Recurrence of a de-differentiated liposarcoma of the colon

Abstract

We present the case of a 56-year-old gentleman who presented with non specific malaise, myalgia and anorexia. Clinical examination revealed a large circumscribed palpable mass in the left iliac fossa. He underwent an intraabdominal pelvic biopsy, computed tomography (CT), magnetic resonance imaging (MRI) of abdominal wall and Positron Emmission Tomography (PET). Differential diagnoses included Gastro Intestinal Stromal Tumour (GIST) and sarcoma. He underwent a laparotomy and excision of the lesion. Histological analysis of the lesion demonstrated a dedifferentiated liposarcoma involving the colon and adjacent pericolic fat. Margins were clear and there was no nodal involvement. He declined adjuvant chemotherapy. He subsequently developed a local recurrence, which was deemed unresectable. He commenced chemotherapy but continued to deteriorate. He received palliative treatment and died 6 months following his initial surgery.

Keywords

Liposarcoma / Sigmoid colon / De-differentiated liposarcoma / Recurrence

CONFLICTS OF INTEREST DISCLOSURE

None.

References

[1] Wood DL, Morgenstern L. Liposarcoma of the ileocecal valve: a case report. Mt Sinai J Med. 1989; 56(1): 62-4. PMid: 2784186.

[2] Fletcher CD. The evolving classification of soft tissue tumours - an update based on the new 2013 WHO classification. Histopathology. 2014; 64(1): 2-11. PMid: 24164390. https://doi.org/10.1111/his.12267

[3] Binh MB, Sastre-Garau X, Guillou L, et al. MDM2 and CDK4 immunostainings are useful adjuncts in diagnosing well-differentiated and dedifferentiated liposarcoma subtypes: a comparative analysis of 559 soft tissue neoplasms with genetic data. Am J Surg Pathol. 2005; 29(10): 1340-7. PMid: 16160477. https://doi.org/10.1097/01.pas.0000170343.09562.39

[4] Sirvent N, Coindre JM, Maire G, et al. Detection of MDM2-CDK4 amplification by fluorescence in situ hybridization in 200 paraffin-embedded tumor samples: utility in diagnosing adipocytic lesions and comparison with immunohistochemistry and real-time PCR. Am J Surg Pathol. 2007; 31(10): 1476-89. PMid: 17895748. https://doi.org/10.1097/PAS.0b013e3180581fff

[5] Mari-o-Enríquez A, Fletcher CD, Dal Cin P, et al. Dedifferentiated liposarcoma with "homologous" lipoblastic (pleomorphic liposarcoma-like) differentiation: clinicopathologic and molecular analysis of a series suggesting revised diagnostic criteria. Am J Surg Pathol. 2010; 34(8): 1122-31. PMid: 20588177. https://doi.org/10.1097/PAS.0b013e3181e5dc49

[6] Parks RW, Mullan FJ, Kamel HM, et al. Liposarcoma of the colon. Ulster Med J. 1994; 63(1): 111-3. PMid: 8658985.

[7] Chen KT. Liposarcoma of the colon: a case report. Int J Surg Pathol. 2004; 12(3): 281-5. PMid:15306943. https://doi.org/10.1177/106689690401200312

[8] Sato Y, Yamamoto S, Fujita S. Retroperitoneal liposarcoma with colonic involvement: a case report. Jpn J Clin Oncol. 2014; 44(4): 374-8. PMid:24558126. https://doi.org/10.1093/jjco/hyu009

[9] Choi YY, Kim YJ, Jin SY. Primary liposarcoma of the ascending colon: a rare case of mixed type presenting as hemoperitoneum combined with other type of retroperitoneal liposarcoma. BMC Cancer. 2010; 10: 239. PMid: 20507577. https://doi.org/10.1186/1471-2407-10-239

[10] Gutsu E, Ghidirim G, Gagauz I, et al. Liposarcoma of the colon: a case report and review of literature. J Gastrointest Surg. 2006; 10(5): 652-6. PMid:16773759. https://doi.org/10.1016/j.gassur.2005.09.014

[11] Suzuki S, Hirasaki S, Yumoto E, et al. A case of liposarcoma of the ascending colon mesenterium. Nihon Shokakibyo Gakkai Zasshi. 2009; 106(9): 1343-50. PMid: 19734706.

[12] D’Annibale M, Cosimelli M, Covello R, et al. Liposarcoma of the colon presenting as an endoluminal mass. World J Surg Oncol. 2009; 7: 78. PMid: 19852822. https://doi.org/10.1186/1477-7819-7-78

[13] Neuhaus SJ, Barry P, Clark MA, et al. Surgical management of primary and recurrent retroperitoneal liposarcoma. Br J Surg. 2005; 92(2): 246-52. PMid: 15505870. https://doi.org/10.1002/bjs.4802

[14] Grifasi C, Calogero A, Carlomagno N, et al. Intraperitoneal dedifferentiated liposarcoma showing MDM2 amplification:case report. World J Surg Oncol. 2013; 11: 305. PMid:24279301. https://doi.org/10.1186/1477-7819-11-305

[15] Singer S, Antonescu CR, Riedel E, et al. Histologic subtype and margin of resection predict pattern of recurrence and survival for retroperitoneal liposarcoma. Ann Surg. 2003; 238(3): 358-70. discussion 70-1. https://doi.org/10.1097/01.sla.0000086542.11899.38