Abstract
Introduction: This case report is one of a fairly common tumour in an extremely uncommon anatomic location. Statistically liposarcoma is the commonest type of soft issue malignancy, but publications of such a tumour arising from the pouch of Douglas (POD) to involve the uterus, are very few and far between. Case details: A 52-year-old woman presented with a mass in the lower abdomen, post-menopausal vaginal bleeding, and lower abdominal discomfort. Investigations revealed a large pelvic tumour that was attached to the posterior wall of a bulky uterus. There was no evidence of dissemination of the tumour to distant sites, and a laparotomy was performed. A massive soft tissue tumour occupied the POD. The tumour was dissected out from the surrounding structures, and the uterus and its appendages were removed in to. The histopathological examination revealed a liposarcoma of the pleomorphic type which was arising from the pouch of Douglas (POD), and was attached to the posterior wall of the uterus. Extensive leiomyomatous changes were seen in the uterus. Immunohistochemistry confirmed the liposarcoma to be of pleomorphic type. Conclusion: This case report is being published for its rarity and to illuminate the specific issues in the treatment of this ubiquitous tumour in an unusual site. The involvement of a Multidisciplinary Team (MDT) helps to choose the optimal combination of cytoreductive surgery, chemotherapy, and radiation for a given case with a POD malignancy.
Highlights
This case report is one of a fairly common tumour in an extremely uncommon anatomic location
Liposarcoma is the commonest type of soft issue malignancy, but publications of such a tumour arising from the pouch of Douglas (POD) to involve the uterus, are very few and far between
The histopathological examination revealed a liposarcoma of the pleomorphic type which was arising from the pouch of Douglas (POD), and was attached to the posterior wall of the uterus
Summary
A 52-year-old woman presented with complaints of severe lower abdominal discomfort, increasing swelling of the lower abdomen, and two episodes of vaginal. The patient was thinly built, and abdominal and vaginal examination revealed an obvious swelling in the lower abdomen that arose from the pelvis. Routine reports were normal and an ultrasonogram showed a large pelvic tumour, possibly of ovarian origin. A Contrast Enhanced CT scan (Figure 1) showed a large pelvic mass with the consistency of fat which was attached to the posterior wall of the uterus. The ovaries were imaged separately, and found to be normal. Tumor markers for ovarian malignancies were normal. A large solid mass occupied most of the pelvis and had infiltrated and displaced an enlarged fibroid uterus upwards against the anterior abdominal wall. The vaginal vault was closed 2 cm lower than usual
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