Large Retroperitoneal Liposarcoma Diagnosed upon Radiological Evaluation of Mild Right-Sided Inguinal Hernia

A case of enormous retroperitoneal liposarcoma with prolapse from the left inguinal canal following hernia repair

BACKGROUND

Liposarcomas represent ~9.8-16% of soft tissue sarcomas, with the extremities and retroperitoneum being the primary sites of occurrence. While liposarcoma in the inguinal region is uncommon, few reported cases originate from the retroperitoneum and protrude into the scrotum through the inguinal canal. Here, we present a case of a retroperitoneal liposarcoma with prolapse from the left inguinal canal into the scrotum following hernia repair with a mesh plug.

CASE PRESENTATION

A 55-year-old male patient underwent a CT scan for a suspected recurrent inguinal hernia, which revealed a sizeable adipose-dense tumor by the left kidney extruded through the left inguinal canal surrounding the scrotum. The patient had undergone mesh plug repair for a left inguinal hernia at another hospital one year ago and noticed ipsilateral inguinal swelling after the hernia repair. The patient was referred to our hospital. The tumor resection was completed with combined resection of potentially involved organs: left side colon, left kidney, and left adrenal gland. Also, complete excision of the tumor was accomplished through surgical resection of the posterior wall of the inguinal canal, the mesh plug, and the tumor extending into the scrotum. Given the nearly complete absence of the inguinal canal's posterior wall and the anterior wall's torn state, sutures were employed to close the external obturator tenosynovitis. Additionally, the inguinal ligament was closed using a tension-free incision technique. Only a mesh was subsequently placed. The resected tumor measured 47 × 30 × 15 cm and 7.5 kg in weight. After surgical resection, a retroperitoneal liposarcoma diagnosis was established. After 2 years and 6 months following the surgical resection, no recurrence has been observed for either liposarcoma or inguinal hernia.

CONCLUSION

The previous inguinal hernia in this case must be a prolapse of retroperitoneal liposarcoma. Thus, it is recommended to conduct a preoperative examination, which should include a CT scan, since the presence of a fatty mass within the hernia may indicate the presence of a retroperitoneal liposarcoma. Even if a preoperative diagnosis cannot be made, a long-term prognosis can be expected if the retroperitoneal liposarcoma can be completely resected at reoperation.

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.

Usefulness of laparoscopy in the management of incidentally discovered retroperitoneal liposarcoma mimicking inguinal hernia: A case report and literature review

INTRODUCTION

Liposarcomas comprise around 10%-16% of soft tissue sarcomas. The two major sites of liposarcoma are the extremities and retroperitoneum. However, retroperitoneal liposarcomas mimicking inguinal hernia are rare. We present a case of retroperitoneal liposarcoma mimicking inguinal hernia, which was diagnosed after laparoscopic surgery and underwent curative resection.

PRESENTATION OF CASE

A 46-year-old man was admitted to our hospital with a right inguinal pain and swelling that had been recognized for 3 years. We diagnosed the inguinal swelling as a right inguinal hernia and planned laparoscopic surgery for inguinal hernia repair. A hernia sac, however, was not found and swollen retroperitoneal fatty tissue near the right internal inguinal ring was observed by laparoscopy. We aborted the surgical procedure and performed computed tomography and magnetic resonance imaging, which revealed an extraperitoneal and lipomatous tumor extending through the inguinal canal to the scrotum. Wide local excision of the tumor, along with right orchidectomy, was performed under laparotomy. Histopathological diagnosis showed well-differentiated liposarcoma of the retroperitoneum and confirmed tumor-free margins. No evidence of recurrence or metastasis was seen in the 9 months after curative resection.

DISCUSSION AND CONCLUSION

Laparoscopic surgery for inguinal hernia enables to observation of the inguinal region and management of rare cases, such as retroperitoneal liposarcoma.

Retroperitoneal Liposarcoma: A Concern in Inguinal Hernia Repair

Background and Objectives:

The goal of the study was to evaluate retroperitoneal sarcomas with continuous growth into the scrotum through the inguinal canal with regard to diagnostic approach, surgical treatment, and outcome. The analysis is based on a comprehensively documented case and a complete systematic review of published literature. Potential pitfalls are highlighted.

Methods:

We describe the case of a 57-year-old male Caucasian who presented with a swelling in the right groin. Suspecting a scrotal hernia, transabdominal preperitoneal plasty surgery was planned but intraoperatively a large retroperitoneal mass was revealed. After computed tomography scan and magnetic resonance imaging, a complete resection of the tumor was performed. Ten previously published cases describing the same pathology were retrieved from the PubMed database and analyzed systematically in a complete literature review.

Results:

Histology showed a well-differentiated liposarcoma with tumor-free resection margins. Twenty-two months postoperatively, the patient is in complete clinical remission.

Conclusion:

Preoperative clinical suspicion of retroperitoneal involvement is paramount for developing of a surgical strategy and in unclear cases demands extended preoperative diagnostic workup. Following the appropriate patient management is crucial to prognosis.

Two-stage surgery for intraperitoneal and retroperitoneal multicentric liposarcoma causing hydronephrosis: a case report

Background

Liposarcoma is a soft tissue sarcoma of adipocyte origin. Liposarcoma represents 20–30% of adult soft tissue tumors, which was most frequently seen in the retroperitoneal space in 45% and abdominal space in only 5% of cases, but the multicentric case is unknown. Herein, we describe a rare case of multicentric, large, intra-abdominal and retroperitoneal liposarcoma, one of which had caused infection and pressing the right ureter causing hydronephrosis, which was resected by two-stage surgery.

Case presentation

The patient was a 46-year-old man who was referred for abdominal bloating and fatigue. Enhanced computed tomography showed a 23-cm intra-abdominal tumor and a 14.6-cm left retroperitoneal tumor. The intra-abdominal tumor which compressed the right ureter caused right unilateral hydronephrosis and deteriorated the renal function. The intra-abdominal tumor had also formed an intra-abdominal abscess. We performed emergent laparotomy and resected the intra-abdominal tumor. After the recovery of renal function, we resected the residual retroperitoneal tumor. Histopathological examination showed both tumors to be myxoid/round cell type liposarcoma. Considering clinical findings and their location, he was diagnosed with multicentric liposarcoma. He underwent adjuvant chemotherapy and has been alive without any recurrence for 9 months after the operation.

Conclusions

We successfully resected large intra-abdominal and retroperitoneal multicentric myxoid/round cell liposarcomas. A two-stage surgery was a rational choice as it provides time to confirm the recovery of renal function.

Clinical curative effect of Mesalt combined with Mepilex dressing in postoperative infection of inguinal hernia

Background

Inguinal hernia is a common surgical disease. Tension-free hernioplasty is currently commonly used for its treatment, with multiple advantages such as simple surgical method, low recurrence rate, and ability to be performed in primary care hospitals, but the risk of incision infection still exists. Mild infection can be cured by local washing, dressing, and systemic antibiotics. If the infection is severe, the wound may not heal after removing the patch, and secondary suturing is needed.

Material/Methods

A total of 60 patients with postoperative infection after tension-free repair of inguinal hernia were randomly divided into control (n=30) and treatment (n=30) groups. Patients in the treatment group received Mesalt combined with Mepilex for dressing while the patients in the control group received conventional gauze for dressing. Pain degree, wound healing time, and dressing times were observed.

Results

The clinical therapeutic effect in the treatment group was significantly better than in the control group. The treatment group exhibited significantly less pain when patients receive dressing, shorter wounds healing time (15±3.5 vs. 30±5.0), and less dressing frequency (10±2.1 vs. 20±2.4).

Conclusions

Mesalt combined with Mepilex can effectively improve postoperative infection after inguinal hernia treatment, obviously reducing pain, shorting wound healing time, and decreasing dressing frequency. It can be widely used in clinical practice.