Abdominal Actinomycosis misdiagnosed as liposarcoma

Actinomycosis is an uncommon, endogenous, and chronic infection with varied and nonspecific clinical features such as abdominal, pelvic or cervical masses, ulcerative lesions, abscesses, draining fistula, fibrosis, and constitutional symptoms. The disease ensues when the bacteria disrupt the mucosal barrier, invade, and spread throughout interfascial planes. Currently, the diagnosis of actinomycosis is challenging because of its very low frequency and depending on the clinical presentation it may masquerade malignancies. Therapy consists initially in intravenous penicillin, followed by an oral regimen that may be extended until a year of treatment. A timely diagnosis is crucial to avoid extensive therapeutic attempt as surgery. However, a biopsy or drainage of abscesses and fistula's tract may be required not only as a diagnostic procedure as part of the therapy. We report the case of a 72-year-old woman with an abdominal mass initially misdiagnosed as a liposarcoma. A second biopsy of a skin lesion of the abdominal wall made the diagnosis of actinomycosis, avoiding a major surgical procedure. The patient was treated with a long-term course of antibiotics with favorable outcome. Liposarcoma was ruled out after the patient's full recovery with antibiotics and the misdiagnosis was credit to the overconfidence on the immunohistochemical positivity to MDM2.

Liposarcoma del cordón espermático simulando una hernia inguinal incarcerada / Liposarcoma of the spermatic cord mimicking an incarcerated inguinal hernia

INTRODUCCIÓN: Los tumores paratesticulares representan del 7%-10% de las masas intraescrotales. Los sarcomas abarcan el 90% de las lesiones malignas del cordón espermático y de éstas, aproximadamente, el 3%-7% son liposarcomas. CASO CLÍNICO: Presentamos el caso de un varón de 45 años, que consultó en urgencias por una masa inguinoescrotal derecha no reductible, diagnosticándose de hernia inguinal incarcerada. Se realizó cirugía urgente evidenciando una gran tumoración de aspecto lipomatoso, dependiente de cordón espermático. Se realizó orquiectomía y hernioplastía inguinal. La anatomía patológica, reveló un liposarcoma bien diferenciado de cordón espermático. Posteriormente, se realizó estudio de extensión, sin afectación a distancia y no precisó tratamiento adyuvante. Actualmente, tras dos años de seguimiento no ha presentado recidiva. DISCUSIÓN: Sólo alrededor de 200 casos han sido comunicados previamente en la literatura y sólo 61 de éstos se presentaron simulando una hernia inguinal incarcerada. Debido a la baja incidencia de esta patología es difícil de conocer la historia natural y llegar a conclusiones sobre los resultados del tratamiento, el cual hasta el momento sigue siendo la orquiectomía radical, con escisión amplia de los tejidos locales. El papel de la radio y quimioterapia aun es controvertido. CONCLUSIONES: Los sarcomas del cordón espermático son neoplasias raras con alta tasa de recurrencia local. Su manejo inicial es quirúrgico. Se requiere de un alto índice de sospecha clínica para el diagnóstico ya que las implicaciones oncológicas varían en función del tratamiento que, en ocasiones, es llevado a cabo por cirujanos generales al simular una hernia inguinal.

INTRODUCTION: Paratesticular tumors represent 7%-10% of intraescrotal masses. Sarcomas account for 90% of malignant lesions of the spermatic cord and of these approximately 3%-7% are liposarcomas. CLINICAL CASE: This is the case of a 45 year old male who consulted in the emergency department for a non-reducible right inguino-scrotal mass and was diagnosed with an incarcerated inguinal hernia. Emergency surgery was performed which revealed a large lipomatous tumor, originating from the spermatic cord. Orchiectomy and hernioplasty were performed. Histopathology revealed a well-differentiated liposarcoma of the spermatic cord. Later extension study was conducted, without distant affectation, and did not require adjuvant treatment. Today, after two years of monitoring has been no recurrence. DISCUSSION: Only about 200 cases have been previously reported in the literature and only 61 of these were presented mimicking an incarcerated inguinal hernia. Due to the low incidence of this disease it is difficult to know the natural history and draw conclusions on the results of treatment, which so far remains the radical orchiectomy with wide local excision of the tissue. The role of radiotherapy and chemotherapy is still controversial

Lipossarcoma de laringe: relato de caso / Laryngeal liposarcoma: a case report

O lipossarcoma de laringe é uma neoplasia extremamente rara, acomete principalmente o sexo masculino, principalmente na quinta década de vida. Existindo apenas cerca de 40 casos descritos na literatura, desses nenhum em língua portuguesa. O presente caso relata o diagnóstico em um paciente do sexo masculino, 57 anos, ex-tabagista, apresentando alteração de voz e obstrução de via área. Foi optado por ressecção cirúrgica completa com achados sugestivos de lipossarcoma bem diferenciado. Foi optado por manter seguimento, não tendo sido indicado quimioterapia e radioterapia adjuvantes.(AU)

Laryngeal liposarcoma is an extremely rare neoplasm that affects especially men in the fifth decade of life. There are only about 40 cases described in the literature, none of them in the Portuguese language. We report the case of a 57-year-old, former smoker man presenting with voice disorders and airway obstruction. We opted for complete surgical resection with findings suggestive of well-differentiated liposarcoma. We chose to keep following the patient, and no adjuvant chemotherapy and radiotherapy were indicated. (AU)

Liposarcoma retroperitoneal: Reporte de caso / Retroperitoneal Liposarcoma: Case report

Los liposarcomas son tumores poco frecuentes, de comportamiento clínico silencioso y evolución variable dependiendo del tipo histológico, la recurrencia local y las metástasis a distancia. El tratamiento de elección es la resección quirúrgica total del tumor. Se presenta el caso de paciente femenina de 57 años de edad que consultó por tumor retroperitoneal cuyo diagnóstico por patología fue de liposarcoma bien diferenciado. Se reseca la totalidad el tumor, preservando el riñón derecho. Conclusión. La cirugía en caso de liposarcoma retroperitoneal es el tratamiento de elección donde la radioterapia y la quimioterapia juegan un papel controversial.

Liposarcomas are rare tumours, of silent clinical behavior and variable evoluton depending on histological type, local recurrence and distant metastases. Treatment of choice is tumors' complete surgical resecton. We hereby report the case of a 57-year-old female patent with a retroperitoneal tumor, whose fnal diagnosis was well-diferentated liposarcoma. The entre tumor was resected, preserving the right kidney. Conclusion. For Retroperitoneal Liposarcoma, surgery is the treatment of choice

Giant atypical lipoma

Abstract: Liposarcomas correspond to the most common histological subtype of soft tissue sarcomas. They can be subdivided into: well differentiated or atypical lipoma, undifferentiated, myxoid, round, and pleomorphic cells. Atypical lipomas are the most prevalent and usually appear as asymptomatic softened tumors. They are locally aggressive but rarely lead to distant metastases. The diagnosis of this tumor is based on the imaging and histopathologic findings. Treatment consists of excision surgery with complete tumor removal. It has a good prognosis due to the low percentage of distant metastases. We report a rare case of giant atypical lipoma as well as the adopted therapy and evolution.

Liposarcoma bien diferenciado con extensa metaplasia ósea y desdiferenciación osteosarcomatosa / Well-differentiated liposarcoma with extensive bone metaplasia and osteosarcomatous dedifferentiation

Dentro de la familia de los liposarcomas, el subtipo bien diferenciado es el más frecuente, caracterizado por su alta tendencia a la recaída local y ubicación retroperitoneal. La desdiferenciación ocurre en alrededor del 10% de los casos y habitualmente se manifiesta histológicamente como sarcoma pleomorfo de alto grado. La desdiferenciación heteróloga es un hecho que ocurre inhabitualmente. Presentamos un caso que debutó como un liposarcoma de bajo grado (lipoma like) que en su evolución tomografica muestra extensas áreas calcificadas y su histología confirma la trasformación a un sarcoma de alto grado con diferenciación osteosarcomatosa (AU)

Within the family of liposarcomas, the welldifferentiated subtype is the most frequent, characterized by its high tendency to local relapse and retroperitoneal localization. Dedifferentiation occurs in about 10% of cases and usually manifests histologically as high-grade pleomorphic sarcoma. Heterologous dedifferentiation is unusual. We present a case that debuted as a low grade liposarcoma (lipoma like) that in its tomographic evolution shows extensive calcified areas and its histology confirms the transformation to a high grade sarcoma with osteosarcomatous differentiation (AU)

Liposarcoma retroperitoneal gigante: reporte de caso y revisión de la literatura / Great retroperitoneal liposarcoma: case report and literature review

Introducción: El liposarcoma es el tumor retroperitoneal más frecuente. Es una enfermedad de evolución silenciosa cuyo tratamiento es el manejo quirúrgico. Caso clínico: Mujer de 42 años de edad, sin antecedentes de importancia, quien acude con gran liposarcoma. Se procede a realizar cirugía R0 y nefrectomía derecha. El resultado de patología reporta lipoma mixoide. Conclusiones: Los liposarcomas son tumores los cuales tienen dificultades en el manejo debido a un índice alto de irresecabilidad, patrón de recurrencia elevado, ineficacia en el empleo de tratamientos adyuvantes que impacten en la sobrevida y el control local.

Introduction: The liposarcoma is the most common retroperitoneal tumor. It is a silent disease evolution whose treatment is surgical management. Case report: 42 years old female with no history of importance who comes with great liposarcoma, we proceed to perform R0 surgery and right nephrectomy, the result of pathology reports myxoid lipoma. Conclusions: Liposarcomas are tumors which have difficulties in handling due to a high rate of unresectable, high recurrence pattern, inefficiency in the use of adjuvant therapies that impact on survival and local control.

Liposarcoma: A Rare Case Report with Review of Literature.

Liposarcoma is one of the most common malignant mesenchymal neoplasms, comprising approximately 15% of all soft-tissue sarcomas. First described by “Virchow” in 1857, it has been extensively reported in the literature, although its incidence remains exceedingly rare in the head and neck region with an annual incidence estimated to be 2.5/1 million inhabitants in population-based studies. It is one of the most common malignant mesenchymal neoplasms, comprising approximately 15% of all soft-tissue sarcomas. It is a heterogeneous disease with distinct sub-entities presenting with differential clinical behavior. The purpose of this article is to report an additional case of liposarcoma of the buccal vestibule and to review the literature.

A Case of Pleomorphic Liposarcoma Originating from Mesentery / 대한소화기학회지

Liposarcoma is one of the most common soft tissue sarcomas that occurs in adults and is currently divided into five main subgroups: well-differentiated, myxoid, round cell, pleomorphic, and dedifferentiated. Primary mesenteric liposarcoma is extremely rare, and the treatment strategy is surgical resection with a wide free margin, often followed by radiation and adjuvant chemotherapy if distant metastasis is not detected. A 73-year-old male patient presented with lower abdominal distension. Abdominal CT scan revealed a large homogeneously enhancing mass lesion abutting the sigmoid colon and urinary bladder. At laparotomy, the solid mass measured 28x26x12 cm in size, was well-demarcated, and originated from the mesentery of the middle ileum. It was removed along with some small intestine (ileocecal valve upper 50-150 cm) and ileal mesentery because of adhesion. Histologically, the tumor proved to be pleomorphic liposarcoma. The patient did not undergo any adjuvant treatment following surgery, but he remains disease free until 33 months after surgery. Herein, we report a case of pleomorphic liposarcoma arising from small bowel mesentery.

Intramuscular lipoma of the subscapularis muscle / Lipoma intramuscular no musculo subescapular

CONTEXT: Intramuscular lipomas are benign tumors that infiltrate the muscles. CASE REPORT: We describe the case of a 58-year-old female patient with an axillary lump. The lump was a lipoma inside the subscapularis muscle. It is important to differentiate these lesions from liposarcomas and from other diseases that may present as axillary lumps. The most accurate imaging method for differentiating benign lipomatous tumors from liposarcomas is magnetic resonance imaging, but surgical removal of these intramuscular lesions to confirm the diagnosis is recommended. CONCLUSION: Intramuscular lipomas are a rare cause of benign axillary lumps and should be considered in making differential diagnoses on axillary masses. .

CONTEXTO: Lipomas intramusculares são tumores benignos que infiltram os músculos. RELATO DE CASO: Descrevemos o caso de uma paciente de 58 anos com nódulo axilar. O nódulo era um lipoma na intimidade do músculo subescapular. É importante diferenciar essas lesões de lipossarcomas e outras doenças que podem acometer a axila. O método de imagem mais eficaz para diferenciar lesão lipomatosa benigna do lipossarcoma é a ressonância magnética, mas é recomendada a remoção cirúrgica dessas lesões intramusculares para confirmar o diagnóstico. CONCLUSÃO: Lipomas intramusculares são causas raras de nódulos axilares benignos e devem ser considerados no diagnóstico diferencial dessas lesões. .

Immunohistochemical detection of p53 and MDM2 expressions in liposarcoma with World health organization classification.

BACKGROUND: Liposarcomas are among the most common soft tissue sarcomas in adulthood. AIM: The purpose of the study is to perform a histopathologic typing according to World Health Organization (WHO) classification of cases diagnosed with liposarcoma and to examine the difference of p53 and MDM2 expressions. MATERIALS AND METHODS: The haematoxylin-eosin stained sections of 48 subjects enrolled in the study have been evaluated on the basis of the WHO classification for liposarcoma and sections stained using p53 and MDM2. STATISTICAL ANALYSIS USED: Chi-Square test was applied. RESULTS: 20 subjects were diagnosed with well-differentiated liposarcoma (WLS), 16 myxoid liposarcoma (ML), 7 pleomorphic liposarcoma (PL), and 5 de-differentiated liposarcoma (DLS). The number of cases stained positive with MDM2 and p53 were positive correlated in all subjects (P = 0.02). p53 and MDM2 positivity increased in high grade tumors (P = 0.01). CONCLUSION: p53 and MDM2 immuno-reactivity was found to be potentially useful in liposarcoma diagnosis but a definitive implication would be rather unhealthy due to the small number of cases in our study.

Primary well differentiated breast liposarcoma with divergent cartilagenous differentiation: a case report

Primary liposarcomas of the female and male breasts are very rare. Heterologous differentiation in adipocytic tumors is also an exceedingly rare phenomenon, which is occasionally reported in the literature. We describe the case of a 22 year-old female who presented with a relatively large left breast mass which was clinically diagnosed as a case of giant fibroadenoma, but histologically showed a well differentiated liposarcoma with evidence of extensive chondroid differentiation. The mammographic and radiological features are presented and correlated with the histopathological appearances together with literature review and comparison with similar reported cases

Liposarcoma de células redondas de colon transverso y retroperitoneo: presentación de caso / Round cell liposarcoma of transverse colon and retroperitoneum: case report

Introducción: El liposarcoma representa la variedad más frecuente de los sarcomas de partes blandas del adulto. El subtipo células redondas representa el 15%. Por lo general compromete extremidades. La ubicación en colon es extremadamente rara. Objetivo: Evaluar el comportamiento de una patología infrecuente del colon y retroperitoneo, a partir de un caso clínico. Lugar de aplicación: Institución privada. Paciente y método: Paciente masculino de 45 años, operado con diagnóstico anatomopatológico de liposarcoma de células redondas por tumor colónico y retroperitoneal. Resultados: Se realizó colectomía derecha y resección de tumor abdominal. Conclusiones: Es una entidad poco frecuente, que por lo general se la diagnostica tardíamente. El tratamiento de elección es la cirugía. La quimioterapia y radioterapia, no han demostrado mejorar la supervivencia. Presenta un pronóstico malo, con alta tasa de recidiva.

Background: liposarcoma represents the most common kind of soft tissue sarcomas in adults. The round cell subtype represents 15%. Usually undertakes extremities. Colon location is extremely rare. Objective: To evaluate the behavior of a rare disease of the colon and retroperitoneum, from a clinical case. Place of application: Private institution. Patient and Methods: Male patient, 45 years, with a colonic and retroperitoneal tumor and pathological diagnosis of round cell liposarcoma. Results: Colectomy and abdominal tumor resection was performed. Conclusions: It is a rare condition, and diagnosis is usually late. Treatment of choice is surgery. Chemotherapy and radiotherapy have not been shown improvement in survival. Prognosis is poor with a high rate of recurrence.

Critical histopathological analysis of 25 dedifferentiated liposarcomas, including uncommon variants, reviewed at a Tertiary Cancer Referral Center.

Background: De-differentiated liposarcomas (DDLSs) are uncommon tumors with a wide histopathological spectrum. Materials and Methods: Over an 8-year period (2003-2011), 25 DDLSs, after review, were critically analyzed for histopathological features. Results: Twenty-five tumors, in 14 men and 11 women (M: F = 1.2:1), with age range of 22-88 years (mean, 53.9), occurred in retroperitoneum (14) (56%), thigh (3) (12%), paratesticular region (3) (12%), chest wall (2) (8%), leg (1) (4%), shoulder (1) (4%), and groin (1) (4%). Tumor size (21 tumors) varied from 7.5 to 25 cm (mean, 17.5). Histopathologically, DD component was high grade in 19 (76%) and low grade in 6 (24%) tumors. Whereas the most common WD component was adipocytic type; the most common DD component was pleomorphic sarcomatous (13) (52%), followed by myxofibrosarcomatous (MFS)-type (6) (24%). Low-grade DD components included MFS (2), fibrosarcoma (2), myogenic/myofibroblastic type (1), and IMFT-type (1). Three tumors displayed meningothelial-like whorls and metaplastic bone formation. Heterologous elements, noted in 11 (44%) tumors, included bone (8) and rhabdomyoblastic differentiation (2). Two tumors displayed homologous differentiation, reinforced with MDM2 staining. S100-P was diffusely positive in WD components (5/7) and focally in DD components (2/9). All patients were treated with surgery, including 10, who underwent adjuvant radiotherapy. Outcomes (16 patients, 64%), over 1-48 months included 10 patients free of disease, 4 died of disease, and 2 patients alive with disease. Conclusions: This study forms the largest documentation of DDLSs, including its wide histopathological spectrum, from our country. Rare cases overlap with pleomorphic liposarcoma. S100-P and MDM2 are useful in substantiating adipocytic differentiation, especially in selected cases. Analysis of adequate tumor sections is vital for correct identification of a DDLS. Surgical excision with adjuvant RT forms optimal treatment.

Primary pleomorphic liposarcoma of breast: A rare case report.

Sarcoma of the breast constitutes less than 1% of all malignant breast tumors and liposarcoma of the breast has an incidence of 0.3% of all the mammary sarcomas. A 47-year-old woman presented with a mass in the right breast and mammography was suggestive of a malignant lesion. Modified radical mastectomy was performed. The tumor was diagnosed histologically as a pleomorphic liposarcoma. The patient was discharged and her postoperative recovery was uneventful.

Primary orbital liposarcoma: histopathologic report of two cases

Liposarcoma is a malignant tumor of adipose tissue. Considered the most common soft tissue sarcoma in adults, orbital liposarcoma is extremely rare. Most cases of orbital liposarcoma are primary and rarely metastatic. We report two cases of primary orbital liposarcoma with clinical presentation, radiologic studies [available for one case], and detailed histopathologic features. A brief review of primary orbital liposarcoma is also presented

A Case of Large Retroperitoneal Lipoma Mimicking Liposarcoma / 대한소화기학회지

Lipomas are the most common benign tumors of adipose tissue among adults. Lipomas can occur almost anywhere in the trunk, extremities, mediastinum, and pelvis, but retroperitoneal lipomas are extremely rare. It should be distinguished from well differentiated liposarcoma in order to provide the appropriate treatment and follow up. We experienced a case of 60-year-old patient with large retroperitoneal lipoma mimicking liposarcoma causing palpable abdominal mass and pain. Abdominal computerized tomography (CT) showed 33x22 cm sized bulky fat-containing mass with contrast enhanced solid portion in right retroperitoneum. Positron emission tomograpgy (PET) revealed increased 18F-FDG uptake at solid portion shown in abdominal CT. Imaging studies confirmed a high index of suspicion on liposarcoma. Laparotomy showed a large encapsulating tumor arising from retroperitoneum with fat necrosis. Pathologic examination of resected specimen revealed normal mature adipocytes without atypical cells, compatible with lipoma.