Kamehama Fumika, Kinjo Tatsuya, Miyagi Yoshihiro, Furugen Tomonori, Teruya Takao, Tamaki Tomoko, Wada Naoki, Takatsuki Mitsuhisa
Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
Department of Thoracic and Cardiovascular Surgery, University Hospital of The Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
Surg Case Rep. 2023 Jul 21;9(1):133. doi: 10.1186/s40792-023-01715-7.
Myxoid liposarcoma (MLS), with its risk factors, tends to spread to the lungs and extraperitoneally, with intraperitoneal metastases occurring rarely. We present an unusual case of a myxoid liposarcoma that metastasized to the abdominal organs.
A 60-year-old female patient was referred to our hospital for the evaluation of a right upper limb tumor that had been growing for 7 years. The patient refused surgery, and during follow-up, tumor hemorrhage resulted in hemorrhagic shock. The patient's right upper limb was immediately amputated. MLS was diagnosed histopathologically. Subsequently, the patient underwent adjuvant chemotherapy. Computed tomography (CT) revealed a right buttock mass, a pelvic mass, and left cardiophrenic angle lymph nodes 3 years after the initial surgery. Contrast-enhanced abdominal CT revealed a relatively low-density, lobulated pelvic tumor. Contrast-enhanced pelvic magnetic resonance imaging (MRI) revealed a low-intensity, lobulated mass on T1-weighted images and a high-intensity mass on T2-weighted images. The pelvic mass showed no significant fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET)-CT. On clinical examination, gynecological malignancies were ruled out as the origin of the pelvic lesions. After resection of the right buttock mass, pelvic mass, and left cardiophrenic angle lymph nodes, the patient underwent laparoscopic surgery for a preoperative diagnosis of small intestinal mesenteric metastasis of MLS. A tumor was found in the mesentery of the small intestine and removed with a margin of 5 cm on both the proximal and distal sides. The specimen measured 10 × 8 × 5 cm and contained a multifocal mass. The tumor was found in the mesentery of the small intestine, with no mucosal or submucosal invasion. The patient was diagnosed with MLS with small mesenteric intestinal metastases. On postoperative day 8, the patient was discharged after an uneventful postoperative course. Twelve months after the surgery, there was no evidence of local or distant recurrence.
Small intestinal mesenteric metastases of MLSs are rare. Moreover, there are few reports on laparoscopic resection. In this case, the laparoscopic approach was useful in detecting the tumor location and determining the range of resection.
黏液样脂肪肉瘤（MLS）及其危险因素使其易于扩散至肺部和腹膜外，腹腔内转移很少见。我们报告一例罕见的黏液样脂肪肉瘤转移至腹部器官的病例。
一名60岁女性患者因评估右上肢生长7年的肿瘤被转诊至我院。患者拒绝手术，在随访期间，肿瘤出血导致失血性休克。患者右上肢立即被截肢。经组织病理学诊断为MLS。随后，患者接受了辅助化疗。初次手术后3年，计算机断层扫描（CT）显示右臀部肿块、盆腔肿块和左心膈角淋巴结。增强腹部CT显示盆腔有一个相对低密度、分叶状肿瘤。增强盆腔磁共振成像（MRI）显示在T1加权图像上为低强度分叶状肿块，在T2加权图像上为高强度肿块。盆腔肿块在正电子发射断层扫描（PET）-CT上未显示明显的氟脱氧葡萄糖（FDG）摄取。经临床检查，排除了妇科恶性肿瘤作为盆腔病变的起源。在切除右臀部肿块、盆腔肿块和左心膈角淋巴结后，患者接受了腹腔镜手术，术前诊断为MLS小肠系膜转移。在小肠系膜中发现一个肿瘤，并在近端和远端各切缘5 cm予以切除。标本大小为10×8×5 cm，包含一个多灶性肿块。肿瘤位于小肠系膜，未侵犯黏膜或黏膜下层。患者被诊断为伴有小肠系膜转移的MLS。术后第8天，患者术后恢复顺利，出院。术后12个月，无局部或远处复发迹象。
MLS小肠系膜转移罕见。此外，关于腹腔镜切除的报道很少。在本病例中，腹腔镜方法有助于检测肿瘤位置并确定切除范围。
