Mid-term outcomes in the treatment of retroperitoneal sarcomas: a 12-year single-institution experience

Giant Mesenteric Cavernous Lymphangioma in an Adult as a Cause of Chronic Intestinal Subocclusion: A Case Report

Giant mesenteric cavernous lymphangioma is a rare lymphatic malformation in adults and an uncommon cause of chronic bowel obstruction. Although these lesions are typical of the paediatric population, their occurrence in adults poses significant diagnostic challenges due to their clinical and radiological similarity to malignant neoplasms such as liposarcoma, lymphoma and gastrointestinal stromal tumours. This report describes the case of a 58-year-old man with chronic bowel obstruction in whom the initial diagnosis suggested malignancy. After surgical resection, histopathological examination confirmed the benign nature of the lesion and identified it as a mesenteric cavernous lymphangioma. The present case contributes to the understanding of this entity in adults and emphasises its importance in the differential diagnosis of chronic intestinal obstruction. It also highlights the need to integrate clinical, radiological and anatomopathological evaluation to establish an accurate diagnosis and guide appropriate therapeutic decisions, with direct implications for the management of complex abdominal pathologies.

Chondrosarcoma From Floating and Nonfloating Ribs Presenting as a Floating Abdominal Tumor: A Case Report on a Rare Medical Condition

Chondrosarcoma is a soft tissue tumor that develops in cartilage cells. It can exhibit an aggressive growth tendency when compared to the chondrosarcomas developing in other regions of the body. Clinical presentation of these tumors can also vary depending on the site of presentation. We aim to present the case of a 69-year-old male with a swelling in the chest extending into the abdomen. It is a rare condition that is treated surgically by wide local excision of the tumor.

A clinical tool to predict overall survival of elderly patients with soft tissue sarcoma after surgical resection

With the aging world population, the incidence of soft tissue sarcoma (STS) in the elderly gradually increases and the prognosis is poor. The primary goal of this research was to analyze the relevant risk factors affecting the postoperative overall survival in elderly STS patients and to provide some guidance and assistance in clinical treatment. The study included 2,353 elderly STS patients from the Surveillance, Epidemiology, and End Results database. To find independent predictive variables, we employed the Cox proportional risk regression model. R software was used to develop and validate the nomogram model to predict postoperative overall survival. The performance and practical value of the nomogram were evaluated using calibration curves, the area under the curve, and decision curve analysis. Age, tumor primary site, disease stage, tumor size, tumor grade, N stage, and marital status, are the risk variables of postoperative overall survival, and the prognostic model was constructed on this basis. In the two sets, both calibration curves and receiver operating characteristic curves showed that the nomogram had high predictive accuracy and discriminative power, while decision curve analysis demonstrated that the model had good clinical usefulness. A predictive nomogram was designed and tested to evaluate postoperative overall survival in elderly STS patients. The nomogram allows clinical practitioners to more accurately evaluate the prognosis of individual patients, facilitates the progress of individualized treatment, and provides clinical guidance.

Synovial Sarcoma in the Right Thigh of a 25-Year-Old Male: A Case Report

In this article, we describe the diagnosis and surgical treatment of synovial sarcoma within the right thigh of a 25-year-old male. Our article aims to demonstrate successful treatment through wide local excision and rotation flap reconstruction, emphasizing the noteworthiness of comprehensive surgical planning and postoperative care. Postoperative care guaranteed satisfactory healing and appendage functionality, with a follow-up plan to monitor for recurrence. This case underscores the need for individualized treatment approaches and highlights the significance of multidisciplinary care for overseeing aggressive tumors like synovial sarcoma. The findings contribute to the ongoing refinement of surgical procedures and postoperative protocols to improve patient results.

Surgical resection due to poor outcome of the immunotherapy of a relapsed mediastinal liposarcoma: a case report

The feasibility of surgery after immunotherapy for mediastinal liposarcoma remains uncertain. Besides, the case of immunotherapy for liposarcoma is still lacking. We report a case of recurrence after resection of a left mediastinal liposarcoma. After recurrence, one course of pembrolizumab plus anlotinib hydrochloride showed no tumor shrinkage, and genetic testing showed CDK4 amplification and PD-L1 TPS <1%; therefore, the plan was changed to one course of pembrolizumab plus palbociclib, but the tumor still did not shrink. Thus, second tumor resection was performed. In addition, the postoperative pathology was still well-differentiated liposarcoma. The significance of immunotherapy in liposarcoma still needs to be further explored. In the absence of surgical contraindications, secondary surgery might be feasible.

Inguinoscrotal Hernia: An Unusual Presentation of Retroperitoneal Liposarcoma

Liposarcoma presenting within an inguinal hernia is rare. It may manifest as either primary spermatic cord liposarcoma or as an extension of retroperitoneal liposarcoma into the inguinoscrotal region. Tumors originating in the retroperitoneum can extend toward the inguinal region through the gonadal vein pathway. Utilizing imaging modalities is crucial for differentiating between a retroperitoneal component and a fat-containing inguinal mass. Identification of non-lipomatous components within a fat-containing tumor provides diagnostic clues on radiological imaging.

Case Report: Successful R0 resection in locally advanced retroperitoneal sarcomas

We present a case series of three successfully resected tumors in our center at Al-Makassed Hospital in Jerusalem, Palestine, all of which primarily involved or invaded adjacent structures and needed a multidisciplinary approach to achieve R0 resection. Our first patient is a 42-year-old previously healthy female with intermittent attacks of dull aching abdominal pain. Her tumor was a leiomyosarcoma that involved major vessels and other adjacent vital structures. Ultimately, she needed major highly advanced surgery necessitating the need for vascular reconstruction of the IVC, as well as R0 resection. The surgery was performed by a multidisciplinary team of highly specialized surgeons in related fields. Our second case is a 75-year-old female patient with a well-differentiated liposarcoma invading the upper pole of the right kidney, necessitating a nephrectomy. Consequently, this case demanded the interdisciplinary involvement of nephrology. Our third patient is a 59-year-old male with dedifferentiated liposarcoma that involved the spleen, pancreas, and splenic flexure while engulfing the left kidney and ureter. Beyond the removal of the tumor, multiorgan resection was imperative to achieve microscopic margin-free resection. This extensive local spread needed broad collaboration from the medical team and other surgical subspecialties. All surgeries went well, and their outcomes were promising. All patients had an uneventful follow-up and, to date, no recurrence. Invasive retroperitoneal sarcomas of different histological types and clinical stages represent a technical challenge. Careful preoperative investigation and an experienced, dedicated multidisciplinary team of surgeons and non-surgeons from related fields, including vascular, urologic, and hepatobiliary surgeons, are usually needed for a safe and successful R0 resection despite extensive tumor involvement in light of difficulty achieving early diagnosis.

A Systematic Review and Meta-Analysis of Surgery for Retroperitoneal Sarcoma With Vascular Resection

This meta-analysis examines the outcomes of patients undergoing surgery with vascular resection for retroperitoneal sarcoma. A systematic literature search based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted, identifying five comparative retrospective cohort studies published from 2015 to 2021, with a total of 1,417 patients (180 in the vascular resection (VR) group and 1,237 in the control (no VR) group). The meta-analysis found that 30-day morbidity rates, as classified by Clavien-Dindo classification > 3, were higher in the VR group compared to the no VR group (46% versus 25%, odds ratio (OR): 1.84, 95% confidence interval (CI): 0.39-8.69, p=0.44). Local recurrence rates during the follow-up period were similar between the two groups (30% versus 30%, OR: 1.46, 95% CI: 0.50-4.25, p=0.49). However, distant recurrence was more frequent in the VR group (32% versus 8.5%, OR: 2.54, 95% CI: 1.05-6.13, p=0.04). In conclusion, although oncovascular procedures are feasible for patients with retroperitoneal sarcomas, the long-term outcomes appear to be worse when compared to procedures that do not involve vessel resections.