A rare case of primary small bowel de-differentiated liposarcoma causing intussusception: A case report

Abstract

Rationale: Liposarcoma (LPS) is a relatively rare malignant soft tissue tumor. Management of LPS including diagnosis is difficult, because it has no characteristic symptoms and no established effective treatment. Herein we reported an extremely rare case of intussusception induced by primary small bowel LPS.

Patient's concern: A-84-year-old male was a consult to our Emergency Department with symptoms of a terrible general fatigue, abdominal pain, and vomiting.

Diagnosis: Abdominal ultrasonography and computed tomography (CT) revealed probable intussusception.

Interventions: After decompression by insertion of an ileus tube, surgery was performed.

Outcomes: The ileum and mesentery of the small intestine had invaginated into the colon. There was no evidence of metastases in the intraabdominal space. The Hutchinson maneuver could not release the invagination, and so ileocecal resection with lymph node dissection was performed. Histopathological examination showed evidence of the growth of spindle-shaped cells. Also, immunohistochemical examination indicated the tumor to be a de-differentiated LPS. The patient was discharged on postoperative day 19 without any complications; and no recurrence of the tumor was observed at 16 months post operation.

Lessons: LPS should be considered in the differential diagnosis of adult intussusception, and careful management should be required, including observation, after surgery.

Figure 1

Highlights of preoperative images. (A) Abdominal ultrasonography image showing a 36.4 mm × 12.7 mm hypoechoic mass in the colon (white arrow). (B) That of the intussusceptional compartment (white arrow). (C) Abdominal CT image showing a continuous low-density tumorous lesion in the lumen of the colon. The white arrow indicates the tumor with ileum.

Figure 2

Highlights of intra and postoperative images. (A) The ileum and its mesentery had invaginated into the colon. (B) The polypoid tumor measured approximately 3 cm in diameter, having arisen from the ileum (white arrow).

Figure 3

Highlights of the microscopic images. (A, B) Hematoxylin-eosin-stained section showing evidence of the growth of spindle-shaped tumor cells. (C, D) Immunohistochemical staining reactions for MDM2 and CDK4. MDM2 was positive; and CDK4, negative (scale bar: A, C, D 100 μm B:10 μm).