Dediferentovan liposarkom natkolenice

Abstract

Liposarcoma is a rare malignant tumor of the origin of adipose tissue, with an incidence less than 1/1000000. We distinguish three types of tumors: benign (lipoma), intermedial (well-differentiated liposarcoma) and malignant (dedifferentiated liposarcoma, myxoid and pleomorphic liposarcoma). Dedifferentiated liposarcoma is a combination of fat and sarcoma cells. Its growth is slow, which makes early diagnosis difficult due to the absence of symptomatology. The tumor is aggressive with recurrences, metastasis and lethal outcomes, resistant to all therapeutic options except surgical treatment. The patient, 48 years old, hypertensive, overweight and a smoker, at the beginning of 2017 indicates an oval tumefaction on her right thigh, lateral side from middle of the femur to the knee, surrounded by cellulite and slowly increasing. The change is of solid structure, located under the skin above the knee. Echosonographically subcutaneous from half the femur to the knee vascularized tumorous formation, 80mm wide, which breaks the architecture of the fat, including the muscles. MRI scan shows a soft tissue infiltrative change, dominantly in the subcutaneous body fat. Shown to a vascular, reconstructive surgeon and orthopedist, the change appears to be a desmoid tumor and they indicate continuation of the treatment at a referenced institution. The tumor was surgically removed. Histopathologically is a high-grade primary malignant mesenchymoma, dedifferentiated liposarcoma, with leiomyoblastic differentiation. A pseudocapsule was infiltrated to the viable tumor cells and the Sarcoma consilium ordinates a postoperative radiotherapy (50 Greja-Gy in 25 fractions). Patient feels well and appears for regular check-ups. In order to successfully treat liposarcoma, a multidisciplinary approach of a surgeon, radiotherapist, pathologist, oncologist and a nuclear medicine specialist in specialized centers are necessary.