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RETROPERITONEUM LIPOSARCOMA: CASE REPORT
Apresentação do caso
A 72-year-old male patient presented with an abdominal mass on the left flank. A biopsy was performed showing atypical cellular infiltrate and immunohistochemistry with characteristics of an inflammatory myofibroelastic tumor. Submitted to surgery, a 30cm tumor in the retroperitoneal region and in the abdominal cavity was visualized, presenting a solid-cystic consistency, adhered to multiple organs. The adhesions were removed, and due to the absence of a tumor cleavage plane with these structures, tactical body-caudal pancreatectomy and splenectomy were performed. After excision of the mass, the procedure was terminated due to the patient's hemodynamic instability, leaving a residual tumor in the retroperitoneum. Pathological examination of the specimen showed pleomorphic liposarcoma of the retroperitoneum and pancreatectomy product with mesenchymal spindle cell proliferation with atypias. Abdominal tomography performed after surgery showed an ovoid peritoneal and subdiaphragmatic nodule on the left, measuring 1.2 cm with a neoplastic appearance, in addition to gross calcifications in the retroperitoneum. The patient follows clinical oncology care for adjuvant therapy.
Retroperitoneal tumors account for about 0.2% of all neoplasms and are frequently found in the age group above 50 years of age, being more common in men. Its presentation is insidious, manifesting nonspecific symptoms and, after extensive growth, symptoms resulting from compression of organs and adjacent structures. The histological presentation of liposarcomas can be classified in 5 ways: well-differentiated, myxoid, pleomorphic, round cell and undifferentiated. In the case above, the patient is diagnosed with pleomorphic liposarcoma, which corresponds to less than 15% of liposarcomas. This subtype is considered a high-grade aggressive tumor, responsible for high rates of local recurrence and systemic metastasis, with a poor prognosis, being quite resistant to chemotherapy and its treatment based on complete resection. Although mesodermal tumors are radioresistant, liposarcoma is the most sensitive of them.
In our case, as it is a retroperitoneal liposarcoma, the aggressive surgical approach was the therapeutic option of choice. As for the therapeutic follow-up, in cases such as the one described above, further studies are needed regarding the effectiveness of adjuvant methods such as radio and chemotherapy for a better disease-free prognosis.
Pleomorphic liposarcoma; Retroperitoneum; Surgery
Tumores De Partes Moles e Retroperitônio
JAMILE BARAKAT AWADA, GUILHERME MENDES GAVA, RAFAEL LEITE NUNES, BERNARD COSTA FAVACHO, NATHALIE ABDALLAH ZAHALAN, RAFAELLA FIQUENE DE BRITO FILGUEIRA, BRUNA REGINA OLIVEIRA MARTINS, RAFAELA MORENO