Giant retroperitoneal liposarcoma treated with radical conservative surgery: A case report and review of literature

Abstract

Background: Retroperitoneal liposarcoma (RLPS) is a rare malignant tumor of the connective tissue and usually grows to a large size, undetected. Diagnosis is currently based on collective findings from clinical examinations and computed tomography (CT) and magnetic resonance imaging, the latter of which show a fat density mass and possible surrounding organ involvement. Surgical resection is the main therapeutic strategy. The efficacy and safety of further therapeutic choices, such as chemotherapy and radiotherapy, are still controversial.

Case summary: A 61-year-old man presented with complaint of a large left inguinal mass that had appeared suddenly, after a slight exertion. Ultrasonography revealed an omental inguinal hernia. During further clinical examination, an enormous palpable abdominal mass, continuing from the left inguinal location, was observed. CT revealed a giant RLPS, with remarkable mass effect and wide visceral dislocation. After multidisciplinary consultation, surgical intervention was performed. Subsequent neoadjuvant chemotherapy and radiotherapy were precluded by the mass' large size and retroperitoneal localization, features typically associated with non-response to these types of treatment. Instead, the patient underwent conservative treatment via radical surgical excision. After 1 year, his clinical condition remained good, with no radiological signs of recurrence.

Conclusion: Conservative treatment via surgery resulted in a successful outcome for a large RLPS.

Keywords: Case report; Differentiated liposarcoma; Giant sarcoma; Retroperitoneal liposarcoma; Retroperitoneal sarcoma surgical outcome; Sarcoma diagnosis; Sarcoma surgical treatment.

Figure 1

Preoperative image and computed tomography scan. A: Preoperative image, the patient was initially diagnosed with a left inguinal hernia; B: Preoperative computed tomography scan. A giant retroperitoneal liposarcoma occupied the entire left abdominal cavity with extreme lateralization of the bowel and the left kidney. A grade III hydronephrosis was evident.

Figure 2

Surgical specimen. A completely encapsulated liposarcoma was entirely removed without any surrounding organ damage.

Figure 3

Postoperative computed tomography scan. The intra-abdominal organs resumed their physiological positions. A: Computed tomography (CT) scan at the level of the celiac trunk; B: CT scan at the level of the left renal vein.

Figure 4

Pathologic picture of well-differentiated liposarcoma. A: Atypical stromal cells (black arrows; mandatory for diagnosis of well-differentiated liposarcoma) and collagen ropey bands (blue arrow; enhance diagnostic confidence) are present; B: Lipoblastic cell (green arrow).