Retroperitoneal sarcomas

Outcome of multidisciplinary treatment of peripheral primitive neuroectodermal tumor

Peripheral primitive neuroectodermal tumors (PNETs) constitute very rare and aggressive malignancies. To date, there are no standard guidelines for management of peripheral PNETs due to the paucity of cases arising in various body sites. Therapeutic approach is derived from Ewing sarcoma family, which currently remains multimodal. Our study retrospectively analyzed 86 PNET patients from February 1, 1998 to February 1, 2018 at Peking Union Medical College Hospital with an additional 75 patients from review of literature. The clinicopathologic and treatment plans associated with survival was investigated. Surgery, chemotherapy, female sex, small tumor size, no lymph node metastasis, R0 surgical resection, (vincristine + doxorubicin + cyclophosphamide)/(isophosphamide + etoposide) regimen, and more than 10 cycles of chemotherapy were associated with improved overall survival in univariate analysis. Surgery, more than 10 cycles of chemotherapy, and small tumor size were independent prognostic factors for higher overall survival. Our data indicates that multimodal therapy is the mainstay therapeutic approach for peripheral PNET.

Management of primary retroperitoneal synovial sarcoma: A case report and review of literature

BACKGROUND

Synovial sarcoma (SS) is a rare type of soft tissue sarcoma that is usually developed from areas where synovial tissue exists, especially at the extremities. Nevertheless, several cases of retroperitoneal SS (RSS) have been described. We herein report a case of RSS presented in our institution.

CASE SUMMARY

A 69-year-old female patient was admitted with a large, palpable, firm mass in the right abdominal space SS. Computerized tomography scan depicted a concentric, sharply marinated retro-peritoneal lesion which was displacing the right kidney and the lower edge of the liver. Subsequently, the patient underwent surgical excision of the mass with additional right nephrectomy and resection of the right adrenal gland and a part of the diaphragm. The final histological diagnosis of the tumour was grade II monophasic RSS.

CONCLUSION

RSS is encountered in the biphasic type, the monophasic fibrous, and the monophasic epithelial category as well. Relevant clinical manifestations are not always documented at early stages. Therefore, the final diagnosis is posed after complete histological examination taking into consideration the results of immunochemistry and genetic analysis. Therapeutic approach happens often late when metastases at the lungs and the liver are apparent. Thus, 5-year survival rates remain low.

A retrospective study comparing contrast-enhanced computed tomography with 18F-FDG-PET/CT in the early follow-up of patients with retroperitoneal sarcomas

OBJECTIVE

To compare 18-fluorine-labeled 2-deoxy-2-fluoro-D-glucose PET/computed tomography ((18)F-FDG-PET/CT) with contrast enhancement computed tomography (CECT) in the early follow-up of patients who had undergone treatment for primitive retroperitoneal sarcomas (RS).

METHODS

This is a retrospective study on 24 patients who underwent (18)F-FDG-PET/CT and CECT within 2 years after therapy for RS. (18)F-FDG-PET/CT and CECT results were compared with results of histological examination and clinical-instrumental follow-up. We calculated the sensitivity and specificity of CECT and (18)F-FDG-PET/CT for retroperitoneal recurrences and compared them with results of the McNemar test. Negative predictive values (NPVs) and positive predictive values (PPVs) were calculated and the positive percentage agreement and negative percentage agreement were evaluated.

RESULTS

The sensitivity and specificity of (18)F-FDG-PET/CT were 66.7 and 100% and those for CECT were 58.3 and 50%, respectively. For (18)F-FDG-PET/CT, PPV was 100% [95% confidence interval (CI): 67-100%] and NPV was 75% (95% CI: 58-75%); for CECT, PPV was 54% (95% CI: 33-73%) and NPV was 55% (95% CI: 30-78%). Positive percentage agreement and negative percentage agreement were, respectively, 38 and 72% for retroperitoneal lesions, 42.8 and 100% for liposarcomas, 40 and 50% for leiomyosarcomas, 14.2 and 94% for abdominal lymph nodes, and 16.6 and 100% for lung metastasis. Neither technique gave reliable results for liver metastasis.

CONCLUSION

Our data show that (18)F-FDG-PET/CT has a higher overall specificity compared with CECT in identifying areas of recurrence, demonstrating its validity for early whole-body detection of lesions. In our hands (18)F-FDG-PET/CT seems to be a good tool in the early follow-up of patients experiencing recurrence of RS.

The value of surgery for retroperitoneal sarcoma

Introduction. Retroperitoneal sarcomas are uncommon large malignant tumors. Methods. Forty-one consecutive patients with localized retroperitoneal sarcoma were retrospectively studied. Results. Median age was 58 years (range 20–91 years). Median tumor size was 17.5 cm (range 4–41 cm). Only 2 tumors were <5 cm. Most were liposarcoma (44%) and high-grade (59%). 59% were stage 3 and the rest was stage 1. Median followup was 10 months (range 1–106 months). Thirty-eight patients had an initial complete resection; 15 (37%) developed recurrent sarcoma and 12 (80%) had a second complete resection. Patients with an initial complete resection had a 5-year survival of 46%. For all patients, tumor grade affected overall survival (P = .006). Complete surgical resection improved overall survival for high-grade tumors (P = .03). Conclusions. Tumor grade/stage and complete surgical resection for high-grade tumors are important prognostic variables. Radiation therapy or chemotherapy had no significant impact on overall or recurrence-free survival. Complete surgical resection is the treatment of choice for patients with initial and locally recurrent retroperitoneal sarcoma.

Radiological imaging features of non-uterine leiomyosarcoma

Leiomyosarcomas are unusual soft-tissue tumours that occur in the retroperitoneum, peripheral soft tissues, gastrointestinal and genito-urinary tracts, vessels and (rarely) in bone. The aim of this pictonal review is to delineate the more specific radiological features that would suggest a radiological diagnosis of leiomyosarcoma prior to biopsy.

Histiocitoma fibroso maligno retroperitoneal con infiltración de órganos vecinos

Retroperitoneal tumours are extremely rare neoplasms, most of them malignant. We described the case of a 48-year-old man with a large retroperitoneal mass detected during the study of a constitutional syndrome. The mass was treated surgerically and pathological diagnosis was malignant fibrous histiocytoma. Literature is reviewed and clinical features, histological findings, radiological techniques and therapeutic management are analyzed.

Use of Tissue Expanders and Pre-operative External Beam Radiotherapy in the Treatment of Retroperitoneal Sarcoma

INTRODUCTION

We report our experience of treating retroperitoneal sarcoma (RPS) using pre-operative external beam radiotherapy (EBRT) in combination with radical resectional surgery from 1990 to 2005.

METHODS

Twenty-eight primary and 10 recurrent tumors were identified from a prospective database.

RESULTS

The resection rate was 71% overall; 82% in primary (23/28) and 40% (4/10) in recurrent cases. EBRT was administered preoperatively in 25 patients, postoperatively in 1, and palliatively in 11. In 33 patients a saline-filled tissue expander was inserted into the abdomen before radiotherapy to displace small bowel from the radiation field. 4,500-5,000 cGy was administered in fractions of 180-200 cGy over a 5-week period; surgery followed 6-8 weeks later. Expander insertion was associated with minimal morbidity; 31/37 patients received a dose of 4,000 cGy or more (median 4,650 cGy). Median resected tumor diameter was 13 cm, and a median of three adjacent organs was resected per patient. Complete macroscopic resection was achieved in 25/27 patients (93%); R0 in 9 (33%) and R1 in 13 (48%) (microscopic margins unclear in 5). There was no postoperative mortality. Tumors were high-grade in 20 patients, low-grade in 14 and ungraded in 4. Actuarial 5- and 10-year survival for all patients was 74 and 60%. For operable primary tumors, the 5-year survival and disease-free rates were 90 and 80%. In four patients with operable recurrent tumors, median disease-free interval was 91 months (27-160). In the 11 inoperable cases, median survival after radiotherapy was 48 months (9-77).

CONCLUSIONS

We conclude that a combination of pre-operative tissue expander placement, high-dose EBRT and radical resectional surgery can achieve acceptable morbidity, extended survival and low long-term recurrence in patients with RPS.

STATISTICS

Median (interquartile range).

A Case of Resected Huge Ileocolonic Mesenteric Liposarcoma which Responded to Pre-operative Chemotherapy using Doxorubicin, Cisplatin and Ifosfamide

Primary mesenteric liposarcoma is a rare entity that has been reported only 14 times in English literature. The treatment strategy for mesenteric liposarcoma is, if no distant metastases are detected, surgical resection with a wide surgical margin, often followed by radiation and/or adjuvant chemotherapy for high-risk patients. However, the efficacy of pre-operative chemotherapy is unknown. If the tumor is shrunk by pre-operative chemotherapy, we could achieve complete surgical resection, which is difficult when the tumor is too large or is invading neighboring organs. We herein describe a case of huge mesenteric liposarcoma that showed significant tumor shrinkage by pre-operative chemotherapy using doxorubicin, cisplatin and ifosfamide, allowing a margin-negative operation.

A case of a large retroperitoneal liposarcoma presenting as an incarcerated inguinal hernia

We report a rare case of retroperitoneal liposarcoma developing within an incarcerated inguinal hernia. A 53-year-old man presented to our hospital with left inguinal mass. Preoperative computed tomography revealed an intraabdominal huge mass, and a clinical diagnosis of liposarcoma. Physical findings except for the inguinal mass and laboratory examination, including tumor markers (CEA, CA19-9), were within normal range. Intraoperatively, the mass was incarcerated in the inguinal canal and involved the left testis. We performed a radical tumor resection, including a left orchiectomy. The resected specimen measured 45 x 30 cm and weighed 7,510 g. Histopathologically, the tumor was diagnosed as a well-differentiated liposarcoma, and originated from retroperitoneum. We did not undergo adjuvant therapy in consideration of histopathological subtype and curable surgical treatment. The patient is well and shows no evidence of recurrence four months after the operation.

Primary and recurrent retroperitoneal soft tissue sarcoma: prognostic factors affecting survival

BACKGROUND AND OBJECTIVES

To analyze treatment and survival in 34 patients (28 resected) with primary or recurrent retroperitoneal sarcoma (RPS).

METHODS

Between July 1994 and January 2001, 34 patients (15M, 19F; mean age: 56 years, range: 25-77) were evaluated. Complete resection was defined as removal of gross tumor with histologically confirmed clear resection margins.

RESULTS

Twenty-eight out of 34 patients (82%) (15 were affected by primary RPS, and 13 by recurrent RPS), underwent surgical exploration. Twenty-three patients had a grossly and microscopically complete resection, (3 having a grossly incomplete resection and 2 patients with a grossly complete resection having histologically involved resection margins). Twenty-one out of 28 patients (75%) underwent removal of contiguous intra-abdominal organs. Preoperative mortality was nil, and morbidity occurred in six cases only (21%). High tumor grade results a significant variable for a worse survival in all 28 patients (100% 5 years survival for low grade vs. 0% for high grade; P = 0.0004). Amongst completely resected patients, only histologic grade and peroperative blood transfusions affected disease-free survival (P = 0.04 and P = 0.05, respectively).

CONCLUSIONS

An aggressive surgical approach in both primary and recurrent RPS is associated with long-term survival.

Chirurgie des sarcomes rétropéritonéaux

Retroperitoneal sarcomas comprise approximately 15% of all soft tissue sarcomas and 50% of all retroperitoneal tumours. Helical CT of the abdomen and pelvis, with selective use of MRI will establish the extent of the tumour, its retroperitoneal location, the degree of necrosis, and the evidence of metastasis. A CT guided core needle biopsy is the optimal pre operative tissue sampling. A complete surgical resection is the mainstay of the treatment with a rim of normal tissue that often requires removal of adjacent organs. The 5-year probability of local control is approximately 50%. The role of adjuvant therapy is evolving and at present should not be used outside the investigational setting.

Retroperitoneal sarcomas

Retroperitoneal sarcomas are rare neoplasms. CT or MR imaging is performed in patients with these tumors to detect local extent and distant metastases of the tumor and for preoperative surgical planning. Most sarcomas cannot be characterized as to cell type with CT or MR, with the exceptions being liposarcomas and intracaval leiomyosarcomas. Similarly histological grading cannot be made definitively with imaging alone, the exception being liposarcoma since well differentiated liposarcomas contain more macroscopic fat than do less differentiated liposarcomas. After surgery, follow up imaging with CT or MR and careful scrutiny of the tumor bed and resection site are essential to detect early recurrences, which can often be managed with re-resection.

Intussusception Secondary to Metastasis from a Low-Grade Retroperitoneal Liposarcoma

Liposarcomas are the most prevalent soft tissue sarcomas in adults. Low-grade liposarcomas are the most frequent and least aggressive and are noted as having a low risk of metastasis. We present a case of low-grade myxoid liposarcoma that metastasized to the small bowel resulting in intussusception. This case involves a 44-year-old woman with a recurrent retroperitoneal liposarcoma. Approximately 30 months after initial diagnosis, the patient was found to have a solitary metastasis to the small bowel that presented as a jejunal intussusception. Interestingly, there was no indication of a round cell component in either the metastasis or recurrent tumor, although the original tumor did contain a small round cell component. This is the first report in the English literature of liposarcoma metastasizing to the small bowel. We suggest that atypical presentations of liposarcoma metastases should always be considered in the management of patients with a history of liposarcoma.

[Calcified retroperitoneal liposarcoma]

Case report of a retroperitoneal liposarcoma pleomorfico with calcification in diagnosed in our hospital. We comment on its clinical characteristics, diagnostic methods and treatment. We likewise comment the possible differential diagnoses.