Abstract A91: Liposarcomas in an indigenous black African population: A clinicopathologic study with emphasis on predictors of outcome and survival

Background: Liposarcomas are very rare in our environment. Detailed studies on the subject in homogenous indigenous black Africans are rare in literature. The objective of the study was to retrospectively analyze and correlate histopathologic and clinical features and also identify confounding factors as related to prognosis in the setting of a developing nation with very limited resources.

Materials and Methods: All cases of liposarcoma diagnosed in the Department of Pathology, University College Hospital Ibadan, Nigeria between January 1989 and December 2007 were included in the study. Details of histopathologic subtypes, clinical parameters like age at presentation, gender, size and site of tumor and stage at presentation and on follow up , imaging methods used in investigation, therapeutic modalities used in management and factors affecting prognosis and outcome were analyzed.

Results: A total of 42 cases were identified and is presented. Patient age at presentation ranged from 16 to 70 years (median, 42 years) and there was a slight male predilection (male/female ratio 1.1:1). The various subtypes were well differentiated (36% of cases), myxoid (36%), round cell (12%) and pleomorphic (16%). Tumor site distribution was lower limb (30% of cases), retroperitoneum (22%), upper limb and trunk (15% each), inguino-scrotal area (11%) and head and neck (7%). Tumor size ranged from 2 to 24 cm (median, 7cm). Sixty-seven percent presented with pT2 (TNM) stage tumor. Only about 20% of our patients could afford a computer axial Tomography (CT) scan or magnetic resonance imaging (MRI) as investigation because the total health care is paid for from direct personal pocket and the rest had their surgeries without these modalities of investigation. The cost implications also significantly delayed surgery and radiotherapy. Majority of our patient (80%) were lost to follow up after less than 6 months. Two patients with myxoid subtype died due to metastatic disease of the tumor.

Conclusion: Myxoid/round cell subtype account for 48% of liposarcomas in this study. The lower limb and retroperitoneum account for a little over 50% of location of tumor. Follow up data of greater than 18 months was available in only 8 patients (approx 20%) as most patients are lost to follow up after on or two clinic visits. The cost implication of care which is directly footed by the patient is thought to significantly influence follow up data which is poor and outcome.