Abstract
BackgroundLiposarcoma is the single most common soft tissue sarcoma. Because mediastinal liposarcomas often grow rapidly and frequently recur locally despite adjuvant chemotherapy and radiotherapy, they require complete excision. Therefore, the feasibility of achieving complete surgical excision must be carefully considered. We here report a case of a huge mediastinal liposarcoma resected via clamshell thoracotomy.Case presentationA 64-year-old man presented with dyspnea on effort. Cardiomegaly had been diagnosed 6 years previously, but had been left untreated. A computed tomography scan showed a huge (36 cm diameter) anterior mediastinal tumor expanding into the pleural cavities bilaterally. The tumor comprised mostly fatty tissue but contained two solid areas. Echo-guided needle biopsies were performed and a diagnosis of an atypical lipomatous tumor was established by pathological examination of the biopsy samples. Surgical resection was performed via a clamshell incision, enabling en bloc resection of this huge tumor. Although there was no invasion of surrounding organs, the left brachiocephalic vein was resected because it was circumferentially surrounded by tumor and could not be preserved. The tumor weighed 3500 g. Pathologic examination of the resected tumor resulted in a diagnosis of a biphasic tumor comprising dedifferentiated liposarcoma and non-adipocytic sarcoma with necrotic areas. The patient remains free of recurrent tumor 20 months postoperatively.ConclusionsClamshell incision provides an excellent surgical field and can be performed safely in patients with huge mediastinal liposarcomas.
Highlights
Liposarcoma is the single most common soft tissue sarcoma
We here present a patient with a huge mediastinal liposarcoma that was resected by an extended surgical approach via clamshell thoracotomy
An appropriate operative field is of paramount important because liposarcomas often have ill-defined borders: because they contain a high proportion of adipose-like tissue, it is sometimes difficult to distinguish tumor-related adipose tissue from normal adipose tissue [9]
Summary
Liposarcoma, the single most common soft tissue sarcoma, comprises 9% of primary sarcomas of the mediastinum [1]. The pattern of metastasis differs considerably between the histologic subtypes, mediastinal liposarcomas often grow rapidly and local recurrence (especially of myxoid and pleomorphic types) occurs frequently [2]. Because liposarcomas often grow rapidly and frequently recur locally despite adjuvant chemotherapy and radiotherapy, they require complete excision [3]. We here present a patient with a huge mediastinal liposarcoma that was resected by an extended surgical approach via clamshell thoracotomy. A chest X-ray film revealed a huge mediastinal tumor (Fig. 1). The tumor comprised mostly fatty tissue but contained two solid areas (Fig. 2a–c). Percutaneous echo-guided needle biopsies of the lesion revealed that the fatty component was an atypical lipomatous tumor and that both solid components. 20-month follow-up visit, he reported a good quality of life and there was no evidence of recurrence
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