Surgery of intraabdominal giant dedifferentiated liposarcoma of ascending colon mesentery: A rare case report

Silent Giant: A Case of Dedifferentiated Retroperitoneal Liposarcoma Presenting as an Incidental Mesenteric Mass

Dedifferentiated liposarcoma (DDL) is a rare and aggressive subtype of liposarcoma, arising most commonly in the retroperitoneum but rarely presenting in the mesentery. Due to its rarity, mesenteric DDL poses significant diagnostic and therapeutic challenges, with few cases documented in the literature. Here, we report the case of a 76-year-old female admitted with acute respiratory failure secondary to pneumonia, during which an incidental finding of a large mesenteric mass was noted on computed tomography (CT) imaging. An elective exploratory laparotomy was performed one month later, revealing a large mesenteric tumor adherent to the terminal ileum, cecum, and ascending colon. En bloc resection, including right hemicolectomy and partial small bowel resection, was successfully performed. Pathology confirmed an intermediate-grade DDL. This case underscores the importance of considering mesenteric DDL in the differential diagnosis of large, asymptomatic intra-abdominal masses. Complete surgical resection remains the mainstay of treatment, with a critical focus on achieving negative margins to reduce recurrence risk. Given the aggressive nature of DDL, vigilant long-term follow-up is essential. This report contributes to the limited body of literature on mesenteric DDL and highlights the challenges in its diagnosis and management.

Intraperitoneal Liposarcoma: A Case Report and Literature Review of a Rare Entity

Liposarcoma is a rare soft-tissue neoplasm originating from adipocytes. The exact cause of liposarcoma is unknown and symptoms vary depending on the tumor's location. A 49-year-old man presented to the emergency room complaining of epigastric pain radiating to the back and right upper quadrant. Cross-sectional imaging revealed a large upper abdominal mass that was thought to be a gastrointestinal stromal tumor (GIST) arising from the duodenum at first. The patient underwent en-bloc resection of the mass and was planned for adjuvant chemotherapy. Subsequently, multiple tissue samples were examined, leading to the final diagnosis of de-differentiated liposarcoma. The patient eventually developed multiple recurrences and was subjected to re-resection surgeries and three different chemotherapy regimens. Given the rarity of the disease, no standardized therapy plan is available, highlighting the need for more case reports/series and trials to broaden our understanding of this disease.

A giant liposarcoma originating from peripancreatic fat tissue with identification using 3D-CT angiography: a case report

BACKGROUND

Liposarcoma originating from peripancreatic fat tissue is extremely rare. This case report presents a surgical case of a giant liposarcoma originating from peripancreatic fat tissue with origin identification using 3-Dimensional Computed Tomography Angiography (3D-CTA).

CASE PRESENTATION

A 59-year-old female was referred to our hospital with a giant abdominal tumor. Computed tomography revealed a 34 cm tumor composed of fatty tissue, exerting pressure on the posterior aspect of the pancreas. Suspecting liposarcoma, we planned for surgery. At first, the tumor appeared to be intra-abdominal tumor, based on the identification of the tumor's feeding artery as a branch of the dorsal pancreatic artery using 3D-CTA, we concluded that the liposarcoma originated from the peripancreatic fat tissue and situated in the retroperitoneum. During surgery, we observed a well-capsulated, elastic, yellowish mass without infiltration into surrounding tissues. We carefully dissected the tumor from the greater omentum and transverse mesocolon while preserving the tumor capsule. We ligated the feeding artery at the border with the pancreatic parenchyma and successfully completed the excision of the tumor. The resected specimen weighted 2620 g and was pathologically diagnosed as a well-differentiated liposarcoma. There was no injury to the tumor's capsule, and the surgical margins were negative.

CONCLUSIONS

In this report, we present an extremely rare case of a liposarcoma originating in the peripancreatic fat tissue. The use of 3D-CTA was instrumental in identifying the primary site of this giant tumor, enabling us to guide the surgery and achieve complete resection successfully.