Dyspnea caused by a giant retroperitoneal liposarcoma: A case report

Abstract

Liposarcomas are the most common soft tissue tumors with various histological subtypes. They usually appear in the retroperitoneal region of the abdomen, but their symptomatology remains unclear and their diagnosis, as well as treatment challenging. A case of a 55-year-old female patient with dyspnea and light diffuse abdominal pain caused by a giant retroperitoneal liposarcoma is presented. The patient had an unremarkable medical history, while the computed tomography scan revealed a large mass at the right portion of the abdomen, with its upper limits to the lower edge and the gate portion of the liver. The mass was in contact with the right kidney, the inferior vena cava and the right renal vein, causing mild dilation of the right kidney pelvis. Without any evidence of intra-abdominal metastases, the tumor was surgically resected. The histological analysis of the tumor revealed a well-differentiated liposarcoma. The patient had an uneventful recovery and was discharged on the 10th postoperative day. Until today (4 years later) she remains asymptomatic, without any signs of recurrence. The retroperitoneal liposarcoma is a clinical entity with unclear clinical symptoms and the physician should consider including it in the differential diagnosis of a majority of symptoms, such as dyspnea.

Primary retroperitoneal liposarcoma with extensive ossification

“…[2] Most of these patients may remain asymptomatic or present with non-specific symptoms since these sarcomas can grow large without pressing on any organ. [5] However, some patients with retroperitoneal sarcomas can present with gastrointestinal symptoms such as vomiting and/or nausea, when the sarcoma is pressing the gastrointestinal tract, while others can have uremia, or hydronephrosis or nephropyelitis, when pressure has been placed on the kidneys. Similarly, patients can present with increased frequency of micturition or urgency when the urinary bladder is affected, and pressure on the nerves can present as neural syndromes.…”

“…[3,4] Primary retroperitoneal liposarcoma (PRPLS) has a higher incidence within the age group of 60 to 70 years old, with no gender predominance. [5] We present a rare 41-year-old male patient with a sclerotic type retroperitoneal well-differentiated liposarcoma, and extensive ossification.…”

Laparoscopic approach to an incidentally found pelvic retroperitoneal liposarcoma

“…[2] WDLPS have no risk of metastasis but a high risk (60%) of local recurrence because defects of the retroperitoneal fat might create a niche for recurrence. [5] In our review, the risk of recurrence was 24.1%: 7 patients had been previously treated with surgery only, [2,8,16,23,29,31,33] whereas 2 patients received also chemotherapy [8,31] and 1 patient also received radiotherapy at the time of 2nd recurrence. [8] Because these tumors are classically chemo and radio resistant, surgical resection is essential to avoid recurrence.…”

“…[5,7,28] In our review, the mean tumor size was of 29.7 cm (SD ±13.3 cm), ranging from 8 to 60 cm and extensive multiorgan resection was required in 28.1% of cases. Most of cases were diagnosed because presenting as huge abdominal/pelvic masses associated with aspecific symptoms such as abdominal discomfort/pain, [2,11,17,18,21,31,35] constipation, [8] dyspnea, [23,31] weight gain, [17,26] or loss. [18] As in our patient, 3/28 (10.7%) cases of retroperitoneal WDLPS were accidentally diagnosed.…”

“…[8] One patient of 7 (14.3%) had 1 recurrence that was treated with surgery and chemotherapy, she was FOD at 8 months from relapse. [31] Four patients of 7 (57.1%) had 1 recurrence that was surgically treated, 1 patient recurred after 16 months, [29] 1 after 20 months, [2] 1 after 35 months, [16] and 1 after 84 months. [23] After surgery 3 patients remained FOD [2,16,29] while we did not find follow-up information about 1 patient.…”