Pouch of Douglas Liposarcoma—A Rarity

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.