1嘉義基督教醫院 外科部 泌尿科 2亞洲大學 食品營養與保健生技學系
Retroperitoenal dedifferentiated liposarcoma with rapid recurrence in six months : A case report and literature review
Pin-Jui Huang1, Wei-Hong Lai1, Yeong-Chin Jou1,2, Cheng-Huang Shen1, Chang-Te Lin1, Ming-Chin Cheng1
1Divisions of Urology, Department of Surgery, Chia-Yi Christian Hospital
2Department of Food Nutrition and Health Biotechnology, Asia University
Dedifferentiated liposarcoma (DDLS) is a rare malignancy in retroperitoneal tumor. In this article, we sincerely report a case who was diagnosed as dedifferentiated liposarcoma, and underwent laparoscopic tumor excision. However, rapid local recurrence was noted in follow-up computed tomography (CT) just six months after operation. The literatures of dedifferentiated liposarcoma is also reviewed in this article.
This is a 73-year-old male with past history of hypertension, type 2 diabetes mellitus, hyperlipidemia, prostate cancer, and lung cancer. He had suffered from general weakness for one week. He went to local medical department firstly, and deteriorated renal function with creatinine 1.99mg/dl. Baseline creatinine was recorded as 1.3-1.4mg/dl in the past year. He was then referred to our nephrological deparment for further survey. At outpatient office, renal sonography and computed tomography (CT) scan revealed a well-defined border soft tissue tumor at left retroperitoneal space, which size was measured as 8.1cm in diameter. The patient underwent laparoscopic transperitoneal tumor excision. The pathologic report revealed dedifferentiated liposarcoma with the French Federation of Cancer Centers Sarcoma Group (FNCLCC) grade 3. Pathological staging was pT2N0, and there was no evidence of lymphovascular invasion and perineural invasion. The postoperative course was smooth without complication. The patient was discharged on postoperative day 4. However, follow-up abdominal CT showed a 7.1cm recurrent liposarcoma at left psoas muscle region just 6 months after operation. Further treatment was undergoing.
Dedifferential liposarcoma is reported to have a highly recurrent and metastatic nature in several previous research. According to the lastest 2020 NCCN guideline, the golden standard treatment of dedifferential liposarcoma is R0 resection. Adjuvant chemotherapy is not recommended due to its chemoresistatant nature. Adjuvant radiotherapy may be considered in high T stage (T3/4) or N stage positive group. In our case, pT2N0 was the final pathological staging. Active survelliance was chosen for this case due to relatively low stage. However, rapid local recurrence was noted just six months after operation of tumor excision. Reviewing the references about dedifferential liposarcoma, Dumitra et al. suggested adjuvant local radiotherapy in tumor size larger than 5cm or irregular tumor border. Unfortunately, the evidence of these journal was not strong enough.
This case reminds us that dedifferential liposarcoma has a high recurrent nature even in low staging level. Aggrressive adjuvant treatment such as radiotherapy and closer follow-up strategy may be considered in huge tumor burden or irregular shape.