A case of recurrent mesocolon myxoid liposarcoma and review of the literature

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.

Recurrent giant retroperitoneal liposarcoma: Review of literature and a rare case report

Introduction and importance

Retroperitoneal liposarcomas (RPLS) are usually grow large with frequent recurrences. Complete surgical excision remains the gold standard treatment for primary and even recurrent tumours. Their prognosis depends on their histological type and grade. We report a recurrent giant de-differentiated RPLS weighing 18.55 kg which was completely excised. To the best of our knowledge, this is one of the largest liposarcoma reported in the literature.

Case presentation

A 40 year old female presented with a gradually progressing large abdominal lump for 1year. She had had a similar large lump twice in the past and undergone excision of the tumour elsewhere. Firm non-tender mass felt all over abdomen with edema noted over abdominal wall and bilateral lower limbs. PET CT showed large heterogeneously enhancing mass occupying almost the entire abdominopelvic cavity. 50 × 40 × 40cm tumour was completely excised and biopsy showed grade 2 dedifferentiated liposarcoma (DDLS). She is under close follow up with no recurrence at 12months.

Clinical discussion

DDLS have lower risk of distant metastases but have a high risk of local recurrence. The most important favourable prognostic factor in these tumours is complete resection with negative margins. Because of the ineffectiveness of current chemotherapy and the requirement of intolerably high radiation doses, surgical excision remains the most effective treatment even for the localized recurrences of RPLS.

Conclusion

The dedifferentiated subtype should be suspected in locally aggressive RPLS. Close follow up with early detection of recurrences and prompt excision with negative margins lowers the risk of recurrences and improves survival.

Recurrent abdominal liposarcoma presenting with intestinal obstruction

Liposarcoma is the most common retroperitoneal sarcoma and mesenchymal tumor in the abdomen. Usually, it presents with vague symptoms due to its large size and slow growth at the time of diagnosis. Liposarcoma is associated with a high local recurrence rate according to its histology, size and growth rate. Up till now, surgical resection is the only effective treatment for primary and recurrent abdominal liposarcoma. Secondary mesenteric liposarcoma is an extremely rare entity and so far a small number of cases have been reported in the literature. In this article, we present a rare case of a 63-year-old female patient who was diagnosed with mesenteric liposarcoma after 3 years of complete excision of retroperitoneal liposarcoma, presenting primarily as abdominal mass causing mechanical intestinal obstruction.

Two-stage surgery for intraperitoneal and retroperitoneal multicentric liposarcoma causing hydronephrosis: a case report

Background

Liposarcoma is a soft tissue sarcoma of adipocyte origin. Liposarcoma represents 20–30% of adult soft tissue tumors, which was most frequently seen in the retroperitoneal space in 45% and abdominal space in only 5% of cases, but the multicentric case is unknown. Herein, we describe a rare case of multicentric, large, intra-abdominal and retroperitoneal liposarcoma, one of which had caused infection and pressing the right ureter causing hydronephrosis, which was resected by two-stage surgery.

Case presentation

The patient was a 46-year-old man who was referred for abdominal bloating and fatigue. Enhanced computed tomography showed a 23-cm intra-abdominal tumor and a 14.6-cm left retroperitoneal tumor. The intra-abdominal tumor which compressed the right ureter caused right unilateral hydronephrosis and deteriorated the renal function. The intra-abdominal tumor had also formed an intra-abdominal abscess. We performed emergent laparotomy and resected the intra-abdominal tumor. After the recovery of renal function, we resected the residual retroperitoneal tumor. Histopathological examination showed both tumors to be myxoid/round cell type liposarcoma. Considering clinical findings and their location, he was diagnosed with multicentric liposarcoma. He underwent adjuvant chemotherapy and has been alive without any recurrence for 9 months after the operation.

Conclusions

We successfully resected large intra-abdominal and retroperitoneal multicentric myxoid/round cell liposarcomas. A two-stage surgery was a rational choice as it provides time to confirm the recovery of renal function.

Solitary pancreatic metastasis of extremity myxoid liposarcoma: a case report and literature review

BACKGROUND

Myxoid liposarcoma has a distinct migration aptitude; however, pancreatic metastasis is rare.

CASE PRESENTATION

We report on the case of a 40-year-old female patient who suffered solitary pancreatic metastasis of myxoid liposarcoma and had a right thigh myxoid liposarcoma radical resection 5 years ago. The patient underwent a medial pancreatectomy and pancreaticojejunostomy for solitary pancreatic metastasis of myxoid liposarcoma. After 12 months of disease-free survival, the patient underwent an extended radical resection for the recurrence of the right thigh primary myxoid liposarcoma and received postoperative radiotherapy. Currently, the disease-free survival time after the last operation has been 22 months.

CONCLUSIONS

We reviewed the relevant literature and suggest that radical surgery might result in a good prognosis for patients with solitary pancreatic metastasis of myxoid liposarcoma.

A case report: Giant intra-abdominal liposarcoma presenting acute renal failure

INTRODUCTION

Liposarcomas represent 20-30% of adult soft tissue tumors and its abdominal localization occurs only in 5% of cases. Most are asymptomatic, but few present with abdominal mass and pain, fatigue, nausea, vomiting. They infiltrate adjacent organs and cause intestinal obstruction, intestinal ischemia-perforation, hydronephrosis, ureteric fistula and even aortic rupture. Here we aimed to report a rare case of a giant liposarcoma which originated from mesentery.

PRESENTATION OF CASE

A 45-year-old male presented with slightly abdomen distention, urinary retention, oliguria since fifteen days. There was no concomitant nausea, vomiting and lower extremity edema. We found renal function tests abnormal. Contrast-enhanced computed tomography (CT) demonstrated a 20 × 18 cm, well-circumscribed, lobulated, heterogeneous mass. Both ureters were compressed by the mass. The entire mass was totally excised. After the operation, the patient's renal function returned to normal levels dramatically. The tumor was diagnosed as dedifferentiated liposarcoma.

DISCUSSION

In cases of intra-abdominal mass is detected, surely abdominal compartment syndrome (ACS) should be considered. If vital signs, pulmonary function tests (PFT) and value of the CVP are abnormal, intra-abdominal pressure should be measured. Our findings mentioned above were not observed.

CONCLUSION

A detailed history should be obtained other abdominal solid organs should also be considered while performing a careful physical examination, the amount of urinary output in particular should be questioned and this sytemic questioning should be supported by specific laboratory tests.

Mesenteric metastases of purely myxoid liposarcoma: An unusual behavior of primary tumor depicted on fludeoxyglucose positron emission tomography/computerized tomography

A 48-year-old male patient with purely myxoid liposarcoma was referred to fludeoxyglucose positron emission tomography/computerized tomography (FDG PET/CT) for restaging. FDG PET/CT images showed a hypodense well-defined intermuscular mass with mild FDG uptake in the right gluteal region. In addition, multiple mild hypermetabolic masses that had similar characteristics with the aforementioned lesion were also revealed in the mesenteric region of abdomen and pelvis.