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Anestiadou E, Tsakona A, Tsagkaropoulos S, Foroulis C, Cheva A. Dedifferentiated Mediastinal Liposarcoma: A Case Report. Cureus 2024; 16:e62825. [PMID: 39036280 PMCID: PMC11260355 DOI: 10.7759/cureus.62825] [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: 06/21/2024] [Indexed: 07/23/2024] Open
Abstract
Liposarcoma is the most common soft tissue sarcoma type in adults, originating mainly from the retroperitoneum and lower extremities. Mediastinal liposarcomas constitute an extremely rare clinical entity of mesenchymal origin. Among subtypes, dedifferentiated liposarcoma is characterized by poor survival, but little is known about its biological behavior. We present the case of a 78-year-old male patient who presented with vague symptoms, predominantly dyspnea and chest pain. Imaging revealed a large mediastinal mass and surgical resection was performed in a piecemeal manner due to the inability to achieve a microscopically negative surgical margin (R0 resection) for the residual tumor. Histological examination confirmed the diagnosis of dedifferentiated liposarcoma. The patient's postoperative course was uneventful, with discharge from the hospital on the 10th postoperative day. However, local recurrence was detected after two months and the patient died four months after the operation. The present case report highlights the importance of radical excision for the prevention of local recurrence and the presentation of histological characteristics of this tumor. Radical surgical resection remains the fundamental treatment, while chemo and radiotherapy may have an adjuvant role. In cases of inability to obtain negative margins, surgical debulking can offer symptomatic relief.
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Affiliation(s)
- Elissavet Anestiadou
- 4th Surgical Department, Papanikolaou General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Anastasia Tsakona
- Pathology Department, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Sokratis Tsagkaropoulos
- Cardiothoracic Surgery Department, Aristotle University Medical School, American Hellenic Educational Progressive Association (AHEPA) University Hospital, Thessaloniki, GRC
| | - Christoforos Foroulis
- Cardiothoracic Surgery Department, Aristotle University Medical School, American Hellenic Educational Progressive Association (AHEPA) University Hospital, Thessaloniki, GRC
| | - Angeliki Cheva
- Pathology Department, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Rao J, Zhu Q, Yang X. Giant primary liposarcoma of the mediastinum: A case report and review of the literature. SAGE Open Med Case Rep 2023; 11:2050313X231206031. [PMID: 37860286 PMCID: PMC10583509 DOI: 10.1177/2050313x231206031] [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: 05/21/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023] Open
Abstract
Liposarcoma is a carcinomatous mesenchymal tumor with various histologic features and is the most common soft tissue sarcoma originating in adipose tissue. Liposarcoma commonly occurs in the lower extremities and retroperitoneum but rarely in the mediastinum, specially extending into the thoracic cavity. We report a giant primary liposarcoma of the posterior mediastinum in a 63-year-old female who complained of cough, sputum, and pain in the right chest wall. A computed tomography scan of the chest showed a giant mass of 24 × 15 × 24 cm in the posterior mediastinum of the right thoracic cavity. After a thorough examination, no suspected lipomatous lesions were found elsewhere in the patient's body. The patient underwent a thoracotomy to remove the mediastinal mass through a right thoracic approach. Subsequently, hematoxylin-eosin staining revealed dedifferentiated liposarcoma (DDL), immunohistochemistry showed positive expression of cyclin-dependent kinase 4, and murine double minute 2 (MDM2), in addition, fluorescence in situ hybridization for the MDM2 gene was also positive, which suggested DDL. The patient was discharged without any complications, and no metastasis or recurrence was observed after 19 months of follow-up. To provide a reference for clinical diagnosis and treatment, we reviewed and discussed the literature on primary liposarcoma of the mediastinum.
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Affiliation(s)
- Jingjing Rao
- Department of Laboratory, Shiyan Maternal and Child Health Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
| | - Qingling Zhu
- Department of Internal Medicine, Yicheng Hospital of Traditional Chinese Medicine, Xiangyang, Hubei, P.R. China
| | - Xuejiao Yang
- Department of Laboratory, Shiyan Maternal and Child Health Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
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Ataya J, Nahle AA, Hamdar H, Sikaria A, Souleiman Y. Mediastinal liposarcoma: a case report and review of the literature. J Med Case Rep 2023; 17:372. [PMID: 37649065 PMCID: PMC10469449 DOI: 10.1186/s13256-023-04121-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Mediastinal Liposarcoma (ML) is an exceedingly rare neoplasm, accounting for less than 1% of all liposarcomas. Surgical resection is the most effective therapeutic modality, while adjuvant radiation therapy may be recommended for unresectable tumors. CASE PRESENTATION This case report presents a rare case of a 52-year-old Syrian male patient with well-differentiated mediastinal liposarcoma (ML) who presented with exertional dyspnea, cough, and weight loss. Imaging studies revealed a large tumor causing extrinsic compression on the right lung, as well as compression of the heart and great vessels. CT-guided biopsy confirmed a diagnosis of well-differentiated liposarcoma, and the patient underwent surgical resection. The patient had a rapid postoperative recovery and was discharged on the fourth day post-operation, displaying an excellent postoperative status. The patient was followed up for 3 months postoperatively with no recurrence. CONCLUSION This report highlights the significance of incorporating ML into the differential diagnosis of mediastinal masses, particularly in individuals presenting with exertional dyspnea and weight loss. Furthermore, this report provides a comprehensive review of previously reported cases of ML in the medical literature.
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Affiliation(s)
- Jamal Ataya
- Faculty of Medicine, University of Aleppo, Aleppo, Syria.
| | | | - Hussein Hamdar
- Faculty of Medicine, Damascus University, Damascus, Syria
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Clinicopathological Features of Intrathoracic Liposarcoma-A Systematic Review with an Illustrative Case. J Clin Med 2022; 11:jcm11247353. [PMID: 36555969 PMCID: PMC9781777 DOI: 10.3390/jcm11247353] [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] [Received: 11/21/2022] [Revised: 12/03/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Liposarcoma (LPS) is one of the most common soft-tissue sarcomas. However, intrathoracic LPS is rare, as only 1% of all LPS cases are found in the thorax. METHODS A systematic literature review through PubMed and Embase databases was performed. Only eligible case reports and case series reporting intrathoracic LPS in adult patients were included. Kaplan-Meier curves were calculated to evaluate the survival rate of included patients based on the histological subtype of LPS. RESULTS 123 studies reporting 197 patients were included. We added a case of a 69-year-old female patient with recurrent giant intrathoracic LPS. The primary tumor measured 15.1cm × 22.9 cm × 21.9 cm and weighed 3100 g. Six months later, the patient was admitted to the hospital with another intrathoracic tumor measuring 9.5 cm × 9 cm× 1.4 cm. The immunohistochemical studies showed expression of murine double minute 2 (MDM2) antigen in both primary and recurrent tumor cells. CONCLUSIONS Dyspnea, chest pain, and cough were the most common symptoms reported in included studies. Overall, the 5-year survival rate was 62%. The highest survival was observed in well-differentiated LPS patients (80%) and the lowest in myxoid LPS (31%).
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Bokhari SA, Haseeb S, Baig MW, Qamar P, Bangash HH, Manzoor ZB, Khan HAB, Kaleem M, Munir S, Haseeb S. Myxomatous Liposarcoma of the Mediastinum: A Review of the Literature. Cureus 2022; 14:e28438. [PMID: 36176865 PMCID: PMC9512315 DOI: 10.7759/cureus.28438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/12/2022] Open
Abstract
Myxomatous liposarcoma is an extremely rare type of mediastinal tumour that manifests in a manner comparable to other lung pathologies. Chest pain, shortness of breath, and dysphagia are the common presenting complaints. Radiological examinations or postoperative histological examinations provide the majority of the diagnostic evidence. The cornerstone of therapy consists of surgery and sometimes chemotherapy. Those who are afflicted have a better chance of experiencing favourable outcomes if they receive a diagnosis and treatment quickly.
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Zheng DB, Zhu SG. Myxomatous liposarcoma in giant pleural cavity: case report and literature review. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2021; 14:369-374. [PMID: 33786154 PMCID: PMC7994144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
Liposarcoma was mainly occurring in the lower extremities and deep retroperitoneal soft tissues, but rarely occurred in the thoracic cavity. Most cases were reported in the literature, and most of them were middle-aged and elderly people. It was even more rare in adolescents with tumors occupying the entire thoracic cavity. Recently, one case of myxomatous liposarcoma was admitted and treated in our hospital. This paper reports this case and discusses the diagnostic method, pathological type and treatment of giant liposarcoma in the chest, in order to provide a reference for the clinical diagnosis and treatment of this rare tumor.
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Affiliation(s)
- Dong-Bin Zheng
- The First Affiliated Hospital Cardiothoracic Surgery Department, Guangdong Pharmaceutical University Guangzhou 510080, Guangdong, China
| | - Shu-Guang Zhu
- The First Affiliated Hospital Cardiothoracic Surgery Department, Guangdong Pharmaceutical University Guangzhou 510080, Guangdong, China
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Casal A, Toubes ME, Martínez de Alegría Alonso A, Valdés L. Liposarcoma of the Anterior Mediastinum Leading to Hemodynamic Compromise. OPEN RESPIRATORY ARCHIVES 2020. [DOI: 10.1016/j.opresp.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Chen HG, Zhang K, Wu WB, Wu YH, Zhang J, Gu LJ, Li XJ. Combining surgery with 125I brachytherapy for recurrent mediastinal dedifferentiated liposarcoma: A case report and review of literature. World J Clin Cases 2020; 8:939-945. [PMID: 32190631 PMCID: PMC7062618 DOI: 10.12998/wjcc.v8.i5.939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/12/2020] [Accepted: 02/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Dedifferentiated liposarcoma in the mediastinum is an extremely rare malignant neoplasm. A few previous case reports indicate that surgical resection is the major treatment, but frequent recurrence occurs locally. Due to its rarity, its clinical characteristics, optimal treatment and clinical outcomes remain unclear. Here, we report a case of multifocal recurrent dedifferentiated liposarcoma in the posterior mediastinum treated by combining surgery with 125I brachytherapy, and summarize its clinical features, treatment and prognosis.
CASE SUMMARY A 75-year-old man was admitted to our hospital with a history of gradual dysphagia for one year and aggravated dysphagia for 3 mo. Contrast-enhanced computed tomography (CT) revealed several large cystic-solid masses with lipomatous density, and calcification in the posterior-inferior mediastinum. The patient received a wide excision by video-assisted thoracoscopic surgery. Pathological analysis confirmed the tumors were dedifferentiated liposarcomas. The tumor locally relapsed 24 mo later, and another operation was performed by video-assisted thoracoscopic surgery. Fifteen months after the second surgery, the tumor recurred again, and the patient received CT-guided radioactive seeds 125I implantation. After 8 mo, follow-up chest CT showed an enlarged tumor. Finally, his condition exacerbated with severe dysphagia and dyspnea, and he died of respiratory failure in July 2018.
CONCLUSION We reviewed the literature, and suggest that surgical resection provides beneficial effects for dedifferentiated liposarcoma in the mediastinum, even in cases with local recurrence. 125I brachytherapy may be beneficial for recurrent unresectable patients.
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Affiliation(s)
- Hui-Guo Chen
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Kai Zhang
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Wei-Bin Wu
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Yong-Hui Wu
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Jian Zhang
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Li-Jia Gu
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Xiao-Jun Li
- Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
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Chen HG, Zhang K, Wu WB, Wu YH, Zhang J, Gu LJ, Li XJ. Combining surgery with 125I brachytherapy for recurrent mediastinal dedifferentiated liposarcoma: A case report and review of literature. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i5.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Miura K, Hamanaka K, Matsuoka S, Takeda T, Agatsuma H, Hyogotani A, Ito KI, Nishimaki F, Koizumi T, Uehara T. Primary mediastinal dedifferentiated liposarcoma: Five case reports and a review. Thorac Cancer 2018; 9:1733-1740. [PMID: 30329218 PMCID: PMC6275824 DOI: 10.1111/1759-7714.12888] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 01/15/2023] Open
Abstract
Background Liposarcoma has been subclassified histologically into well‐differentiated, myxoid, pleomorphic, and dedifferentiated types. The dedifferentiated type generally shows poorer prognosis than the well‐differentiated type. Because of its rarity, the clinicopathological features and clinical outcomes of primary mediastinal dedifferentiated liposarcoma remain unclear. Methods Five patients with primary mediastinal dedifferentiated liposarcoma were treated at Shinshu University Hospital between January 2012 and August 2017. We investigated the clinical characteristics, including age, gender, radiographic findings, pathological status, and clinical and treatment outcomes. Results Four of the five patients initially underwent radical surgical resection. One patient was disease‐free after surgery, but the remaining three patients developed local recurrence in the mediastinum after surgical resection. Two of these patients underwent repeat surgical resection, resulting in long survival (60 and 40 months, respectively), while the other underwent proton beam therapy and showed no evidence of recurrence as of 17 months after treatment. The remaining patient was treated with chemotherapy using doxorubicin because of advanced inoperable disease, but failed to show a response and died within a month of the initiation of chemotherapy. Although the maximum standardized uptake values on fluorodeoxyglucose‐computed tomography were relatively low, there was a slight positive relation between these values and the Ki‐67‐positive ratio in the tumor. Conclusion Aggressive treatment by surgical resection should be considered for mediastinal dedifferentiated liposarcoma, even in cases with local recurrence.
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Affiliation(s)
- Kentaro Miura
- Department of Breast, Endocrine and Thoracic Surgery, Shinshu University, Matsumoto, Japan
| | - Kazutoshi Hamanaka
- Department of Breast, Endocrine and Thoracic Surgery, Shinshu University, Matsumoto, Japan
| | - Shunichiro Matsuoka
- Department of Breast, Endocrine and Thoracic Surgery, Shinshu University, Matsumoto, Japan
| | - Tetsu Takeda
- Department of Breast, Endocrine and Thoracic Surgery, Shinshu University, Matsumoto, Japan
| | - Hiroyuki Agatsuma
- Department of Breast, Endocrine and Thoracic Surgery, Shinshu University, Matsumoto, Japan
| | - Akira Hyogotani
- Department of Breast, Endocrine and Thoracic Surgery, Shinshu University, Matsumoto, Japan
| | - Ken-Ichi Ito
- Department of Breast, Endocrine and Thoracic Surgery, Shinshu University, Matsumoto, Japan
| | - Fumihiro Nishimaki
- Department of Dentistry and Oral Surgery, Shinshu University, Matsumoto, Japan
| | - Tomonobu Koizumi
- Department of Comprehensive Cancer Therapy, Shinshu University, Matsumoto, Japan
| | - Takeshi Uehara
- Department of Laboratory Medicine, Shinshu University, Matsumoto, Japan
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Koike H, Nagayasu T, Hayashi T, Ashizawa K. Dedifferentiated Liposarcoma Occurring in the Right Pulmonary Hilum. Intern Med 2018; 57:765-766. [PMID: 29491279 PMCID: PMC5874358 DOI: 10.2169/internalmedicine.9352-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hirofumi Koike
- Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
- Department of Radiology, Nagasaki Rosai Hospital, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Tomayoshi Hayashi
- Department of Pathology, Nagasaki Prefecture Shimabara Hospital, Japan
| | - Kazuto Ashizawa
- Department of Clinical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Abstract
Primary mediastinal liposarcomas are extremely rare conditions often resected through standard median sternotomy or lateral thoracotomy. However, the management of a very huge mediastinal tumor involving hemithorax through these two common surgical approaches is always challenging. Herein, we report a case of applying median sternotomy with a sternum transection plus a right fourth intercostal thoracotomy (‘⊣ shape’ incision) to resect a giant primary anterior mediastinal liposarcoma extending into the whole right thorax. The final pathological diagnosis was a well-differentiated liposarcoma. The patient experienced an uneventful recovery. The ‘⊣ shape’ incision is a good backup for the extension of standard median sternotomy and provides a better exposure for both mediastinum and hemithorax.
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Affiliation(s)
- Wei Huang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ge Ning Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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