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Differential diagnosis of atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL):
Localized Massive Lymphedema: Massive lymphedema localized to an extremity may resemble ALT/WDL clinically as well as histologically. The patients are often morbidly obese. Sections through the lesions show acanthosis of the overlying skin, dermal fibrosis, ectatic lymph channels, large lobules of mature fat with edema, and prominent connective tissue septa with vascular proliferation. These septa may be mistaken for the fibrous bands seen in sclerosing liposarcomas.
Localized Massive Lymphedema: Massive lymphedema localized to an extremity may resemble ALT/WDL clinically as well as histologically. The patients are often morbidly obese. Sections through the lesions show acanthosis of the overlying skin, dermal fibrosis, ectatic lymph channels, large lobules of mature fat with edema, and prominent connective tissue septa with vascular proliferation. These septa may be mistaken for the fibrous bands seen in sclerosing liposarcomas.