Pérez-Ponce Yisvanth, Castellanos-Alejandre Raúl, Guerrero-Romero J Francisco, Estrada-León Felipe, Torres-Lobatón Alfonso
Servicio de Cirugía General, Centro Médico del Instituto de Seguridad y Servicio del Estado de México y Municipios, Egresado del Hospital Central Norte PEMEX, Mexico, D.F., Mexico.
Cir Cir. 2008 Jan-Feb;76(1):77-82.
Soft tissue sarcomas are very uncommon types of tumors, with their embryological origin in the mesoderm and in nerve structures of the neuroectodermic layer. They represent only 1.5% of cases in the National Registry of Malignant Tumors in Mexico. They can be encountered anywhere connective soft tissue is found. Because of their specialized localization, retroperitoneal soft tissue sarcomas have a propensity to remain asymptomatic for long periods of time and reach a large size before being diagnosed. The only accepted treatment is wide surgical excision with clear margins, without a clear benefit for adjuvant treatment. The very uncommon nature of these tumors and their varied histopathology, site and behavior classify them as a difficult entity in terms of treatment. We present here the case of a 66-year-old female with a left-side retroperitoneal tumor, complaining only of vague abdominal pain as the presenting symptom. A CT-guided needle biopsy reported a sarcoma and the patient was subjected to laparatomy with complete resection of the tumor (30 x 13 x 10 cm). Histopathological report demonstrated a low-grade retroperitoneal sarcoma and free macroscopic and microscopic borders, without obvious invasion except for left kidney and ureter. The patient refused adjuvant treatment, and she is disease-free 7 years after treatment. Retroperitoneal sarcomas can cause pain and reach very large sizes. The best treatment available is wide surgical resection with clear margins. The most important prognostic factors are free margins, type of resection, age of patient and tumor histology.
软组织肉瘤是非常罕见的肿瘤类型，其胚胎起源于中胚层以及神经外胚层的神经结构。在墨西哥国家恶性肿瘤登记处，它们仅占病例的1.5%。在任何发现结缔组织软组织的部位都可能出现。由于其特殊的定位，腹膜后软组织肉瘤往往长时间无症状，在被诊断之前就长得很大。唯一被认可的治疗方法是进行切缘清晰的广泛手术切除，辅助治疗并无明确益处。这些肿瘤非常罕见，且其组织病理学、部位和行为各不相同，这使得它们在治疗方面成为一个棘手的病种。我们在此介绍一例66岁女性患者，其左侧腹膜后有肿瘤，仅主诉有模糊的腹痛作为首发症状。CT引导下针吸活检报告为肉瘤，患者接受了剖腹手术，肿瘤被完整切除（30×13×10厘米）。组织病理学报告显示为低级别腹膜后肉瘤，肉眼和显微镜下切缘均为阴性，除左肾和输尿管外无明显侵犯。患者拒绝辅助治疗，治疗后7年无疾病复发。腹膜后肉瘤可引起疼痛并长得非常大。现有的最佳治疗方法是进行切缘清晰的广泛手术切除。最重要的预后因素是切缘阴性、切除类型、患者年龄和肿瘤组织学。
