Surgical management of giant recurrent retroperitoneal liposarcoma: a case report and review of the literature.

’ Case Report Surgical management of giant recurrent retroperitoneal liposarcoma: a case report and review of the literature Madani Ayoub, MDa,b,*, Bouzayan Leila, MDa,b, Mabrouk Yassin, MDa,b, Miry Achraf, MDa,b, Jabi Rachid, PhDa,b, Pr Bouziane Mohamed, PhDa,b Introduction: Liposarcoma is a rare, primary, malignant mesenchymal tumor. It represents ∼7% of all mesenchymal sarcomas and 1% of all cancers. Their incidence does not exceed to 2.5 cases/million inhabitants/year. This tumor is locally invasive, diagnosed at a late stage, and can reach a significant size and weight, resulting in a locally advanced tumor. Case presentation: A 59-year-old female patient consulting for a large abdominal mass. The abdominal computed tomography showed three retroperitoneal masses, and the surgical exploration revealed a huge process in the retroperitoneal cavity, which takes the left renal compartment, and the left colon. The intervention consisted of a mono-bloc excision of the mass taking the spleen, the left renal compartment, and the left colon with colonic anastomosis. The histological examination concluded the existence of a well-differentiated myxoid liposarcoma of grade I, the postoperative follow-up was simple. One year later, she underwent an excision of a recurrence of the same retroperitoneal location, but of a pleomorphic cell histological type of grade II according to the FNCLCC classification. We review the literature, the pathological, therapeutic, and prognostic aspects of this tumor. Discussion: Retroperitoneal liposarcoma is a rare tumor. Its gravity is due to an often-late diagnosis, a complete imaging workup including ultrasound, computed tomography and often MRI is necessary preoperatively to determine the relationship with the different organs. The definitive diagnosis is histological, surgery is the most effective treatment and can be extended to neighboring organs. the frequency of recurrence requires particular surveillance. Conclusions: We highlight the importance of radical surgical excision to avoid retroperitoneal liposarcoma tumor complications and to minimize the recurrence risk. Keywords: case report, giant masses, liposarcoma, myxoid cells, pleomorphic cells Introduction HIGHLIGHTS LPS is a rare, primitive, malignant mesenchymal tumor; it most often develops from soft tissue, it represents ∼7% of all mesenchymal sarcomas, 1% of cancers[1] and their incidence does not exceed 2.5 cases/million inhabitants/year[2]. It is locally invasive, late diagnosed, and can reach a significant size and weight, resulting a locally advanced tumor. The diagnosis of retroperitoneal LPS is often delayed due to • Liposarcoma (LPS) is a rare, primitive, malignant mesenchymal tumor. It is locally invasive, of late diagnosis. • Computed tomography (CT) scan is the best examination for the diagnosis of these tumors and specifies the relationship with the surrounding organs. • The definitive diagnosis is anatomopathological of the tumor resection specimen. • Surgical resection with a negative margin is considered a primary treatment for LPS. • The prognostic factors are: the histological grade of the tumor, local recurrence, and distant metastases. a Department of Visceral Surgery and Digestive Oncology A, Mohammed VI University Hospital and bLaboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM), Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. *Corresponding author. Address: Universite Mohammed Premier Oujda Faculte de Medecine et de Pharmacie Oujda, Oujda 60000, Morocco. Tel.: 0658584535; Fax: 0536533554. E-mail address: (M. Ayoub). Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Annals of Medicine & Surgery (2023) 85:2130–2134 Received 23 August 2022; Accepted 22 March 2023 Published online 12 April 2023 http://dx.doi.org/10.1097/MS9.0000000000000592 the compliance of the abdominal cavity. In addition, there is a higher rate of recurrence compared with LPSs in other locations[1]. LPS risk factors identified by the American Cancer Society include radiation (especially radiation therapy used to treat other malignancies), certain family cancer syndromes, damage/trauma to the lymphatic system, and exposure to toxic chemicals[3]. We report the case of a 59-year-old woman who underwent complete excision of a giant retroperitoneal LPS. Three months later, she had a recurrence of the same retroperitoneal location, but of a different histological type and grade. We review the literature on the pathological, therapeutic, and prognostic aspects 2130 Ayoub et al. Annals of Medicine & Surgery (2023) of this tumor. This work has been reported in line with the SCARE criteria[4]. Case presentation A 59-year-old female patient with no previous pathological history presented with vague abdominal pain for 9 months, progressive increase in abdominal volume, and weight loss. The examination revealed edema of the lower limbs, two large abdominal masses, one located in the iliac fossa and the right flank, the other in the left flank, as well as a shifting dullness. The biology revealed an inflammatory syndrome with C-reactive protein at 56 mg/l, hypoproteinemia at 57 g/l, and hypoalbuminemia at 29 g/l. Abdominal ultrasound showed the presence of a large tissue and cystic mass of the abdominopelvic region and significant infiltration of the mesenteric fat. The abdominal CT helical (64 strips), 1–2 mm slice thickness, 2–3 mm axial slices and multiplanar reconstructions, thick volumetric three-dimensional sections for vascular assessment showed three abdominopelvic masses in three locations. One on the right side, hyperdense and poorly circumscribed, measuring 16 cm, one on the left side, cystic, measuring 11 cm, and the third one , has a tissue aspect with cystic areas measuring 12cm in the left iliac fossa. These aspects were suggestive of a LPS. The thoracic CT scan was normal (Figs. 1 and 2). The patient underwent a midline incision that extended from the subxiphoid to the suprapubic area. The intraoperative exploration revealed: A huge bilobed retroperitoneal process compressed the peritoneal cavity, which took the left renal compartment, and the left colon which was pushed forward between the two lobes of the tumor. After reaching the retroperitoneal space and identification of the limits of the tumor, the mass was immediately exposed and extensively dissected using coagulating shears (HARMONIC ACE; Ethicon). A mono-bloc excision of the retroperitoneal mass taking the (...truncated)