Cheng Li-Li, Tang Biao, Liu Hui, Zhu Fan, Chen Yi-Fa, Zhang Wei
The First Department of General Surgery, Ezhou Central Hospital, Ezhou 436000, Hubei Province, China.
Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 43000, Hubei Province, China.
World J Clin Cases. 2025 Sep 16;13(26):108308. doi: 10.12998/wjcc.v13.i26.108308.
Retroperitoneal liposarcoma (RPLS) is a rare malignant tumor initiated in adipocytes. It is discovered only when the tumor is large because of its deep anatomical location and insidious onset. Giant RPLS with a diameter exceeding 30 cm is extremely rare. Its diagnosis and treatment present extremely great challenges.
The patient, a 62-year-old woman, presented to the hospital complaining of abdominal distension for more than six months. Imaging examination revealed a large retroperitoneal mass. Finally, the patient was diagnosed with giant RPLS. The tumor occupied the entire abdominal cavity, severely compressed the abdominal organs, and adhered tightly to the bilateral ureters. After careful preoperative preparation (including three-dimensional visualization and bilateral ureteral stent implantation), we performed resection of the large retroperitoneal mass. The tumor was completely removed and consisted of multiple masses, with a total weight of 17 kg and the largest mass size of 35 cm × 28 cm × 14 cm. Postoperative pathological results revealed that the mass was a well-differentiated liposarcoma. The patient recovered well after surgery, and there was no sign of recurrence after 2 months of follow-up.
Surgical resection is the only radical treatment for giant RPLS. Preoperative preparation is essential, and three-dimensional visualization reconstruction is helpful for the formulation of surgical plans. Postoperative radiotherapy and neoadjuvant therapy can be reasonably selected, but whether they can reduce the recurrence rate is still controversial.
腹膜后脂肪肉瘤(RPLS)是一种起源于脂肪细胞的罕见恶性肿瘤。由于其解剖位置较深且起病隐匿,通常在肿瘤较大时才被发现。直径超过30 cm的巨大RPLS极为罕见。其诊断和治疗极具挑战性。
患者为一名62岁女性,因腹胀6个多月入院。影像学检查发现腹膜后有一巨大肿块。最终,患者被诊断为巨大RPLS。肿瘤占据整个腹腔,严重压迫腹腔脏器,并与双侧输尿管紧密粘连。经过仔细的术前准备(包括三维可视化和双侧输尿管支架植入),我们对巨大腹膜后肿块进行了切除。肿瘤被完整切除,由多个肿块组成,总重17 kg,最大肿块尺寸为35 cm×28 cm×14 cm。术后病理结果显示肿块为高分化脂肪肉瘤。患者术后恢复良好,随访2个月无复发迹象。
手术切除是巨大RPLS唯一的根治性治疗方法。术前准备至关重要,三维可视化重建有助于制定手术方案。术后放疗和新辅助治疗可合理选择,但它们是否能降低复发率仍存在争议。