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Sriussadaporn S, Sriussadaporn S, Pak-Art R, Kritayakirana K, Prichayudh S, Samorn P, Narueponjirakul N, Aimsupanimitr P, Uthaipaisanwong A. A preliminary study of primary retroperitoneal sarcoma at a tertiary University Hospital in Bangkok, Thailand: a retrospective observational study. ASIAN BIOMED 2024; 18:236-243. [PMID: 39483711 PMCID: PMC11524672 DOI: 10.2478/abm-2024-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2024]
Abstract
Background Retroperitoneal sarcoma (RPS) is rare and difficult to treat with a high recurrent rate. Very little data regarding primary RPS exists in Thailand. Objectives To study the outcome of treatment of primary RPS at a tertiary University Hospital in Bangkok, Thailand. Methods All patients who had RPS undergoing the first surgical resection at King Chulalongkorn Memorial Hospital from June 2003 to December 2019 were retrospectively enrolled in the study. Perioperative management, results of treatment, postoperative complications, and outcome were analyzed. Results Thirty-eight patients entered the study. Large abdominal mass was the most common presentation (90%). Liposarcoma was the most common histology (58%). Twenty patients (53%) had preoperative core needle biopsy and 21 (55%) underwent preoperative radiotherapy (RT). The tumor size ranged from 3 cm to 48 cm (median 22 cm). Five patients (13%) had total mass removal only while 33 (87%) had complete gross resection with ≥1 visceral organ resection. Surgical margins classified as R0, R1, and R2 were 61%, 34%, and 5%, respectively. Five patients (16%) had postoperative complications. There was no 30-day postoperative mortality. The local recurrence rate was 34%. Survival analysis revealed a 5-year overall survival rate of 37% and 5-year disease-free survival rate of 29%. The 5-year and 10-year recurrent rates were 71% and 95%, respectively. Multivariate analysis showed that preoperative radiation was the only factor reducing recurrence (19% vs. 53%, OR: 0.21, P = 0.011). Conclusion The preliminary study of outcome of the treatment of primary RPS at our institution showed a fair prognosis of this rare malignancy despite our aggressive surgical approaches. Preoperative radiation may help reduce recurrence in selected primary RPS patients.
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Affiliation(s)
- Suvit Sriussadaporn
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
| | - Sukanya Sriussadaporn
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
| | - Rattaplee Pak-Art
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
| | - Kritaya Kritayakirana
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
| | - Supparerk Prichayudh
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
| | - Pasurachate Samorn
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
| | - Natawat Narueponjirakul
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
| | - Punthita Aimsupanimitr
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
| | - Apinan Uthaipaisanwong
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
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Bao Z, Zhang Z, Ding P, Zhao Q, Li Y. A case report of retroperitoneal liposarcoma. Medicine (Baltimore) 2024; 103:e39633. [PMID: 39287238 PMCID: PMC11404892 DOI: 10.1097/md.0000000000039633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 08/14/2024] [Accepted: 08/20/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Retroperitoneal liposarcoma is a rare and complex tumor originating from the mesenchymal tissues, with no specific manifestations in the early stage, and a large tumor size in the late stage. Patients often consult a physician because of large abdominal mass, increased abdominal circumference, and abdominal pain, and rarely because of leukocytosis. PATIENT CONCERNS A 54-year-old female presented to our hospital with complaints of "abdominal distension for over 3 months, left lumbar pain for over 2 months." Considering the comprehensive symptoms, examinations, computed tomography scans, and pathological results, the possibility of retroperitoneal liposarcoma is high. DIAGNOSES Retroperitoneal liposarcoma with leukocytosis. INTERVENTIONS Open retroperitoneal mass excision along with transcystoscopic left ureteral Double-J Ureterl Stent Insertion tube placement and left nephrectomy. OUTCOMES The postoperative pathological findings of the abdominal mass, combined with morphological and immunohistochemical results, are consistent with retroperitoneal liposarcoma. The patient had no recurrence in 7 months of postoperative follow-up conducted on the telephone and is now in continued follow-up. CONCLUSION Retroperitoneal liposarcoma is highly malignant and prone to recurrence. Radical surgery is currently the primary treatment modality for patients with this condition. Analogous to cancer patients, those with elevated white blood cell counts and retroperitoneal liposarcoma may have poor prognoses, with a high likelihood of local recurrence and distant metastasis. Close postoperative follow-up is necessary. Therefore, regular postoperative review of blood routine may be a relatively economical and convenient method for the early detection of recurrence and metastasis of retroperitoneal liposarcoma.
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Affiliation(s)
- Zicheng Bao
- Third Department of Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhidong Zhang
- Third Department of Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Pingan Ding
- Third Department of Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qun Zhao
- Third Department of Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yong Li
- Third Department of Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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3
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Nitta S, Kandori S, Takahashi R, Suzuki S, Hamada K, Tanuma K, Shiga M, Kojo K, Sakka S, Nagumo Y, Hoshi A, Mathis BJ, Negoro H, Okuyama A, Higashi T, Nishiyama H. Retroperitoneal sarcoma: a 10-year follow-up analysis using hospital-based cancer registry data in Japan. Jpn J Clin Oncol 2024; 54:716-721. [PMID: 38411262 DOI: 10.1093/jjco/hyae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/03/2024] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVES We sought clinical characteristics, survival outcomes, and prognostic factors for overall survival of retroperitoneal sarcoma in Japan. METHODS A Japanese hospital-based cancer registry database with a pivotal 10-year follow-up was used to identify and enroll patients, registered from 106 institutions, diagnosed with retroperitoneal sarcoma in 2008-2009. Treating hospitals were divided by hospital care volume; high-volume hospitals and low-volume hospitals were defined as ≥ 4 and < 4 cases/year, respectively. RESULTS A total of 91 men and 97 women were included, with a median age of 64 years. The most common histological type was liposarcoma in 101 patients, followed by leiomyosarcoma in 38 patients. The 5-year and 10-year overall survival rates were 44.1 and 28.3%. The majority of patients (n = 152, 80.9%) were treated at low-volume hospitals. High-volume hospital patients had higher 10-year overall survival rates than low-volume hospital patients (51.2% vs 23.2%, P = 0.026). Multivariate analysis revealed age over 60 years, treatment in low-volume hospitals and chemotherapy were independent predictors of unfavorable survival while treatment with surgery was an independent predictor of favorable survival. CONCLUSIONS The possibility of surgical removal was suggested to be the most important prognostic factor for retroperitoneal sarcoma. Better survival was shown in patients treated at high-volume hospitals in our series.
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Affiliation(s)
- Satoshi Nitta
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Shuya Kandori
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Reo Takahashi
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Shuhei Suzuki
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Kazuki Hamada
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Kozaburo Tanuma
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Masanobu Shiga
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Kosuke Kojo
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Shotaro Sakka
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Yoshiyuki Nagumo
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Akio Hoshi
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Bryan J Mathis
- International Medical Center, University of Tsukuba Affiliated Hospital, Ibaraki
| | - Hiromitsu Negoro
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Ayako Okuyama
- Graduate School of Nursing, St Luke's International University, Tokyo
- Institute for Cancer Control, National Cancer Center Japan, Tokyo, Japan
| | - Takahiro Higashi
- Institute for Cancer Control, National Cancer Center Japan, Tokyo, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki
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Xu J, Wang F, Liu J, Ma S. A patient with retroperitoneal liposarcoma. Asian J Surg 2024; 47:1019-1020. [PMID: 37985323 DOI: 10.1016/j.asjsur.2023.10.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/20/2023] [Indexed: 11/22/2023] Open
Affiliation(s)
- Jinming Xu
- Department of the Second Affiliated Hospital of Kunming Medical University, China.
| | - Feng Wang
- Department of the Second Affiliated Hospital of Kunming Medical University, China
| | - Jianhe Liu
- Department of the Second Affiliated Hospital of Kunming Medical University, China
| | - Shuang Ma
- Department of Jinning District People's Hospital, China
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Putra LS, Santoso RB, Harahap EU, Cahyanti D, Bramono IA, Hamid ARAH. Solitary fibrous tumor in the retroperitoneum: A case report. Int J Surg Case Rep 2024; 114:109118. [PMID: 38159392 PMCID: PMC10800751 DOI: 10.1016/j.ijscr.2023.109118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Solitary fibrous tumor (SFT) is an uncommon mesenchymal tumor that can manifest in a variety of locations, including the retroperitoneum. The most effective standard diagnostic approach and treatment is yet to be determined due to unpredictable behavior of SFT, including retroperitoneal SFT. CASE PRESENTATION A 43-year-old female with a retroperitoneal SFT presented with a palpable mass and symptomatology. Surgical exploration disclosed a tumor encompassing the left renal artery and vein, necessitating left nephrectomy and retroperitoneal mass removal. Initial histological examination suggested rhabdomyosarcoma, but subsequent immunohistochemistry confirmed the diagnosis of retroperitoneal SFT. No adjuvant therapy was administered, and there was no detectable mass on follow-up imaging. The patient remained symptom-free. CLINICAL DISCUSSION Retroperitoneal SFTs are difficult to diagnose due to their non-specific morphology, thus immunohistochemistry plays a crucial role in confirming its diagnosis. Surgical excision with negative resection margins continues to be the standard treatment. Recurrence rates are low in comparison to other retroperitoneal sarcomas, hence routine chemotherapy or radiation therapy is not advised. CONCLUSION This case demonstrates the significance of contemplating SFT as the differential diagnosis of retroperitoneal tumors and the role of immunohistochemistry in confirming the diagnosis. The optimal management strategies for retroperitoneal SFTs should be determined by additional research.
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Affiliation(s)
- Lenggo Septiady Putra
- Department of Urology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia.
| | - Rachmat Budi Santoso
- Department of Urology, National Cancer Centre - Dharmais Cancer Hospital, Jakarta, Indonesia
| | - Edward Usfie Harahap
- Department of Urology, National Cancer Centre - Dharmais Cancer Hospital, Jakarta, Indonesia
| | - Dian Cahyanti
- Department of Pathological Anatomy, National Cancer Centre - Dharmais Cancer Hospital, Jakarta, Indonesia
| | - Ikhlas Arief Bramono
- Department of Urology, National Cancer Centre - Dharmais Cancer Hospital, Jakarta, Indonesia
| | - Agus Rizal A H Hamid
- Department of Urology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
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Gao X, Ding P, Zhang Z, Li Y, Zhao Q, Wang D, Zhao X, Liu Y, Tan B. Analysis of recurrence and metastasis patterns and prognosis after complete resection of retroperitoneal liposarcoma. Front Oncol 2023; 13:1273169. [PMID: 38188302 PMCID: PMC10771260 DOI: 10.3389/fonc.2023.1273169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
Objective To analyze the recurrence and metastasis patterns and prognosis after complete resection of retroperitoneal liposarcoma. Methods The clinical postoperative follow-up data and results of patients who underwent complete resection of retroperitoneal liposarcoma from September 10, 2014, to September 8, 2021, at Hebei Medical University hospital were collected retrospectively. Results A total of 60 patients with complete resection of retroperitoneal liposarcoma, including 33 cases of retroperitoneal liposarcoma recurrence, 2 cases of liver metastasis, and 1 case of lung metastasis, were included. The results showed that 100% of the recurrent sites were located in the primary region of the tumor, with most recurrences located near the kidney, paracolic sulci, and iliac vessels. Three patients had distant metastasis without obvious recurrence on imaging examination. The pathological type of retroperitoneal liposarcoma, Ki67 expression, and presence of serum albumin were risk factors for recurrence and metastasis after complete resection of retroperitoneal liposarcoma. The malignancy and Ki67 expression were independent risk factors for recurrence and metastasis as well as for overall survival of patients undergoing complete resection of retroperitoneal liposarcoma. Conclusion Complete resection remains the most effective method to treat retroperitoneal liposarcoma. Patients with pathological types of retroperitoneal liposarcoma showing dedifferentiation, pleomorphism, mixed type, and high Ki67 expression should be closely monitored and observed after complete resection, especially for imaging changes in the primary tumor area.
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Affiliation(s)
| | | | - Zhidong Zhang
- Hebei Cancer Clinical Medical Research Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Deng H, Gao J, Xu X, Liu G, Song L, Pan Y, Wei B. Predictors and outcomes of recurrent retroperitoneal liposarcoma: new insights into its recurrence patterns. BMC Cancer 2023; 23:1076. [PMID: 37936091 PMCID: PMC10631151 DOI: 10.1186/s12885-023-11586-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/29/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The clinical profiles of recurrent retroperitoneal liposarcoma (RLS) need to be explored. The recurrence patterns of RLS are controversial and ambiguous. METHODS A total of 138 patients with recurrent RLS were finally recruited in the study. The analysis of overall survival (OS) and recurrence-free survival (RFS) was performed by Kaplan‒Meier analysis. To identify independent prognostic factors, all significant variables on univariate Cox regression analysis (P ≤ 0.05) were subjected to multivariate Cox regression analysis. The corresponding nomogram model was further built to predict the survival status of patients. RESULTS Among patients, the 1-, 3-, and 5-year OS rates were 70.7%, 35.9% and 30.9%, respectively. The 1-, 3- and 5-year RFS rates of the 55 patients who underwent R0 resection were 76.1%, 50.8% and 34.4%, respectively. The multivariate analysis revealed that resection method, tumor size, status of pathological differentiation, pathological subtypes and recurrence pattern were independent risk factors for OS or RFS. Patients with distant recurrence (DR) pattern usually had multifocal tumors (90.5% vs. 74.7%, P < 0.05); they were prone to experience changes of pathological differentiation (69.9% vs. 33.3%, P < 0.05) and had a better prognosis than those with local recurrence (LR) pattern. R0 resection and combined organ resection favored the survival of patients with DR pattern in some cases. CONCLUSIONS Patients with DR pattern had better prognosis, and they may benefit more from aggressive combined resection than those with LR pattern. Classifying the recurrence patterns of RLS provides guidance for individualized clinical management of recurrent RLS.
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Affiliation(s)
- Huan Deng
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing, 100034, China
- Department of General Surgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Jingwang Gao
- Department of General Surgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Xingming Xu
- Department of General Surgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Guibin Liu
- Department of General Surgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Liqiang Song
- Department of General Surgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Yisheng Pan
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing, 100034, China.
| | - Bo Wei
- Department of General Surgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.
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Deng H, Xu X, Gao J, Huang J, Liu G, Song L, Wei B. Predictors and outcomes of recurrent retroperitoneal liposarcoma with multiple tumors. Front Med (Lausanne) 2023; 10:1161494. [PMID: 37746091 PMCID: PMC10514494 DOI: 10.3389/fmed.2023.1161494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
Background Retroperitoneal liposarcoma (RLS) is a rare but severe disease. Repeated postoperative recurrence with multiple tumors is a therapeutic dilemma. The clinical outcomes and survival predictors of recurrent RLS with multiple tumors remain to be explored. Methods Patients with recurrent RLS were retrospectively analyzed. Univariate and multivariate analysis was performed to find independent prognostic factors that were correlated with Overall survival (OS) or progression-free survival (PFS). Factors significant in univariate analysis were further included into multivariate Cox proportional hazards regression model. The nomogram model was built to predict the survival status of patients. Variables that were significant in multivariable analysis were added to the internally validated nomogram models. The analysis of OS and PFS was performed by Kaplan-Meier analysis and log-rank test. Results A total of 113 recurrent RLS patients with multiple tumors were enrolled in the study. The 1-, 3-, and 5-years OS (PFS) rates were 70.7% (76.1%), 35.9% (76.1%), and 30.9% (76.1%), respectively. Univariate and multivariate analyses showed that number of surgeries, resection methods, tumor size, status of pathological differentiation, pathological subtypes, and recurrence patterns were important prognostic factors for OS or PFS (each p < 0.05). Nomogram models were established to efficiently predict the prognostic status of patients. Patients with the local recurrence (LR) pattern had a poor prognosis and would derive no survival benefit from combined organ resection and R0/R1 resection (each p < 0.05). Conclusion RLS patients recurrence with multiple tumors had a poor prognosis. Those patients should be followed up more frequently after surgery. The strategies of aggressive resection may not improve the survival of patients with LR pattern in the retroperitoneum. Prognostic factors in the efficient nomogram models should be considered in the individualized clinical management of recurrent RLS with multiple tumors.
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Affiliation(s)
- Huan Deng
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing, China
- Department of General Surgery, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Xingming Xu
- Department of General Surgery, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Jingwang Gao
- Department of General Surgery, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Jun Huang
- Department of General Surgery, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Guibin Liu
- Department of General Surgery, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Liqiang Song
- Department of General Surgery, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Bo Wei
- Department of General Surgery, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
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Liu T, Zhang J, Xu Z, Zhou H. Abdominal viscera and gone? A rare case of giant retroperitoneal liposarcoma. Asian J Surg 2022; 45:2963-2964. [PMID: 35798602 DOI: 10.1016/j.asjsur.2022.06.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 06/23/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Tao Liu
- Department of Thoracic Surgery, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, Suining, Sichuan, China
| | - Jun Zhang
- Department of Thoracic Surgery, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, Suining, Sichuan, China
| | - Zhengwen Xu
- Department of Gastrointestinal Surgery, Suining Central Hospital, Suining, Sichuan, China
| | - Haining Zhou
- Department of Thoracic Surgery, Respiratory Center of Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan, China.
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Osuna-Soto J, Caro Cuenca T, Sanz-Zorrilla A, Torrecilla-Martínez A, Ortega Salas R, Leiva-Cepas F. Prognosis and survival of patients diagnosed with well-differentiated and dedifferentiated retroperitoneal liposarcoma. Cir Esp 2022; 100:622-628. [PMID: 35753575 DOI: 10.1016/j.cireng.2022.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/29/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The main objective is to establish the overall survival and disease-free survival profiles regarding the patients with retroperitoneal liposarcoma, making a comparison based on the well-differentiated and dedifferentiated histological subtypes. The secondary objectives are to descriptively analyze the clinical characteristics of said patients and to identify and analyze other independent variables that might modify these survival profiles significantly. METHODS An observational and analytical study was performed using a retrospective historical cohort that was followed prospectively. The inclusion criteria consisted of: the procedure of liposarcoma located in the retroperitoneum, the well-differentiated and dedifferentiated histological subtypes, between January of 2002 and May of 2019. As a result, 32 patients took part in this study's sample. Kaplan-Meier estimator was used to summarise the results and log-rank test was used in the comparative analysis. RESULTS The overall survival at 5 years was around 59%. No differences were found between the patients with a well-differentiated subtype compared to the dedifferentiated ones (p = 0.834). The disease-free survival at 2 years was 59% regarding the well-differentiated and 26% regarding the dedifferentiated, with these differences being statistically significant (p = 0.005). None of the other studied variables modified these survival profiles significantly. CONCLUSIONS Dedifferentiated retroperitoneal liposarcomas show less disease-free survival than well-differentiated liposarcomas. However, regarding overall survival no differences can be claimed.
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Affiliation(s)
- Julio Osuna-Soto
- Departamento de Ciencias Morfológicas y Sociosanitarias, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, Spain
| | - Teresa Caro Cuenca
- Servicio de Anatomía Patológica, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - Alicia Sanz-Zorrilla
- Servicio de Anatomía Patológica, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - Antonio Torrecilla-Martínez
- Departamento de Ciencias Morfológicas y Sociosanitarias, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, Spain
| | - Rosa Ortega Salas
- Servicio de Anatomía Patológica, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - Fernando Leiva-Cepas
- Departamento de Ciencias Morfológicas y Sociosanitarias, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, Spain; Servicio de Anatomía Patológica, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain; Grupo de Investigación en Regeneración Muscular (REGMUS), Universidad de Córdoba, Córdoba, Spain.
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Paik B, Seo CJ, Tan JWS, Juan WKD, Soo KC, Ong CAJ, Chia CS, Wong JSM. A systematic review of margin status in retroperitoneal liposarcomas: Does the R0 margin matter? Front Oncol 2022; 12:891710. [PMID: 36033535 PMCID: PMC9404241 DOI: 10.3389/fonc.2022.891710] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Retroperitoneal liposarcomas (RPLPSs) are a rare tumor group for which current guidelines recommend aggressive en bloc resection to attain microscopically negative (R0) margins. To ensure R0 margins, resection of adherent or adjacent organs is often required. However, it is still unclear if R0 margins confer any additional benefit to patients over a grossly negative but microscopically positive (R1) margin. We performed a systematic search of PubMed and Embase databases for studies including patients receiving R0 or R1 resection for RPLPS. Nine retrospective cohort studies, one prospective cohort study, and 49 case reports/case series were included. A total of 552 patients with RPLPS were evaluated: 346 underwent R0 resection and 206 underwent R1 resection. In the R0 group, 5-year overall survival (OS) ranged from 58.3% to 85.7%; local recurrence (LR) ranged from 45.5% to 52.3%. In the R1 group, 5-year OS ranged from 35% to 55.3%; LR ranged from 66.7% to 91.7%. Among cohort studies, OS, disease-free survival (DFS), LR rate, and LR-free survival (LRFS) were significantly associated with R0 resections. Assessment of case series and reports suggested that the R0 margin led to a slightly higher morbidity than that of R1. In conclusion, this review found the R0 margin to be associated with reductions in LR rates and improved OS when compared with the R1 margins, though accompanied by slight increases in morbidity. The roles of tumor histotype and perioperative chemotherapy or radiotherapy were not well-elucidated in this review.
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Affiliation(s)
- Benjamin Paik
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Chin Jin Seo
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Sing Health Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Joey Wee-Shan Tan
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Laboratory of Applied Human GenetiCJS, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Wen Kai Darryl Juan
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
| | - Khee Chee Soo
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
| | - Chin-Ann Johnny Ong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Sing Health Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Laboratory of Applied Human GenetiCJS, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
- Sing Health Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Institute of Molecular and Cell Biology, ASTAR Research Entities, Singapore, Singapore
| | - Claramae Shulyn Chia
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Sing Health Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Sing Health Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Jolene Si Min Wong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Sing Health Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Sing Health Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- *Correspondence: Jolene Si Min Wong, j
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12
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Pancreatic Incidentaloma. J Clin Med 2022; 11:jcm11164648. [PMID: 36012893 PMCID: PMC9409921 DOI: 10.3390/jcm11164648] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Pancreatic incidentalomas (PIs) represent a clinical entity increasingly recognized due to advances in and easier access to imaging techniques. By definition, PIs should be detected during abdominal imaging performed for indications other than a pancreatic disease. They range from small cysts to invasive cancer. The incidental diagnosis of pancreatic cancer can contribute to early diagnosis and treatment. On the other hand, inadequate management of PIs may result in overtreatment and unneeded morbidity. Therefore, there is a strong need to evaluate the nature and clinical features of individual PIs. In this review, we summarize the major characteristics related to PIs and present suggestions for their management.
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Zhuang A, Zhuang A, Wu Q, Lu W, Tong H, Zhang Y. Prognostic Factor Analysis and Nomogram Construction of Primary Retroperitoneal Liposarcoma: A Review of 10 Years of Treatment Experience in a Single Asian Cohort of 211 Cases. Front Oncol 2022; 11:777647. [PMID: 35096578 PMCID: PMC8790090 DOI: 10.3389/fonc.2021.777647] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study intended to retrospectively analyze the data of patients with primary retroperitoneal liposarcoma in a single Asian large-volume sarcoma center and to establish nomograms focused on PRLPS for predicting progression-free survival (PFS) and overall survival (OS). METHODS A total of 211 patients treated surgically for primary, non-metastatic retroperitoneal liposarcoma during 2009-2021 were identified, and clinicopathologic variables were analyzed. PFS and OS nomograms were built based on variables selected by multivariable analysis. The discriminative and predictive ability of the nomogram was assessed by concordance index and calibration curve. RESULTS The median follow-up time was 25 months. A total of 117 (56%) were well-differentiated, 78 (37%) were dedifferentiated, 13 (6%) were myxoid, and 3 (1%) were pleomorphic morphology. Compared to the western population cohort reported by the Memorial Sloan-Kettering Cancer Center, the median age of patients in this cohort was younger (57 vs. 63 years), the tumor burden was lower (20 vs. 26 cm), and the proportion of patients with R0 or R1 resection was higher (97% vs. 81%). The 5-year PFS rate was 49%, and factors independently associated with PFS were symptoms at visit, preoperative needle biopsy, histologic subtypes, and postoperative hospital stay. The 5-year OS rate was 72%. American Society of Anesthesiologists Physical Status and Clavien-Dindo classification were independently associated with OS. The concordance indexes for PFS and OS nomograms were 0.702 and 0.757, respectively. The calibration plots were excellent. CONCLUSIONS The proposed nomogram provided a favorable reference for the treatment of primary retroperitoneal liposarcoma patients.
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Affiliation(s)
- Aobo Zhuang
- Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Aojia Zhuang
- Institute of Biomedical Sciences, Fudan University, Shanghai, China
| | - Qian Wu
- Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Weiqi Lu
- Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hanxing Tong
- Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Zhang
- Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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14
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Osuna-Soto J, Caro Cuenca T, Sanz-Zorrilla A, Torrecilla-Martínez A, Ortega Salas R, Leiva-Cepas F. Prognosis and survival of patients diagnosed with well-differentiated and dedifferentiated retroperitoneal liposarcoma. Cir Esp 2021; 100:S0009-739X(21)00224-4. [PMID: 34366104 DOI: 10.1016/j.ciresp.2021.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/26/2021] [Accepted: 06/29/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The main objective is to establish the overall survival and disease-free survival profiles regarding the patients with retroperitoneal liposarcoma, making a comparison based on the well-differentiated and dedifferentiated histological subtypes. The secondary objectives are to descriptively analyze the clinical characteristics of said patients and to identify and analyze other independent variables that might modify these survival profiles significantly. METHODS An observational and analytical study was performed using a retrospective historical cohort that was followed prospectively. The inclusion criteria consisted of: the procedure of liposarcoma located in the retroperitoneum, the well-differentiated and dedifferentiated histological subtypes, between January 2002 and May 2019. As a result, 32 patients took part in this study's sample. Kaplan-Meier estimator was used to summarize the results and log-rank test was used in the comparative analysis. RESULTS The overall survival at 5 years was around 59%. No differences were found between the patients with a well-differentiated subtype compared to the dedifferentiated ones (p=0.834). The disease-free survival at 2 years was 59% regarding the well-differentiated and 26% regarding the dedifferentiated, with these differences being statistically significant (p=0.005). None of the other studied variables modified these survival profiles significantly. CONCLUSIONS Dedifferentiated retroperitoneal liposarcomas show less disease-free survival than well-differentiated liposarcomas. However, regarding overall survival no differences can be claimed.
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Affiliation(s)
- Julio Osuna-Soto
- Departamento de Ciencias Morfológicas y Sociosanitarias, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, España
| | - Teresa Caro Cuenca
- Servicio de Anatomía Patológica, Hospital Universitario Reina Sofía de Córdoba, Córdoba, España
| | - Alicia Sanz-Zorrilla
- Servicio de Anatomía Patológica, Hospital Universitario Reina Sofía de Córdoba, Córdoba, España
| | - Antonio Torrecilla-Martínez
- Departamento de Ciencias Morfológicas y Sociosanitarias, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, España
| | - Rosa Ortega Salas
- Servicio de Anatomía Patológica, Hospital Universitario Reina Sofía de Córdoba, Córdoba, España
| | - Fernando Leiva-Cepas
- Departamento de Ciencias Morfológicas y Sociosanitarias, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, España; Servicio de Anatomía Patológica, Hospital Universitario Reina Sofía de Córdoba, Córdoba, España; Grupo de Investigación en Regeneración Muscular (REGMUS). Universidad de Córdoba, Córdoba, España.
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15
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Yan Y, Xia S, Teng D, Hu S, Li S, Wang Y, Du X, Li R. Resection outcomes for primary and local recurrent retroperitoneal liposarcoma patients. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1450. [PMID: 33313195 PMCID: PMC7723604 DOI: 10.21037/atm-20-6316] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background The clinical characteristics of primary retroperitoneal liposarcoma (PR RPLPS) and local recurrent retroperitoneal liposarcoma (LR RPLPS) cases were compared to determine the related factors involved in postoperative survival. Methods A total of 90 patients who underwent surgery between 2006 and 2013 were included in this study. Clinicopathological data that was prospectively gathered was analyzed to identify factors associated with overall survival (OS) and progression-free survival (PFS). Results The PR cases showed a higher complete resection rate when compared to the LR group. The LR group showed a greater number that were poorly differentiated and highly malignant. More blood loss was observed in the LR compared to the PR group. Multivariate analysis suggested that blood loss and tumor grade were prognostic factors for OS and PFS of the PR group, but extent of resection was a prognostic factor only for OS. In the LR group, the extent of resection was a significant prognostic factor associated with OS, whereas tumor grade was associated with PFS. Conclusions Complete surgical resection is the most important factor for the survival of RPLPS patients. Tumor grade is an independent prognostic factor for PFS. In PR RPLPS, poor tumor classification and increased intraoperative bleeding are associated with a poor prognosis.
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Affiliation(s)
- Yang Yan
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shaoyou Xia
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Da Teng
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shidong Hu
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Songyan Li
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yufeng Wang
- Department of Patient Admission Management, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiaohui Du
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Rong Li
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, China
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16
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The Role of Tc-99m DTPA Renal Dynamic Scintigraphy in Retroperitoneal Liposarcoma. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9765162. [PMID: 32185230 PMCID: PMC7060424 DOI: 10.1155/2020/9765162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 11/18/2022]
Abstract
Purpose Technetium-99m diethylene triamine pentaacetic acid (Tc-99m DTPA) renal dynamic scintigraphy is a widely used imaging technique that evaluates renal function of patients with extrarenal abnormalities, but its clinical value in potentially offering us information on proliferation of liposarcoma has not yet been reported. Methods We retrospectively reviewed 7 patients with histopathologically confirmed retroperitoneal liposarcoma who underwent Tc-99m DTPA renal dynamic scintigraphy. The clinical data, histopathological findings, Glomerular Filtration Rate (GFR), and Tc-99m DTPA uptake were recorded. Results Dedifferentiated liposarcoma and well-differentiated liposarcoma showed dissimilar degrees of Tc-99m DTPA uptake, an observation that correlated with Ki-67 expression (p < 0.01). 4 of the 7 patients were diagnosed with dedifferentiated liposarcoma, showing a moderate uptake of Tc-99m DTPA and greater than 20% Ki-67 expression on histological slides. Meanwhile, the remaining 3 patients, diagnosed with well-differentiated liposarcoma, showed no uptake of Tc-99m DTPA and Ki-67 expression of less than 5%. Conclusions This study suggests that Tc-99m DTPA renal dynamic scintigraphy provides diagnostic value in patients with retroperitoneal liposarcoma, not only in evaluating renal function but also in visualizing lesion-related radionuclide uptake, which may potentially offer further clinical insights into tumor proliferation and provide prognostic value for clinical outcomes in patients with retroperitoneal liposarcoma.
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Atypical Lipomatous Tumors: Does Our Inconsistent Terminology Have Patient Repercussions? Results of a Meta-Analysis. Am J Clin Oncol 2020; 42:487-492. [PMID: 30932920 DOI: 10.1097/coc.0000000000000540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Misnaming low-grade lipomatous tumors poses a clinical and medicolegal challenge, potentially subjecting patients to expensive and unnecessary surgeries. The terms atypical lipomatous tumor (ALT) and "well-differentiated" liposarcoma (WDL) have been used interchangeably in pathology reports, scholarly works and consensus recommendations, creating vagaries between low-virulence extremity tumors and retroperitoneal disease with metastatic potential. METHODS A systematic review was performed on all studies that reported on the local recurrence rate and metastasis of ALTs and WDLs in living human subjects. Local recurrence and metastases were compared using Fisher's Exact Test. RESULTS In total, 20 studies evaluated ALTs (n=936), whereas 13 studied WDLs (n=626). Mean follow-up was 6.6±2.0 years (median, 7.0 y). No metastatic disease was observed among ALTs, whereas 15 patients with WDLs (2.7%, P<0.0001) had metastases. The local recurrence rate of ALTs was significantly lower than WDLs after both marginal (15.1%, 141/936 vs. 46.0%, 288/626, P<0.0001) and wide excisions (3.3%, 2/59 in ALT vs. 17.4%, 19/109, P=0.007). CONCLUSIONS ALT should be reserved for extremity lesions meeting appropriate histopathologic criteria that represent nonmetastatic disease, reducing over-diagnosis, over-treatment, and patient risk.
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Xin Q, Liu X, Yu X, Ye J, Peng X, Zhou M, Zhang P. Primary retroperitoneal liposarcoma with extensive ossification: A case report. Medicine (Baltimore) 2019; 98:e14996. [PMID: 30921215 PMCID: PMC6456147 DOI: 10.1097/md.0000000000014996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Primary retroperitoneal liposarcoma, which originates from mesenchymal tissues, can rarely present with extensive ossification. PATIENT CONCERNS A 41-year-old male patient presented with a chief complaint of discomfort around the waist for 2 months. DIAGNOSES Computerized tomography (CT) and magnetic resonance imaging suggested a lesion of approximately 5.6 × 5.1 × 8.7 cm in front of the psoas major muscle, which was considered to be a mesenchymal or neurogenic tumor. INTERVENTIONS The hard mass was removed by laparotomy, and the pathological investigation revealed that this was an atypical lipomatous tumor/well-differentiated liposarcoma, with extensive ossification. OUTCOMES The patient was discharged from the hospital after surgery. There was no sign of reoccurrence after 1 year of follow-up. LESSONS Retroperitoneal liposarcomas with extensive ossification are rare tumors that can present with nonspecific symptoms, and are difficult to diagnose. CT is the most common imaging technique, and surgical resection has been considered to be the most effective treatment. This rare case can be challenging for diagnosis and treatment.
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Affiliation(s)
- Qi Xin
- Department of Hepatopancreatobiliary Surgery
| | - Xingkai Liu
- Department of Hepatopancreatobiliary Surgery
| | - Xiaoyuan Yu
- Department of Hematology, The First Bethune Hospital of Jilin University, Changchun, China
| | - Junfeng Ye
- Department of Hepatopancreatobiliary Surgery
| | | | | | - Ping Zhang
- Department of Hepatopancreatobiliary Surgery
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Ioannidis A, Koutserimpas C, Konstantinidis M, Drikos I, Voulgaris P, Economou N. Dyspnea caused by a giant retroperitoneal liposarcoma: A case report. Oncol Lett 2018; 16:1539-1542. [PMID: 30008834 PMCID: PMC6036330 DOI: 10.3892/ol.2018.8791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/08/2018] [Indexed: 11/09/2022] Open
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.
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Affiliation(s)
- Argyrios Ioannidis
- Department of General Surgery, 'Sismanoglion' General Hospital of Attika, 15126 Athens, Greece
| | - Christos Koutserimpas
- Department of General Surgery, 'Sismanoglion' General Hospital of Attika, 15126 Athens, Greece
| | - Michael Konstantinidis
- National and Kapodistrian University of Athens, School of Medicine, 11527 Athens, Greece
| | - Ioannis Drikos
- Department of General Surgery, 'Sismanoglion' General Hospital of Attika, 15126 Athens, Greece
| | - Panagiotis Voulgaris
- Department of General Surgery, 'Sismanoglion' General Hospital of Attika, 15126 Athens, Greece
| | - Nikolaos Economou
- Department of General Surgery, 'Sismanoglion' General Hospital of Attika, 15126 Athens, Greece
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Tahri R, Gamra L, El Otmany A. [Liposarcoma in the renal compartment: about two cases and literature review]. Pan Afr Med J 2018; 29:167. [PMID: 30050631 PMCID: PMC6057569 DOI: 10.11604/pamj.2018.29.167.1850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 07/23/2012] [Indexed: 11/17/2022] Open
Abstract
Retroperitoneal sarcomas are rare and heterogeneous tumors. We here report two cases of liposarcoma in the renal compartment with a literature review in order to emphasize on the anatomical and surgical features of this tumor location and on its possible prognostic implications. The first reported case was a 45-year old female patient with liposarcoma at the level of the left renal compartment. The diagnosis of myxoid liposarcoma was based on anatomo-pathological examination of the surgical specimen. The second reported case was a 70-year old man with liposarcoma at the level of the right renal compartment. The diagnosis of dedifferentiated liposarcoma was based on anatomo-pathological examination of the surgical specimen. Retroperitoneal sarcomas are often diagnosed with a palpable mass. The gold standard treatment is complete tumor resection with healthy resection margins and without damage or rupture. For this purpose resection involving adjacent organs is recommended by some authors. However the anatomical constraints of tretroperitoneal compartment and the often important tumor volume limit the possibilities to achieve a satisfactory resection. CT scan and MRI are very useful imaging techniques. Histological diagnosis poses some problems; therefore immunohistochemistry and sometimes molecular biology are significantly helpful. Patient evolution is marked by the frequent occurrence of recurrences. A specialized multidisciplinary management of these rare and very varied tumors is recommended in order to optimize therapeutic outcomes.
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Affiliation(s)
- Rajae Tahri
- Centre Hospitalo-universitaire Ibn Sina, Faculté de Médecine et de Pharmacie, Rabat, Maroc
| | - Lamiaa Gamra
- Centre Hospitalo-universitaire Ibn Sina, Faculté de Médecine et de Pharmacie, Rabat, Maroc
| | - Azzedine El Otmany
- Centre Hospitalo-universitaire Ibn Sina, Faculté de Médecine et de Pharmacie, Rabat, Maroc
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Abstract
RATIONALE Pleomorphic liposarcoma (PLS), is a rare subtype of liposarcoma, and is considered to be of the highest malignancy grade. PATIENT CONCERNS We aimed to analyze the clinical features, diagnosis, treatment, and recurrence of the 6 cases of PLS. DIAGNOSES Six cases with confirmed pathological PLS presented at out hospital from January 2003 to January 2017. The postoperative pathology of 5 cases confirmed PLS, and the other was confirmed as PLS with well-differentiated liposarcoma. INTERVENTIONS All 6 patients underwent complete tumor resection at the time of the first definite diagnosis, and one of them had underwent 3 cycles of chemotherapy treatment. OUTCOMES There were 4 cases with local recurrence and surgery was repeated after the first radical excision. One case was not recurrent after 27 months post-operation, and the other was lost. The shortest recurrence time of all of these cases was 4 months, and the longest was 29 months after the first radical surgery. LESSONS PLS is a rare and high-grade malignancy with high recurrence, poor prognosis, and its treatment is still highly controversial. More studies are required to determine the appropriate treatment and therapeutic strategies to improve the survival rate of patients with PLS, as the disease is associated with frequent relapse.
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Affiliation(s)
- Lianwei Wang
- Department of General Surgery, Fuling Central Hospital of Chongqing City, Chongqing
| | - Runlan Luo
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zuming Xiong
- Department of General Surgery, Fuling Central Hospital of Chongqing City, Chongqing
| | - Jinming Xu
- Department of General Surgery, Fuling Central Hospital of Chongqing City, Chongqing
| | - Dengyang Fang
- Department of General Surgery, Fuling Central Hospital of Chongqing City, Chongqing
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Wu YX, Liu JY, Liu JJ, Yan P, Tang B, Cui YH, Zhao YL, Shi Y, Hao YX, Yu PW, Qian F. A retrospective, single-center cohort study on 65 patients with primary retroperitoneal liposarcoma. Oncol Lett 2017; 15:1799-1810. [PMID: 29434876 DOI: 10.3892/ol.2017.7533] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/13/2017] [Indexed: 12/25/2022] Open
Abstract
Primary retroperitoneal liposarcoma (PRPLS) is the most common soft tissue malignancy of the retroperitoneum. To determine the pathological features and the curative effects of surgery in patients with PRPLS, and to elucidate key prognostic factors, the present study retrospectively analyzed the clinical cases of 65 patients with PRPLS. Immunohistochemical analysis demonstrated that vimentin and Ki-67 are better indicators for PRPLS immunohistochemical diagnosis compared with S-100 protein. S-100 protein was predominantly expressed in well-differentiated PRPLS. Positive expression of vimentin and Ki-67 were observed in almost all PRPLS samples, and Ki-67 exhibited a higher expression level in high-grade PRPLS. The level of Ki-67 expression was negatively correlated with disease-specific survival (DSS). Survival analysis revealed that the pathological subtype and histological grade were associated with DSS and local recurrence in the patients, whereas the tumor burden was associated with DSS but not local recurrence. In addition, complete tumor resection and contiguous organ resection were able to improve DSS. Microscopically positive margins did not affect DSS, whereas gross margins did. Multivariate analysis revealed that pathological subtype, histological grade and contiguous organ resection were independent prognostic factors, and that histological grade was an independent factor for local recurrence. Patient sex and age at presentation were not independent factors associated with prognosis or local recurrence. Correlation analysis demonstrated that postoperative local recurrence significantly affected DSS, and local recurrence was the most common cause of mortality among patients. Histological grade was strongly associated with the invasion of adjacent organs but not with tumor burden. Furthermore, the tumor burden was not associated with recurrence or tumor invasion of adjacent organs. Ki-67 expression was associated with prognosis. Pathological subtype, histological grade and contiguous organ resection were independent prognostic factors, while histological grade was an independent factor which affected tumor recurrence.
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Affiliation(s)
- Yi-Xi Wu
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
| | - Jun-Yan Liu
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
| | - Jia-Jia Liu
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
| | - Peng Yan
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
| | - Bo Tang
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
| | - You-Hong Cui
- Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
| | - Yong-Liang Zhao
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
| | - Yan Shi
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
| | - Ying-Xue Hao
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
| | - Pei-Wu Yu
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
| | - Feng Qian
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, and Key Laboratory of Tumor Immunopathology of Ministry of Education of China, Chongqing 400038, P.R. China
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23
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Ng DWJ, Tan GHC, Chia CS, Chee SK, Quek R, Farid M, Teo MCC. Tumor biology remains the main determinant of prognosis in retroperitoneal sarcomas: a 14-year single-center experience. Asia Pac J Clin Oncol 2017; 13:e458-e465. [PMID: 28371454 DOI: 10.1111/ajco.12662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/11/2016] [Accepted: 12/14/2016] [Indexed: 11/30/2022]
Abstract
AIM To review our experience in the management of retroperitoneal sarcomas (RPSs) in a single institution, with a predominantly Asian population, and identify associated prognostic factors for overall survival (OS), disease-free survival (DFS) and local recurrence. MATERIALS AND METHODS All RPSs diagnosed and managed at our center between January 2000 and March 2014 were included. Exclusion criteria included patients whose medical records were untraceable and patients who underwent biopsy but did not undergo resection. The variables studied were age, gender, histological subtype, tumor size, tumor grade, surgical margins, type of presentation of tumor (primary or recurrent) and presence of contiguous organ resection. The primary outcome measured was OS. RESULTS Eighty-five patients underwent resection of RPS with curative intent. Eight patients underwent adjuvant chemotherapy and 15 patients underwent radiotherapy. The median DFS was 21 months (range: 0-146) and median OS was 45 months (range: 1-233). On univariate analysis, resection margin (P = 0.04), tumor grade (P = 0.011) and type of presentation of tumor (P = 0.007) were found to significantly affect OS. Patients with tumor adherent to contiguous organs had a greater OS as compared to patients with tumor invasive into the contiguous organs (P = 0.02). CONCLUSION An aggressive surgical approach in primary and recurrent RPS is associated with good OS. Complete resection, with contiguous organ resection if necessary should be performed to achieve microscopically negative surgical margins to allow for long-term survival. However, tumor biology remains the main determinant for OS.
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Affiliation(s)
- Deanna Wan Jie Ng
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | | | | | - Soo Khee Chee
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Richard Quek
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Mohamad Farid
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
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Zhou Y, Chu X, Yi Y, Tong L, Dai Y. Malignant solitary fibrous tumor in retroperitoneum: A case report and literature review. Medicine (Baltimore) 2017; 96:e6373. [PMID: 28296778 PMCID: PMC5369933 DOI: 10.1097/md.0000000000006373] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
RATIONALE Solitary fibrous tumor (SFT) is a rare mesenchymal tumor occurs in various sites. Malignant SFT in retroperitoneum is extremely rare. PATIENT CONCERNS We report a case of malignant retroperitoneal SFT in a 59-year-old man presented with right flank pain for 1 month. DIAGNOSES, INTERVENTIONS AND OUTCOMES A laparotomy and resection of the tumor were performed, the histopathologic and immunohistochemical findings were consistent with malignant retroperitoneal SFT. No adjuvant treatment was performed, and the patient had no signs of recurrence or metastasis at the 12 months follow-up. LESSONS Complete surgical excision is the basic treatment principle for malignant retroperitoneal SFT. The histologic features and the Ki-67 label index are helpful for the diagnosis of malignant SFT.
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Lee HS, Yu JI, Lim DH, Kim SJ. Retroperitoneal liposarcoma: the role of adjuvant radiation therapy and the prognostic factors. Radiat Oncol J 2016; 34:216-222. [PMID: 27730802 PMCID: PMC5066451 DOI: 10.3857/roj.2016.01858] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To evaluate the benefit of adjuvant radiation therapy (RT) for retroperitoneal liposarcoma (RPLS) following gross tumor removal. MATERIALS AND METHODS We reviewed 77 patients with primary RPLS surgically treated between January 2000 and December 2013. Cases with gross residual disease were excluded. Tumor grade was evaluated according to the French Federation of Cancer Centers Sarcoma Group (FNCLCC) system. Adjuvant RT was delivered to 32 patients (42%) using external beam RT alone. Median follow-up time was 36 months (range, 5 to 169). RESULTS Among 77 patients, 33 (43%) presented with well-differentiated, 31 (40%) with de-differentiated, 8 (10%) with myxoid/round and 4 (5%) with pleomorphic morphology. The RT group included less well-differentiated subtype than surgery group (28% vs. 53%). During follow up, 34 patients (44%) showed local recurrence. Local recurrence rate was lower in the RT group (38%) compared to the surgery group (49%). The 3-year local control rate (LC) was 55.6%, and the 3-year overall survival (OS) was 82.1%. Tumor histology and FNCLCC grade were significantly associated with local recurrence. There was no statistical significance of adding adjuvant RT in LC (p = 0.312). However, patients with tumor histology other than well-differentiated subtype showed marginally decreased local recurrence rate after adjuvant RT (3-year LC, RT 43.9% vs. no RT 35.3%; p = 0.087). CONCLUSION RPLS patients receiving RT experienced less local recurrence. We suggest that the addition of adjuvant RT may be related to improvement of LCs, especially in patients with non-favorable histologic subtypes.
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Affiliation(s)
- Hong Seok Lee
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Joo Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Machado MCC, Fonseca GM, de Meirelles LR, Zacchi FFS, Bezerra ROF. Primary liposarcoma of the pancreas: A review illustrated by findings from a recent case. Pancreatology 2016; 16:715-718. [PMID: 27423533 DOI: 10.1016/j.pan.2016.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/08/2016] [Accepted: 07/06/2016] [Indexed: 02/07/2023]
Abstract
Liposarcoma is the most common soft tissue sarcoma and accounts for 15%-20% of all mesenchymal malignancies. The tumor occurs most frequently in limbs and retroperitoneum, with only rare instances of visceral location reported. Pancreas is a very rare site of primary liposarcoma, with a total of seven cases reported since 1979 and only four of those in the English literature. We review the literature specific for primary liposarcoma of the pancreas and discuss radiological and pathological aspects of this rare tumor type as well as emerging options of treatment. The review is illustrated by findings of a recent case of a dedifferentiated liposarcoma of the pancreas coupled with undifferentiated pleomorphic sarcoma, including the first description of this rare tumor by magnetic resonance imaging. The patient was successfully treated with distal pancreatectomy and splenectomy, followed by adjuvant chemotherapy and radiotherapy. At the 5-year follow-up, the patient showed no signs of recurrence.
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Affiliation(s)
| | - Gilton Marques Fonseca
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-900, Brazil
| | | | | | - Regis Otaviano Franca Bezerra
- Department of Radiology, Hospital Sírio-Libanês and Instituto do Câncer do Estado de São Paulo-ICESP, São Paulo 01308-050, Brazil
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27
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Retroperitoneal liposarcomas: a representative literature review occasioned by a rare case of laterelapse abdominal liposarcoma. Urologia 2016; 83:68-70. [PMID: 26350044 DOI: 10.5301/uro.5000142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 11/20/2022]
Abstract
Soft tissue sarcomas (STS) are rare and heterogeneous tumours representing approximately 0.7%-1% of all adult tumours. In the adults and among the retroperitoneal sarcomas (RPS), Liposarcoma (LS) is the most common variant accounting for 12% -20% of all sarcomas and up to 45% of sarcomas at retroperitoneal localization. A rare case of LS relapsed after 15 years is giving the occasion to review the published literature and emphasise the followings concepts: 1) Despite extensive surgery remains the mainstay of treatment for localized STS at present, anatomical complexity and occult localization result in local recurrence in the majority of patients; 2) The role of imaging and tumour markers is still limited; 3) Indefinite prolonged surveillance is a key point of treatment; 4) Referral to tertiary centres with dedicated Retroperitonal Surgeons and Oncology expertise is mandatory.
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Chou YS, Liu CY, Chang YH, King KL, Chen PCH, Pan CC, Shen SH, Liu YM, Lin AT, Chen KK, Shyr YM, Lee RC, Chao TC, Yang MH, Chan CH, You JY, Yen CC. Prognostic factors of primary resected retroperitoneal soft tissue sarcoma: Analysis from a single asian tertiary center and external validation of gronchi's nomogram. J Surg Oncol 2016; 113:355-60. [DOI: 10.1002/jso.24155] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 12/17/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Yi-Sheng Chou
- Division of Medical Oncology; Department of Oncology; Taipei Veterans General Hospital; Taipei Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Institute of Clinical Medicine; National Yang-Ming University; Taipei Taiwan
- Division of Hematology and Oncology; Department of Medicine; Lo-Hsu Foundation; Lotung Poh-Ai Hospital; Luodong Yilan Taiwan
| | - Chun-Yu Liu
- Division of Medical Oncology; Department of Oncology; Taipei Veterans General Hospital; Taipei Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Yen-Hwa Chang
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Urology; Taipei Veterans General Hospital; Taipei Taiwan
- Department of Urology and Shu-Tien Urological Research Center; National Yang-Ming University; Taipei Taiwan
| | - Kuang-Liang King
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Division of General Surgery; Department of Surgery; Taipei Veterans General Hospital; Taipei Taiwan
| | - Paul Chih-Hsueh Chen
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Pathology and Laboratory Medicine; Taipei Veterans General Hospital; Taipei Taiwan
| | - Chin-Chen Pan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Pathology and Laboratory Medicine; Taipei Veterans General Hospital; Taipei Taiwan
| | - Shu-Huei Shen
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Radiology; Taipei Veterans General Hospital; Taipei Taiwan
| | - Yu-Ming Liu
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Oncology; Taipei Veterans General Hospital; Taipei Taiwan
| | - Alex T.L. Lin
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Urology; Taipei Veterans General Hospital; Taipei Taiwan
| | - Kuang-Kuo Chen
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Urology; Taipei Veterans General Hospital; Taipei Taiwan
| | - Yi-Ming Shyr
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Division of General Surgery; Department of Surgery; Taipei Veterans General Hospital; Taipei Taiwan
| | - Rheun-Chuan Lee
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Radiology; Taipei Veterans General Hospital; Taipei Taiwan
| | - Ta-Chung Chao
- Division of Medical Oncology; Department of Oncology; Taipei Veterans General Hospital; Taipei Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Muh-Hwa Yang
- Division of Medical Oncology; Department of Oncology; Taipei Veterans General Hospital; Taipei Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Chung-Huang Chan
- Division of Hematology and Oncology; Department of Medicine; Lo-Hsu Foundation; Lotung Poh-Ai Hospital; Luodong Yilan Taiwan
| | - Jie-Yu You
- Division of Hematology and Oncology; Department of Medicine; Lo-Hsu Foundation; Lotung Poh-Ai Hospital; Luodong Yilan Taiwan
| | - Chueh-Chuan Yen
- Division of Medical Oncology; Department of Oncology; Taipei Veterans General Hospital; Taipei Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
- Therapeutical and Research Center of Musculoskeletal Tumor; Taipei Veterans General Hospital; Taipei Taiwan
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Rudnicki C, Romanowski M, Mędrek-Socha M, Stec-Michalska K. The Diagnosis of Sigmoid Liposarcoma in a Young Male with Metabolic Syndrome. J Clin Diagn Res 2015; 9:OD01-3. [PMID: 26816934 DOI: 10.7860/jcdr/2015/14589.6893] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/23/2015] [Indexed: 11/24/2022]
Abstract
The clinical picture and risk factors are decisive in differential diagnosis. It was proved that patients with metabolic syndrome have increased incidence of malignant tumours. The visceral adipose tissue releases active proteins that promote oncogenesis. We are presenting a case of 34-year-old male with metabolic syndrome suffering from pain in left iliac fossa with accompanying variable stool pattern. At first, the sigmoid diverticulosis was suspected. Patient's condition after the treatment has improved. The ambulatory, partial colonoscopy revealed a cauliflower-like, balloting, wide-base growth in the sigmoid that narrowed its lumen. The biopsy did not reveal atypical growth characteristics. Because of tumour type and enlarged regional lymph nodes seen in abdomen CT scan, the segmental colon resection and end-to-end anastomosis was performed in the area of sigmoid-rectal junction. Macroscopically, there were no visible metastases in the operation field. The surgery and postoperative period ran without any complications. On histopathological examination, the removed tumour was a well differentiated liposarcoma (WDL) stemming unusually from adipose tissue of colonic submucosa in an obese male. WDL is a hard to diagnose tumour, especially in early stages of its growth. In the presented case, the tumour was completely resected.
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Affiliation(s)
- Cezary Rudnicki
- Assistant Lecturer, Department of Gastroenterology, Medical University of Lodz , Lodz, Poland
| | - Marek Romanowski
- Assistant Lecturer, Department of Gastroenterology, Medical University of Lodz , Lodz, Poland
| | - Marta Mędrek-Socha
- Junior Lecturer, Department of Gastroenterology, Medical University of Lodz , Lodz, Poland
| | - Krystyna Stec-Michalska
- Head of Department, Department of Gastroenterology, Medical University of Lodz , Lodz, Poland
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30
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Rajeev R, Patel M, Jayakrishnan TT, Johnston FM, Bedi M, Charlson J, Turaga KK. Retroperitoneal solitary fibrous tumor: surgery as first line therapy. Clin Sarcoma Res 2015; 5:19. [PMID: 26322223 PMCID: PMC4551387 DOI: 10.1186/s13569-015-0034-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Solitary fibrous tumors (SFT) of the retroperitoneum are rare spindle cell neoplasms, with a paucity of data on treatment outcomes. We hypothesized that surgical excision offered acceptable outcomes in SFTs. METHODS The National Cancer Database (NCDB) was used to identify patients with SFT from 2004 to 2011. Primary outcome measures were 30 day mortality and overall survival. Descriptive analyses were performed. Furthermore, a systematic review of published literature was conducted after creating a pre-specified search strategy. RESULTS Of 51 patients in the NCDB, 58.8 % (n = 30) were males, with a median age 60 years (IQR 49-72 years). Median tumor size was 16 cm (IQR 11-21 cm). Surgical resection was performed in 92.2 % (n = 47) with 63.8 % (n = 30) having a margin negative resection. Peri-operative mortality was 2.1 % (n = 1). Of survival outcomes available for 18 patients, the median OS was 51.1 months. From the systematic review, we identified 8 studies, with 24 patients. Median age and tumor size was similar to the NCDB [47.5 years (IQR 39-66.5 years), 12 cm (IQR 7-17 cm)]. Majority [91.7 % (n = 22)] underwent surgical excision alone while one received adjuvant chemotherapy and none received radiation. After median follow up of 54 months (IQR 28-144 months), 79.2 % (n = 19) were alive without disease. Three patients (12.5 %) died of disease, one was alive with disease and one was lost to follow up. Recurrence was reported in 16.7 % (n = 4) of patients. CONCLUSION Complete surgical excision is a viable treatment modality for retroperitoneal SFT leading to long term survival. Low recurrence rates would argue against the need for routine adjuvant radiation or chemotherapy.
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Affiliation(s)
- Rahul Rajeev
- />Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226 USA
| | - Mohit Patel
- />Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226 USA
| | - Thejus T. Jayakrishnan
- />Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226 USA
| | - Fabian M. Johnston
- />Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226 USA
| | - Meena Bedi
- />Department of Radiation Oncology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226 USA
| | - John Charlson
- />Section of Hematology and Oncology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226 USA
| | - Kiran K. Turaga
- />Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226 USA
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Abstract
Retroperitoneal liposarcomas are rare mesenchymal tumors of the retroperitoneum that typically present with advanced disease and often carry a poor prognosis. Because of their rarity and anatomic location, these malignant tumors can cause a diagnostic dilemma and present several therapeutic challenges. They are usually associated with a high rate of recurrence despite grossly complete resection, thus requiring long-term and often indefinite follow-up. Relevant data on this topic was procured and synthesized with the aid of a comprehensive Medline search in addition to oncologic, pathologic, urologic, radiologic, and surgical literature review on retroperitoneal sarcomas. This article provides an in-depth review into the natural history, pathology, clinical manifestations, and prognostic features of retroperitoneal liposarcomas. It also discusses the reliability of diagnostic procedures and novel curative approaches that are currently being evaluated for the disease.
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Zhang WD, Liu DAR, Que RS, Zhou CB, Zhan CN, Zhao JG, Chen LI. Management of retroperitoneal liposarcoma: A case report and review of the literature. Oncol Lett 2015; 10:405-409. [PMID: 26171040 DOI: 10.3892/ol.2015.3193] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 04/21/2015] [Indexed: 11/05/2022] Open
Abstract
Retroperitoneal liposarcoma is a rare tumor with an incidence of 2.5 per million individuals. Early diagnosis is difficult as there is an absence of specific clinical presentations. The present case study reports a patient diagnosed with retroperitoneal liposarcoma who was treated by complete surgical resection and relapsed 3 months following the surgery. In addition, the clinical data of 14 patients with retroperitoneal liposarcoma were reviewed and analyzed. The mean age of the 14 patients at presentation was 54.1 (range, 36-73 years) and 5/14 patients experienced recurrence, ranging between 1 and 10 times. Of the 12 cases that reported histological subtypes, 7 were well-differentiated liposarcoma, 2 were dedifferentiated liposarcoma, 2 were myxoid liposarcoma and 1 was mixed subtype. All the patients underwent complete resection and 5 received combined multiple organs resection (3 nephrectomy, 1 sigmoid colon and 1 multiple visceral organs). However, no patients received chemotherapy or radiotherapy. In conclusion, retroperitoneal liposarcoma is a rare disease with a high rate of recurrence. Complete resection is the predominant treatment and combined resection of adjacent organs is occasionally necessary.
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Affiliation(s)
- Wei-Dong Zhang
- Department of Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| | - DA-Ren Liu
- Department of Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| | - Ri-Sheng Que
- Department of Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| | - Chuan-Biao Zhou
- Department of Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| | - Chen-Ni Zhan
- Department of Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| | - Jian-Gang Zhao
- Department of Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| | - L I Chen
- Department of Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
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Gemici K, Buldu İ, Acar T, Alptekin H, Kaynar M, Tekinarslan E, Karatağ T, Efe D, Çolak H, Küçükkartallar T, İstanbulluoğlu MO. Management of patients with retroperitoneal tumors and a review of the literature. World J Surg Oncol 2015; 13:143. [PMID: 25881253 PMCID: PMC4404658 DOI: 10.1186/s12957-015-0548-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 03/16/2015] [Indexed: 11/21/2022] Open
Abstract
Background Retroperitoneal tumors (RTs) develop insidiously and are generally seen as large masses, and 50% of RTs are larger than 20 cm at the time of diagnosis. In this article, we share our experience of 5 years of surgical management of RTs. Methods We evaluated 28 RT cases operated on in three education hospitals in Turkey from January 2008 onwards, with regard to patients’ demographic characteristics, complaints, weight loss figures, the location and size of the tumor, blood transfusion, intra-operational time, metastases (in malignant cases), additional organ resection, histological grade, local recurrences, average life expectancy, and post-operative treatment methods. Results The mean age of the patients was 49 years (range, 18 to 78 years). Twenty (71.43%) were female, and 8 (28.57%) were male. The primary complaint was abdominal pain in 18 patients (64.28%). CT scans were performed in 17 (61%) patients, 10 (35.4%) underwent abdominal MR imaging, and 1 (3.6%) underwent both abdominal CT and abdominal MR imaging. A mass was palpated in the pelvis (suprapubic region) in seven (25%) of the patients during physical examination. The largest tumors were detected in the left lumbar area. The mean tumor size was 12.78 cm (range, 2 to 30 cm). The mean intra-operational time was 192 min (range, 70 to 380 min). The mean hospitalization period was 11 days (range, 8 to 23 days). Seven (25%) patients were reported to have benign tumors, while 21 (75%) were reported to have malignant tumors. The most frequently seen malignant pathology was liposarcoma (eight cases; 38.09%) followed by leiomyosarcoma (five cases; 23.8%) and malignant fibrous histiocytoma (four cases; 19.04%). The earliest local recurrence was detected in the 12th month and the latest in the 28th month. A total of 11 (52.3%) of the total of 21 malignant cases experienced local recurrence within 3 years. The 3-year average life expectancy was 85.7% in the 18 malignant cases. Conclusions Due to the low response rate of all but two types of RT to chemotherapy, the best remaining treatment option is surgery with wide resection margins, whereby all macroscopic traces of tumor are removed.
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Affiliation(s)
- Kazım Gemici
- Faculty of Medicine, Department of General Surgery, Mevlana University, Konya, Turkey.
| | - İbrahim Buldu
- Faculty of Medicine, Department of Urology, Mevlana University, Konya, Turkey.
| | - Türker Acar
- Faculty of Medicine, Department of Radiology, Mevlana University, Konya, Turkey.
| | - Hüsnü Alptekin
- Faculty of Medicine, Department of Gynaecology, Mevlana University, Konya, Turkey.
| | - Mehmet Kaynar
- Konya Education and Research Hospital, Konya, Turkey.
| | | | - Tuna Karatağ
- Faculty of Medicine, Department of Urology, Mevlana University, Konya, Turkey.
| | - Duran Efe
- Faculty of Medicine, Department of Radiology, Mevlana University, Konya, Turkey.
| | - Haldun Çolak
- Faculty of Medicine, Department of General Surgery, Necmettin Erbakan University, Konya, Turkey.
| | - Tevfik Küçükkartallar
- Faculty of Medicine, Department of General Surgery, Necmettin Erbakan University, Konya, Turkey.
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Kerkhofs TM, Roumen RM, Demeyere TB, van der Linden AN, Haak HR. Adrenal tumors with unexpected outcome: a review of the literature. Int J Endocrinol 2015; 2015:710514. [PMID: 25883649 PMCID: PMC4389822 DOI: 10.1155/2015/710514] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 10/01/2014] [Accepted: 10/01/2014] [Indexed: 12/21/2022] Open
Abstract
The finding of an adrenal mass should induce a diagnostic work-up aimed at assessing autonomous hormone production and differentiating between benign and (potentially) malignant lesions. The common differential diagnosis in adrenal incidentaloma consists of (non-)functioning adenoma, pheochromocytoma, myelolipoma, metastasis, and primary carcinoma. There remains a category of lesions that are hormonally inactive and display nonspecific imaging characteristics. We provide a succinct literature review regarding pathologies from this category. Imaging and histological characteristics are discussed, as well as clinical management. In conclusion, an adrenal mass may present a diagnostic challenge. After exclusion of most common diagnoses, it can be difficult to differentiate between possible pathologies based on preoperative diagnostic tests. Surgical resection of possibly harmful tumors is indicated, for example, lesions with malignant potential or risk of spontaneous hemorrhage. Resection of an obviously benign lesion is not necessary, unless problems due to tumor size are expected.
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Affiliation(s)
- Thomas M. Kerkhofs
- Department of Internal Medicine, Máxima Medical Center, Ds. Th. Fliednerstraat 1, 5631 BM Eindhoven, The Netherlands
- *Thomas M. Kerkhofs:
| | - Rudi M. Roumen
- Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB Veldhoven, The Netherlands
- Research School GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Thomas B. Demeyere
- Department of Pathology, Stichting PAMM, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
| | | | - Harm R. Haak
- Department of Internal Medicine, Máxima Medical Center, Ds. Th. Fliednerstraat 1, 5631 BM Eindhoven, The Netherlands
- Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
- Department of Health Services Research and CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Ikeguchi M, Urushibara S, Shimoda R, Saito H, Wakatsuki T. Surgical treatment of retroperitoneal liposarcoma. Yonago Acta Med 2014; 57:129-32. [PMID: 25901099 PMCID: PMC4404522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/03/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Retroperitoneal liposarcoma (RL) is a relatively rare tumor and is usually found at the advanced stage. Chemotherapy or radiotherapy for this tumor is not yet defined, and if operable, surgery is the treatment of choice. Complete resection of tumor with wide margins including excision of other organs has been recommended. However, many patients suffer from deterioration of the quality of a postoperative life. In the present study, we retrospectively analyzed the ideal surgical procedures for treating RL. METHODS RL patients treated at our institute between 2003 and 2013 amounted to 10. RL was primary in 5 patients and recurrent in the rest 5. We analyzed cases of the 10 patients retrospectively. RESULTS Tumor resection was performed for 9 patients, 7 of whom underwent complete tumor resection. RL was well-differentiated in 6 patients and dedifferentiated in 4. We analyzed the overall survival of 10 patients, and the relapse free survival of the operated 9 patients. Patients with well-differentiated RL showed better survival than those with dedifferentiated RL. Even the recurrent RL was huge, complete tumor resection could be performed in the well-differentiated type, but it was difficult in the dedifferentiated type. CONCLUSION In the recurrent huge RL, the chance of a margin-negative resection remains low, but surgery remains the treatment of choice. Tumor resection with preserving important organs may improve patients' quality of postoperative life and survival.
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Affiliation(s)
- Masahide Ikeguchi
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Shoichi Urushibara
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Ryugo Shimoda
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Hiroaki Saito
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Toshiro Wakatsuki
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
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A case of myxoid liposarcoma of the retroperitoneum: a challenging tumour for diagnosis and treatment. Case Rep Surg 2014; 2014:572805. [PMID: 25024863 PMCID: PMC4082922 DOI: 10.1155/2014/572805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 05/20/2014] [Indexed: 12/27/2022] Open
Abstract
Retroperitoneal sarcomas are rare neoplasms that account for only 1%-2% of all solid tumors and liposarcomas represent the most frequent histological type. We describe the case of a 44-year-old female with a retroperitoneal myxoid liposarcoma of 22 × 19 × 8 cm in size. The only symptoms were persistent pain and progressive tenderness of the abdomen lasting for two months. The mass was radically excised during laparotomy. CT and MRI were useful to clarify the site of origin of the tumor, relationships with other organs, and planning surgery but final diagnosis was based on histological findings. Here we review the literature about the challenging diagnosis, treatment, and prognostic factors of this disease.
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Shen Z, Wang S, Fu L, Shi J, Yin M, Ye Y, Wang S. Therapeutic experience with primary liposarcoma from the sigmoid mesocolon accompanied with well-differentiated liposarcomas in the pelvis. Surg Today 2014; 44:1863-8. [PMID: 24829099 DOI: 10.1007/s00595-014-0866-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 09/30/2013] [Indexed: 01/01/2023]
Abstract
Multifocal liposarcoma with different histological types is rare, especially that originating from the mesentery. We herein report a case of primary myxoid liposarcoma from the sigmoid mesocolon that was accompanied with well-differentiated liposarcomas in the pelvis. The location, the fat signal and the relationship with adjacent organs of the liposarcomas were well shown in the axial, coronal and sagittal dimensions of MRI, giving a comprehensive and specific image before surgery. To alleviate the patient's symptoms and mental stress, a laparotomy was performed. The tumors were all completely excised with macroscopic free margins. The final histopathological report showed that the tumor in the sigmoid mesocolon was a pure myxoid liposarcoma, while the pelvic tumors were spindle cell liposarcomas, a special type of well-differentiated liposarcoma. According to the AJCC staging system, they were all stage IIB. No further adjuvant therapy was performed. Close follow-up after the surgery has been performed, and the patient has remained healthy without any evidence of recurrence or metastasis for 17 months after the surgery.
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Affiliation(s)
- Zhanlong Shen
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, 100044, People's Republic of China
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Ngan R, Wang E, Porter D, Desai J, Prayogo N, Devi B, Quek R. Soft-tissue Sarcomas in the Asia-Pacific Region: A Systematic Review. Asian Pac J Cancer Prev 2013; 14:6821-32. [DOI: 10.7314/apjcp.2013.14.11.6821] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Keung EZ, Hornick JL, Bertagnolli MM, Baldini EH, Raut CP. Predictors of outcomes in patients with primary retroperitoneal dedifferentiated liposarcoma undergoing surgery. J Am Coll Surg 2013; 218:206-17. [PMID: 24315890 DOI: 10.1016/j.jamcollsurg.2013.10.009] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/18/2013] [Accepted: 10/23/2013] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although sarcoma histology is recognized as a prognostic factor, most studies of retroperitoneal sarcomas report results combining multiple histologies and are inadequately powered to identify prognostic factors specific to a particular histology. We reviewed our experience with retroperitoneal dedifferentiated liposarcoma (RP DDLPS) to identify factors predictive of outcomes. STUDY DESIGN All patients with RP DDLPS treated at our institution between 1998 and 2008 were reviewed. Multivariable Cox regression analyses were performed to identify factors predictive of progression-free survival (PFS), local recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), and overall survival (OS). RESULTS We identified 119 patients with primary DDLPS. Median tumor size was 20.5 cm; 21% were multifocal. French Federation of Cancer Centers Sarcoma Group tumor grades were intermediate in 53% of patients and high in 28% (unknown 19%). Resections were complete (R0/R1) in 80% of patients and incomplete (R2) in 11% (unknown 9%). Tumors were removed intact in 72% of patients and fragmented in 16% (unknown 12%). Median follow-up was 74.1 months. One hundred patients (84%) experienced recurrence or progression, with 92% occurring in the retroperitoneum. Median PFS, LRFS, DRFS, and OS were 21.1, 21.5, 45.8, and 59.0 months, respectively, and were significantly worse with R2 resection. On multivariate analysis, tumor integrity (intact vs fragmented) was predictive of PFS, multifocality predicted LRFS, and extent of resection (R0/R1 vs R2), grade, and tumor integrity predicted OS. CONCLUSIONS In this cohort of primary RP DDLPS, factors under surgeon control (tumor integrity, extent of resection) and reflective of tumor biology (grade, multifocality) impact patient outcomes.
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Affiliation(s)
- Emily Z Keung
- Department of Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Boston, MA; Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - Monica M Bertagnolli
- Department of Surgery, Brigham and Women's Hospital, Boston, MA; Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - Elizabeth H Baldini
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA; Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Boston, MA; Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA.
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Lu W, Lau J, Xu MD, Zhang Y, Jiang Y, Tong HX, Zhu J, Lu WQ, Qin XY. Recurrent abdominal liposarcoma: Analysis of 19 cases and prognostic factors. World J Gastroenterol 2013; 19:4045-4052. [PMID: 23840151 PMCID: PMC3703193 DOI: 10.3748/wjg.v19.i25.4045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 02/08/2013] [Accepted: 03/27/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the clinical outcome of re-operation for recurrent abdominal liposarcoma following multidisciplinary team cooperation.
METHODS: Nineteen consecutive patients who had recurrent abdominal liposarcoma underwent re-operation by the retroperitoneal sarcoma team at our institution from May 2009 to January 2012. Patient demographic and clinical data were reviewed retrospectively. Multidisciplinary team discussions were held prior to treatment, and re-operation was deemed the best treatment. The categories of the extent of resection were as follows: gross total resection (GTR), palliative resection and partial resection. Surgical techniques were divided into discrete lesion resection and combined contiguous multivisceral resection (CMR). Tumor size was determined as the largest diameter of the specimen. Patients were followed up at approximately 3-monthly intervals. For survival analysis, a univariate analysis was performed using the Kaplan-Meier method, and a multivariate analysis was performed using the Cox proportional hazards model.
RESULTS: Nineteen patients with recurrent abdominal liposarcoma (RAL) underwent 32 re-operations at our institute. A total of 51 operations were reviewed with a total follow-up time ranging from 4 to 120 (47.4 ± 34.2) mo. The GTR rate in the CMR group was higher than that in the non-CMR group (P = 0.034). CMR was positively correlated with intra-operative bleeding (correlation coefficient = 0.514, P = 0.010). Six cases with severe postoperative complications were recorded. Patients with tumor sizes greater than 20 cm carried a significant risk of profuse intra-operative bleeding (P = 0.009). The ratio of a highly malignant subtype (dedifferentiated or pleomorphic) in recurrent cases was higher compared to primary cases (P = 0.027). Both single-factor survival using the Kaplan-Meier model and multivariate analysis using the Cox proportional hazards model showed that overall survival was correlated with resection extent and pathological subtype (P < 0.001 and P = 0.02), however, relapse-free interval (RFI) was only correlated with resection extent (P = 0.002).
CONCLUSION: Close follow-up should be conducted in patients with RAL. Early re-operation for relapse is preferred and gross resection most likely prolongs the RFI.
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Na JC, Choi KH, Yang SC, Han WK. Surgical experience with retroperitoneal liposarcoma in a single korean tertiary medical center. Korean J Urol 2012; 53:310-6. [PMID: 22670189 PMCID: PMC3364469 DOI: 10.4111/kju.2012.53.5.310] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 02/15/2012] [Indexed: 01/31/2023] Open
Abstract
Purpose This is a report of the surgical treatment and prognosis of retroperitoneal liposarcoma (RPLS) in Koreans. Materials and Methods Nineteen patients treated for RPLS between July 1, 1984, and March 31, 2009, were included. Patient demographics, histopathologic subtypes, survival rate, disease recurrence rate and interval, and adjuvant therapy were reviewed and analyzed. Results Of the 19 patients diagnosed with RPLS, 26.3% presented with well-differentiated RPLS, 10.5% with dedifferentiated RPLS, 15.8% with myxoid/round cell type, and 47.4% with mixed-type liposarcoma. The mean follow-up period was 66.8 months (range, 6 to 165 months). Primary RPLS was treated in 17 patients. Nine patients (52.9%) had recurrent disease, and recurrence developed at a mean of 47.7 months after primary or repeated surgical treatment. The overall survival rate was 84.2% during a mean follow-up of 66.8 months. The 3- and 5-year survival rates were 86.9%, and the 10-year survival rate was 69.5%. The recurrence interval was significantly shorter in recurrent RPLS cases (p=0.023). The mean growth rate of locally recurrent tumors was 0.34 cm per month. Conclusions The survival rates reported here were higher than in previous studies. Locally recurrent tumors presented with a low growth rate, which may have contributed to the relatively high survival rate. A high prevalence of mixed-type RPLS was also noted, and its cause and prognosis require further research.
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Affiliation(s)
- Joon Chae Na
- Department of Urology, Urological Science Institute, Yonsei University Health System, Seoul, Korea
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Lee SY, Thng CH, Chow PKH. Lipoma of the pancreas, a case report and a review of the literature. World J Radiol 2011; 3:246-8. [PMID: 22229078 PMCID: PMC3252557 DOI: 10.4329/wjr.v3.i10.246] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 07/25/2011] [Accepted: 08/01/2011] [Indexed: 02/06/2023] Open
Abstract
Lipomas of the pancreas are very rare. There are fewer than 25 reported cases of lipoma originating from the pancreas. We present a case of pancreatic lipoma in a 61-year-old woman with magnetic resonance imaging findings and confirmatory histological findings. We discuss and highlight the radiological features distinguishing a pancreatic lipoma from other fatty lesions of the pancreas and pancreatic liposarcoma and provide a brief review of the literature.
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