Itagaki Yuki, Fukunaga Akira, Takano Hironobu, Yamamoto Kazuyuki, Nishigami Kohei, Ichimura Tatsunosuke, Manase Hiroto, Obata Masahiko, Kato Tatsuya, Hirano Satoshi
Department of Surgery, Japanese Red Cross Asahikawa Hospital, 1-1, Akebono 1-1, Hokkaido, Asahikawa, 070-8530, Japan.
Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, North 15 West 7, Kita-Ku, Hokkaido, Sapporo, 060-8638, Japan.
Surg Case Rep. 2023 Feb 15;9(1):26. doi: 10.1186/s40792-023-01606-x.
An 80-year-old man presented to our emergency department complaining of a mass on the right side of his chest and pain in the right flank of his back. A chest computed tomography (CT) scan showed a relatively heterogenous oval-shaped tumor measuring 7.5 × 6.0 cm eroded to the 8th rib, with slightly dense fluid accumulation inside and calcification of the tumor wall. A 1-month follow-up CT scan showed spontaneous shrinkage of the tumor. The tumor was completely excised from the thoracic wall and the wall was reconstructed with a polytetrafluoroethylene mesh. Pathological examination showed coagulation necrosis in the chest wall tumor, but immunohistochemical staining revealed murine double minute 2- and Cyclin-dependent kinase 4-positive cells with irregular nuclear size and bizarre morphology. Therefore, dedifferentiated liposarcoma (DDLPS) was the final pathological diagnosis. Remarkable infiltration of CD8+ lymphocytes into the tumor was observed, along with a 90% positive ratio for programmed cell death-ligand 1. The patient has been followed-up for 1 year without any recurrence, despite not receiving any additional treatment. Liposarcoma is one of the most common types of soft tissue sarcomas; however, spontaneous regression of primary DDLPS arising from the chest wall is extremely rare. Herein, we report a case of DDLPS primary to the chest wall with spontaneous regression, probably due to a spontaneously induced T cell response.
一名80岁男性因右侧胸部肿块及右后腰疼痛就诊于我院急诊科。胸部计算机断层扫描(CT)显示一个相对不均匀的椭圆形肿瘤,大小为7.5×6.0厘米,侵犯第8肋骨,内部有稍高密度的液体聚集,肿瘤壁有钙化。1个月后的随访CT扫描显示肿瘤自发缩小。肿瘤从胸壁完整切除,并用聚四氟乙烯网重建胸壁。病理检查显示胸壁肿瘤有凝固性坏死,但免疫组化染色显示鼠双微体2和细胞周期蛋白依赖性激酶4阳性细胞,核大小不规则,形态怪异。因此,去分化脂肪肉瘤(DDLPS)是最终的病理诊断。观察到肿瘤内有显著的CD8 +淋巴细胞浸润,程序性细胞死亡配体1阳性率达90%。尽管未接受任何额外治疗,该患者已随访1年,无任何复发。脂肪肉瘤是最常见的软组织肉瘤类型之一;然而,胸壁原发性DDLPS自发消退极为罕见。在此,我们报告一例胸壁原发性DDLPS自发消退的病例,可能是由于自发诱导的T细胞反应所致。