A Rare Case of Dedifferentiated Retroperitoneal Liposarcoma Presenting As Cardiac-Sounding Chest Pain.

Bhagat Manku,Amjad Ali,Parvati Addingadoo

doi:10.7759/cureus.19503

Abstract

Retroperitoneal liposarcomas (RPL) are rare mesenchymal tumours with an annual incidence of 2.7 cases per million. Well-differentiated liposarcomas (WDLs) and dedifferentiated liposarcomas (DDLs) are the most common subtype. WDLs are widely known to be low-grade tumours that are less likely to metastasise and easily resected. In contrast, DDLs are high-grade aggressive metastatic tumours with mortality rates between 50% and 70%.We present an unusual case of a 47-year-old male with a background of hypertension presenting with cardiac-sounding chest pain. Initially managed as an acute coronary syndrome (ACS), he eventually underwent a CT scan which revealed a 20x18x17cm retroperitoneal complex mass with possible infiltrates to the posterior wall of the greater curvature of the stomach. Ultrasound-guided biopsy and subsequent histopathology analysis revealed DDL consistent with MDM2 amplification.This case highlights how RPL can present with diagnostic difficulties. Multidisciplinary input from haematology, surgery and specialist teams is vital to optimise patient management.

Highlights

Retroperitoneal liposarcomas (RPL) are rare tumours that contribute to 10%-15% of sarcomas with an annual incidence of 2.7 cases per million [1,2]
Retroperitoneal liposarcomas (RPL) are rare mesenchymal tumours with an annual incidence of 2.7 cases per million
There was evidence of diaphoresis and raised blood pressure (172/119mmHg); all other observations were unremarkable. Despite his ECG showing sinus rhythm with no ischaemic changes, he was started on acute coronary syndrome (ACS) treatment with dual antiplatelets, enoxaparin and glyceryl trinitrate (GTN) spray due to what initially looked like a cardiac clinical presentation; the former medications only partially improved symptoms

Summary

Introduction

Retroperitoneal liposarcomas (RPL) are rare tumours that contribute to 10%-15% of sarcomas with an annual incidence of 2.7 cases per million [1,2]. There was evidence of diaphoresis and raised blood pressure (172/119mmHg); all other observations were unremarkable Despite his ECG showing sinus rhythm with no ischaemic changes, he was started on acute coronary syndrome (ACS) treatment with dual antiplatelets, enoxaparin and glyceryl trinitrate (GTN) spray due to what initially looked like a cardiac clinical presentation; the former medications only partially improved symptoms (mainly the GTN spray). The mass effect caused by this rapid growth displaced the stomach, left adrenal gland, small bowel, coeliac axis and superior mesenteric artery He is currently being followed up by the sarcoma team and after his third cycle of chemotherapy, imaging will be repeated to reassess for the possibility of surgical resection

Discussion

Conclusions

Findings

Disclosures

Nascimento AG