Background/Objectives: The most common soft tissue sarcomas in adults are liposarcomas, a heterogeneous group of malignant tumors. A structured literature search was conducted to better understand the clinical-imaging aspects and molecular behavior underlying the therapeutic approach. Methods: A scoping review was performed according to the PRISMA-ScR guidelines. Searches were conducted in MEDLINE, Web of Science Core Collection, and Google Scholar for the period of 1 January 2016–27 March 2026. Studies that addressed liposarcomas and their subtypes were included. Data were extracted descriptively and synthesized narratively. Results: We identified 113 studies that met the inclusion and exclusion criteria. Most studies have focused on a subtype of liposarcomas or on aspects such as clinical, imaging, histopathological, molecular, therapeutic, or prognostic features. The collected data identify, in each case, the need to develop new techniques useful for their identification and deeper molecular analysis. These needs arise from the need to improve treatment and to provide better prognosis, especially in rare or high-grade subtypes. Conclusions: The heterogeneity of these tumors requires the provision of a diagnosis that takes into account all possible instruments: clinical, imaging, and histo-molecular. Therefore, further research and translational medicine are needed to discover new pathogenic mechanisms in order to develop individualized therapies that increase quality of life.

Background/Objectives: Astrocytoma IDH-mutant CNS WHO grade 4 is a malignant tumor of the central nervous system characterized by tumor necrosis, microvascular proliferation, and/or homozygous CDKN2A/B deletion. This study aims to investigate the prognostic role of the consequences of hypoxic events leading to necrosis and microvascular density, observing their associations with clinical-imaging parameters and morphogenetics. Methods: We performed a retrospective analysis over a 10-year period. Clinical and imaging data were collected from observation sheets and electronic databases. Six immunohistochemical markers and FISH testing were used to evaluate the prognosis and neoformation of blood vessels. Based on the whole slide image, the necrotic percentage was assessed, and the microvascular density was quantified. All data were statistically analyzed. Results: We identified 44 cases, with a mean age of 57.86 years. From a clinical perspective, advanced age, arterial hypertension, diabetes mellitus, and acute onset of clinical manifestations represent negative prognostic factors. In imaging, the increased rate of resectability is a protective factor, while the presence of residual volume and an increased residual volume have a negative impact on survival. The consequences of hypoxic events (tumor necrosis and microvascular density) are negative risk factors for survival. Added to these are p53 overexpression, loss of PTEN, deletion, and amplification of the CDKN2A gene. Conclusions: We observed that necrosis and increased microvascular density resulting from microvascular proliferation are both defining features of the tumor and impact patient prognosis and survival. In addition, they induce or are associated with other essential changes (p53, PTEN, CDKN2A) that promote tumor aggressiveness.