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病例报告:巨大腹腔内脂肪肉瘤伴急性肾衰竭

A case report: Giant intra-abdominal liposarcoma presenting acute renal failure.

作者信息

Duman Kazim, Girgin Mustafa, Artas Gokhan

机构信息

Department of General Surgery, Elazig Training and Research Hospital, 23200, Elazig, Turkey.

Department of General Surgery, Faculty of Medicine, Firat University, 23200, Elazig, Turkey.

出版信息

Ann Med Surg (Lond). 2016 Sep 22;12:90-93. doi: 10.1016/j.amsu.2016.09.005. eCollection 2016 Dec.

Abstract

INTRODUCTION

Liposarcomas represent 20-30% of adult soft tissue tumors and its abdominal localization occurs only in 5% of cases. Most are asymptomatic, but few present with abdominal mass and pain, fatigue, nausea, vomiting. They infiltrate adjacent organs and cause intestinal obstruction, intestinal ischemia-perforation, hydronephrosis, ureteric fistula and even aortic rupture. Here we aimed to report a rare case of a giant liposarcoma which originated from mesentery.

PRESENTATION OF CASE

A 45-year-old male presented with slightly abdomen distention, urinary retention, oliguria since fifteen days. There was no concomitant nausea, vomiting and lower extremity edema. We found renal function tests abnormal. Contrast-enhanced computed tomography (CT) demonstrated a 20 × 18 cm, well-circumscribed, lobulated, heterogeneous mass. Both ureters were compressed by the mass. The entire mass was totally excised. After the operation, the patient's renal function returned to normal levels dramatically. The tumor was diagnosed as dedifferentiated liposarcoma.

DISCUSSION

In cases of intra-abdominal mass is detected, surely abdominal compartment syndrome (ACS) should be considered. If vital signs, pulmonary function tests (PFT) and value of the CVP are abnormal, intra-abdominal pressure should be measured. Our findings mentioned above were not observed.

CONCLUSION

A detailed history should be obtained other abdominal solid organs should also be considered while performing a careful physical examination, the amount of urinary output in particular should be questioned and this sytemic questioning should be supported by specific laboratory tests.

摘要

引言

脂肪肉瘤占成人软组织肿瘤的20%-30%,其腹部定位仅见于5%的病例。大多数无症状,但少数表现为腹部肿块、疼痛、疲劳、恶心、呕吐。它们浸润相邻器官,导致肠梗阻、肠缺血穿孔、肾积水、输尿管瘘甚至主动脉破裂。在此,我们旨在报告一例罕见的起源于肠系膜的巨大脂肪肉瘤病例。

病例介绍

一名45岁男性,自15天前出现轻微腹胀、尿潴留、少尿。无恶心、呕吐及下肢水肿。我们发现肾功能检查异常。增强计算机断层扫描(CT)显示一个20×18cm、边界清晰、分叶状、不均匀的肿块。双侧输尿管均被肿块压迫。整个肿块被完整切除。术后,患者肾功能显著恢复至正常水平。肿瘤被诊断为去分化脂肪肉瘤。

讨论

在检测到腹腔内肿块的病例中,肯定应考虑腹腔间隔室综合征(ACS)。如果生命体征、肺功能测试(PFT)和中心静脉压值异常,应测量腹内压。我们未观察到上述情况。

结论

应获取详细病史,在进行仔细体格检查时还应考虑其他腹部实体器官,尤其应询问尿量情况,且这种系统询问应由特定实验室检查支持。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e531/5133731/b3362edd88e8/gr1.jpg

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