Management of retroperitoneal liposarcoma: A case report and review of the literature

Giant retroperitoneal liposarcoma with multiple organ involvement: a case report and literature review

BACKGROUND

Retroperitoneal liposarcoma (RPLPS) is a relatively rare disease. Liposarcomas vary in size, but sizeable RPLPS larger than 30 cm in diameter are very rare, and their diagnosis and treatment present significant challenges.

CASE PRESENTATION

We report a 58-year-old male patient who was admitted to the hospital with an increased abdominal circumference and was later diagnosed with a giant RPLPS. The liposarcoma was found to adhere to the right kidney and the entire ureter, invading the ascending colon. The patient underwent complete combined surgical resection. The tumor was removed intact, measured 55.0 cm × 30.0 cm × 18.0 cm, and weighed 19.8 kg. Histopathologic analysis revealed well-differentiated liposarcoma (WDLPS). The patient was successfully discharged from the hospital and followed up for 6 months with no signs of recurrence.

CONCLUSION

RPLPS is a rare tumor with atypical clinical presentation. Surgery remains the most effective method of treatment for retroperitoneal sarcomas, with complete removal if there is local invasion. Preoperative examination, including three-dimensional (3D) reconstruction, is essential for surgical success. The role of adjuvant radiotherapy or chemotherapy remains controversial. However, clinicians should not rule them out as viable options.

Giant retroperitoneal well differentiated liposarcoma: A case report and literature review

INTRODUCTION AND IMPORTANCE

The most prevalent type of primary retroperitoneal tumors is soft tissue sarcoma (STS). Liposarcoma accounts for 40 % of retroperitoneal tumors (Mack, 1995). Retroperitoneal liposarcoma accounts for 12 % to 40 % of all liposarcomas (Vijay and Ram, 2015). They 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 (Vijay and Ram, 2015).

CASE PRESENTATION

A 48-year-old male patient presented to our gastrointestinal oncology clinic with a 2-year history of abdominal discomfort, weight loss and steadily growing abdominal swelling. A soft, rubbery lobulated mass with a positive "slippage sign" was palpable over all the quadrants of the abdomen. CT scan conclusion was retroperitoneal lipoma with internal enhancing nodular components. During laparotomy, a fatty mass measuring 55*60*22 cm and weighing 14 kg was excised. Histopathologic report showed a well differentiated liposarcoma (WDLS).

CLINICAL DISCUSSION

Giant retroperitoneal liposarcoma (RPL) is exceedingly rare. Liposarcomas have diverse MRI and CT appearances due to the various subtypes. WDLS are difficult to identify from lipomas before surgery. Histopathology is the only way to provide a reliable diagnosis; therefore en block resection is the recommended approach when malignancy cannot be ruled out.

CONCLUSION

Although imaging with ultrasound, CT, and MRI can aid in the diagnosis, differentiating WDLS from lipoma pre-operatively can be difficult, and en block resection is the recommended approach when malignancy cannot be ruled out.

A Large Retroperitoneal Liposarcoma Mimicking an Angiomyolipoma on Pre-operative Imaging: A Case Report

Retroperitoneal masses present a diagnostic challenge due to their elusive origin and varied clinical manifestations. Among these masses, retroperitoneal liposarcomas, rare tumors of mesenchymal origin, often grow asymptomatically until compressing surrounding structures, necessitating accurate and early diagnosis. Renal angiomyolipomas (AMLs) have also been reported to mimic retroperitoneal liposarcomas on radiographic imaging, further complicating diagnostic processes. The presented case report describes a rare instance of a large well-differentiated liposarcoma that mimicked a renal angiomyolipoma on imaging in a 58-year-old male patient. The patient initially presented with worsening abdominal distension, early satiety, and left-sided flank pain for the past year. Radiographic imaging revealed a large mixed echogenic lesion measuring 22 x 13 cm in the left kidney with diffuse fat contribution, suspected to be a giant renal angiomyolipoma. The patient underwent selective arterial embolization by interventional radiology. Follow-up imaging eight months later showed an increase in the size of the mass, raising suspicion of a liposarcoma. Surgical resection of the mass and a radical left nephrectomy were performed, with final pathology confirming the diagnosis of a well-differentiated liposarcoma. This case highlights the importance of accurate diagnosis and the potential for liposarcomas to mimic other masses on imaging, despite their rarity.

Giant Retroperitoneal Liposarcoma: Correlation Between Size and Risk for Recurrence

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

Retroperitoneal Liposarcoma: The Giant Type

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

Giant retroperitoneal liposarcoma: A case report

INTRODUCTION AND IMPORTANCE

Retroperitoneal liposarcomas are rare malignancy. They can grow usually asymptomatic until large enough to compress the surrounding organ. Giant retroperitoneal liposarcoma with diameter over 30 cm and weight over 20 kg is extremely rare. There has been limited report of giant retroperitoneal liposarcoma.

CASE PRESENTATION

A 34-year old woman complained about intermittent abdominal discomfort and progressive abdominal distension for last 2 years. There was history of weight loss for last 3 months. CT scan with contrast showed giant right abdominal mass that expanded to the pelvis (30.4 × 28 × 34 × 29 cm), oppressed surrounding organs and displaced the intestine to the left side with no visualization of normal right kidney structure. Complete resection of this retroperitoneal tumor was performed without combined resection of the surrounding organ. The biopsy of tumor showed a well differentiated liposarcoma. We diagnosed this patient with giant retroperitoneal liposarcoma. The postoperative course was uneventful and the patient was discharged on the 3th postoperative day. Last follow up, 3 months after surgical resection, patient had no complaints and there was no recurrence of this retroperitoneal liposarcoma.

CLINICAL DISCUSSION

Complete resection is the predominant treatment of retroperitoneal liposarcoma to avoid recurrence. Successful complete resection of retroperitoneal liposarcoma may increase the 5-year survival rate from 16.7 to 58 %. However, complete resection is a challenge, particularly in the well-differentiated subtype, for the reason that the margins are not easily distinguishable.

CONCLUSION

Giant retroperitoneal liposarcoma is an extremely rare tumor with high rate of recurrence, depends on some factors such as the histological type and grade, the metastasis, and also completeness of tumor resection. In this case we performed complete resection without combined resection of the surrounding organ. Furthermore, we will continue to observe our patient closely for recurrence.

Effects of marital status on survival of retroperitoneal liposarcomas stratified by age and sex: A population-based study

BACKGROUND

Previous studies have shown that marital status is associated with survival in patients with a variety of cancer types, including lung cancer, prostate cancer, and bladder cancer. However, to date, the impact of marital status on the survival of patients with retroperitoneal liposarcomas (RPLs) has not been established.

METHODS

A total of 1211 eligible patients diagnosed with RPLs were identified in the Surveillance, Epidemiology, and End Results (SEER) database. The relationships between marital status and survival in patients with RPLs were assessed. Patients were stratified by age to determine whether an association exists between marital status and age. We also probed the association between marital status and survival in males and females.

RESULTS

Our findings suggest that divorced, separated, or widowed patients have more advanced cancer stages, and more of these patients do not undergo surgery. Meanwhile, divorced, separated, or widowed patients have worse survival outcomes than married patients (overall survival (OS): HR = 1.66 (95% CI, 1.12, 2.46)); cancer-specific survival (CSS): HR = 1.90 (95% CI, 1.13, 3.19)). OS does not differ between single patients and married patients (HR = 1.21 [95% CI, 0.81, 1.81]) or CSS (HR = 1.36 [95% CI, 0.80, 2.29]). In addition, these results demonstrate that being divorced, separated, or widowed can play a significant detrimental role in mortality in older and female patients.

CONCLUSION

Married patients have earlier disease stages at diagnosis and better survival outcomes than divorced, separated, or widowed patients with RPLs. In addition, this effect is especially pronounced in older people and females.

Complex Surgical Management of Radiation-Associated Left Retroperitoneal Sarcoma

Radiation-associated sarcomas (RASs) are rare entities that tend to have an aggressive course and poor prognosis. Criteria for diagnosis of radiation-associated sarcoma include therapeutic radiation preceding the development of sarcoma, sarcoma arising within or near the irradiated field, and tumor histology that is distinct from the primary tumor necessitating radiation. Despite their relatively uncommon occurrence, RASs are a well-established complication of radiation therapy. We present the complex, multidisciplinary surgical management of a patient with multi-compartmental radiation-associated sarcoma of the left retroperitoneum occurring nearly 25 years after undergoing whole trunk radiation for Hodgkin's lymphoma.

A patient with large retroperitoneal liposarcoma - a challenge for an anesthesiologist

Retroperitoneal liposarcoma is a rare type of tumor characterized by slow growth and nonspecific symptoms, and is usually diagnosed at an advanced stage. Patients with huge retroperitoneal liposarcoma have a high risk of developing perioperative complications, and require special preoperative preparation and a carefully planned anesthetic approach. We present the case of a 57-year-old man, who was diagnosed with a huge retroperitoneal liposarcoma, 70 cm in diameter, weighing 30.4 kg and planned for surgical resection of the tumor under general anesthesia. Perioperative treatment and anesthesia for this patient were a great challenge for the anesthesiologist. However, due to preoperative preparation, monitoring and fluid replacement, hemodynamic and respiratory stability of the patient was maintained perioperatively.

Recurrent retroperitoneal liposarcoma: A case report and literature review

Retroperitoneal liposarcoma frequently recurs within 2 years of the initial surgical resection. For the early detection of recurrent retroperitoneal liposarcomas, a shorter follow-up interval with CT or MRI would be helpful.

Recurrent giant retroperitoneal liposarcoma: Review of literature and a rare case report

Introduction and importance

Retroperitoneal liposarcomas (RPLS) are usually grow large with frequent recurrences. Complete surgical excision remains the gold standard treatment for primary and even recurrent tumours. Their prognosis depends on their histological type and grade. We report a recurrent giant de-differentiated RPLS weighing 18.55 kg which was completely excised. To the best of our knowledge, this is one of the largest liposarcoma reported in the literature.

Case presentation

A 40 year old female presented with a gradually progressing large abdominal lump for 1year. She had had a similar large lump twice in the past and undergone excision of the tumour elsewhere. Firm non-tender mass felt all over abdomen with edema noted over abdominal wall and bilateral lower limbs. PET CT showed large heterogeneously enhancing mass occupying almost the entire abdominopelvic cavity. 50 × 40 × 40cm tumour was completely excised and biopsy showed grade 2 dedifferentiated liposarcoma (DDLS). She is under close follow up with no recurrence at 12months.

Clinical discussion

DDLS have lower risk of distant metastases but have a high risk of local recurrence. The most important favourable prognostic factor in these tumours is complete resection with negative margins. Because of the ineffectiveness of current chemotherapy and the requirement of intolerably high radiation doses, surgical excision remains the most effective treatment even for the localized recurrences of RPLS.

Conclusion

The dedifferentiated subtype should be suspected in locally aggressive RPLS. Close follow up with early detection of recurrences and prompt excision with negative margins lowers the risk of recurrences and improves survival.

Renal liposarcoma: case report and review of systemic treatment

Liposarcomas are malignant mesenchymal tumours usually located in the retroperitoneum, rarely occurring as a single lesion in the kidney. We present a case of a 59-year-old male patient with a left renal mass detected by computed tomography scan. He underwent radical nephrectomy and the histopathological study reported a primary undifferentiated liposarcoma of the kidney without nodal involvement. After 15 months of surgery, he remained asymptomatic and without evidence of disease recurrence. The objective of this report is to present a case and literature review with current evidence of treatment options and prognostic factors for survival.

Retroperitoneal liposarcoma in a nonagenarian

Retroperitoneal liposarcomas are rare tumors arising from the soft tissue of the retroperitoneum and are of mesenchymal cell origin. They can reach a large size prior to causing symptoms and generally have a poor prognosis. We present the case of a 93-year-old lady presenting with a large retroperitoneal liposarcoma at the site of a previous colonic anastomosis for the adenocarcinoma treatment. It caused minimal symptoms initially, but surgical resection was undertaken when the tumor was found to be growing significantly in size. However, due to the tumor's location and its invasion into surrounding structures, the resection was not feasible and subsequently abandoned. A retroperitoneal liposarcoma arising from the site of a previous colonic resection has not been previously described. A review of the diagnosis and current management of these lesions is also given.

Giant retroperitoneal liposarcoma with a maximum diameter of 37 cm: a case report and review of literature

Retroperitoneal liposarcoma is a rare malignancy derived from adipocytes. They can grow to large sizes before inducing clinical symptoms. Giant retroperitoneal liposarcoma with a diameter over 30 centimeters is extremely rare. So far, only 13 cases of giant retroperitoneal liposarcoma with a diameter greater than 30 cm have been reported. There is very little experience in the treatment of these bulky tumors. Herein, we report a 65-year-old male patient diagnosed with giant retroperitoneal liposarcoma. The patient underwent successful complete surgical resection. The tumor was found to occupy almost the entire abdominal cavity, measuring 37.0 cm × 32.0 cm × 26.5 cm in size and 21.0 kg in weight. Histopathological analysis indicated a grade I, well-differentiated liposarcoma. The patient was discharged uneventfully, and no sign of recurrence was observed at 12-month follow-up. Moreover, we reviewed 13 literatures in English published on PubMed database regarding retroperitoneal liposarcoma greater than 30 cm in diameter. The analysis suggests that size alone should not be considered as a contraindication to surgical resection. Combined resection of adjacent organs is necessary if local invasion is confirmed. The role of adjuvant radio or chemotherapy remains controversial. Thorough evaluation on the extent of resection should be made to minimize post-surgery decline in quality of life.

Recurrent giant retroperitoneal liposarcoma with 10 years follow up. Case report and review of literature

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".

[Multiple recurrent retroperitoneal liposarcoma in a 66-year-old man]

In this article, the authors present the case of a 66-year-old man who was diagnosed with the first recurrence of his retroperitoneal liposarcoma 7 years after initial diagnosis. In the following 10 years, he needed a total of eight operations, chemotherapy, and radiotherapy because of another seven recurrences. This is the first report on a patient with eight recurrences of a retroperitoneal liposarcoma being in a relatively good general condition even 17 years after initial diagnosis.

Myxoma versus myxoid liposarcoma involving the kidneys

Myxoid lesions of the kidney are rare. We present a case of a 74-year-old man who presented with an 8.5 × 8.0 × 6.0 cm left kidney mass that was grossly confined to the kidney and had a gelatinous cut surface. Histology of the tumor showed bland spindle cells in a myxoid stroma with interspersed thin-walled vessels. The tumor was negative for smooth muscle actin, desmin, CD34 (highlighted vessels), S100, and HMB-45 by immunohistochemistry. There was focal, nonspecific staining of MDM2 and CDK4. The lesion appeared more vascular than would be expected for a classic myxoma and, therefore, fluorescence in situ hybridization was performed for the 12q13 (DDIT3 or CHOP) rearrangement to rule out myxoid liposarcoma and the result was negative for a rearrangement. This case highlights the difficulty of delineating a primary myxoma of the kidney from a well-differentiated myxoid liposarcoma.

Giant recurrent mixed-type liposarcoma of the retroperitoneum: report of a case and review of literature

Retroperitoneal liposarcoma is a rare tumor with an incidence of 2.5 per million individuals, especially tumors of mixed histologic pattern. We present a case of a 63-year-old woman with a history of slowly increasing abdominal volume over 2 years. The diagnosis of giant and multiple retroperitoneal mass suspected of liposarcoma was confirmed by computed tomography. The patient underwent resection of 7 tumor masses together weighing 5 kg. The microscopic diagnosis was mixed-type liposarcoma of the retroperitoneum. 8 months after surgery, the patient suffered multiple metastases in the liver and abdominal wall, and upper digestive tract hemorrhage. Although this type of tumor is rarely seen, tumor tissue should be thoroughly gathered and analyzed on histologic examination to reach final diagnosis. Knowledge of the subtype of liposarcoma is important for proper prognosis and treatment of the patient. To the best of our knowledge, this is the first report of mixed-type retroperitoneal liposarcoma with three components described in the English literature.

Dedifferentiated retroperitoneal large liposarcoma and laparoscopic treatment: Is it possible and safe? The first literature case report

INTRODUCTION

Soft tissue sarcomas are rare neoplasms often characterized by local invasiveness and distant metastasis with poor prognosis for affected patients. Among the most frequent sarcomas we find well-differentiated and dedifferentiated liposarcomas characterized by a better survival compared to the other histological types. When it is possible the only curative treatment for these neoplasms is surgical resection.

CASE REPORT

We report a case of a 62-year-old caucasian woman with CT abdominal scan that demonstrated a voluminous solid oval mass in the left perirenal space with dislocation of the kidney and in continuity with the anterior renal fascia. After a percutaneous CT-guided biopsy of the mass the histopathological diagnosis was a dedifferentiated retroperitoneal liposarcoma. We performed a laparoscopic surgical resection of the retroperitoneal mass in block with kidney and left adrenal gland.

DISCUSSION

When possible, surgical resection with adequate margins represents the only curative therapeutic option for this pathology. Only a few papers are available in literature which take into consideration the possibility of laparoscopic approach for retroperitoneal masses with better vision of surgical field, reduction of post-operative pain and better cosmesis.

CONCLUSION

A retroperitoneal mass represents a serious diagnostic challenge. The choice of the best surgical procedure can benefit to the patient prognosis. To our opinion laparoscopy can be a safe and successful treatment and it can represent a valid alternative to open surgery. However, we have no randomized controlled trials that compare laparoscopic versus open resection for retroperitoneal liposarcomas.

Primary retroperitoneal liposarcoma with extensive ossification: A case report

RATIONALE

Primary retroperitoneal liposarcoma, which originates from mesenchymal tissues, can rarely present with extensive ossification.

PATIENT CONCERNS

A 41-year-old male patient presented with a chief complaint of discomfort around the waist for 2 months.

DIAGNOSES

Computerized tomography (CT) and magnetic resonance imaging suggested a lesion of approximately 5.6 × 5.1 × 8.7 cm in front of the psoas major muscle, which was considered to be a mesenchymal or neurogenic tumor.

INTERVENTIONS

The hard mass was removed by laparotomy, and the pathological investigation revealed that this was an atypical lipomatous tumor/well-differentiated liposarcoma, with extensive ossification.

OUTCOMES

The patient was discharged from the hospital after surgery. There was no sign of reoccurrence after 1 year of follow-up.

LESSONS

Retroperitoneal liposarcomas with extensive ossification are rare tumors that can present with nonspecific symptoms, and are difficult to diagnose. CT is the most common imaging technique, and surgical resection has been considered to be the most effective treatment. This rare case can be challenging for diagnosis and treatment.

Retroperitoneal Liposarcoma Masquerading as an Impending Rupture of Inflammatory Abdominal Aortic Aneurysm

BACKGROUND

We present a unique case scenario of a periaortic liposarcoma masquerading as an impending rupture of an inflammatory abdominal aortic aneurysm (AAA).

METHODS AND RESULTS

A 57-year-old man was referred to our unit for an emergency endovascular repair of "an inflammatory AAA with computed tomography (CT) features of impending rupture." He underwent an uneventful endovascular repair with a bifurcated endograft (C3; Gore, Flagstaff, AZ). Seven weeks later, CT showed that the periaortic "mass" grew larger and asymmetric, and a CT-guided needle biopsy suggested the presence of a high-grade malignant mesenchymal tumor. He underwent laparotomy and excision of the retroperitoneal tumor en bloc with the anterior wall of the infrarenal aorta. The endograft acted as an excellent "safety net" providing adequate hemostatic control and obviating the need for aortic cross-clamping and repair of the aortic defect with a patch or tube graft.

CONCLUSIONS

The learning point from the present case is that when faced with an inflammatory AAA and/or retroperitoneal fibrosis, the rare possibility of a retroperitoneal neoplasm should be kept in mind.

Devascularization of the superior mesenteric vein without reconstruction during surgery for retroperitoneal liposarcoma: A case report and review of literature

A 61-year-old female patient with chronic hepatitis B virus infection was diagnosed with liposarcoma in a community hospital. Fine needle aspiration biopsy confirmed the diagnosis of well-differentiated liposarcoma. Abdominal computed tomographic angiography (CTA) showed that the mass adhered to and constricted the main trunk and branch of the superior mesenteric vein (SMV), especially the ileocolic vein, and collateral circulation was observed during the vascular reconstruction scan. The abdominal liposarcoma was resected. Because of the collateral circulation, devascularization of the SMV was attempted, and we resected the eroded SMV. The condition of the blood vessels was evaluated 20 d after surgery using CTA, which showed that the SMV had disappeared. Significant improvements in SMV collateral circulation and the inferior mesenteric vein were observed after vascular reconstruction. The patient had an uneventful postoperative course except for transient gastroplegia. Twenty months after surgery, the patient had a recurrence of liposarcoma. She underwent tumor resection to remove the distal small intestine and right hemicolon. We learned that (1) direct devascularization of the main SMV trunk without a vein graft is possible. The presence of collateral circulation can increase the success rate of patients undergoing radical surgery and prevent the occurrence of serious postoperative complications. In addition, (2) this case demonstrated the clinical value of 3D reconstruction.

Complete Remission of Recurrent Retroperitoneal Liposarcoma after the Administration of Gemcitabine and Docetaxel as First-Line Adjuvant Chemotherapy: A Case Report

Retroperitoneal liposarcoma is a rare type of cancer. Relapse after surgery is frequent, and relapsing tumors tend to be more aggressive and less differentiated each episode, worsening the prognosis. This report describes the case of a 42-year-old female diagnosed with retroperitoneal liposarcoma after complete tumor resection. At the 3-month follow-up, another expansive lipomatous mass in the retroperitoneal area almost the same size as the previous one was detected. The patient underwent a new surgery, followed by first-line treatment with a gemcitabine- and docetaxel-based regimen for 8 cycles. Finally, the patient achieved complete tumor remission confirmed by CT after the end of the treatment proposed. Although recurrence is a well-known characteristic of this neoplasia, no other case with such a vast expansion of a new tumor shortly after complete resection was found in the literature.

Liposarcoma in the spermatic cord presenting as an inguinal swelling

Liposarcoma in the spermatic cord is a rare condition with an incidence of 1 per 2.5 million. The condition can present as paratesticular pain and a quick diagnosis is important in order to ensure proper treatment and to improve the prognosis. We describe a case of a 69-year-old man who suffered from long-lasting swelling in the inguinal area and experienced increasing pain through a period of 2 weeks. Due to increasing pain and fast growing swelling, an exploration of the inguinal area was performed and peroperatively a tumour in the spermatic cord was found. Subsequent histological examination revealed a de-differentiated liposarcoma.

Huge retroperitoneal liposarcoma with renal involvement requires nephrectomy: A case report and literature review

A 60-year-old female visited Guihang Guiyang Hospital (Guiyang, China). She presented with abdominal pain in the right side for the previous 2-months, with a touchable mass identified for the previous 1-month. Computed tomography with magnetic resonance imaging revealed a huge mass in the right abdomen. The diagnosis of well-differentiated retroperitoneal liposarcoma with renal involvement was made. During surgery, the tumor was removed, including the fatty renal capsule; however, the kidney was preserved. It is currently debatable whether resection of adjacent organs is required to obtain the negative margins. Conventional viewpoints advise that multi-organ resection is required in order to obtain the negative-margin. However, even if an R0 resection is achieved, the local recurrence rate remains markedly high. Additionally, the complications of organ resection have more impact on patients. Radiotherapy and chemotherapy are an important adjuvant method for these patients. In conclusion, retroperitoneal liposarcoma is a rare disease with a high rate of recurrence. Complete resection is the predominant treatment; however, combined resection of adjacent organs must be considered.

Prognostic Model to Predict Survival Outcome for Curatively Resected Liposarcoma: A Multi-Institutional Experience

Purpose: We performed this study to analyze the clinical features and prognosis of Korean patients with liposarcoma.

Patients & Methods: Between October 1986 and April 2013, 231 patients who were diagnosed with liposarcoma by histologic examination were enrolled in this study.

Results: The distribution of histologic subtypes was well-differentiated (n = 97, 42%), myxoid (n = 74, 32%), dedifferentiated (n = 32, 13.9%), pleomorphic (n = 15, 6.5%), and round-cell liposarcoma (n = 13, 5.6%). The majority of liposarcomas were located in the lower extremities (35.5%) and retroperitoneum (34.2%). Prognosis was worse for the trunk group compared with the extremity group (median disease-free survival [DFS] 3.3 vs. 9.9 years, respectively, P <0.001). Median DFS was significantly worse in patients with high grade histology compared to those with low grade histology (16.9% vs. 65.7%, P <0.001). The independent prognostic factors associated with survival were histology (hazard ratio [HR] 3.01; 95% confidence interval [CI], 1.82-4.97; P <0.001) and primary site (HR 1.80; 95% CI, 1.12-2.89; P = 0.015). Three risk groups with different survival outcomes were identified: group 1 (n = 98), no risk factors; group 2 (n = 92), one risk factor; and group 3 (n = 41), two risk factors.

Conclusions: Histologic subtype and primary site were independent prognostic factors for curatively resected liposarcoma. A prognostic model for patients with liposarcoma clarified distinct groups of patients with good prognostic discrimination.