1
|
Paredes O, Eom SS, Park SH, Kim YW. Laparoscopy-assisted trans gastric wedge resection: A safe treatment for gastric pyloric liposarcoma: A case report and literature review. Heliyon 2024; 10:e30410. [PMID: 38774071 PMCID: PMC11106821 DOI: 10.1016/j.heliyon.2024.e30410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/24/2024] Open
Abstract
Background Gastric liposarcoma (GL) is extremely rare and radical surgery has been the conventional treatment, even in small tumors. Laparoscopic wedge resection has been reported worldwide for subepithelial tumors of the stomach. Case presentation The patient was an asymptomatic 63-year-old man presenting with a subepithelial gastric tumor. The esophagogastroduodenoscopy showed a 3 cm ulcerated soft tumor located in the posterior wall of the antrum just above the pylorus. Two preoperative biopsies were performed with a negative result for malignant neoplasm. Dynamic computerized tomography revealed 35 × 35 mm well-defined pyloric mass with fat density. Despite the difficult location of the tumor, function-preserving surgery was performed. Surgery was initiated by a laparoscopic approach with four trocars. After the dissection of the greater omentum, the greater curvature and the posterior wall of the stomach were exposed. A gastrostomy was performed in the anterior wall of the antrum. Due to the difficulty in identifying the tumor location, a mini-laparotomy was conducted. After assessing the pylorus and section parameters, the tumor was extracted by gastrostomy and resected with a linear stapler. The patient was discharged after five days with no complications. The histological diagnosis was a well-differentiated liposarcoma. Resection margins were clear. The tumor cells tested negative for MDM2. No adjuvant therapy was indicated. The patient is alive without recurrence. Conclusions Despite its rarity, gastric liposarcoma should be respected for differential diagnosis in submucosal tumors. The main diagnostic method is histological, and surgery is the conventional treatment without yet having a consensus. Minimally invasive wedge resection might be a suitable treatment even if the location is close to the pylorus. Multicenter studies are required to obtain better results in the management of this pathology.
Collapse
Affiliation(s)
- Oscar Paredes
- Center for Gastric Cancer, National Cancer Center, Goyang, South Korea
| | - Sang Soo Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, South Korea
| | - Sin Hye Park
- Center for Gastric Cancer, National Cancer Center, Goyang, South Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, South Korea
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea
| |
Collapse
|
2
|
Choi K. Laparoscopic management of a gastric liposarcoma with malignant transformation from a gastric lipoma: A rare case report. Int J Surg Case Rep 2023; 113:109039. [PMID: 37992666 DOI: 10.1016/j.ijscr.2023.109039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Liposarcoma is one of the most common mesenchymal neoplasms in adults. Among liposarcomas, gastrointestinal tract involvement is uncommon, and liposarcoma of the stomach is a particularly rare entity, In addition, few cases of gastric liposarcoma with malignant transformation from benign gastric lipoma have been reported. PRESENTATION OF CASE Here we present the case of a 62-year-old male patient who was diagnosed with gastric liposarcoma and managed with laparoscopic surgical resection. He was first diagnosed with subepithelial lipoma of the stomach 4 years ago and was under observation, but underwent laparoscopic distal gastrectomy due to malignant transformation of gastric lipoma. He has been following up for 1 year after surgery, and there are no recurrence or other complications to date. CLINICAL DISCUSSION This patient was initially diagnosed with gastric lipoma and was surgically resected after 4 years of observation to show malignant transformation. To the best of our knowledge, this case represents the first report of gastric lipoma demonstrating malignant transformation into gastric liposarcoma. CONCLUSION Gastric lipoma can be transformed into gastric liposarcoma, so if the size is large or the rate of size change is fast, surgical resection is recommended in the early state, and en-bloc resection including node dissection and reconstruction are desirable during surgery.
Collapse
Affiliation(s)
- KyeongWoon Choi
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Ilsan, Gyeonggido, Republic of Korea.
| |
Collapse
|
3
|
Vasilakis T, Ziogas D, Tziatzios G, Gkolfakis P, Koukoulioti E, Kapizioni C, Triantafyllou K, Facciorusso A, Papanikolaou IS. EUS-Guided Diagnosis of Gastric Subepithelial Lesions, What Is New? Diagnostics (Basel) 2023; 13:2176. [PMID: 37443568 DOI: 10.3390/diagnostics13132176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/18/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
Gastric subepithelial lesions (SELs) are intramural lesions that arise underneath the gastric mucosa. SELs can be benign, but can also be malignant or have malignant potential. Therefore, correct diagnosis is crucial. Endosonography has been established as the diagnostic gold standard. Although the identification of some of these lesions can be carried out immediately, solely based on their echo characteristics, for certain lesions histological examination is necessary. Sometimes histology can be inconclusive, especially for smaller lesions. Therefore, new methods have been developed in recent years to assist decision making, such as contrast enhanced endosonography, EUS elastography, and artificial intelligence systems. In this narrative review we provide a complete overview of the gastric SELs and summarize the new data of the last ten years concerning the diagnostic advances of endosonography on this topic.
Collapse
Affiliation(s)
- Thomas Vasilakis
- Hepatology and Gastroenterology Clinic, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Dimitrios Ziogas
- 1st Department of Internal Medicine, 251 Hellenic Air Force & VA General Hospital, 3 Kanellopoulou Str., 11525 Athens, Greece
| | - Georgios Tziatzios
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital, 3-5, Theodorou Konstantopoulou Str., Nea Ionia, 14233 Athens, Greece
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital, 3-5, Theodorou Konstantopoulou Str., Nea Ionia, 14233 Athens, Greece
| | - Eleni Koukoulioti
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Christina Kapizioni
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Antonio Facciorusso
- Department of Medical Sciences, University of Foggia, Section of Gastroenterology, 71122 Foggia, Italy
| | - Ioannis S Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| |
Collapse
|
4
|
Baker WG, Albright S, Aragan T, Mederos R. Giant Dedifferentiated Gastric Liposarcoma: Largest to Date. Cureus 2023; 15:e39595. [PMID: 37384096 PMCID: PMC10295811 DOI: 10.7759/cureus.39595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 06/30/2023] Open
Abstract
Liposarcoma is one of the most common soft tissue malignancies in adults, accounting for 15% to 20% of all sarcomas. We report a case of the largest dedifferentiated gastric liposarcoma recorded to date in a patient who presented with upper gastrointestinal bleeding. Initial pathology reports indicated a benign cause even after multiple biopsies were performed; only after surgical resection was the diagnosis confirmed. We discuss histopathology, genetic markers, and differential diagnoses.
Collapse
|
5
|
Cho JH, Byeon JH, Lee SH. Primary gastric dedifferentiated liposarcoma resected endoscopically: A case report. World J Gastroenterol 2022; 28:2625-2632. [PMID: 35949354 PMCID: PMC9254141 DOI: 10.3748/wjg.v28.i23.2625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/29/2022] [Accepted: 05/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liposarcoma is one of the most common adult mesenchymal tumors but is uncommon in the gastrointestinal tract and extremely rare in the stomach. Furthermore, the histological subtypes of liposarcoma usually reported in the stomach are well-differentiated or myxoid, and few reports have been issued on small-sized gastric liposarcomas resected endoscopically and followed up. Herein, we report a case of primary gastric dedifferentiated liposarcoma (DL) that was resected endoscopically.
CASE SUMMARY A 67-year-old female Korean patient was referred to our institution for further evaluation of a gastric submucosal tumor (SMT) located in the lesser curvature of the gastric body by esophagogastroduodenoscopy. Endoscopic ultrasound revealed a well-circumscribed, slightly heterogeneous, isoechoic, 17 mm × 10 mm sized mass originating from the third sonographic layer. Computed tomography showed no evidence of significant lymph node enlargement or distant metastasis. Endoscopic resection was undertaken using the snare resection technique after mucosal precutting to provide a definitive histopathologic diagnosis, which proved to be consistent with DL, based on its morphology and the immunoexpressions of MDM2 and CDK4. The patient was planned for surgery because the deep resection margin was positive for malignancy. After declining any invasive procedure or adjuvant treatment, the patient was placed under close follow-up, and at one year after endoscopic resection, remained disease free.
CONCLUSION This is the first reported case of a small primary gastric DL resected endoscopically and followed up. This report demonstrates that when diagnosis of a SMT is uncertain, the use of invasive techniques, including endoscopic resection, should be considered.
Collapse
Affiliation(s)
- Joon Hyun Cho
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 42415, South Korea
| | - Jun Hyeon Byeon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 42415, South Korea
| | - Si Hyung Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 42415, South Korea
| |
Collapse
|
6
|
[Primary liposarcomas of the digestive tract: Diversity of clinicopathological presentations and diagnostic challenges]. Ann Pathol 2021; 41:399-404. [PMID: 34120784 DOI: 10.1016/j.annpat.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/21/2021] [Accepted: 05/25/2021] [Indexed: 11/21/2022]
Abstract
Sarcomas are rare tumours that represent less than 1% of all malignant tumours in adults. Liposarcomas are among the most common malignant mesenchymal tumours. They are preferentially located in the limbs and the retroperitoneum. Liposarcomas primarily arising in the digestive tract are exceptional with a few cases reported in the literature. Their clinical presentation is variable and the symptoms are not specific. Anatomopathological examination remains the gold standard for the diagnosis and the classification of these tumours, which are divided into 5 histological types according to the 5th edition of the WHO classification of soft tissue tumours. We report two observations of unusual digestive liposarcomas, located in the oesophagus and the colon, emphasizing the variability of the diagnostic challenges, depending on the clinical presentation, the histological type and the analysed material.
Collapse
|
7
|
Kuboyama Y, Yamada Y, Kohashi K, Toda Y, Kawakami K, Kitahara D, Nishiyama K, Hiraki Y, Oya M, Oda Y. Three cases of synovial sarcoma of gastric wall: A case report and review of the literature. Pathol Res Pract 2021; 219:153352. [PMID: 33582394 DOI: 10.1016/j.prp.2021.153352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 12/16/2022]
Abstract
Synovial sarcoma (SS) is a malignant soft tissue neoplasm that occurs in various parts of the human body, but most commonly affects the extremities. Its diagnosis of synovial sarcoma often requires adjunctive techniques such as immunohistochemical staining and molecular studies, especially for synovial sarcoma at unusual locations. SS at a gastrointestinal location is exceedingly rare. We report here three cases of primary gastric synovial sarcoma. Malignant gastric mesenchymal tumor has many differential diagnoses other than synovial sarcoma, such as gastrointestinal stromal tumor (GIST), leiomyosarcoma, schwannoma, malignant peripheral nerve sheath tumor (MPNST) and so on. In our three cases, using reverse transcription polymerase chain reaction (RT-PCR) and direct sequencing, we detected an SS18-SSX1 fusion gene, which is specific to synovial sarcoma. In addition, we found the reduced expression of SMARCB1/INI1 in the tumor cells in two of the three cases. Through histopathological, immunohistochemical, and molecular analyses, we confirmed the diagnosis of primary gastric synovial sarcoma.
Collapse
Affiliation(s)
- Yusuke Kuboyama
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichi Yamada
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichi Kohashi
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yu Toda
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Kawakami
- Department of Surgery, Okinawa Kyodo Hospital, Okinawa, Japan
| | - Daichi Kitahara
- Department of Pathology, Japanese Red Cross Society Fukuoka Hospital, Fukuoka, Japan
| | - Kenichi Nishiyama
- Department of Pathology, Japanese Red Cross Society Fukuoka Hospital, Fukuoka, Japan
| | - Yuka Hiraki
- Department of Pathology, Aso Iizuka Hospital, Iizuka, Japan
| | - Masafumi Oya
- Department of Pathology, Aso Iizuka Hospital, Iizuka, Japan; Department of Pathology, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| |
Collapse
|
8
|
Diamantis A, Samara AA, Baloyiannis I, Symeonidis D, Diamantis AM, Tolia M, Bouliaris K, Koukoulis G, Tepetes K. Gastrointestinal Stromal Tumor (GIST) and Synchronous Intra-Abdominal Liposarcoma: A Report of Two Rare Cases and Literature Review. Int J Surg Oncol 2021; 2021:2626635. [PMID: 34518784 PMCID: PMC8434899 DOI: 10.1155/2021/2626635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/25/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs) quite frequently occur synchronously with other malignancies, with most cases being adenocarcinomas. GISTs and liposarcomas are both of mesenchymal origin, and their coexistence is extremely rare. METHODS We conducted a review of the current literature regarding the synchronous occurrence of GISTs and intra-abdominal liposarcomas. An electronic search of the literature was undertaken using MEDLINE (database provider PubMed). Furthermore, we present the first described case of an 86-year-old male with a GIST and synchronous liposarcoma, both located in the stomach, as well as a 66-year-old male with a gastric GIST and concurrent retroperitoneal liposarcoma. RESULTS A total of 5 cases of synchronous GIST and intra-abdominal liposarcoma have been reported in the literature to date, with the most recent cases included in the present study. CONCLUSION Further research is required to explain any possible correlation in the coexistence of these different neoplasms of the same origin. Meanwhile, R0 resection of both tumors remains the treatment of choice.
Collapse
Affiliation(s)
| | - Athina A. Samara
- Department of General Surgery, University Hospital of Larissa, Larissa, Greece
| | - Ioannis Baloyiannis
- Department of General Surgery, University Hospital of Larissa, Larissa, Greece
| | | | | | - Maria Tolia
- Department of Radiotherapy, University of Crete, Heraklion, Greece
| | | | - Georgios Koukoulis
- Department of Pathology, University Hospital of Larissa, Larissa, Greece
| | | |
Collapse
|
9
|
Cure HW, Gómez D, Pedraza M, Bulicie HC, Cabrera LF, Gil LPG, Acevedo D, Cabrera L, Moreno V, Mendoza A. Laparoscopic management of gastric liposarcoma: A case report and review of the literature. Int J Surg Case Rep 2020; 73:268-270. [PMID: 32721886 PMCID: PMC7388163 DOI: 10.1016/j.ijscr.2020.07.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/03/2020] [Accepted: 07/13/2020] [Indexed: 01/08/2023] Open
Abstract
Soft tissue tumors are characterized by frequent somatic chromosomal rearrangements. Symptoms include epigastric pain, nausea, anorexia, and gastrointestinal bleeding. Gastric liposarcoma is the least common sarcoma of the gastrointestinal tract. CT and pathological analysis of resected specimens enable diagnosis. The gold standard of treatment is surgery with radical resection of the tumor.
Introduction Liposarcoma is one of the most common mesenchymal neoplasms in adults. Predominant locations are the retroperitoneum and limbs, it rarely occurs in the gastrointestinal tract. Gastric liposarcoma is extremely rare, with fewer than 30 cases reported around the world. Presentation of case Here we present the case of a 70-year-old female patient who was diagnosed with gastric liposarcoma and managed with laparoscopic surgical resection. The patient is currently being followed up and is alive without recurrence 12 months after the operation. Discussion Gastric liposarcoma approach requires proper diagnosis with computed tomography and endoscopy, in order to develop an adequate surgical plan. Laparoscopic en-bloc resection and gastrointestinal reconstruction is the ideal management in this type of patient. Conclusion Gastric liposarcoma is an extremely rare entity, his management consists of wide en-bloc resection with a gastrointestinal reconstruction.
Collapse
Affiliation(s)
- Hector W Cure
- Department of Neuroscience, University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel Gómez
- Department of General Surgery, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Mauricio Pedraza
- Department of General Surgery, Universidad El Bosque, Bogotá, Colombia.
| | | | - Luis Felipe Cabrera
- Department of General Surgery, Universidad El Bosque, Bogotá, Colombia; Departament of Surgery José Félix Patiño, Fundación Santa Fe de Bogotá, Universidad de los Andes, Universidad El Bosque, Colombia
| | | | - David Acevedo
- Department of General Surgery, Universidad El Bosque, Bogotá, Colombia
| | - Laura Cabrera
- Department of General Surgery, Universidad El Bosque, Bogotá, Colombia
| | - Valery Moreno
- Department of General Surgery, Universidad El Bosque, Bogotá, Colombia
| | - Andrés Mendoza
- Department of General Surgery, Universidad El Bosque, Bogotá, Colombia
| |
Collapse
|
10
|
Lochman P, Rejchrt S, Páral J. Proximal Gastrectomy in a Case of Giant Gastric Liposarcoma and a 5-Year Follow-Up. Case Rep Oncol 2020; 13:617-620. [PMID: 32595472 PMCID: PMC7315206 DOI: 10.1159/000507477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/22/2020] [Indexed: 12/20/2022] Open
Abstract
Even though liposarcomas account for 10–20% of all mesenchymal malignancies, they are extremely rarely located in the stomach. We report the case of a female patient with gastric liposarcoma. CT revealed a giant hypoechogenic tumour subcardially on the posterior gastric wall. Endoscopic tumour resection by piecemeal technique was done, and a lipoma was confirmed on histopathological examination. A recurrent bleeding tumour was proven 6 weeks later. The patient underwent an open proximal gastrectomy with pyloroplasty, and liposarcoma was surprisingly revealed in the resected specimen, finally. Five years later, our patient had been without recurrence or any somatic difficulties. The CT finding of a submucosal fatty tumour with heterogeneous density within the gastric wall should raise the suspicion for liposarcoma. The goal is the surgical removal of the tumour with sufficient margins ensuring R0 resection.
Collapse
Affiliation(s)
- Petr Lochman
- Department of Field Surgery, Faculty of Military Health Science, University of Defence, Hradec Králové, Czechia.,Department of Surgery, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czechia
| | - Stanislav Rejchrt
- 2nd Department of Internal Medicine - Gastroenterology, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czechia
| | - Jiří Páral
- Department of Field Surgery, Faculty of Military Health Science, University of Defence, Hradec Králové, Czechia.,Department of Surgery, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czechia
| |
Collapse
|
11
|
Shahini E, Grignani G, Maldi E, Staiano T. Endoscopic submucosal dissection for chronically bleeding gastric metastasis from undifferentiated liposarcoma. Dig Liver Dis 2020; 52:588. [PMID: 32192915 DOI: 10.1016/j.dld.2020.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/16/2020] [Accepted: 02/19/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Endrit Shahini
- Istituto di Candiolo, FPO - IRCCS - Candiolo (To), Italy.
| | | | - Elena Maldi
- Istituto di Candiolo, FPO - IRCCS - Candiolo (To), Italy
| | - Teresa Staiano
- Istituto di Candiolo, FPO - IRCCS - Candiolo (To), Italy
| |
Collapse
|
12
|
Gajzer DC, Fletcher CD, Agaimy A, Brcic I, Khanlari M, Rosenberg AE. Primary gastrointestinal liposarcoma-a clinicopathological study of 8 cases of a rare entity. Hum Pathol 2019; 97:80-93. [PMID: 31884085 DOI: 10.1016/j.humpath.2019.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/15/2019] [Accepted: 12/17/2019] [Indexed: 12/11/2022]
Abstract
Primary gastrointestinal liposarcoma is rare, and information regarding this entity is largely based on single case studies. We report on 8 patients with primary liposarcoma of the gastrointestinal tract and review the pertinent literature. The cohort includes 6 men and 2 women who ranged in age from 51 to 81 years (median 68.5). Two tumors arose in the stomach, 4 in the small intestine, and 2 in the large intestine. Tumors ranged in size from 2.5 to 14.5 cm (median 7 cm), originated in the submucosa or muscularis propria of the intestinal wall, and frequently protruded into the bowel lumen, resulting in mucosal ulceration and luminal obstruction. Six tumors were dedifferentiated liposarcomas, and 2 were well-differentiated liposarcoma. Surgical excision was performed on all tumors except for 1 case of dedifferentiated liposarcoma. On follow-up, 1 patient with dedifferentiated liposarcoma developed a lytic sacral lesion suspicious for metastasis 4 months after resection of the primary, and another underwent marginal resection and presented with recurrence 4 years later, had tumor re-resection, and was considered disease-free at 6 weeks postsurgery. A third patient with dedifferentiated liposarcoma was alive with unknown disease status at 17 months following surgery, and another patient with dedifferentiated liposarcoma was alive without evidence of disease at 30 months following surgery. No follow-up information on the remaining patients is available. Overall, liposarcomas of the intestinal tract are most frequently high-grade dedifferentiated tumors that are biologically aggressive and require surgical excision with widely negative margins to help reduce the risk of local recurrence and dissemination. Important in the differential diagnosis is malignant gastrointestinal stromal tumor. Care must be taken not to misdiagnose one entity for the other because the correct diagnosis carries important therapeutic implications.
Collapse
Affiliation(s)
- David C Gajzer
- Department of Pathology and Laboratory Medicine, University of Miami, Miami, FL
| | - Christopher D Fletcher
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Germany
| | - Iva Brcic
- Institute of Pathology, Medical University of Graz, Austria
| | - Mahsa Khanlari
- Department of Pathology and Laboratory Medicine, University of Miami, Miami, FL
| | - Andrew E Rosenberg
- Department of Pathology and Laboratory Medicine, University of Miami, Miami, FL.
| |
Collapse
|
13
|
Sonoda A, Sawayama H, Miyanari N, Mizumoto T, Kubota T, Baba H. Giant myxoid liposarcoma of the stomach: Report of a case. Int J Surg Case Rep 2019; 60:234-238. [PMID: 31252381 PMCID: PMC6600042 DOI: 10.1016/j.ijscr.2019.06.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 02/07/2023] Open
Abstract
Myxoid liposarcoma of the stomach is extremely rare. The tumor in the present case was too large to confirm its origin. Imaging findings of liposarcoma vary, and few reports have described gastric liposarcoma with a huge cyst. Even for large tumors, curative resection can provide the patient a good prognosis.
Introduction Liposarcoma is one of the most common soft tissue sarcomas in adults, but liposarcoma arising primarily from the stomach is very rare. Presentation of case A 56-year-old man was referred to our hospital with abdominal distension and discomfort. A computed tomography scan showed a huge mass located between the stomach and transverse colon. The preliminary differential diagnoses were sarcoma with a mucinous component, gastrointestinal stromal tumor, lymphangioma, and mesenteric cyst. Upper and lower endoscopy was not performed because the patient declined. The patient underwent surgical resection, and the tumor was completely removed. Macroscopic examination revealed a 39- × 26- × 20-cm tumor weighing 13,000 g. On histological examination, the tumor was diagnosed as a myxoid liposarcoma in the gastric submucosa. The patient was still doing well 2 years postoperatively. Discussion Preoperative diagnosis of liposarcoma of the stomach is difficult. In the present case, the tumor was very large but was able to be resected completely. Conclusion Even in patients with very large myxoid liposarcoma, curative resection can provide a good prognosis.
Collapse
Affiliation(s)
- Akari Sonoda
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Japan
| | - Hiroshi Sawayama
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Japan
| | - Nobutomo Miyanari
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Japan
| | - Takao Mizumoto
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Japan
| | - Tatsuo Kubota
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Japan.
| |
Collapse
|