Liposarcoma of the stomach: A rare case report

Laparoscopic management of a gastric liposarcoma with malignant transformation from a gastric lipoma: A rare case report

INTRODUCTION AND IMPORTANCE

Liposarcoma is one of the most common mesenchymal neoplasms in adults. Among liposarcomas, gastrointestinal tract involvement is uncommon, and liposarcoma of the stomach is a particularly rare entity, In addition, few cases of gastric liposarcoma with malignant transformation from benign gastric lipoma have been reported.

PRESENTATION OF CASE

Here we present the case of a 62-year-old male patient who was diagnosed with gastric liposarcoma and managed with laparoscopic surgical resection. He was first diagnosed with subepithelial lipoma of the stomach 4 years ago and was under observation, but underwent laparoscopic distal gastrectomy due to malignant transformation of gastric lipoma. He has been following up for 1 year after surgery, and there are no recurrence or other complications to date.

CLINICAL DISCUSSION

This patient was initially diagnosed with gastric lipoma and was surgically resected after 4 years of observation to show malignant transformation. To the best of our knowledge, this case represents the first report of gastric lipoma demonstrating malignant transformation into gastric liposarcoma.

CONCLUSION

Gastric lipoma can be transformed into gastric liposarcoma, so if the size is large or the rate of size change is fast, surgical resection is recommended in the early state, and en-bloc resection including node dissection and reconstruction are desirable during surgery.

Incidental Diagnosis of Primary Pleural Liposarcoma in a COVID-19-Positive Patient

A few cases of primary liposarcoma of pleura have been reported worldwide. We report a young gentleman who was admitted with what was initially thought as coronavirus disease 2019 (COVID-19)-related pulmonary symptoms. His chest CT showed a large pleural effusion causing a mediastinal shift and compressing vital structures. He did not respond to conservative drainage intervention and subsequently underwent a left thoracotomy for his worsening clinical picture. He was found to have a large left pleural mass that was incompletely resected. Histopathology examination showed low-grade soft tissue sarcoma with lipogenic differentiation suggestive of myxoid liposarcoma. He was subsequently given adjuvant chemotherapy but succumbed and died because of the progression of the disease.

Primary gastric dedifferentiated liposarcoma resected endoscopically: A case report

BACKGROUND

Liposarcoma is one of the most common adult mesenchymal tumors but is uncommon in the gastrointestinal tract and extremely rare in the stomach. Furthermore, the histological subtypes of liposarcoma usually reported in the stomach are well-differentiated or myxoid, and few reports have been issued on small-sized gastric liposarcomas resected endoscopically and followed up. Herein, we report a case of primary gastric dedifferentiated liposarcoma (DL) that was resected endoscopically.

CASE SUMMARY

A 67-year-old female Korean patient was referred to our institution for further evaluation of a gastric submucosal tumor (SMT) located in the lesser curvature of the gastric body by esophagogastroduodenoscopy. Endoscopic ultrasound revealed a well-circumscribed, slightly heterogeneous, isoechoic, 17 mm × 10 mm sized mass originating from the third sonographic layer. Computed tomography showed no evidence of significant lymph node enlargement or distant metastasis. Endoscopic resection was undertaken using the snare resection technique after mucosal precutting to provide a definitive histopathologic diagnosis, which proved to be consistent with DL, based on its morphology and the immunoexpressions of MDM2 and CDK4. The patient was planned for surgery because the deep resection margin was positive for malignancy. After declining any invasive procedure or adjuvant treatment, the patient was placed under close follow-up, and at one year after endoscopic resection, remained disease free.

CONCLUSION

This is the first reported case of a small primary gastric DL resected endoscopically and followed up. This report demonstrates that when diagnosis of a SMT is uncertain, the use of invasive techniques, including endoscopic resection, should be considered.

Gastrointestinal Stromal Tumor (GIST) and Synchronous Intra-Abdominal Liposarcoma: A Report of Two Rare Cases and Literature Review

INTRODUCTION

Gastrointestinal stromal tumors (GISTs) quite frequently occur synchronously with other malignancies, with most cases being adenocarcinomas. GISTs and liposarcomas are both of mesenchymal origin, and their coexistence is extremely rare.

METHODS

We conducted a review of the current literature regarding the synchronous occurrence of GISTs and intra-abdominal liposarcomas. An electronic search of the literature was undertaken using MEDLINE (database provider PubMed). Furthermore, we present the first described case of an 86-year-old male with a GIST and synchronous liposarcoma, both located in the stomach, as well as a 66-year-old male with a gastric GIST and concurrent retroperitoneal liposarcoma.

RESULTS

A total of 5 cases of synchronous GIST and intra-abdominal liposarcoma have been reported in the literature to date, with the most recent cases included in the present study.

CONCLUSION

Further research is required to explain any possible correlation in the coexistence of these different neoplasms of the same origin. Meanwhile, R0 resection of both tumors remains the treatment of choice.

Laparoscopic management of gastric liposarcoma: A case report and review of the literature

•

Soft tissue tumors are characterized by frequent somatic chromosomal rearrangements.

•

Symptoms include epigastric pain, nausea, anorexia, and gastrointestinal bleeding.

•

Gastric liposarcoma is the least common sarcoma of the gastrointestinal tract.

•

CT and pathological analysis of resected specimens enable diagnosis.

•

The gold standard of treatment is surgery with radical resection of the tumor.

Introduction

Liposarcoma is one of the most common mesenchymal neoplasms in adults. Predominant locations are the retroperitoneum and limbs, it rarely occurs in the gastrointestinal tract. Gastric liposarcoma is extremely rare, with fewer than 30 cases reported around the world.

Presentation of case

Here we present the case of a 70-year-old female patient who was diagnosed with gastric liposarcoma and managed with laparoscopic surgical resection. The patient is currently being followed up and is alive without recurrence 12 months after the operation.

Discussion

Gastric liposarcoma approach requires proper diagnosis with computed tomography and endoscopy, in order to develop an adequate surgical plan. Laparoscopic en-bloc resection and gastrointestinal reconstruction is the ideal management in this type of patient.

Conclusion

Gastric liposarcoma is an extremely rare entity, his management consists of wide en-bloc resection with a gastrointestinal reconstruction.

Proximal Gastrectomy in a Case of Giant Gastric Liposarcoma and a 5-Year Follow-Up

Even though liposarcomas account for 10–20% of all mesenchymal malignancies, they are extremely rarely located in the stomach. We report the case of a female patient with gastric liposarcoma. CT revealed a giant hypoechogenic tumour subcardially on the posterior gastric wall. Endoscopic tumour resection by piecemeal technique was done, and a lipoma was confirmed on histopathological examination. A recurrent bleeding tumour was proven 6 weeks later. The patient underwent an open proximal gastrectomy with pyloroplasty, and liposarcoma was surprisingly revealed in the resected specimen, finally. Five years later, our patient had been without recurrence or any somatic difficulties. The CT finding of a submucosal fatty tumour with heterogeneous density within the gastric wall should raise the suspicion for liposarcoma. The goal is the surgical removal of the tumour with sufficient margins ensuring R0 resection.

Liposarcoma of the stomach: Report of two cases and review of the literature

Liposarcoma of the stomach is extremely rare, and only 37 cases have been reported worldwide. We herein report two cases of liposarcoma of the stomach. The first patient was referred to our hospital with upper abdominal discomfort. The endoscopic examination revealed a tumor mass about 3 cm in diameter. The patient underwent a partial gastrectomy and had an uneventful recovery. The histopathological examination revealed a well-differentiated liposarcoma. The second patient had symptoms of upper abdominal discomfort combined with nausea and anorexia. Several palpable masses were found with endoscopy. Endoscopic submucosal dissection was the treatment used, and the postoperative course was uneventful. The histopathological diagnosis was a well-differentiated liposarcoma. The two patients did not undergo any adjuvant therapy. They are both currently in good condition without recurrence. Therefore, we believe that the outcome of liposarcoma of the stomach is positive, and surgical resection may be the first choice for treatment at present.

Gastric liposarcoma in a patient with severe obesity

Liposarcoma is the most common soft tissue sarcoma in adults. Predominant locations are the limbs and retroperitoneum. Intra-abdominal liposarcoma represents only 2% of all cases and visceral location is exceptional. Gastric liposarcoma is extremely rare, with fewer than 20 cases reported. The treatment of choice is wide en-bloc surgical resection. If the tumour arises in the area of the cardia, resection involves resection of the proximal stomach as well as the distal oesophagus. Traditional reconstruction with oesophagogastrostomy often leads to troublesome reflux. We report a case of gastric liposarcoma arising in the gastro-oesophageal junction in a severely obese patient.

Gastric liposarcoma resected by laparoscopic total gastrectomy to achieve a wide surgical margin

Gastric liposarcoma is an extremely rare tumour that usually affects the extremities and retroperitoneum. Preoperative diagnosis is difficult, and operative procedures are not well standardised. A 61-year-old woman presented with melaena, epigastric discomfort and palpitations. Upper endoscopy revealed a submucosal tumour at the posterior gastric fundus with an actively bleeding ulcer on the top. Our preoperative diagnosis was lipoma, and we performed laparoscopic intragastric surgery. However, the histopathological diagnosis was liposarcoma. Laparoscopic total gastrectomy was performed to achieve a wide surgical margin. Several recent series have shown that a positive microscopic margin is associated with a higher rate of local recurrence than a negative margin. We have added a staged operation to obtain a wide margin in cases involving a positive surgical margin. Preoperative diagnosis of liposarcoma is still challenging. Gastric lipoma-like tumours should be resected with a wide margin because of their possibility of malignancy.

Resectable primary pleural myxoid liposarcoma with a pedicle: report of a rare case and literature review

Primary pleural myxoid liposarcoma is a rare tumor. Here, we report a primary myxoid liposarcoma occupying the majority of the left thoracic cavity with features suggesting invasion. Computed tomography (CT) at medical check-up incidentally revealed a bulky inhomogeneous fatty mass. The tumor's large size made a prediction of its resectability by preoperative CT difficult. The patient underwent an operation, which revealed that the tumor was attached to the pleura with a thin pedicle; the tumor was resected completely. Few therapies for pleural liposarcoma other than resection are available; hence, surgery should be considered even if the tumor's size implies invasion on radiological imaging. In this case report, we discuss the imaging findings of this case with a review of the related literature.

Primary liposarcoma of the pancreas: A review illustrated by findings from a recent case

Liposarcoma is the most common soft tissue sarcoma and accounts for 15%-20% of all mesenchymal malignancies. The tumor occurs most frequently in limbs and retroperitoneum, with only rare instances of visceral location reported. Pancreas is a very rare site of primary liposarcoma, with a total of seven cases reported since 1979 and only four of those in the English literature. We review the literature specific for primary liposarcoma of the pancreas and discuss radiological and pathological aspects of this rare tumor type as well as emerging options of treatment. The review is illustrated by findings of a recent case of a dedifferentiated liposarcoma of the pancreas coupled with undifferentiated pleomorphic sarcoma, including the first description of this rare tumor by magnetic resonance imaging. The patient was successfully treated with distal pancreatectomy and splenectomy, followed by adjuvant chemotherapy and radiotherapy. At the 5-year follow-up, the patient showed no signs of recurrence.

Gastric lipoma presenting with massive upper gastrointestinal bleeding

A case of massive upper gastrointestinal bleeding in a 37-year-old female is presented showing a submucosal mass in the gastric body. At laparotomy a pedunculated submucosal mass was found located on the posterior wall at the junction of the body and antrum of the stomach, 8 cm from the pylorus. Pathology confirmed that it was a 4 cm benign gastric lipoma with a bleeding central ulcer. Gastric lipomas are rare, benign, typically submucosal tumors occurring in the gastric antrum. They are usually asymptomatic but can become symptomatic depending on size, location, and if there is ulceration of the lesion. These lesions may be mistaken as malignant tumors or present with upper GI bleeding or intussusception. The diagnosis can be made using a combination of upper endoscopy, endoscopic ultrasound, CT, and MRI with surgical excision being the definitive treatment of choice. We hope that this case highlights the fact that these lesions can present with massive upper GI haemorrhage and should be included in the diagnosis when appropriate.

Myxoid liposarcoma with gastric localisation – Case Report

Liposarcoma is the most common malignant mesenchymal neoplasm affecting soft tissues and, less frequently, viscera. Gastric localisation of liposarcoma is extremely rare. We present the case of a 69-year-old female patient, who underwent subtotal gastrectomy with processing of the specimen in the Clinical Service of Pathology, Emergency County Hospital of Constantza. Histopathologically, the tumor exhibits a neoplastic population composed predominantly of lipoblasts in different stages of differentiation, with a massive disposition involving submucosa, muscularis and serosa. These cells contain intracytoplasmic small optically empty lipid vacuoles that produce indentations of centrally located nuclei; isolated lipoblasts have the appearance of signet ring cells. Predominant cellular population is admixed with scattered mature adipocytes and with stellate/spindled mesenchymal cells. Tumoral stroma has a myxoid character. A distinctive feature of this neoplasm is the existence of a vascular network composed of curved thin-walled capillaries with a branching pattern (“chicken-wire”). The histopathological traits and immunohistochemical profile of this tumor, characterized by positive reaction to Vimentin and S100 and negative staining to pancytokeratin, support the diagnosis of myxoid liposarcoma. The rare incidence of this tumor in the stomach requires a careful microscopical examination, in order to differentiate it from other clinico-pathological entities and to apply an appropriate therapy with a proper monitoring protocol.

[Atypical lipomatous tumors of the stomach. Clinical, morphological and molecular findings]

Two cases of primary gastric atypical lipomatous tumors (ALT) are presented. In case No.1, a 7x4x3 cm submucosal ALT (lipoma-like subtype) of the antrum/pyloric region in a 60-year-old woman was completely resected. Using interphase dual-color-FISH, MDM2- and CDK4 amplifications could be detected in distinguished amplicons. The patient was continuously free of disease after 56 months. In case No. 2, a 3.5 cm (in diameter) submucosal ALT (lipoma-like subtype) of the gastric body in a 56-year-old woman was completely resected. FISH revealed MDM2 amplification while the CDK4 gene remained in diploid copies. This patient was continuously free of disease after 36 months. The morphologic and molecular biological findings of this rare primary gastric mesenchymal tumor are discussed in comparison with the corresponding soft tissue lesions.