Murata Ryohei, Yoshida Tadashi, Kobayashi Nobuhiro, Watanabe Yoshito, Homma Shigenori, Echizenya Hayato, Taketomi Akinobu
Department of Surgery, Otaru General Hospital, 047-8550, 1-1-1, Wakamatsu, Otaru-shi, Hokkai-do, Japan.
Department of Gastroenterological Surgery I, Hokkaido University Hospital, 060-8648, Nishi 5 chome, Kita 14 jyo, Kita-ku, Sapporo-shi, Japan.
Surg Case Rep. 2019 Feb 4;5(1):18. doi: 10.1186/s40792-019-0576-y.
Liposarcoma is a soft tissue sarcoma of adipocyte origin. Liposarcoma represents 20-30% of adult soft tissue tumors, which was most frequently seen in the retroperitoneal space in 45% and abdominal space in only 5% of cases, but the multicentric case is unknown. Herein, we describe a rare case of multicentric, large, intra-abdominal and retroperitoneal liposarcoma, one of which had caused infection and pressing the right ureter causing hydronephrosis, which was resected by two-stage surgery.
The patient was a 46-year-old man who was referred for abdominal bloating and fatigue. Enhanced computed tomography showed a 23-cm intra-abdominal tumor and a 14.6-cm left retroperitoneal tumor. The intra-abdominal tumor which compressed the right ureter caused right unilateral hydronephrosis and deteriorated the renal function. The intra-abdominal tumor had also formed an intra-abdominal abscess. We performed emergent laparotomy and resected the intra-abdominal tumor. After the recovery of renal function, we resected the residual retroperitoneal tumor. Histopathological examination showed both tumors to be myxoid/round cell type liposarcoma. Considering clinical findings and their location, he was diagnosed with multicentric liposarcoma. He underwent adjuvant chemotherapy and has been alive without any recurrence for 9 months after the operation.
We successfully resected large intra-abdominal and retroperitoneal multicentric myxoid/round cell liposarcomas. A two-stage surgery was a rational choice as it provides time to confirm the recovery of renal function.
脂肪肉瘤是一种起源于脂肪细胞的软组织肉瘤。脂肪肉瘤占成人软组织肿瘤的20%-30%，最常见于腹膜后间隙，占45%，而仅5%的病例见于腹腔，但多中心病例尚不清楚。在此，我们描述一例罕见的多中心、巨大、腹腔内及腹膜后脂肪肉瘤病例，其中一个肿瘤引起感染并压迫右侧输尿管导致肾积水，通过两阶段手术切除。
患者为一名46岁男性，因腹胀和疲劳就诊。增强计算机断层扫描显示腹腔内有一个23厘米的肿瘤和左侧腹膜后有一个14.6厘米的肿瘤。压迫右侧输尿管的腹腔内肿瘤导致右侧单侧肾积水并使肾功能恶化。腹腔内肿瘤还形成了腹腔脓肿。我们进行了急诊剖腹手术并切除了腹腔内肿瘤。肾功能恢复后，我们切除了残留的腹膜后肿瘤。组织病理学检查显示两个肿瘤均为黏液样/圆形细胞型脂肪肉瘤。结合临床表现及其位置，他被诊断为多中心脂肪肉瘤。他接受了辅助化疗，术后9个月一直存活且无任何复发。
我们成功切除了巨大的腹腔内及腹膜后多中心黏液样/圆形细胞脂肪肉瘤。两阶段手术是一个合理的选择，因为它为确认肾功能恢复提供了时间。
