Liposarcoma retroperitoneal gigante

PSMA and FDG PET/CT Findings in Patient With Dedifferentiated Liposarcoma and Prostate Cancer Metastases

ABSTRACT

Dedifferentiated liposarcoma is an extremely rare and highly malignant tumor. We demonstrated a case of a 75-year-old man with significantly PSMA-avid and mildly FDG uptake-dedifferentiated liposarcoma in the retroperitoneal area. The double-tracer (PSMA and FDG) PET scans could further contribute to differential diagnosis and the following treatment strategy for patients who were suspected with prostate cancer metastases and other malignant tumors simultaneously.

Acute hemorrhage from a retroperitoneal liposarcoma treated by embolization

Liposarcomas are rare retroperitoneal mesenchymal tumors that present at an advanced stage and often have poor prognoses. These malignant tumors create a diagnostic conundrum and pose several treatment difficulties due to their rarity and anatomic placement. Retroperitoneal liposarcomas often present as asymptomatic abdominal tumors and rarely cause acute bleeding. Surgery is typically required in cases with acute malignant bleeding and hemodynamic instability. Angioembolization and other bleed-control methods should be researched where available. This case report describes the case of a 17-year-old male patient whose tumor had an acute abdominal hemorrhage treated by embolization.

Giant retroperitoneal low grade liposarcoma with left kidney displacement: A case report

Retroperitoneal liposarcomas are diagnostic and therapeutic challenge due to their expansive growth and tendency for recurrence. They represent the most of the sarcomas of the retroperitoneal space with the incidence of 41%. Most of them can grow in large proportions before symptom occurrence and change the anatomy of the retroperitoneum. Computerized tomography remains the main diagnostic tool in such cases that provides precise tumor location, size and relation to the adjacent organs. Surgery is the method of choice for treatment. Nevertheless, they tend to recur in 50%-80% of patients despite the appropriate surgery. We present a case of giant retroperitoneal liposarcoma in a female patient with significant left kidney displacement that recurred within 5 years of its removal.

Giant Retroperitoneal Liposarcoma: Correlation Between Size and Risk for Recurrence

Soft tissue sarcomas (STSs) are rare tumors that represent almost 1% of adult malignant tumors. The annual incidence rate for such tumors is 2 - 5/100,000 population. The most common type of STS in adults is liposarcoma, which represents 15-20% of adult STSs. It is of mesodermic origin derived from adipose tissues, and known as the most common primary malignant tumor of the retroperitoneum. Other sites of involvement include the extremities, trunk and to a lesser extent the pleural cavity, esophagus, mediastinum and others. Due to the potential large retroperitoneal space, retroperitoneal liposarcoma (RPL) is usually asymptomatic during the initial phase, developing symptoms at a late stage due to large mass compressing nearby retroperitoneal structures. The average diameter and weight of RPL during diagnosis is 20 - 25 cm and 15 - 20 kg, respectively. Several factors were labelled as risk factors for recurrence, such as histological type, tumor grade, age, resectability and tumor size. Controversy exists regarding the relationship between tumor size and recurrence rate, thus, tumor size as a risk factor for recurrence should be clarified. Although there is no consensus regarding the precise definition of giant RPL, it is defined by several literatures as an RPL of greater than 30 cm in diameter or with weight of more than 20 kg. The main purpose of this article is to review the current English literature regarding giant RPL and examine the relationship between tumor size and risk for recurrence.

Retroperitoneal Liposarcoma: The Giant Type

Retroperitoneal tumors (RPTs) are very rare tumors that arise in the large space of the retroperitoneum. About two-third of these tumors are malignant, of which soft tissue sarcoma (STS) is the most common and comprises almost one-third of malignant RPTs. Twenty to thirty percent of RPTs are benign. The retroperitoneal cavity has a very large potential space for tumor enlargement to a very high diameters without causing specific symptoms, especially during the initial phase of tumor enlargement. On diagnosis, the average tumor weight is 15 - 20 kg and tumor diameter is 20 - 25 cm. The most common retroperitoneal sarcoma type is liposarcoma, which account for 20% of all sarcoma types and 40% of all retroperitoneal sarcomas (RPSs). Other less common STS arise in the retroperitoneum include leiomyosarcoma and undifferentiated pleomorphic type. Giant liposarcoma is usually defined either as tumor diameter of 30 cm or more or tumor weight of 20 kg or higher. This specific type of sarcoma is very uncommon, with few case reports published in the English literature. Herein, we present a case of a healthy 33-year-old male patient, who was admitted due to abdominal distension and increased body weight since few months. An abdominopelvic computed tomography (CT) scan demonstrated a giant retroperitoneal mass of almost 40 cm in diameter in its largest dimension, located in the right retroperitoneal space. Ultrasound (US)-guided fine needle biopsy (FNB) was consistent with well differentiated liposarcoma. Surgical resection of the tumor along with the right colon, right ureter and kidney, third and fourth duodenal parts and part of the right iliopsoas muscle was contemplated. Histopathological report revealed well-differentiated liposarcoma of 50 cm in diameter, with foci of dedifferentiation, presented by pleomorphic sarcoma. Surgical margins were microscopically negative.

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

Introduction

Liposarcoma, a lipogenic tumor of large deep-seated connective tissue space, presents the most common type of soft tissue sarcoma arising in the retroperitoneum. Liposarcoma that arises from colonic mesentery is especially a very rare disease. The present case describes a surgery of giant dedifferentiated liposarcoma at ascending colon mesentery.

Presentation of case

A 47-year-old South Korean man was admitted and presented with palpable abdominal mass. Abdominal pelvic computed tomography scan revealed a huge mass at his right sided abdomen (about 25 × 19 cm sized mass at right abdomen with encapsulation). After the surgery, the entire mass was completely excised en bloc with the ascending colon. The specimen consisted of multinodular, pinkish tanned, focally myxoid tissue, which measured up to 25.5 × 19 × 12.5 cm. Final pathological analysis reported dedifferentiated liposarcoma (high grade sarcoma) with MDM2 and CDK2 (+) in immunohistochemistry.

Conclusion

The present case report concerns a 47-year-old male with giant dedifferentiated liposarcoma arising from colonic mesentery and achieved en-bloc resection of liposarcoma with right hemicolectomy.

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Dedifferentiated liposarcoma arising from colonic mesentery is a rare form of the soft tissue sarcoma.

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In giant dedifferentiated liposarcoma, grossly complete resection is known as the better prognostic factor.

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liposarcoma excision with right hemicolectomy was inevitable for this case to achieve the complete resection due to colon wall invasion.

Giant retroperitoneal well-differentiated liposarcoma presenting in emergency with intestinal occlusion: Case report and review of the literature

INTRODUCTION AND IMPORTANCE

Liposarcoma (LPS) represents the most common type of retroperitoneal sarcoma (RPS) and can be classified into four subtypes. Preoperative diagnosis of retroperitoneal liposarcoma (RLPS) is a challenge because of its late and nonspecific clinical presentation. Imaging may be helpful for determining the correct diagnosis. Surgery represents a potentially curative treatment of RLPS.

CASE PRESENTATION

A 55-year-old Caucasian female presented to the Emergency Department with a two-day history of abdominal pain, abdominal distension, inability to pass gas or stool, nausea, vomiting and lipothymia. Abdominal examination revealed abdominal distention, abdominal pain without obvious muscle guarding and a giant non-tender mass. Laboratory tests reported neutrophilic leukocytosis and anemia. Abdominal contrast-enhanced computed tomography (CECT) showed a heterogeneous and hypodense giant retroperitoneal mass compressing and displacing the surrounding organs and vessels. The patient underwent excision of a giant retroperitoneal mass. The postoperative course of the patient was uneventful.

CLINICAL DISCUSSION

RLPS is a malignant neoplasm that can slowly grow to enormous size with possible involvement of adjacent organs and vessels; it may recur locally and has a minimal capacity to metastasize. Preoperative diagnosis and staging of RLPS are important to establish appropriate management and prognosis. Surgery represents the gold standard for non-metastatic RLPS treatment.

CONCLUSION

RLPS is a rare malignant neoplasm generally difficult to detect early due to its late and nonspecific clinical presentation. CECT represents the most commonly used modality for diagnosis, staging and preoperative evaluation. Surgery represents the appropriate treatment of non-metastatic RLPS.

Perioperative strategy and outcome in giant retroperitoneal dedifferentiated liposarcoma-results of a retrospective cohort study

Background and objectives

Retroperitoneal liposarcoma (RPLS) are common soft tissue sarcomas of adulthood. The aim of this study is to show resectability of even giant liposarcomas and to identify factors associated with recurrence and survival in primary retroperitoneal liposarcomas.

Methods

We retrospectively reviewed the records of patients with retroperitoneal liposarcoma. Seventy-seven patients met inclusion criteria. Out of these 10 patients with primary giant, dedifferentiated retroperitoneal liposarcomas were operated with en bloc compartment resection with intention of radical resection. Treatment consisted of neoadjuvant radiochemotherapy and surgical resection or surgical resection.

Results

In 6 patients, neoadjuvant radiochemotherapy was performed; 3 patients were treated with surgical resection alone and 1 patient received adjuvant chemotherapy. The median diameter of tumor size was 360 mm (300 to 440 mm). Operative outcome showed complete resection in all 10 patients. Local tumor free survival was in median 19 month. Tumor recurrence was seen in 3 of 4 patients (75%) without neoadjuvant radiochemotherapy, and in 2 of 6 patients (33%) after neoadjuvant radiochemotherapy in 2 years follow-up.

Conclusion

Even in case of giant retroperitoneal liposarcoma, complete resection is possible and remains the principal treatment. The rate of recurrence was improved in patients with neoadjuvant radiochemotherapy.

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.

Retroperitoneal liposarcoma: a comprehensive review

Retroperitoneal liposarcomas are rare mesenchymal tumors of the retroperitoneum that typically present with advanced disease and often carry a poor prognosis. Because of their rarity and anatomic location, these malignant tumors can cause a diagnostic dilemma and present several therapeutic challenges. They are usually associated with a high rate of recurrence despite grossly complete resection, thus requiring long-term and often indefinite follow-up. Relevant data on this topic was procured and synthesized with the aid of a comprehensive Medline search in addition to oncologic, pathologic, urologic, radiologic, and surgical literature review on retroperitoneal sarcomas. This article provides an in-depth review into the natural history, pathology, clinical manifestations, and prognostic features of retroperitoneal liposarcomas. It also discusses the reliability of diagnostic procedures and novel curative approaches that are currently being evaluated for the disease.

Giant retroperitoneal liposarcoma

Background

Liposarcoma is the most frequent histopathological variety of the retroperitoneum, surgery is the gold standard for treatment.

Case presentation

We present the case of a 24-year-old male who was diagnosed with a giant retroperitoneal liposarcoma. The patient received palliative treatment due to non-resectability on the basis of chemotherapy. We decided to perform surgery after no benefit was received with systemic treatment. Complete macroscopic resection of the tumor was performed, without multi-organ resection. The patient is currently alive and disease free at 14 months of evolution.

Conclusion

Retroperitoneal liposarcomas represent a unique situation and require a more aggressive surgical approach including multiple resections for recurrences. Based on the ability of the patient to tolerate the procedure, surgery is suggested to evaluate resectability of the tumor. We must take into consideration whether prolonged survival will be attained and tumor removal will result in palliation of symptoms.

[Retroperitoneal sarcomas. Report of five new cases and review of the current situation]

INTRODUCTION

Soft-tissue sarcomas represent a heterogeneous group of rare tumors arising from the mesenchymal cells of the connective tissue. Approximately 15% of these tumors arise in the retroperitoneum. These neoplasms are locally aggressive and the only curative treatment is surgical resection "en-bloc". The main cause of mortality is locoregional recurrence. Five-year survival is 3-58%, depending on the histologic subtype and grade.

PATIENTS AND METHOD

Over a 5-year period (2001 to 2006), we performed surgery in five patients with retroperitoneal sarcomas. The mean age was 59 years (range, 46-76) with a male-to-female ratio of 3:2. The most frequent signs were abdominal pain and the appearance of a mass. In 2 patients, an incidental diagnosis was made during the surgical intervention.

RESULTS

Surgical resection was performed in 5 patients but was incomplete in two patients. We removed 2 liposarcomas, 1 leiomyosarcoma, 1 chondrosarcoma and 1 fusocellular sarcoma arising in the kidney. Locoregional recurrence occurred in four patients, requiring between 1 and 2 new relaparotomies (using the retroperitoneal approach in 2 patients). There was one death.

CONCLUSIONS

Retroperitoneal sarcomas are a heterogeneous group of tumors, in which the only common factor is the anatomical location. New randomized, prospective, multicenter trials are required to apply different therapeutic options according to the subtype of retroperitoneal sarcoma.