Liposarcoma retroperitoneal complicado: a propósito de un caso / Complicated retroperitoneal liposarcoma: a case report

Resumen Las neoplasias retroperitoneales suponen un reto para el profesional sanitario, tanto en el diagnóstico como en el tratamiento. Caso clínico: Varón de 56 años diabético tipo 2. Acude por edema en extremidad inferior derecha y parestesias. Se realiza ecografía doppler con resultados de trombosis venosa profunda y conglomerado adenopático. En TAC abdominal se observa gran masa retroperitoneal que engloba paquete vasculonervioso iliaco derecho. Se realiza vaciamiento ganglionar con resultado inicial de hamartoma. Se practica cirugía de resección de la masa y ligadura de la vena iliaca externa trombosada preservando la arteria iliaca. Anatomía patológica intraoperatoria sugestiva de sarcoma y definitiva de liposarcoma. Reingresa por shock hipovolémico y rotura de la arteria iliaca derecha. Se realiza ligadura y bypass femoro-femoral izquierdo-derecho. Al alta es derivado a oncología, falleciendo a los 6 meses. Discusión: El sarcoma es el tumor primario más frecuente a nivel retroperitoneal (15%). De difícil diagnóstico y tardío tratamiento, suelen ser asintomáticos hasta que debutan como una masa y clínica de compresión local o afectación de estructuras vasculonerviosas. El TAC es la prueba diagnóstica de elección. El tratamiento del tumor localizado es la cirugía; la radioterapia y quimioterapia se reservan para tumores irresecables o de alto grado.

Abstract Retroperitoneal neoplasias may be a diagnostic and therapeutic challenge for the clinician. Case report: A 56 year old male with prior history of type 2 diabetes consults with right inferior limb edema and paresthesias. He was diagnosed of deep vein thrombosis and lymph node conglomerate by ultrasound. A CT scan was performed, observing great retro peritoneal mass enclosing vascular and nervous structures. An initial histological diagnosis of hamartoma was made. Surgery was scheduled to remove the tumour, ligation of thrombosed external iliac vein and the external iliac artery was preserved. Intraoperative histological findings suggested sarcoma, definite studies showed presence of high grade liposarcoma. Two weeks after the intervention, the patient presents in hypovolemic shock due to rupture of the right external iliac artery. Emergent ligation of the artery and femorofemoral bypass was performed, with adequate postoperatory recovery. The patient was discharged and continued adjuvant oncology treatment and was exitus six months later. Discussion: Sarcomas are the most frequent primary retroperitoneal tumours. They are difficult to diagnose and often have untimely treatment. Sarcomas tend to be asymptomatic, or present with local compression symptoms, affecting vascular and nervous structures. CT scan is the gold standard for diagnostic imaging. Treatment requires a multidisciplinary approach, surgical resection as the main therapy; radio and chemotherapy represents a solution for irresectable or high grade malignancies.

Liposarcoma with perineal hernia in dog / Lipossarcoma associado à hérnia perineal em um cão

Liposarcoma is an uncommon malignant tumor originated in the lipoblasts that usually does not produce metastases, but is locally invasive. The final diagnosis is made by histopathology and wide surgical excision is the treatment. A four years old male Pinscher, weighing 2.8 kg, which was previously submitted to seven therapeutic procedures for hepatoid adenoma, was brought to us. On clinical examination a large, soft consistency and painless tumor on lumbodorsal area, besides perineal hernia, was observed. The CT scan revealed an image of an extensive paravertebral intramuscular tumor, embracing retroperitoneal, pelvic canal and ad-anal region. After surgical resection, the material was sent for histopathological examination which confirmed it was a liposarcoma. Thus, chemotherapy protocol with doxorubicin was established. 12 months after the last application of chemotherapy, the patient shows no signs of tumor recurrence nor metastases.

O lipossarcoma é um tumor maligno incomum, originário dos lipoblastos que geralmente não produz metástases; entretanto, élocalmente invasivo. O diagnóstico definitivo é obtido por exame histopatológico e o tratamento consiste na excisão cirúrgica ampla.Foi atendido um cão, da raça Pinscher, macho, com quatro anos de idade, pesando 2,8kg, que fora submetido anteriormentea sete procedimentos terapêuticos para adenoma hepatoide. Ao exame clínico o paciente apresentava uma grande tumoraçãona região dorsolombar, de consistência amolecida e indolor, além de hérnia perineal. O exame de tomografia computadorizadarevelou imagem de uma massa intramuscular paravertebral extensa, invadindo retroperitônio, canal pélvico e região ad-anal. Apósressecção cirúrgica, o material foi encaminhado para análise histopatológica, que confirmou tratar-se de um lipossarcoma; dessaforma, foi instituído protocolo quimioterápico com doxorrubicina. Decorridos 12 meses da última aplicação do quimioterápico, opaciente não apresenta sinais de recidiva da neoplasia maligna, nem tampouco metástases.

successful resection of cardiac metastasis of round cell liposarcoma

Myxoid is a common type of liposarcoma. Cardiac metastasis of sarcoma is a rare diagnosis. Transthoracic echocardiography is a useful tool for beginning the diagnosis. Curative resection of metastasis and then combination systemic chemotherapy for advanced disease is recommended. We report a 50 year old woman who presented with a cardiac metastasis of high grade round cell liposarcoma to right atrium and right ventricle. The tumor was diagnosed with computed tomography and transthoracic echocardiography. The tumor size was 10*10 cm. This is the second report of successful resection of a large intracardiac metastasis of liposarcoma

A Case of Pleomorphic Liposarcoma in a Patient with Crohn's Disease Taking Azathioprine / 대한소화기학회지

Azathioprine is frequently used for the treatment of inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis. Lymphomas, squamous cell carcinomas, and undifferentiated pleomorphic sarcomas have been reported among patients receiving azathioprine therapy. Herein, we report a case of pleomorphic liposarcoma of chest wall which occurred in a 44-year-old man with Crohn's disease taking azathioprine. He was diagnosed with Crohn's disease 3 years ago after suffering from abdominal pain and hematochezia for 12 years. He had been taking 50 mg of azathioprine per day for 23 months when he visited the thoracic and cardiovascular surgery clinic due to right chest palpable mass that had rapidly grown during the past 2 months. Excisional biopsy was performed and the mass was diagnosed as pleomorphic liposarcoma. Therefore, he underwent radical excision of the right chest wall mass, which measured 11.0x6.5 cm in size. He is scheduled to receive radiation therapy and chemotherapy.

Liposarcoma retroperitoneal como etiología de dolor abdominal: presentación de un caso y revisión de la literatura / Retroperitoneal liposarcoma as etiology of abdominal pain: case report and literature review

Soft tissue sarcomas are very uncommon types of tumors, with their embryological origin in the mesoderm and in nerve structures of the neuroectodermic layer. They represent only 1.5% of cases in the National Registry of Malignant Tumors in Mexico. They can be encountered anywhere connective soft tissue is found. Because of their specialized localization, retroperitoneal soft tissue sarcomas have a propensity to remain asymptomatic for long periods of time and reach a large size before being diagnosed. The only accepted treatment is wide surgical excision with clear margins, without a clear benefit for adjuvant treatment. The very uncommon nature of these tumors and their varied histopathology, site and behavior classify them as a difficult entity in terms of treatment. We present here the case of a 66-year-old female with a left-side retroperitoneal tumor, complaining only of vague abdominal pain as the presenting symptom. A CT-guided needle biopsy reported a sarcoma and the patient was subjected to laparatomy with complete resection of the tumor (30 x 13 x 10 cm). Histopathological report demonstrated a low-grade retroperitoneal sarcoma and free macroscopic and microscopic borders, without obvious invasion except for left kidney and ureter. The patient refused adjuvant treatment, and she is disease-free 7 years after treatment. Retroperitoneal sarcomas can cause pain and reach very large sizes. The best treatment available is wide surgical resection with clear margins. The most important prognostic factors are free margins, type of resection, age of patient and tumor histology.

Well-differentiated inflammatory liposarcoma presenting as pyrexia of unknown origin.

Liposarcomas have diverse histological appearance and clinical manifestations. Well-differentiated inflammatory liposarcoma is an uncommon sub-type, which often causes diagnostic difficulty. We report here a young female patient who presented with prolonged pyrexia and sub-diaphragmatic mass and was detected to have this uncommon soft tissue sarcoma on laparotomy.

Liposarcoma de laringe / Liposarcoma of the larynx

O liposarcoma de retroperitonio, extremidades e cintura escapular e um dos tipos de Sarcoma de partes moles mais frequente na idade adulta. Em raras ocasioes (4//) eles sao observados na regiao da cabeca e pescoco. Neste setor da economia geralmente o Liposarcoma se localiza nos tecidos moles do pescoco. Sua localizacao na Laringe e considerada muito rara, tendo-se conhecimento de apenas 16 casos descritos na literatura