BACKGROUND
Atypical spindle cell lipomatous tumor (ASLT) is a rare soft tissue neoplasm with a low potential for malignancy. ASLT frequently occurs in the limb and limb girdles. However, large retroperitoneal ASLTs are extremely rare. There was no concrete case report of retroperitoneal ASLTs.
CASE SUMMARY
An 18-year-old woman presented with abdominal pain and a palpable mass. Abdominal computed tomography revealed a large fatty mass that was approximately 30 cm in size and filled the entire abdominal cavity. Surgical excision was indicated. The tumor did not invade the adjacent organs. The pelvic cavity was then too narrow to dissect smoothly. The mass was successfully excised without tumor rupture or adjacent organ injury. Microscopically, the neoplasm was a well-differentiated adipocytic neoplasm. Immunohistochemical staining showed that the spindle cells were positive for CD34 and desmin, in addition to multifocal positivity for S100 protein. These histological features were consistent with an ASLT. The patient’s postoperative course was uneventful. At the 12-mo follow-up, no evidence of recurrence or metastasis was observed.
CONCLUSION
To the best of our knowledge, our study is the first concrete report of a large retroperitoneal ASLT in the English literature. In the large retroperitoneal ASLT located in the pelvic cavity, which made it too narrow and tight to dissect, complete excision is difficult but very important because of recurrence risk. Although large retroperitoneal ASLTs are considered extremely rare, their detection is important for accurate evaluation and management. Owing to their significant rarity, retrospective multicenter case studies are required to determine the clinicopathologic characteristics.
Background
Idiopathic chronic ulcerative enteritis (ICUE) is a very rare disease with high mortality. Because of clinical rarity, several small case reports have been published and there is a lack of large sample study. Preoperative definite diagnosis is difficult. Although definite treatment for ICUE is radical surgical resection, surgical decision in operative field is difficult.
Case presentation
A 77-year-old man came to the emergency department with complaints of a 1-day history of abdominal pain and abdominal distension. Abdominal computed tomography revealed ileus and focal free air. Laparotomy revealed multiple small bowel tiny perforations in the ileum. The serosa surface in the whole small bowel had small multiple yellowish tiny discolored lesions. Despite the presence of multiple mucosal ulcers in entire small bowel, the ileum including perforation site was resected segmentally. Microscopically, mucosal ulcers in resected small bowel demonstrated transmural inflammation, no granuloma, and no lymphoid aggregates. These features were consistent with a diagnosis of ICUE with panenteritis and perforation. After surgery, the patient’s general condition gradually aggravated. Unfortunately, the patient died of multiple organ failure on post-operative day 14.
Conclusion
Surgically, the decision including resection range, anastomosis or enterotomy becomes difficult in ICUE with panenteritis. According to recent 40 year’s revised data, the post-operative mortality of ICUE is about 53.4%. Although ICUE is rare, its recognition is important for appropriate diagnosis and treatment. Retrospective multicenter case studies are required to determine proper treatment and improve prognosis.
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