Cai Mingzhe, Siew Caroline Ching Hisa, Tay Timothy Kwang Yong, Tan Grace Hwei Ching
Department of General Surgery, Singapore General Hospital, 20 College Road, 169856, Singapore.
Department of General Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, 308433, Singapore.
Int J Surg Case Rep. 2019;60:331-335. doi: 10.1016/j.ijscr.2019.06.051. Epub 2019 Jun 26.
Dedifferentiated liposarcoma is rare and tends to present with discrete tumors in the retroperitoneum, limbs and trunk. Majority of cases arise de-novo as primary tumors, while a minority occur as recurrences of well-differentiated liposarcomas. There has been no previous report of dedifferentiated liposarcoma presenting as disseminated intraperitoneal sarcomatosis.
This report describes a young Asian female with disseminated intraperitoneal sarcomatosis arising from de-novo dedifferentiated liposarcoma, and discusses the diagnostic challenges faced in this highly unusual disease presentation. Initial biopsy was unconclusive, and considerations included sclerosing mesenteritis or an inflammatory myofibroblastic tumor. Fluorescence in situ hybridization was subsequently performed and showed amplification of the MDM2 gene. A diagnosis of dedifferentiated liposarcoma was then made.
This was an extremely unusual presentation of advanced dedifferentiated liposarcoma that was eventually diagnosed using fluorescence in situ hybridization. Prognosis is poor and the only viable treatment options was palliative chemotherapy.
The diagnosis of dedifferentiated liposarcoma should be considered early and surgery carried out when still feasible.
去分化脂肪肉瘤较为罕见,往往表现为腹膜后、四肢和躯干的孤立性肿瘤。大多数病例为原发性肿瘤,少数为高分化脂肪肉瘤复发。此前尚无去分化脂肪肉瘤表现为弥漫性腹膜内肉瘤病的报道。
本报告描述了一名年轻亚洲女性,其弥漫性腹膜内肉瘤病源于原发性去分化脂肪肉瘤,并讨论了这种极为罕见的疾病表现所面临的诊断挑战。最初的活检结果不明确,考虑的疾病包括硬化性肠系膜炎症或炎性肌纤维母细胞瘤。随后进行了荧光原位杂交,结果显示MDM2基因扩增。于是做出了去分化脂肪肉瘤的诊断。
这是晚期去分化脂肪肉瘤一种极其罕见的表现,最终通过荧光原位杂交得以诊断。预后较差,唯一可行的治疗选择是姑息性化疗。
应尽早考虑去分化脂肪肉瘤的诊断,在仍可行时进行手术。