Prugue Cesar, Bao Emma, Pereira Camden, Yi Bing
Edward Via College of Osteopathic Medicine, 350 Howard St, Spartanburg, SC, 29303, USA.
Duke University, Durham, NC, 27708, USA.
J Med Case Rep. 2025 Jul 3;19(1):313. doi: 10.1186/s13256-025-05379-9.
Dedifferentiated liposarcoma is a rare, aggressive subtype of liposarcoma known for its high recurrence rate and local invasiveness. This case demonstrates the challenges in managing a rapidly recurring dedifferentiated liposarcoma and underscores the need for improved surveillance and additional treatment options.
A 57-year-old non-Hispanic white male presented in November 2023 with a 2-month history of intermittent fevers, nonproductive cough, and lower abdominal discomfort. Imaging revealed a 12 cm × 12 cm × 16 cm retroperitoneal mass, confirmed to be a high-grade dedifferentiated liposarcoma. Initial surgical resection in December 2023 removed the tumor, which was densely adhered to the left kidney. Despite adjuvant chemotherapy, follow-up imaging in July 2024 showed tumor recurrence with a 15 cm × 14 cm × 21 cm multiloculated cystic mass extending from the spleen to the lower pole of the kidney, as well as a 12 cm × 6 cm × 15 cm mass inferior to the left kidney. Owing to the extensive local invasion, a second surgery in August 2024 required a left nephrectomy, splenectomy, hemicolectomy, and distal pancreatectomy. The tumor's proximity to the abdominal aorta and invasion into the psoas muscle posed significant surgical challenges, requiring careful resection.
This case highlights the aggressive nature of high-grade dedifferentiated liposarcoma and its resistance to chemotherapy. Surgical resection remains the primary treatment option, but the recurrence emphasizes the need for more effective therapies. The case further illustrates the complexity of multiorgan involvement in recurrent dedifferentiated liposarcoma and the critical role of experienced oncologic surgeons in managing these cases. More research is necessary to develop alternative treatments that can better control tumor progression and improve patient outcomes.
去分化脂肪肉瘤是一种罕见的侵袭性脂肪肉瘤亚型，以其高复发率和局部侵袭性而闻名。本病例展示了管理快速复发的去分化脂肪肉瘤所面临的挑战，并强调了改进监测和增加治疗选择的必要性。
一名57岁的非西班牙裔白人男性于2023年11月就诊，有2个月的间歇性发热、干咳和下腹部不适病史。影像学检查发现一个12厘米×12厘米×16厘米的腹膜后肿块，确诊为高级别去分化脂肪肉瘤。2023年12月进行了初次手术切除肿瘤，该肿瘤与左肾紧密粘连。尽管进行了辅助化疗，但2024年7月的随访影像学检查显示肿瘤复发，一个15厘米×14厘米×21厘米的多房囊性肿块从脾脏延伸至肾下极，以及左肾下方一个12厘米×6厘米×15厘米的肿块。由于广泛的局部侵犯，2024年8月的第二次手术需要进行左肾切除术、脾切除术、半结肠切除术和远端胰腺切除术。肿瘤靠近腹主动脉并侵犯腰大肌带来了重大的手术挑战，需要仔细切除。
本病例突出了高级别去分化脂肪肉瘤的侵袭性及其对化疗的耐药性。手术切除仍然是主要的治疗选择，但复发强调了需要更有效的治疗方法。该病例进一步说明了复发性去分化脂肪肉瘤多器官受累的复杂性以及经验丰富的肿瘤外科医生在处理这些病例中的关键作用。需要更多的研究来开发能够更好地控制肿瘤进展并改善患者预后的替代治疗方法。
