Well-Differentiated Liposarcoma of the Retroperitoneum with Dedifferentiation and Multiple Recurrences: Case Report

• Autor(a) principal: Gonçalves, Ivna Silva
• Data de Publicação: 2023
• Outros Autores: Macêdo, Davi Teixeira de, Saldanha , Iasmin Maria Rodrigues, Silva , Lívia Fernandes e, Nunes , Paulo Henrique Silva, Gerson, Gunter, Costa , Marcelo Leite Vieira, Araújo Filho , Irapuan Teles de
• Tipo de documento: Artigo
• Idioma: por; eng; spa
• Título da fonte: Revista Brasileira de Cancerologia (Online)
• Texto Completo: https://rbc.inca.gov.br/index.php/revista/article/view/3626
• topic: lipossarcoma; neoplasias retroperitoneais; recidiva; desdiferenciação celular; oncologia cirúrgica; liposarcoma; neoplasias retroperitoneales; recurrencia; desdiferenciación celular; oncología quirúrgica; liposarcoma; retroperitoneal neoplasms; recurrence; cell dedifferentiation; surgical oncology

Introduction: Retroperitoneal liposarcomas are rare mesenchymal neoplasms, with well-differentiated and dedifferentiated liposarcomas being most common. The well differentiated subtype can undergo dedifferentiation to higher grade tumors. These are difficult neoplasms to treat surgically because they have high rates of local recurrence, some subtypes can metastasize, and are poorly responsive to radiotherapy and chemotherapy. Case report: Female patient, 45 years old, presented abdominal pain and palpable abdominal mass in 2017. She underwent resection of well-differentiated liposarcoma of the retroperitoneum, without intercurrences. In 2020, she manifested abdominal pain and weight loss. Tomography showed multiple voluminous abdominal masses, with biopsy suggestive of dedifferentiated liposarcoma. The patient was submitted to neoadjuvant radiotherapy, followed by surgical resection of the masses and right ileocolectomy. In 2022, she presented symptoms suggestive of intestinal obstruction, and underwent laparotomy that revealed intense blockage of intestinal loops, duodenal fistula, retroperitoneal tumor, and fecal peritonitis. Retroperitoneal neoplasm resection, ileostomy and fistula closure were performed. Histopathology showed relapsed dedifferentiated liposarcoma. The patient evolved with operative and infectious complications, requiring intensive care and antibiotic therapy. After clinical improvement, the patient was discharged with enteral diet and continues under outpatient follow-up. Conclusion: Retroperitoneal liposarcoma may undergo multifocal dedifferentiation and recurrence, requiring several surgical approaches, increasing morbidity and the risk of complications. Wide margin surgery remains the main therapeutic modality.