Giant Retroperitoneal Liposarcoma Research Articles

Giant retroperitoneal liposarcoma with spread to the upper third of the left thigh

Background. Large tumors, such as giant liposarcoma, are a challenge for modern medicine because of difficulty of treatment and possible impact on functions of the adjacent tissues and organs. The review of this clinical case may help develop new strategies and approaches to treatment of similar pathologies. Purpose. Review of the clinical case has a goal to educate medical specialists and students by helping to expand their understanding of rare oncologic diseases and to prove high effectiveness of surgery in locally advanced types of retroperitoneal liposarcomas using the clinical case as an example. Materials and methods. Female patient C., 56 years old, sought for medical help in the clinical unit of State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine» in June 2021. The following diagnosis was established: retroperitoneal liposarcoma with spread to the left thigh, St. II–ІІІ сТ3N0M0. An en-bloc surgery (removal of the retroperitoneal tumor with mobilization of the left ureter, intraabdominal removal of the thigh part of the tumor of the left thigh from beneath the inguinal ligament) was performed after the standard preoperative preparation. The surgery went without complications. The wound healed primarily. The follow-up period of the patient was 16 months. Clinical laboratory examination did not show any local recurrences and distant metastases. Results. For retroperitoneal sarcoma, the goal of surgery is to achieve the complete resection of the tumor (R0). Partial removal (R2) tumor should be strongly avoided, as this has been demonstrated to have higher recurrence risk and a detrimental effect on oncologic outcomes. The tumor involvement of organs and structures does necessitate concomitant resection. Resection of one or more adjacent organs is carried out in 58–87% of all cases of primary RPS. Most commonly, ipsilateral nephrectomy and partial colectomy are also performed. In cases of hypothetical necessity of removing all adjacent organs, an extended or compartmental approach to resection is recommended. The main idea is to resect not only evidently affected organs but also surfaces to obtain circumferential «soft tissue margins». This approach is controversial but data from some sarcoma care centers in Italy and France indicate its effectiveness. Conclusions. Treating RPS in specialized centers of oncosurgery with surgical planning based on CT and MRI data is of vital importance, especially using assessment by related surgical specialists. In large RPS, achieving a classic R0 resection level is a challenge, even in a compartmental approach, therefore division of resections into R2 and R0/R1 is reasonable. The choice of approach determines success of the surgery due to the narrowness of the surgical field.

Surgical approach for complete resection of giant retroperitoneal liposarcoma with diaphragmatic hernia via ninth rib thoracotomy.

Resection of a giant retroperitoneal liposarcoma is difficult and technically demanding, especially for large retroperitoneal tumors accompanied by a diaphragmatic hernia. Technically, the open abdominal approach can be time-consuming and difficult to perform, with possible intraoperative complications and other factors bringing psychological and physical difficulties to the patient. This study reports a safe and feasible approach for the complete resection of a large retroperitoneal tumor complicated by a diaphragmatic hernia. A 58-year-old male patient with persistent upper abdominal pain and distension was treated at a local hospital on 4 July 2022. Computed tomography showed a mixed-density mass on the right retroperitoneum, and liposarcoma was considered. On 6 July 2022, the patient was transferred to our hospital for further treatment. Computed tomography showed a mass with low-density fatty shadow in the right adrenal region. The boundary with the right adrenal gland was unclear. The mass was 102mm × 74mm, and the right lobe of the liver was compressed. Insufficiency of the right middle lobe of the liver was seen due to a right diaphragmatic hernia and left mediastinal deviation. We considered the traditional approach for tumor resection via laparotomy, but we opted to perform a comprehensive evaluation first. The tumor was close to the back of the right kidney and liver, causing the diaphragm to rise because of its proximity to these organs. Exposing the tumor through laparotomy would be difficult, making it challenging to remove. The patient had a diaphragmatic hernia and moderate pulmonary dysfunction; therefore, we decided to enter the abdomen through a thoracotomy of the ninth rib. Using our technique, the tumor was easily visualized and completely removed in approximately 30min. The intraoperative blood loss was 100ml, and no postoperative bleeding, pneumothorax, intestinal fistula, infection, or other complications occurred. The transthoracic approach may be a safer and more feasible resection method than the traditional open approach for patients with giant retroperitoneal liposarcoma with a diaphragmatic hernia.

Giant retroperitoneal dedifferentiated liposarcoma - A rare case report

Retroperitoneal liposarcomas are uncommon malignancy accounting for 0.15% of all malignancies. The overall survival and prognosis is predominantly based on the total completeness of resection i.e. margin status and the histopathologic grade of the tumour. The retroperitoneal sarcomas usually present late in the disease course and often develops local invasion of the vital structures at the time of clinical presentation which makes resection with clear margins difficult and challenging. Here we present a case of Giant dedifferentiated liposarcoma arising from retroperitoneum.

Clinical analysis of 5-year survival and recurrence in giant retroperitoneal liposarcoma after surgery.

Clinical analysis of 5-year survival and recurrence in giant retroperitoneal liposarcoma after surgery.

Giant Liposarcoma of the Lumbar Fossa: A Case Report

Retroperitoneal sarcomas are rare tumors that develop in the mesenchymal tissue, where liposarcoma is the most frequently encountered subtype. The symptoms they induce are often vague and nonspecific, thus requiring thorough evaluation. Their diagnosis primarily relies on imaging techniques such as CT scans and MRI, and is confirmed by biopsy. Despite excision surgery, which remains the main treatment aiming for total resection, local recurrences remain a frequent challenge. Although radiotherapy and chemotherapy in the perioperative period are sometimes considered, their effectiveness remains subject to debate. The histological type of the tumor is of paramount importance in prognosis, with well-differentiated liposarcomas being associated with better outcomes than myxoid or dedifferentiated forms. Optimal management of these tumors requires a multidisciplinary approach, involving close collaboration between surgeons, oncologists, radiologists, and pathologists to ensure adequate and personalized treatment. Hence, the interest of a case of giant retroperitoneal liposarcoma in a 65-year-old man that we managed and report here.

Successful management of a patient with preoperative respiratory failure due to a solid giant retroperitoneal tumor: a case report

BackgroundWe report the successful preoperative management of respiratory failure in a patient with a solid giant retroperitoneal tumor with a hemodynamic monitoring system and nasal high-flow therapy (NHFT).Case presentationTwenty days before his scheduled resection of a giant retroperitoneal liposarcoma, a 64-year-old man presented with dyspnea. After admission to our intensive care unit, he received NHFT and hemodynamic therapy using a LiDCOrapid V3™ monitor (Masimo Japan, Tokyo). NHFT and intense diuresis improved his respiratory condition. The tumor resection was performed on the 5th day. He was discharged to the general ward with an oxygen nasal cannula on the second postoperative day. Although preoperative transthoracic echography showed mild aortic regurgitation and moderate mitral regurgitation, the degree of regurgitation had become trivial about 1-month post-surgery.ConclusionsA cause of preoperative respiratory failure associated with a giant retroperitoneal tumor might be not only diaphragmatic compression but also heart failure and excess fluid volume.

Giant Retroperitoneal Liposarcoma: Correlation Between Size and Risk for Recurrence.

Soft tissue sarcomas (STSs) are rare tumors that represent almost 1% of adult malignant tumors. The annual incidence rate for such tumors is 2 - 5/100,000 population. The most common type of STS in adults is liposarcoma, which represents 15-20% of adult STSs. It is of mesodermic origin derived from adipose tissues, and known as the most common primary malignant tumor of the retroperitoneum. Other sites of involvement include the extremities, trunk and to a lesser extent the pleural cavity, esophagus, mediastinum and others. Due to the potential large retroperitoneal space, retroperitoneal liposarcoma (RPL) is usually asymptomatic during the initial phase, developing symptoms at a late stage due to large mass compressing nearby retroperitoneal structures. The average diameter and weight of RPL during diagnosis is 20 - 25 cm and 15 - 20 kg, respectively. Several factors were labelled as risk factors for recurrence, such as histological type, tumor grade, age, resectability and tumor size. Controversy exists regarding the relationship between tumor size and recurrence rate, thus, tumor size as a risk factor for recurrence should be clarified. Although there is no consensus regarding the precise definition of giant RPL, it is defined by several literatures as an RPL of greater than 30 cm in diameter or with weight of more than 20 kg. The main purpose of this article is to review the current English literature regarding giant RPL and examine the relationship between tumor size and risk for recurrence.

Giant retroperitoneal liposarcoma: A case report.

Introduction and importanceRetroperitoneal liposarcomas are rare malignancy. They can grow usually asymptomatic until large enough to compress the surrounding organ. Giant retroperitoneal liposarcoma with diameter over 30 cm and weight over 20 kg is extremely rare. There has been limited report of giant retroperitoneal liposarcoma.Case presentationA 34-year old woman complained about intermittent abdominal discomfort and progressive abdominal distension for last 2 years. There was history of weight loss for last 3 months. CT scan with contrast showed giant right abdominal mass that expanded to the pelvis (30.4 × 28 × 34 × 29 cm), oppressed surrounding organs and displaced the intestine to the left side with no visualization of normal right kidney structure. Complete resection of this retroperitoneal tumor was performed without combined resection of the surrounding organ. The biopsy of tumor showed a well differentiated liposarcoma. We diagnosed this patient with giant retroperitoneal liposarcoma. The postoperative course was uneventful and the patient was discharged on the 3th postoperative day. Last follow up, 3 months after surgical resection, patient had no complaints and there was no recurrence of this retroperitoneal liposarcoma.Clinical discussionComplete resection is the predominant treatment of retroperitoneal liposarcoma to avoid recurrence. Successful complete resection of retroperitoneal liposarcoma may increase the 5-year survival rate from 16.7 to 58 %. However, complete resection is a challenge, particularly in the well-differentiated subtype, for the reason that the margins are not easily distinguishable.ConclusionGiant retroperitoneal liposarcoma is an extremely rare tumor with high rate of recurrence, depends on some factors such as the histological type and grade, the metastasis, and also completeness of tumor resection. In this case we performed complete resection without combined resection of the surrounding organ. Furthermore, we will continue to observe our patient closely for recurrence.

Challenging surgical treatment of giant retroperitoneal liposarcoma: A case report

Liposarcoma is a rare malignant tumor type and surgical resection is the gold standard treatment. The present study reported on the case of a 51-year-old woman who presented with a mass in the left upper abdomen. Computed tomography revealed a 32-cm giant retroperitoneal liposarcoma. Complete tumor resection was performed without the removal of other organs. Postoperative pathological examination indicated retroperitoneal well-differentiated liposarcoma and immunohistochemistry revealed S-100(−), MDM2(+), vimentin(+), CDK4(+), p16(+) and STAT6(+) results. The patient recovered well after the surgery. Complete tumor resection during the first surgery is key to cure liposarcoma. The present case report will be helpful for clinical oncologists to fully understand giant retroperitoneal liposarcoma and treat it accordingly.

Giant retroperitoneal well-differentiated liposarcoma presenting in emergency with intestinal occlusion: Case report and review of the literature.

Introduction and importanceLiposarcoma (LPS) represents the most common type of retroperitoneal sarcoma (RPS) and can be classified into four subtypes. Preoperative diagnosis of retroperitoneal liposarcoma (RLPS) is a challenge because of its late and nonspecific clinical presentation. Imaging may be helpful for determining the correct diagnosis. Surgery represents a potentially curative treatment of RLPS.Case presentationA 55-year-old Caucasian female presented to the Emergency Department with a two-day history of abdominal pain, abdominal distension, inability to pass gas or stool, nausea, vomiting and lipothymia. Abdominal examination revealed abdominal distention, abdominal pain without obvious muscle guarding and a giant non-tender mass. Laboratory tests reported neutrophilic leukocytosis and anemia. Abdominal contrast-enhanced computed tomography (CECT) showed a heterogeneous and hypodense giant retroperitoneal mass compressing and displacing the surrounding organs and vessels. The patient underwent excision of a giant retroperitoneal mass. The postoperative course of the patient was uneventful.Clinical discussionRLPS is a malignant neoplasm that can slowly grow to enormous size with possible involvement of adjacent organs and vessels; it may recur locally and has a minimal capacity to metastasize. Preoperative diagnosis and staging of RLPS are important to establish appropriate management and prognosis. Surgery represents the gold standard for non-metastatic RLPS treatment.ConclusionRLPS is a rare malignant neoplasm generally difficult to detect early due to its late and nonspecific clinical presentation. CECT represents the most commonly used modality for diagnosis, staging and preoperative evaluation. Surgery represents the appropriate treatment of non-metastatic RLPS.

Giant retroperitoneal liposarcoma: Surgical management of a difficult case with acute abdomen

Retroperitoneal sarcomas are a relatively rare disease that represent a challenge for the surgeon especially when the mass reaches remarkable size and causes anatomical subversion. Liposarcoma is one of the most common histological subtypes. It often grows asymptomatic till considerable dimensions. From literature we know that the only possibility of radical treatment is the complete surgical resection. Although that approach improves the prognosis, local recurrence is the main cause of mortality. Actually, liposarcomas have no support of complementary radio-chemotherapies. This report describes the clinical presentation and surgical management of a patient with a symptomatic huge retroperitoneal sarcoma.

Surgical Resection of A Giant Liposarcoma in the Renal Compartment: A Case Report and Literature Review

Retroperitoneal sarcomas are rare tumors that develop in the mesenchymal tissue, where liposarcoma is the most frequently encountered subtype. The symptoms they induce are often vague and nonspecific, thus requiring thorough evaluation. Their diagnosis primarily relies on imaging techniques such as CT scans and MRI, and is confirmed by biopsy. Despite excision surgery, which remains the main treatment aiming for total resection, local recurrences remain a frequent challenge. Although radiotherapy and chemotherapy in the perioperative period are sometimes considered, their effectiveness remains subject to debate. The histological type of the tumor is of paramount importance in prognosis, with well-differentiated liposarcomas being associated with better outcomes than myxoid or dedifferentiated forms. Optimal management of these tumors requires a multidisciplinary approach, involving close collaboration between surgeons, oncologists, radiologists, and pathologists to ensure adequate and personalized treatment. Hence, the interest of a case of giant retroperitoneal liposarcoma in a 65-year-old man that we managed and report here.

Gerota Liposarcoma: A Case Report

We report an observation of a giant retroperitoneal liposarcoma encompassing the kidney. The patient was operated on by midline incision laparotomy. In light of this observation, the symptomatology, diagnosis and treatment options are discussed.

A giant retroperitoneal liposarcoma with hemoperitoneum: A rare tumor with unusual presentation

Retroperitoneal liposarcoma (RPLS) is a rare mesenchymal tumor which accounts for 0.02–0.7% of all malignancy. The presentations of these tumors are non-specific and early diagnosis is often missed. We are reporting a rare case of 17-year-old girl who came to us with complaints of abdominal distension and other non-specific symptoms but after few hours of admission, she had acute abdomen with hemodynamic instability. She underwent emergency laparotomy and found to have a giant 25 × 20 × 10 cm ruptured retroperitoneum tumor causing hemoperitoneum. The tumor involved left ovary and fallopian tube as well. Complete resection of tumor with left salpingooophorectomy was done. The patient was kept in intensive care unit and discharged in good health after 15 days. This presentation of RPLS has not been reported yet and may demand early diagnosis and management of these tumors. The histopathology revealed dedifferentiated liposarcoma with rhabdomyosarcomatous differentiation. The patient is completely fine at 16 months of follow-up while writing this report. Again, heterologous dedifferentiation of liposarcoma with spindle cell component is a rare morphologic spectrum. Liposarcomas can have various histologic types. In dedifferentiated types, the line of differentiation needs to be identified to decide further line of treatment. Therefore, thorough histopathological analysis and immunostaining is needed. Treatment includes complete surgical resection. Role of radiotherapy and chemotherapy is debatable and is still under trial. Dedifferentiated RPLS with rhabdomyosarcomatous differentiation is a rare tumor and its presentation as acute abdomen and hemoperitoneum has never been reported previously.

A 60-year-old female with giant retroperitoneal liposarcoma.

Retroperitoneal tumors give non-specific symptoms until they have reached a substantial size. Liposarcoma and leiomyosarcoma are the most common retroperitoneal carcinoma amount of 70% and 15% respectively. Hodgkin´s and non-Hodgkin lymphoma and epithelial tumors or metastatic disease are less common. We present a 60-year-old female who was referred to the Emergency Department with acute onset of abdominal distension, nausea, vomiting, right back pain and lipothymia. She had a medical history of essential hypertension and diabetes mellitus. On Physical examination, she had a good performance status, arterial blood pressure was 90/60 mmHg, pulse rate was 120 b/min, oxygen saturation of 93%. Blood exams demonstrated no Lymphocytes 4x 103/mmc, Hemoglobin 7g/dl. Physical examination of the abdomen revealed a giant non-tender mass in the left and midline quadrants. The patient was transfused with 4 units of blood. Abdomen computed tomography (CT) scan revealed a retroperitneal mass of 35 cm involving the stomach, the spleen, the kidney and surrounding the vena cava (A). He was referred to a Multidisciplinary Team (MDT) to perform a CT Scan Fine-Needle-Aspiration (FNA) which confirm a well differentiated liposarcoma. A laparotomy was performed with total excision of retroperitoneal mass (B). At 6th day, the patient was in good clinical condition and he was discharged. Hystopathological finding: well differentiated liposarcoma. French Federation of Cancer Centers Sarcoma Group: Grade 1 tumor differentiation: 1; mitotic count: 1; tumor necrosis: 0 (C).

Dev Retroperitoneal Liposarkomun Yönetimi: Bir Olgu Sunumu

Retroperitoneal liposarcoma (RPLS) is a rare tumor. Early diagnosis and treatment are difficult due to absence of specific clinical presentations. We report a case of a 66-years-old woman who succesfully underwent complete surgical resection for a giant retroperitoneal liposarcoma. The complete surgical resection is the most important predictor of local recurrence and overall survival. We believe that complete surgical resection involving adjacent organs is a curative treatment to increase overall survival, especially in the presence of invasion of large tumors.

Perioperative strategy and outcome in giant retroperitoneal dedifferentiated liposarcoma\u2014results of a retrospective cohort study

Background and objectivesRetroperitoneal liposarcoma (RPLS) are common soft tissue sarcomas of adulthood. The aim of this study is to show resectability of even giant liposarcomas and to identify factors associated with recurrence and survival in primary retroperitoneal liposarcomas.MethodsWe retrospectively reviewed the records of patients with retroperitoneal liposarcoma. Seventy-seven patients met inclusion criteria. Out of these 10 patients with primary giant, dedifferentiated retroperitoneal liposarcomas were operated with en bloc compartment resection with intention of radical resection. Treatment consisted of neoadjuvant radiochemotherapy and surgical resection or surgical resection.ResultsIn 6 patients, neoadjuvant radiochemotherapy was performed; 3 patients were treated with surgical resection alone and 1 patient received adjuvant chemotherapy. The median diameter of tumor size was 360 mm (300 to 440 mm). Operative outcome showed complete resection in all 10 patients. Local tumor free survival was in median 19 month. Tumor recurrence was seen in 3 of 4 patients (75%) without neoadjuvant radiochemotherapy, and in 2 of 6 patients (33%) after neoadjuvant radiochemotherapy in 2 years follow-up.ConclusionEven in case of giant retroperitoneal liposarcoma, complete resection is possible and remains the principal treatment. The rate of recurrence was improved in patients with neoadjuvant radiochemotherapy.

Клінічний випадок «невидимої» гігантської неорганної заочеревинної пухлини

SummaryBackground. The problem of verification of abdominal and retroperitoneal spacegiant tumors deserves special attention. At first glance, such verification should not bedifficult, but real clinical practice suggests otherwise. Often such a tumor can remainundetected for a long time, despite repeated examinations. This is especially true forliposarcomas, which have a heterogeneous structure, can be perceived duringultrasound as the intestine, which worsens visualization due to flatulence. As a result,patients receive treatment for a long time for various pathologies, the size of the tumorincreases, the prognosis of such patients deteriorates.Materials and methods. The case of a patient with giant retroperitonealliposarcoma is presented in order to draw attention to the importance of cancervigilance for timely diagnosis of the tumor.Results. A 77-year-old male patient was treated for a long time for heart failure(HF) and was repeatedly hospitalized for HF decompensation. The main complaintswere an increase in abdominal volume, flatulence, shortness of breath, impaired qualityof life and decreased tolerance to exercise. Ultrasound examination of the abdominalcavity and retroperitoneal space was performed repeatedly, poor visualization wasexplained by severe flatulence. During the last hospitalization, a very large tumor wasdetected by multidetector spiral computed tomography (MSCT). According to theautopsy, the liposarcoma of gigantic size (approximately 8 kg) was found. The diagnosiswas confirmed histologically.Conclusion. Computed tomography and MSCT is a useful diagnostic tool to verifygiant «invisible» tumors in the abdomen.

Treatment management of giant retroperitoneal localized liposarcoma

Liposarcoma is a tumor that reaches large diameters inside soft tissue tumors. It is rare. It is more common in people between the ages of 40-60. Liposacoma patients are mostly asymptomatic, so their diagnosis may be delayed.
 A 65-year-old female patient was admitted to our clinic. She had complaints of mass and pain in her abdomen. Abdominal examination revealed a mass extending to the pelvic area. The patient was evaluated by examination and radiology. Retroperitoneal liposarcoma diagnosed. Since the mass captured the left colon and kidney, the patient underwent left nephrectomy and left hemicolectomy. After histological and immunohistochemical examination, the patient was diagnosed with well-differentiated liposarcoma. The patient was evaluated with abdominal and pelvic computed tomography at the postoperative 4th month. No recurrence was observed in computed tomography scans. With the review of the literature, we found that the giant well-differentiated liposarcoma case extending into the pelvic region was scarce. 
 In this study, a rare case with giant well-differentiated liposarcoma that fills the abdomen almost completely is presented and the clinical features and surgical management of these tumors are discussed.

A recurrent giant retroperitoneal myxoid liposarcoma: a case report and literature review

Retroperitoneal liposarcoma (RPLS) is a very rare type of tumor, accounting for less than 1% of all malignancies, especially the “large retroperitoneal liposarcoma” (GRPLS) of more than 20 kg (kilograms). Herein, we describe the treatment experience in a case of recurrent GRPLS. A 70-year-old woman was admitted with an enlarged abdomen, and computed tomography (CT) showed a large, low- density, homogeneous retroperitoneal mass (40×37×26 cm). In laparotomy, this 55×40×20 cm liposarcoma was completely removed and pathologically diagnosed as low-grade myxoid liposarcoma. The patient did not receive any adjuvant therapy, and CT showed no evidence of recurrence during follow-up.