A Multi-Modality Treatment of Retroperitoneal De-Differentiated Liposarcoma

Abstract

Objective:Rare disease Background:Retroperitoneal sarcomas are rare tumors, only affecting 2 to 5 people per million population and accounting for 0.1% of all malignancies. Liposarcoma is the most common of all retroperitoneal sarcomas, responsible for approximately 20% of all sarcomas in adults. The most important prognostic factors are tumor grade, the presence of positive margins, tumor integrity, and degree of resection. Case Report:Our patient was a 73-year-old man with abdominal pain whose CT scan of the abdomen and pelvis demonstrated a 15×15 cm heterogeneous, left-sided intra-abdominal mass. He underwent resection of the retroperitoneal tumor, left colectomy, and left nephrectomy. Final pathology demonstrated a high-grade, de-differentiated liposarcoma with a rhabdosarcomatous component. The postoperative course was complicated by a small intra-abdominal abscess and abdominal dehiscence. a CT scan after surgery showed a residual tumor of the retroperitoneal posterior margin. Re-exploration to resect the residual tumor and repair the fascial dehiscence were performed. The patient underwent an initial chemotherapy regimen with doxorubicin, then moved to targeted therapy with Palbociclib, and is now on chemotherapy using Eribulin. Conclusions:Achieving complete resection and the grade of the tumor at diagnosis are the 2 most important prognostic factors for patient survival in retroperitoneal liposarcoma, as survival rates are inversely proportional to the grade of the tumor. Even with the best resection attempts, there is always a risk of residual tumor cells within the tumor bed, which contribute to recurrence and need for additional surgical interventions. It is important to approach this disease process with a multidisciplinary team that includes surgical, medical, and radiation oncology to ensure the best survival outcomes. Retroperitoneal sarcoma recurrence and survival are directly related to the ability to achieve negative margins of resection, as well as the grade and size of the primary tumor. Adjuvant therapies that include radiation and immunotherapy may be effective in treating recurrent disease.

Long-Term Recurrence of Retroperitoneal Dedifferentiated Liposarcoma After a Complete Surgical Resection: A Report of a Rare Phenomenon

“…To our knowledge, the long-term recurrence of retroperitoneal liposarcomas after 20 years post complete resection has not been reported previously. In fact, a case report published by Horowitz et al gives an inside look into the treatment method for a DDL [ 12 ]. Their particular patient was a 73-year-old male who was clinically diagnosed with a left-sided intra-abdominal mass with pathology showing a high-grade DDL with also a rhabdosarcomatous component [ 12 ].…”

“…In fact, a case report published by Horowitz et al gives an inside look into the treatment method for a DDL [ 12 ]. Their particular patient was a 73-year-old male who was clinically diagnosed with a left-sided intra-abdominal mass with pathology showing a high-grade DDL with also a rhabdosarcomatous component [ 12 ]. A residual tumor of the retroperitoneal posterior margin was noted on the post-operative CT for this patient [ 12 ].…”

“…Their particular patient was a 73-year-old male who was clinically diagnosed with a left-sided intra-abdominal mass with pathology showing a high-grade DDL with also a rhabdosarcomatous component [ 12 ]. A residual tumor of the retroperitoneal posterior margin was noted on the post-operative CT for this patient [ 12 ]. The patient’s treatment modality consisted of resection of the retroperitoneal tumor followed by both a left colectomy and left nephrectomy [ 12 ].…”

“…A residual tumor of the retroperitoneal posterior margin was noted on the post-operative CT for this patient [ 12 ]. The patient’s treatment modality consisted of resection of the retroperitoneal tumor followed by both a left colectomy and left nephrectomy [ 12 ]. Although both our case report and Horowitz et al mentioned how postoperatively a new growth was found in the patient, our particular case report outlines a new mass growth in the patient that occurred 20 years after complete resection [ 12 ].…”

Prediction of intraoperative bleeding and blood transfusion in patients with recurrent retroperitoneal liposarcoma: a retrospective study

“…Surgical resection is the mainstay of therapy for RPLS and is the only curative treatment available (2,3,7), and the roles of radiotherapy and chemotherapy in the management of RPLS remain controversial (8)(9)(10)(11)(12)(13). Although RPLS metastasis is uncommon, local tumor recurrence occurs in >50% of patients after surgery (14,15).…”