Huang Wenpeng, Chao Fangfang, Zhang Yongbai, Li Liming, Gao Yuan, Qiu Yongkang, Gao Jianbo, Kang Lei
Department of Nuclear Medicine, Peking University First Hospital, Beijing, China.
Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Front Med (Lausanne). 2023 Jul 27;10:1235843. doi: 10.3389/fmed.2023.1235843. eCollection 2023.
Myxoid liposarcoma (MLS) is a rare malignant soft tissue sarcoma that predominantly manifests in the deep soft tissues of the extremities, particularly within the musculature of the thigh. Unlike other types of liposarcoma, MLS demonstrates a propensity for metastasis to atypical sites, including the lung parenchyma, soft tissues, retroperitoneum, mediastinum, breast, liver, thymus, lymph nodes, and bones. The definitive diagnosis primarily relies on histology with HE staining. Imaging modalities such as ultrasound, CT, MRI, and F-FDG PET/CT scans serve as valuable tools for tumor identification.
A 57-year-old man presented with symptoms of abdominal distention and vomiting 1 month ago. Contrast-enhancement CT revealed a heterogeneous hypodense mass in the upper-middle part of the left kidney, displaying irregular morphology and protrusion towards the exterior of the kidney, with abundant blood supply and had a maximum dimension of approximately 10.7 cm × 9.0 cm. Additionally, a rounded soft tissue density was identified in the pancreatic body. Multiplanar reconstruction demonstrated a connection between the pancreatic lesion and the kidney mass. F-FDG PET/CT was conducted for staging, revealing significant growth of the lesion in the upper-middle part of the left kidney, extending beyond the kidney and infiltrating the pancreatic body. The lesion demonstrated remarkably high F-FDG uptake (SUVmax = 10.2, MTV = 136.13 cm, TLG = 484.62). The postoperative pathological examination confirmed the diagnosis of MLS. On the 10th day post-surgery, the patient presented with tumor recurrence and underwent another surgical resection. Unfortunately, during the operation, the patient experienced a sudden cardiac arrest and died.
Renal MLS with invasion into the pancreas is very rare in clinical practice. Due to the limited research on the utilization of F-FDG PET/CT in this particular context, given the rarity and low incidence of MLS, its role remains largely unexplored. As PET/CT imaging becomes increasingly prevalent, thorough imaging of disease sites becomes indispensable for the development of treatment protocols and the monitoring of treatment response.
黏液样脂肪肉瘤（MLS）是一种罕见的恶性软组织肉瘤，主要发生于四肢深部软组织，尤其是大腿肌肉组织内。与其他类型的脂肪肉瘤不同，MLS有转移至非典型部位的倾向，包括肺实质、软组织、腹膜后、纵隔、乳腺、肝脏、胸腺、淋巴结和骨骼。明确诊断主要依靠苏木精-伊红（HE）染色的组织学检查。超声、CT、MRI和F-FDG PET/CT扫描等影像学检查手段是肿瘤识别的重要工具。
一名57岁男性1个月前出现腹胀和呕吐症状。增强CT显示左肾中上段有一不均匀低密度肿块，形态不规则，向肾外突出，血供丰富，最大径约10.7 cm×9.0 cm。此外，在胰体部发现一个圆形软组织密度影。多平面重建显示胰腺病变与肾肿块之间有连接。进行F-FDG PET/CT分期检查，结果显示左肾中上段病变显著增大，超出肾脏并侵犯胰体。该病变显示出极高的F-FDG摄取（SUVmax = 10.2，MTV = 136.13 cm，TLG = 484.62）。术后病理检查确诊为MLS。术后第10天，患者出现肿瘤复发并接受了再次手术切除。不幸的是，手术过程中患者突发心脏骤停死亡。
临床实践中，侵犯胰腺的肾MLS非常罕见。鉴于MLS的罕见性和低发病率，在这种特殊情况下对F-FDG PET/CT应用的研究有限，其作用在很大程度上仍未得到充分探索。随着PET/CT成像越来越普遍，对疾病部位进行全面成像对于制定治疗方案和监测治疗反应变得不可或缺。
