Yokoyama Yukihiro, Nishida Yoshihiro, Ikuta Kunihiro, Nagino Masato
Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
Department of Orthopedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
Surg Case Rep. 2020 May 24;6(1):105. doi: 10.1186/s40792-020-00865-2.
Retroperitoneal liposarcoma (RPLS) is the most commonly observed soft tissue sarcoma in the retroperitoneal space. Although the beneficial effect of chemotherapy for RPLS is controversial, there are some reports that have shown a considerable tumor-suppressive effect of chemotherapy in RPLS. We demonstrate a case of dedifferentiated RPLS, which was initially considered inoperable but was successfully treated by neoadjuvant chemotherapy and subsequent curative resection.
A 59-year-old female was referred to our hospital with a chief complaint of right lower quadrant abdominal pain. Abdominal computed tomography revealed a large retroperitoneal tumor with a maximum diameter of 11 cm. The tumor involved retroperitoneal major vasculatures, such as the right common iliac vein and artery, as well as the right psoas muscle and femoral nerve. The right ureter was also involved and obstructed by the tumor. A biopsy was performed through the retroperitoneal route, and the tumor was diagnosed as a dedifferentiated liposarcoma with the Fédération Nationale des Centres de Lutte Contre le Cancer grade 3. Because the tumor was highly invasive and complete resection was not feasible, we decided to administer neoadjuvant chemotherapy with doxorubicin and ifosfamide (AI). After completing 6 courses of AI, the tumor size was considerably reduced, and we decided to perform surgery with curative intent. Before laparotomy, femoro-femoral arterial bypass was performed to prepare for the right common iliac artery resection. Thereafter, the patient underwent laparotomy and tumor resection combined with right nephrectomy, resection of the right common iliac artery and vein, and resection of the right psoas muscle and femoral nerve. The postoperative course was uneventful, although the patient needed a walking brace to support her gait. The pathological findings indicated a 99% disappearance of tumor cells. The patient was healthy without any complaints after 1 year of surgery, and a follow-up CT scan revealed no tumor recurrence.
To the best of our knowledge, this is the first report that showed a nearly complete pathological response to AI in dedifferentiated RPLS, which was subsequently completely resected.
腹膜后脂肪肉瘤（RPLS）是腹膜后间隙最常见的软组织肉瘤。尽管化疗对RPLS的有益效果存在争议，但有一些报告显示化疗对RPLS有相当显著的肿瘤抑制作用。我们展示了一例去分化型RPLS病例，该病例最初被认为无法手术，但通过新辅助化疗及随后的根治性切除成功得到治疗。
一名59岁女性因右下腹痛为主诉转诊至我院。腹部计算机断层扫描显示一个最大直径为11厘米的巨大腹膜后肿瘤。该肿瘤累及腹膜后主要血管，如右髂总静脉和动脉，以及右腰大肌和股神经。右侧输尿管也被肿瘤累及并阻塞。通过腹膜后途径进行了活检，肿瘤被诊断为法国国立癌症中心联合会3级的去分化脂肪肉瘤。由于肿瘤具有高度侵袭性且无法进行完整切除，我们决定给予多柔比星和异环磷酰胺（AI）新辅助化疗。完成6个疗程的AI治疗后，肿瘤大小显著缩小，我们决定进行根治性手术。在剖腹手术前，进行了股-股动脉搭桥术，为切除右髂总动脉做准备。此后，患者接受了剖腹手术及肿瘤切除术，同时进行了右肾切除术、右髂总动脉和静脉切除术以及右腰大肌和股神经切除术。术后过程顺利，尽管患者需要步行支架来辅助步态。病理结果显示肿瘤细胞消失了99%。术后1年患者健康无任何不适，随访CT扫描未发现肿瘤复发。
据我们所知，这是第一份显示去分化型RPLS对AI有近乎完全病理反应且随后得以完全切除的报告。
