Preoperative diagnosis and surgical treatment for giant retroperitoneal liposarcoma: A case report

A Successful En Bloc Excision of a Giant Retroperitoneal Liposarcoma With Distal Splenopancreatectomy

Retroperitoneal sarcomas are considered a rare type of malignant tumors, accounting for fewer than one-fifth of all cases. Among all malignancies, the incidence of soft tissue sarcomas is approximately 1%. It constitutes 38% of soft tissue sarcomas in liposarcomas. Putting it that way may better indicate that liposarcomas are a rare tumor. They are frequently asymptomatic until they become large enough to compress the adjacent organs. As a result, it must be validated using appropriate imaging modalities, for example, computed tomography (CT) abdomen or magnetic resonance imaging (MRI) abdomen with contrast. The preferred treatment is complete surgical resection.

The patient presented with vague symptoms. She had a CT abdomen with contrast, as well as an MRI abdomen. Both images revealed the presence of a giant sarcoma displacing the pancreas and left kidney posteriorly and the transverse colon inferomedially. The patient underwent en bloc resection of the mass with distal splenopancreatectomy. The patient tolerated the procedure well and was discharged on day 6 postoperatively in a stable state.

Giant liposarcoma is a rare and aggressive form of sarcoma. Because of the unique presentation, it is difficult to diagnose clinically. CT scans with MRIs are viable imaging modalities for determining tumor extent and ruling out any vascular invasion. Complete surgical resection of liposarcoma is a treatment of choice. En bloc resection of retroperitoneal sarcoma with distal splenopancreatectomy can be performed successfully and safely.

Retroperitoneal liposarcoma mimicking pheochromocytoma

Retroperitoneal liposarcomas are rare mesenchymal tumors which carry a poor prognosis because of their late presentation. When symptoms do occur, they are usually nonspecific and related to mass effect or invasion of local structures. Rarely, retroperitoneal liposarcomas can clinically and biochemically mimic phaeochromocytomas. We discuss one such case of a 56-year-old Afro-Trinidadian female who presented to her primary care physician with a 3-month history of weakness, intermittent sweating, difficulty sleeping and elevated blood pressure. After a 2 week trial of an oral antihypertensive regime her blood pressure was still elevated and she complained of new right sided abdominal pain. A subsequent Computed Tomography scan of her abdomen revealed an enhancing, heterogeneous right suprarenal mass suspicious for pheochromocytoma. Urinary catecholamines were also elevated and an MRI of her abdomen supported the diagnosis of pheochromocytoma although intralesionsal fat was noted, an uncommon feature of pheochromocytomas. She was booked for laparoscopic adrenalectomy. Histological analysis of the resected specimen confirmed a dedifferentiated retroperitoneal liposarcoma. While the imaging features of phaeochromocytomas and retroperitoneal liposarcomas can be similar, the presence of intralesional fat on CT and MRI should favour the diagnosis of a retroperitoneal liposarcoma, albeit the clinical and biochemical picture.

Giant retroperitoneal liposarcoma with a maximum diameter of 37 cm: a case report and review of literature

Retroperitoneal liposarcoma is a rare malignancy derived from adipocytes. They can grow to large sizes before inducing clinical symptoms. Giant retroperitoneal liposarcoma with a diameter over 30 centimeters is extremely rare. So far, only 13 cases of giant retroperitoneal liposarcoma with a diameter greater than 30 cm have been reported. There is very little experience in the treatment of these bulky tumors. Herein, we report a 65-year-old male patient diagnosed with giant retroperitoneal liposarcoma. The patient underwent successful complete surgical resection. The tumor was found to occupy almost the entire abdominal cavity, measuring 37.0 cm × 32.0 cm × 26.5 cm in size and 21.0 kg in weight. Histopathological analysis indicated a grade I, well-differentiated liposarcoma. The patient was discharged uneventfully, and no sign of recurrence was observed at 12-month follow-up. Moreover, we reviewed 13 literatures in English published on PubMed database regarding retroperitoneal liposarcoma greater than 30 cm in diameter. The analysis suggests that size alone should not be considered as a contraindication to surgical resection. Combined resection of adjacent organs is necessary if local invasion is confirmed. The role of adjuvant radio or chemotherapy remains controversial. Thorough evaluation on the extent of resection should be made to minimize post-surgery decline in quality of life.

En Bloc Resection of a Giant Retroperitoneal Liposarcoma: A Surgical Challenge

Liposarcomas are exceedingly rare entities that evoke malignant transformation of connective tissue and fat cells. These tumours occur throughout the soft tissues of the body, afflicting a myriad of regions. In the adult population, liposarcomas represent the most prevalent subtype of sarcomas, and often arise de novo. Retroperitoneal liposarcomas (RLS) are a ubiquitous subset of sarcomas that, due to their deep location in the hollow abdomen, can grow to astronomical proportions before manifesting any noticeable symptoms; a prompt diagnosis of RLS is therefore often rendered dilatory. We hereby delineate the case of a 43-year-old woman who presented with vague left hemiabdominal distention and discomfort. A subsequent computed tomography scan divulged a giant retroperitoneal growth impaling on and thus displacing the pancreas. A compartmental, en bloc resection was performed, with subsequent histopathology of the excised specimen revealing a well-differentiated liposarcoma. The surgical intervention was curative and led to an uneventful recovery. This paper highlights the pertinence of surgical management as an appropriate treatment modality for a complete resection of RLS.