
  
  RESULTS
  From a total of 230 patients with MLS diagnosis confirmed histologically, who were managed and followed prospectively at MSKCC, 40 (17%) developed skeletal metastases, comprising 56% of all metastatic events. A significant number of these bone metastases were identified early in the disease course, before the manifestation of disease in sites where sarcomas usually metastasize, such as lung. From the time of 1st metastasis, the 5 years median survival was 16%. The majority (78%) of MLS patients developing bone metastases had a histologic high grade primary tumor. The median overall survival for the high grade tumors was 55 months, as compared to 105 months for low grade cases. Eleven (84%) of 13 cases tested by RT-PCR demonstrated a type II TLS-CHOP fusion transcript.
  
  
  CONCLUSIONS
  These findings suggest that MLS has a high incidence of osseous metastases, with predilection to spine, and often associated with the most common type of TLS-CHOP transcript. Screening should include images of the spine in high-risk MLS patients to exclude spinal metastases.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Schwab
authors.forename: Patrick
authors.initials: P
authors.lastname: Boland
authors.forename: Tianhua
authors.initials: T
authors.lastname: Guo
authors.forename: Murray F
authors.initials: MF
authors.lastname: Brennan
authors.forename: Samuel
authors.initials: S
authors.lastname: Singer
authors.forename: John H
authors.initials: JH
authors.lastname: Healey
authors.forename: Cristina R
authors.initials: CR
authors.lastname: Antonescu
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000235:genetics / Q000401:mortality / Q000556:secondary*; D005260:Female; D006801:Humans; D018208:Liposarcoma, Myxoid / Q000235:genetics / Q000401:mortality / Q000556:secondary*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D015514:Oncogene Proteins, Fusion / Q000235:genetics; D011446:Prospective Studies; D012333:RNA, Messenger / Q000235:genetics; D012334:RNA, Neoplasm / Q000235:genetics; D034702:RNA-Binding Protein FUS / Q000235:genetics; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013125:Spinal Neoplasms / Q000556:secondary; D015996:Survival Rate; D051742:Transcription Factor CHOP / Q000235:genetics
chemical_list: D015514:Oncogene Proteins, Fusion; D012333:RNA, Messenger; D012334:RNA, Neoplasm; D034702:RNA-Binding Protein FUS; C106030:TLS-CHOP fusion protein, human; D051742:Transcription Factor CHOP