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Zhou W, Liu D, Fang T, Chen X, Jia H, Tian X, Hao C, Yue S. Rapid and Precise Diagnosis of Retroperitoneal Liposarcoma with Deep-Learned Label-Free Molecular Microscopy. Anal Chem 2024; 96:9353-9361. [PMID: 38810149 DOI: 10.1021/acs.analchem.3c05417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
The retroperitoneal liposarcoma (RLPS) is a rare malignancy whose only curative therapy is surgical resection. However, well-differentiated liposarcomas (WDLPSs), one of its most common types, can hardly be distinguished from normal fat during operation without an effective margin assessment method, jeopardizing the prognosis severely with a high recurrence risk. Here, we combined dual label-free nonlinear optical modalities, stimulated Raman scattering (SRS) microscopy and second harmonic generation (SHG) microscopy, to image two predominant tissue biomolecules, lipids and collagen fibers, in 35 RLPSs and 34 normal fat samples collected from 35 patients. The produced dual-modal tissue images were used for RLPS diagnosis based on deep learning. Dramatically decreasing lipids and increasing collagen fibers during tumor progression were reflected. A ResNeXt101-based model achieved 94.7% overall accuracy and 0.987 mean area under the ROC curve (AUC) in differentiating among normal fat, WDLPSs, and dedifferentiated liposarcomas (DDLPSs). In particular, WDLPSs were detected with 94.1% precision and 84.6% sensitivity superior to existing methods. The ablation experiment showed that such performance was attributed to both SRS and SHG microscopies, which increased the sensitivity of recognizing WDLPS by 16.0 and 3.6%, respectively. Furthermore, we utilized this model on RLPS margins to identify the tumor infiltration. Our method holds great potential for accurate intraoperative liposarcoma detection.
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Affiliation(s)
- Wanhui Zhou
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Institute of Medical Photonics, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
| | - Daoning Liu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Tinghe Fang
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Institute of Medical Photonics, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
| | - Xun Chen
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Institute of Medical Photonics, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
- School of Engineering Medicine, Beihang University, Beijing 100191, China
| | - Hao Jia
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Institute of Medical Photonics, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
| | - Xiuyun Tian
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Chunyi Hao
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Shuhua Yue
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Institute of Medical Photonics, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
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Hu BE, Wu CL, Liu JP, Zhang WJ. Surgical approach for complete resection of giant retroperitoneal liposarcoma with diaphragmatic hernia via ninth rib thoracotomy. Front Oncol 2023; 13:1239962. [PMID: 37681019 PMCID: PMC10482435 DOI: 10.3389/fonc.2023.1239962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023] Open
Abstract
Background Resection of a giant retroperitoneal liposarcoma is difficult and technically demanding, especially for large retroperitoneal tumors accompanied by a diaphragmatic hernia. Technically, the open abdominal approach can be time-consuming and difficult to perform, with possible intraoperative complications and other factors bringing psychological and physical difficulties to the patient. This study reports a safe and feasible approach for the complete resection of a large retroperitoneal tumor complicated by a diaphragmatic hernia. Methods A 58-year-old male patient with persistent upper abdominal pain and distension was treated at a local hospital on 4 July 2022. Computed tomography showed a mixed-density mass on the right retroperitoneum, and liposarcoma was considered. On 6 July 2022, the patient was transferred to our hospital for further treatment. Computed tomography showed a mass with low-density fatty shadow in the right adrenal region. The boundary with the right adrenal gland was unclear. The mass was 102 mm × 74 mm, and the right lobe of the liver was compressed. Insufficiency of the right middle lobe of the liver was seen due to a right diaphragmatic hernia and left mediastinal deviation. We considered the traditional approach for tumor resection via laparotomy, but we opted to perform a comprehensive evaluation first. The tumor was close to the back of the right kidney and liver, causing the diaphragm to rise because of its proximity to these organs. Exposing the tumor through laparotomy would be difficult, making it challenging to remove. The patient had a diaphragmatic hernia and moderate pulmonary dysfunction; therefore, we decided to enter the abdomen through a thoracotomy of the ninth rib. Results Using our technique, the tumor was easily visualized and completely removed in approximately 30 min. The intraoperative blood loss was 100 ml, and no postoperative bleeding, pneumothorax, intestinal fistula, infection, or other complications occurred. Conclusion The transthoracic approach may be a safer and more feasible resection method than the traditional open approach for patients with giant retroperitoneal liposarcoma with a diaphragmatic hernia.
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Affiliation(s)
- Bai-e Hu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
- Department of Physical Examination, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
| | - Chang-lei Wu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
| | - Ji-peng Liu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
| | - Wen-jun Zhang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
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Lieu DQ, Anh TN, Hoa TT, Quynh MT, Duc NM. Acute hemorrhage from a retroperitoneal liposarcoma treated by embolization. Radiol Case Rep 2023; 18:1909-1912. [PMID: 36942008 PMCID: PMC10024038 DOI: 10.1016/j.radcr.2023.02.033] [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: 01/11/2023] [Revised: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 03/14/2023] Open
Abstract
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.
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Affiliation(s)
- Dau Quang Lieu
- Department of Internal Medicine, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Tran Ngoc Anh
- Department of Internal Medicine, Hanoi Medical University Hospital, Hanoi, Vietnam
- Department of Internal Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Tran-Thi Hoa
- Department of Pathology, Hanoi Medical University, Hanoi, Vietnam
| | - Mai-Thi Quynh
- Department of Radiology, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, 2 Duong Quang Trung Ward 12 District 10, Ho Chi Minh City, Vietnam
- Corresponding author.
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Xia H, Fang F, Yuan H, Tu Y. Survival of a patient with multiple-recurrent giant retroperitoneal dedifferentiated liposarcoma for 15 years: A case report. Front Surg 2022; 9:916802. [DOI: 10.3389/fsurg.2022.916802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022] Open
Abstract
BackgroundRetroperitoneal liposarcoma (RPLS) is a variety of soft tissue sarcoma that originates from mesenchymal cells. A tumor measuring greater than 30 cm is called a “giant liposarcoma.” A part of the neoplasm tends to grow in size, recur locally, or metastasize distantly. In those with such a condition, long-term survival is uncommon. Therefore, it is necessary to present a uniform and optimized program to improve the prognosis.MethodsBy successfully treating a multiple-recurrent giant retroperitoneal dedifferentiated liposarcoma (RP DDLPS) in July 2010, we hope to devise more comprehensive strategies to improve diagnosis, therapy, and outcome.ResultsIn July 2010, we thoroughly resected a giant multifocal RPLS with a concomitant part of the gastric wall. The histopathological examination revealed a high-grade (grade III) dedifferentiated liposarcoma. The patient was discharged uneventfully on the 15th postoperative day. She relapsed after 16 months and needed another complete excision. After 9 months, she died after the fourth recidive. The patient had experienced four recurrences and underwent operations with 15 years of follow-up.ConclusionsThe above demonstrates that we were able to successfully treat the multirecurrent giant RPLS, despite the patient’s poor medical condition, with meticulous management. Moreover, this indicates that long-term survival could be achieved for high-grade RP DDLPS.
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Giant retroperitoneal low grade liposarcoma with left kidney displacement: A case report. Radiol Case Rep 2022; 17:4091-4095. [PMID: 36065244 PMCID: PMC9440367 DOI: 10.1016/j.radcr.2022.07.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 07/26/2022] [Accepted: 07/31/2022] [Indexed: 11/28/2022] Open
Abstract
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.
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Rampersad F, Diljohn J, Teelucksingh S, Greaves W, Dan D. Retroperitoneal liposarcoma mimicking pheochromocytoma. Radiol Case Rep 2021; 16:1493-1498. [PMID: 33936355 PMCID: PMC8079243 DOI: 10.1016/j.radcr.2021.03.033] [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: 02/14/2021] [Revised: 03/13/2021] [Accepted: 03/17/2021] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Fidel Rampersad
- Radiology Unit, Department of Clinical Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad, West Indies
| | - Jason Diljohn
- The University of the West Indies, St Augustine Campus, Trinidad, West Indies
| | - Surujpal Teelucksingh
- Department of Clinical Medicine Sciences, The University of the West Indies, St Augustine Campus, Trinidad, West Indies
| | - Wesley Greaves
- Nexgen Pathology Services Limited, San Juan, Trinidad and Tobago, Puerto Rico
| | - Dilip Dan
- Department of Clinical Surgical Sciences, The University of the West Indies, St Augustine Campus, Trinidad, West Indies
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El-Helou E, Alimoradi M, Sabra H, Naccour J, Haddad MM, Bitar H. Recurrent giant retroperitoneal liposarcoma with 10 years follow up. Case report and review of literature. Int J Surg Case Rep 2020; 75:504-512. [PMID: 33076205 PMCID: PMC7530305 DOI: 10.1016/j.ijscr.2020.09.143] [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: 08/17/2020] [Accepted: 09/19/2020] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION This case is of a patient with a recurrent giant retroperitoneal liposarcoma, followed-up and operated multiple times over 10 years. We report this case because of its rarity and review all previous articles reporting "Giant Retroperitoneal Liposarcoma" in the English literature. CASE DESCRIPTION A 70 years old man presented to our clinic for dizziness and fatigue. He was incidentally found to have a large retroperitoneal mass filling all the length of the abdominal cavity and shifting all intraabdominal viscera and kidney to the left side. En bloc excision of a 50 × 30 × 18 cm, 9 kg tumor was performed. Final pathology revealed a well-differentiated liposarcoma. Five years later, the patient was reoperated for recurrence and a well-differentiated liposarcoma was excised in 2 pieces (the biggest measuring 14 × 11 × 7 cm) along with the appendix. Four years later the patient was operated on again for a second recurrence, and again a well-differentiated liposarcoma (16 × 10 × 7 cm) extending into the right inguinal canal was excised. One year thereafter, the patient was diagnosed with a third recurrence (22 × 12 cm). DISCUSSION Retroperitoneal Liposarcomas are rare tumors, presenting with different histological differentiation. They are diagnosed using multiple imaging modality, mainly CT scan, and it is confirmed by percutaneous large core needle biopsy. R0 Surgical excision remains the proper treatment for non-metastatic tumors, which may necessicate multiorgan resection. They rarely grow to reach a large size and be labled as "Giant Retroperitoneal Liposarcoma".
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Affiliation(s)
- Etienne El-Helou
- General Surgery Department, Faculty of Medical Sciences, Lebanese University, Mount Lebanon, Lebanon.
| | - Mersad Alimoradi
- General Surgery Department, Faculty of Medical Sciences, Lebanese University, Mount Lebanon, Lebanon.
| | - Hassan Sabra
- General Surgery Department, Faculty of Medical Sciences, Lebanese University, Mount Lebanon, Lebanon.
| | - Jessica Naccour
- Emergency Medicine Department, Faculty of Medical Sciences, Lebanese University, Mount Lebanon, Lebanon.
| | - Marwan M Haddad
- Radiology Department, Mount Lebanon Hospital, Mount Lebanon, Lebanon.
| | - Henri Bitar
- General Surgery Department, Mount Lebanon Hospital, Mount Lebanon, Lebanon.
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Tober N, Gentile M, Iodice G. Long-term eribulin treatment in patients with a single kidney and retroperitoneal liposarcoma. Future Oncol 2019; 16:5-8. [PMID: 31872769 DOI: 10.2217/fon-2019-0595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Retroperitoneal sarcomas are extremely rare malignant tumors. The most common type of sarcomas arising in the retroperitoneum are liposarcomas, occurring mostly in the sixth and seventh decades of life. The only potentially curative approach to liposarcomas is the complete surgical resection of the tumor with negative microscopic margins. However, retroperitoneal liposarcomas exhibit a propensity for local recurrence and distant metastasis despite the negative surgical margins, thus requiring additional therapy. Eribulin demonstrated a benefit in terms of overall survival in patients with advanced or metastatic liposarcoma. We report two cases of patients, both submitted to concomitant right nephrectomy, who experienced a long-lasting control of recurrent retroperitoneal liposarcoma before being submitted to eribulin-based therapeutic regimens (23 and 24 treatment cycles completed, respectively).
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Affiliation(s)
- Nastassja Tober
- Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi di Bologna, Bologna, Italy
| | - Marica Gentile
- Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Giuseppe Iodice
- Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy
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Mandato VD, Mastrofilippo V, De Marco L, Aguzzoli L. Laparoscopic approach to an incidentally found pelvic retroperitoneal liposarcoma: Case report and review. Medicine (Baltimore) 2019; 98:e15184. [PMID: 30985710 PMCID: PMC6485822 DOI: 10.1097/md.0000000000015184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
RATIONALE Well-differentiated liposarcomas (WDLPS) are rare retroperitoneal tumors that can reach significant size as they can grow without constrains before becoming symptomatic. Laparotomic open radical tumor resection represents the most common surgical approach. PATIENT CONCERNS A mass with "fat fluid level" was found in the right pelvis of an asymptomatic woman undergoing routine transvaginal ultrasound: the preoperative diagnosis was right mature ovarian teratoma. DIAGNOSIS Postoperative histopathology confirmed the diagnosis of WDLPS. INTERVENTIONS A radical laparoscopic excision of the retroperitoneal mass with bilateral salpingectomy was performed. OUTCOMES Patient is free of disease at 18 months after surgery. LESSON Despite computed tomography scan is the gold standard technique to identify WDLPS, such neoplasms can be misdiagnosed for mature ovarian teratomas. When a retroperitoneal mass is incidentally discovered during a surgery, an open core-needle biopsy is usually performed, and appropriate treatment planned only after complete staging and final pathology are available. Instead, when tumor margins are identified, resection of an incidentally diagnosed WDLPS would benefit from laparoscopic magnification that could improve distinguishing the disease from the surrounding tissues. Therefore, laparoscopy could represent a safe and effective technique to diagnose and treat retroperitoneal diseases.
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Affiliation(s)
| | | | - Loredana De Marco
- Unit of Pathology, Azienda USL-IRCCS of Reggio Emilia, Risorgimento, Italy
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Optimal maximum duration for delaying salvage operation when recurrence of retroperitoneal liposarcoma is suspected: a single-center study. Int J Clin Oncol 2019; 24:583-589. [PMID: 30604162 DOI: 10.1007/s10147-018-01383-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study was designed to identify the optimal maximum duration for delaying salvage operation when recurrence of retroperitoneal liposarcoma (LPS) is suspected. METHODS Patients who underwent salvage operation at Samsung Medical Center for recurrent retroperitoneal LPS from January 2000 to December 2015 were reviewed. The time interval between recurrence and operation for recurrence was divided by 1, 2 or 3 months. A Cox proportional-hazards model was used to analyze factors related to disease-free survival along with recurrence-to-operation interval divided by 1, 2 or 3 months. RESULTS The 1-, 3-, and 5-year disease-free survival rates were 43.2%, 15.6% and 13.4%, respectively. FNCLCC grade (p = 0.023) and recurrence-to-operation interval divided by 3 months (p = 0.003) were significant factors associated with recurrence. FNCLCC grade 2 (HR 1.940, CI 0.935-4.026, p = 0.238) and grade 3 (HR 4.049, CI 1.767-9.281, p = 0.007) showed increased risk compared to grade 1. Patients who underwent salvage operation more than 3 months after recurrence showed significantly increased risk of recurrence compared to patients within 3 months (HR 2.724, CI 1.391-5.337, p = 0.003). CONCLUSIONS Based on our analysis of recurrence-free survival, salvage operation can be delayed for less than 3 months when recurrence is suspected. A short-term follow-up imaging study should be performed within this period.
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Ioannidis A, Koutserimpas C, Konstantinidis M, Drikos I, Voulgaris P, Economou N. Dyspnea caused by a giant retroperitoneal liposarcoma: A case report. Oncol Lett 2018; 16:1539-1542. [PMID: 30008834 PMCID: PMC6036330 DOI: 10.3892/ol.2018.8791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/08/2018] [Indexed: 11/09/2022] Open
Abstract
Liposarcomas are the most common soft tissue tumors with various histological subtypes. They usually appear in the retroperitoneal region of the abdomen, but their symptomatology remains unclear and their diagnosis, as well as treatment challenging. A case of a 55-year-old female patient with dyspnea and light diffuse abdominal pain caused by a giant retroperitoneal liposarcoma is presented. The patient had an unremarkable medical history, while the computed tomography scan revealed a large mass at the right portion of the abdomen, with its upper limits to the lower edge and the gate portion of the liver. The mass was in contact with the right kidney, the inferior vena cava and the right renal vein, causing mild dilation of the right kidney pelvis. Without any evidence of intra-abdominal metastases, the tumor was surgically resected. The histological analysis of the tumor revealed a well-differentiated liposarcoma. The patient had an uneventful recovery and was discharged on the 10th postoperative day. Until today (4 years later) she remains asymptomatic, without any signs of recurrence. The retroperitoneal liposarcoma is a clinical entity with unclear clinical symptoms and the physician should consider including it in the differential diagnosis of a majority of symptoms, such as dyspnea.
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Affiliation(s)
- Argyrios Ioannidis
- Department of General Surgery, 'Sismanoglion' General Hospital of Attika, 15126 Athens, Greece
| | - Christos Koutserimpas
- Department of General Surgery, 'Sismanoglion' General Hospital of Attika, 15126 Athens, Greece
| | - Michael Konstantinidis
- National and Kapodistrian University of Athens, School of Medicine, 11527 Athens, Greece
| | - Ioannis Drikos
- Department of General Surgery, 'Sismanoglion' General Hospital of Attika, 15126 Athens, Greece
| | - Panagiotis Voulgaris
- Department of General Surgery, 'Sismanoglion' General Hospital of Attika, 15126 Athens, Greece
| | - Nikolaos Economou
- Department of General Surgery, 'Sismanoglion' General Hospital of Attika, 15126 Athens, Greece
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Wu YX, Liu JY, Liu JJ, Yan P, Tang B, Cui YH, Zhao YL, Shi Y, Hao YX, Yu PW, Qian F. A retrospective, single-center cohort study on 65 patients with primary retroperitoneal liposarcoma. Oncol Lett 2017; 15:1799-1810. [PMID: 29434876 DOI: 10.3892/ol.2017.7533] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/13/2017] [Indexed: 12/25/2022] Open
Abstract
Primary retroperitoneal liposarcoma (PRPLS) is the most common soft tissue malignancy of the retroperitoneum. To determine the pathological features and the curative effects of surgery in patients with PRPLS, and to elucidate key prognostic factors, the present study retrospectively analyzed the clinical cases of 65 patients with PRPLS. Immunohistochemical analysis demonstrated that vimentin and Ki-67 are better indicators for PRPLS immunohistochemical diagnosis compared with S-100 protein. S-100 protein was predominantly expressed in well-differentiated PRPLS. Positive expression of vimentin and Ki-67 were observed in almost all PRPLS samples, and Ki-67 exhibited a higher expression level in high-grade PRPLS. The level of Ki-67 expression was negatively correlated with disease-specific survival (DSS). Survival analysis revealed that the pathological subtype and histological grade were associated with DSS and local recurrence in the patients, whereas the tumor burden was associated with DSS but not local recurrence. In addition, complete tumor resection and contiguous organ resection were able to improve DSS. Microscopically positive margins did not affect DSS, whereas gross margins did. Multivariate analysis revealed that pathological subtype, histological grade and contiguous organ resection were independent prognostic factors, and that histological grade was an independent factor for local recurrence. Patient sex and age at presentation were not independent factors associated with prognosis or local recurrence. Correlation analysis demonstrated that postoperative local recurrence significantly affected DSS, and local recurrence was the most common cause of mortality among patients. Histological grade was strongly associated with the invasion of adjacent organs but not with tumor burden. Furthermore, the tumor burden was not associated with recurrence or tumor invasion of adjacent organs. Ki-67 expression was associated with prognosis. Pathological subtype, histological grade and contiguous organ resection were independent prognostic factors, while histological grade was an independent factor which affected tumor recurrence.
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Affiliation(s)
- Yi-Xi Wu
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
| | - Jun-Yan Liu
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
| | - Jia-Jia Liu
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
| | - Peng Yan
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
| | - Bo Tang
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
| | - You-Hong Cui
- Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
| | - Yong-Liang Zhao
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
| | - Yan Shi
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
| | - Ying-Xue Hao
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
| | - Pei-Wu Yu
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
| | - Feng Qian
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
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Zielinski J, Haponiuk I, Jaworski R, Peksa R, Irga-Jaworska N, Jaskiewicz J. Retroperitoneal tumor: giant cavernous hemangioma - case presentation and literature review. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2016; 13:375-379. [PMID: 28096841 PMCID: PMC5233774 DOI: 10.5114/kitp.2016.64889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 11/17/2016] [Indexed: 11/17/2022]
Abstract
Retroperitoneal hemangiomas are very rare. This paper presents the case of a 71-year-old female patient with giant cavernous hemangioma of the retroperitoneum who underwent surgical treatment for abdominal pain and left lower limb edema. Interventional staged treatment with percutaneous transcatheter arterial embolization prior to surgery was considered. Radical resection of the tumor was performed, which caused the symptoms to abate. Additionally a literature review of cases involving cavernous hemangioma in the retroperitoneal space is presented. No description of retroperitoneal cavernous hemangioma originating from the bowel was found in the analyzed reports.
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Affiliation(s)
- Jacek Zielinski
- Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Ireneusz Haponiuk
- Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland
| | - Radoslaw Jaworski
- Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland
| | - Rafal Peksa
- Department of Pathology, Medical University of Gdansk, Gdansk, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | - Janusz Jaskiewicz
- Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland
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Park H, Lee S, Kim B, Lim DH, Choi YL, Choi GS, Kim JM, Park JB, Kwon CHD, Joh JW, Kim SJ. Tissue expander placement and adjuvant radiotherapy after surgical resection of retroperitoneal liposarcoma offers improved local control. Medicine (Baltimore) 2016; 95:e4435. [PMID: 27512857 PMCID: PMC4985312 DOI: 10.1097/md.0000000000004435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 06/26/2016] [Accepted: 07/07/2016] [Indexed: 12/28/2022] Open
Abstract
Given that retroperitoneal liposarcoma (LPS) is extremely difficult to completely resect, and has a relatively high rate of recurrence, radiotherapy (RT) is the treatment of choice after surgical resection. However, it is difficult to obtain a sufficient radiation field because of the close proximity of surrounding organs. We introduce the use of tissue expanders (TEs) after LPS resection in an attempt to secure a sufficient radiation field and to improve recurrence-free survival.This study is a retrospective review of 53 patients who underwent surgical resection of LPS at Samsung Medical Center between January 1, 2005, and December 31, 2012, and had no residual tumor detected 2 months postoperatively. The median follow-up period was 38.9 months.Patients were divided into 3 groups. Those in group 1 (n = 17) had TE inserted and received postoperative RT. The patients in group 2 (n = 9) did not have TE inserted and received postoperative RT. Finally, those in group 3 (n = 27) did not receive postoperative RT. Multivariate analysis was performed to identify the risk factors associated with recurrence-free survival within 3 years. Younger age, history of LPS treatment, and RT after TE insertion (group 1 vs group 2 or 3) were significantly favorable factors influencing 3-year recurrence-free survival.TE insertion after LPS resection is associated with increased 3-year recurrence-free survival, most likely because it allows effective delivery of postoperative RT.
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Affiliation(s)
- Hyojun Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea & Sheikh Khalifa Specialty Hospital, Ras al Khaimah, U.A.E. Department of Radiation Oncology Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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15
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Abstract
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.
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16
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Giant retroperitoneal liposarcoma: Case report and review of the literature. Int J Surg Case Rep 2015; 9:23-6. [PMID: 25722109 PMCID: PMC4392328 DOI: 10.1016/j.ijscr.2015.02.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 02/09/2015] [Accepted: 02/12/2015] [Indexed: 11/23/2022] Open
Abstract
AIM Retroperitoneal soft-tissue sarcomas are relatively uncommon diseases, the most frequent histotype, ranging from 20% to 45% of all cases, is represented by liposarcoma, which is a hard-to treat condition for its local aggressiveness and clinical aspecificity. PRESENTATION OF CASE We report a case of a 64-years-old woman who underwent surgical resection for a giant pleomorphic retroperitoneal liposarcoma. DISCUSSION Currently chemotherapy for retroperitoneal soft-tissue sarcomas is no effective, and radiotherapy has limited efficacy due to the toxicity affecting adjacent intra-abdominal structures, showed validity only in case of high-grade malignancy by reducing local recurrence, but with no advantage in overall survival. Nowadays only, the complete surgical resection remains the most important predictor of local recurrence and overall survival. CONCLUSION The removal of a retroperitoneal sarcoma of remarkable size is a challenge for the surgeon owing to the anatomical site, to the absence of an anatomically evident vascular-lymphatic peduncle and to the adhesions contracted with the contiguous organs and with the great vessels. Therefore, we believe that, particularly for large-size diseases associated to high-grade malignancy, a complete surgical resection with removal of the contiguous intra and retroperitoneal organs when infiltrated represents the only therapeutic option to obtain a negative margin and therefore an oncological radicality.
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17
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Bhat SP, Prasad KHL, Shetty R, Ballal R, Kumar SY, Hegde P. Giant inflammatory variant of well-differentiated liposarcoma of retroperitoneum: a rare case report. Indian J Surg Oncol 2014; 4:272-4. [PMID: 24426736 DOI: 10.1007/s13193-013-0239-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 03/19/2013] [Indexed: 11/25/2022] Open
Affiliation(s)
- Shubha P Bhat
- Department of Pathology, K S Hegde Medical Academy of Nitte University, Mangalore, Karnataka India 575018
| | - Kishan H L Prasad
- Department of Pathology, K S Hegde Medical Academy of Nitte University, Mangalore, Karnataka India 575018
| | - Rohan Shetty
- Department of General Surgery, K S Hegde Medical Academy of Nitte University, Deralakatte, Mangalore, Karnataka India 575018
| | - Rajesh Ballal
- Department of General Surgery, K S Hegde Medical Academy of Nitte University, Deralakatte, Mangalore, Karnataka India 575018
| | - Sunil Y Kumar
- Department of Pathology, K S Hegde Medical Academy of Nitte University, Mangalore, Karnataka India 575018
| | - Panna Hegde
- Department of Pathology, K S Hegde Medical Academy of Nitte University, Mangalore, Karnataka India 575018
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18
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Giant retroperitoneal liposarcoma: a case report. Case Rep Oncol Med 2012; 2012:869409. [PMID: 23227387 PMCID: PMC3513723 DOI: 10.1155/2012/869409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 10/31/2012] [Indexed: 11/17/2022] Open
Abstract
Soft tissue sarcomas represent less than 1% of all human neoplasms. One-third of malignant tumors that arise in the retroperitoneum are sarcomas and liposarcoma is the most common retroperitoneal sarcoma. More often than not, patients report late to the hospital due to the slow progress and few late symptoms. Thus, the tumor is known to grow to enormous sizes. Here, we report a case of giant retroperitoneal liposarcoma weighing more than 7 kgs.
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Akhoondinasab MR, Omranifard M. Huge retroperitoneal liposarcoma. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2011; 16:565-7. [PMID: 22091275 PMCID: PMC3214364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 02/09/2011] [Indexed: 11/18/2022]
Abstract
Liposarcoma are one of the common soft tissue sarcomas of adulthood which are remarkable because of their frequently large size. We report a case with an extremely large well-differentiated retroperitoneal liposarcoma that weighted 32 kilograms. The patient had relapse about one year later and two recurrent tumors were successfully excised.
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Affiliation(s)
- Mohammad Reza Akhoondinasab
- Assistant Professor, Department of Plastic and Reconstructive Surgery, Tehran University of Medical Sciences, Tehran, Iran., Corresponding Author E-mail:
| | - Mahmoud Omranifard
- Department of Surgery, Alzahra Hospital, Isfahan University of Medical Science, Isfahan, Iran
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20
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Aji S, Alhassan S, Ibrahim S. Giant Retroperitoneal Liposarcoma Mimicking Ovarian tumour - A Case report. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2011; 1:105-111. [PMID: 25452957 PMCID: PMC4170257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Retroperitoneal liposarcomas are rare tumours representing less than 1% of all malignant tumours. They are generally slow growing and may attain enormous sizes. We report a case of a giant (9.8kg) retroperitoneal liposarcoma in a 65 years old lady which was initially misdiagnosed as an ovarian tumour. She had a successful surgical removal and has been followed up for more than one year with no evidence of recurrence.
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Affiliation(s)
- Sa Aji
- Department of Surgery & Department of Obstetrics & Gynaecology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Su Alhassan
- Department of Surgery & Department of Obstetrics & Gynaecology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Sa Ibrahim
- Department of Surgery & Department of Obstetrics & Gynaecology, Aminu Kano Teaching Hospital, Kano, Nigeria
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21
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Milone M, Pezzullo LS, Salvatore G, Pezzullo MG, Leongito M, Esposito I, Milone F. Management of high-grade retroperitoneal liposarcomas: personal experience. Updates Surg 2011; 63:119-24. [PMID: 21455814 DOI: 10.1007/s13304-011-0061-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 03/10/2011] [Indexed: 02/03/2023]
Abstract
Sarcomas are uncommon malignant tumors arising from mesenchymal tissue, accounting for approximately 10% of soft-tissue sarcomas and less than 1% of all malignant neoplasms. The most frequent subtypes of retroperitoneal sarcomas are liposarcoma. Total surgical extirpation appears the only chance for patient cure since medical therapies have shown little efficacy. We have analyzed our series of 32 retroperitoneal liposarcoma that undergone surgical resection and with at least 5 years of follow-up. We have included 21 patients who underwent a complete resection (R0) and 6 patients who underwent an incomplete resection (R1). However, the operation's goal was a complete tumor resection with tumor-free resection margins. The 5-year survival was 85.7% when we performed a R0 resection, while it was 33.3% when we performed a R1 resection with a significant statistical difference (p = 0.02). Surgery is the gold standard for treatment of liposarcoma. Despite advances in diagnostic modalities, surgical techniques and the adoption of more aggressive procedure, such disease still has a propensity for local recurrence, even after an apparent complete resection. Therefore, locoregional recurrence remains the main cause of death in patients with a retroperitoneal liposarcoma. Moreover when the tumor recurs locally, the treatment of choice is to remove the recurrence. Our experience shows that a complete resection of primary lesions and further resection of recurrences early detected with CT examination could improve the overall survival of patients with retroperitoneal liposarcoma. Moreover in our series, the patients who undergo R1 resection had a worse prognosis.
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Affiliation(s)
- Marco Milone
- Department of Surgery Orthopedy Traumatology and Emergency, University of Naples Federico II, Naples, Italy.
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22
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Kuratate S, Chikakiyo M, Kaneda Y, Harino Y, Hirose T, Yagi T, Saitoh S, Sumitomo M, Fujino R, Satake N, Hirose T. A case of perinephric liposarcoma which recurred ten years later from the initial operation. THE JOURNAL OF MEDICAL INVESTIGATION 2011; 58:154-8. [PMID: 21372501 DOI: 10.2152/jmi.58.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A 58-year old man was referred to our hospital for treatment of an abdominal mass. As for him, tumor resection with right nephrectomy had been performed ten years ago for a giant well-differentiated perinephric liposarcoma. CT examination showed a huge tumor shadow in the abdominal cavity. Abdominal MRI examination showed a 15 × 8 cm tumor with almost high signal intensity on the T2 weighted images. At laparotomy, a large bulky retroperitoneal tumor pointed out before an operation was found. Surgical extirpation of the tumor was performed. Besides, several tumors of the thumb head size were detected into right retroperitoneal fatty tissue. The right side mesocolon and the tumors were not able to exfoliate, therefore right hemicolectomy was performed. Histological features showed dedifferentiated liposarcoma. The postoperative course was uneventful. But eight months after surgery, he was admitted again for treatment of a 4 × 3 cm retroperitoneal tumor. Extirpation of the tumor was performed. Histological finding of this tumor also showed dedifferentiated liposarcoma. Dedifferentiation, occurring in 15% of the well-differentiated liposarcomas, sometimes may develop later. Long-term detailed follow-up is necessary for well-differentiated liposarcoma.
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Affiliation(s)
- Shinji Kuratate
- Department of Surgery, Tokushima Prefectural Central Hospital, Tokushima, Japan
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23
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Hashimoto Y, Hatakeyama S, Tachiwada T, Yoneyama T, Koie T, Kamimura N, Yanagisawa T, Hakamada K, Ohyama C. Surgical treatment of a giant liposarcoma in a Japanese man. Adv Urol 2010; 2010:943073. [PMID: 21197426 PMCID: PMC3010627 DOI: 10.1155/2010/943073] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 10/23/2010] [Accepted: 11/13/2010] [Indexed: 12/19/2022] Open
Abstract
We report a case of a rapidly progressing giant retroperitoneal liposarcoma weighing 22 kg in a 41-year-old Japanese man, successfully treated with surgical excision. To our knowledge, this is the largest liposarcoma in the Japanese population reported in the literature.
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Affiliation(s)
- Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan
| | - Tokushi Tachiwada
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan
| | - Takahiro Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan
| | - Takuya Koie
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan
| | - Noritaka Kamimura
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan
| | - Takeshi Yanagisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan
- Department of Urology, Aomori Rosai Hospital, Hachinohe 031-8551, Japan
| | - Kenichi Hakamada
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan
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