We report a case of a rapidly progressing giant retroperitoneal liposarcoma weighing 22 kg in a 41-year-old Japanese man, successfully treated with surgical excision. To our knowledge, this is the largest liposarcoma in the Japanese population reported in the literature

Hakamada, Kenichi

Hashimoto, Yasuhiro

Hatakeyama, Shingo

Kamimura, Noritaka

Koie, Takuya

Ohyama, Chikara

Tachiwada, Tokushi

Yanagisawa, Takeshi

Yoneyama, Takahiro

English

PubMed

Yasuhiro Hashimoto

Shingo Hatakeyama

Tokushi Tachiwada

Takahiro Yoneyama

Takuya Koie

Noritaka Kamimura

Takeshi Yanagisawa

Kenichi Hakamada

Chikara Ohyama

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Advances in Urology

Surgical Treatment of a Giant Liposarcoma in a Japanese Man

We report a case of a rapidly progressing giant retroperitoneal liposarcoma weighing 22 kg in a 41-year-old Japanese man, successfully treated with surgical excision. To our knowledge, this is the largest liposarcoma in the Japanese population reported in the literature.</jats:p

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Hindawi Publishing CorporationAdvances in UrologyVolume 2010, Article ID 943073, 3 pagesdoi:10.1155/2010/943073Case ReportSurgical Treatment of a Giant Liposarcoma in a Japanese ManYasuhiro Hashimoto,1 Shingo Hatakeyama,1 Tokushi Tachiwada,1 Takahiro Yoneyama,1Takuya Koie,1 Noritaka Kamimura,1 Takeshi Yanagisawa,1, 2 Kenichi Hakamada,1, 3and Chikara Ohyama11 Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan2 Department of Urology, Aomori Rosai Hospital, Hachinohe 031-8551, Japan3 Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, JapanCorrespondence should be addressed to Yasuhiro Hashimoto, bikkuri@opal.plala.or.jpReceived 19 August 2010; Revised 23 October 2010; Accepted 13 November 2010Academic Editor: Peter E. ClarkCopyright © 2010 Yasuhiro Hashimoto et al. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.We report a case of a rapidly progressing giant retroperitoneal liposarcoma weighing 22 kg in a 41-year-old Japanese man,successfully treated with surgical excision. To our knowledge, this is the largest liposarcoma in the Japanese population reportedin the literature.1. IntroductionLiposarcoma is a common soft tissue sarcoma which occursin adults [1, 2]. Its common sites of occurrence arethe extremities, retroperitoneum, and inguinal region [3].Although liposarcomas can often grow into large tumors,resected tumors weighing over 20 kg are extremely rare andconsidered to be “giant liposarcomas.” Here, we report ourexperience of a giant retroperitoneal liposarcoma, presum-ably the largest reported from Japan; it weighed 22 kg andcaused abdominal swelling, marked leg edema, and coughdue to the pressure it exerted on the patient’s diaphragm.2. Case PresentationA 41-year-old Japanese man became aware of abdominalswelling in December 2008 but did not seek a medicalopinion until he developed marked leg edema, a 30 kgweight gain, and cough. He was hospitalized the same dayafter a retroperitoneal tumor was detected by computedtomography (CT). After hospitalization, the patient wasdiagnosed with a liposarcoma by CT-guided needle biopsy.The patient was emergently transferred to our hospital due toworsening respiratory status. On admission his body surfacearea was 2.18m2. A CT scan detected a 43 × 37 × 31 cmtumor in the right retroperitoneum, with the right kidneysignificantly displaced to the left and anterior side (Figure 1).Whole-body CT scan detected no metastasis. His conditionwas diagnosed as respiratory failure due to elevation of thediaphragm as a consequence of the rapid growth of thetumor (Figure 2).We concluded that surgical resection was the onlyoption for saving the patient’s life, so we performed atumorectomy 3 weeks later through a midline incision. Theoperation took 3 hours and 20 minutes, and the estimatedblood loss was 3990mL requiring 800mL blood transfusion.During surgery, the tumor and right kidney were completelyresected.Pathological examination showed that the resectedmass weighed 22 kg and was 45 × 40 × 30 cm in size(Figure 3). Grossly, the tumor was well encapsulated andtransverse sectioning revealed a solid multinodular tumormass. Histopathologic analysis demonstrated many spindlecells with high-grade atypia; some of which were lipoblastson a myxoid background; there were no split signals onFISH analysis using CHOP DNA probes, thus leading tothe diagnosis of dediﬀerentiated liposarcoma (Figure 4).Microscopically, no tumor cells were identified in the rightkidney and this was an R0 resection. He declined adjuvanttherapy. The patient was discharged from our hospital after2 Advances in UrologyFigure 1: Computerized tomography detected a 43 × 37 × 31-cm tumor in the right retroperitoneum, and the right kidney wasdeflected greatly to the left ventral side (white arrow).Figure 2: Chest X-ray showed that elevation of the diaphragm dueto rapid growth of retroperitoneal tumor and cardiac enlargement.18 days. His body surface area at discharge was 1.66m2.A CT scan performed 12 months after surgery detected norecurrence.3. DiscussionLiposarcoma is the most common soft tissue sarcoma andaccounts for 10–20% of all cases. It commonly occursbetween 40–60 years of age and has a 1:1 ratio betweengenders [1, 2]. Liposarcoma occurs most commonly in theextremities (52%), retroperitoneum (19%), and inguinalregion (12%) [3]. Although liposarcomas sometimes weighas much as 10 kg or more, those exceeding 20 kg areextremely rare. Some published reports have noted tumorsweighing 103.6 lb (46.6 kg) [4], 42 kg [5], and 18 kg [6].According to previous reports, the heaviest tumor to date inFigure 3: Intra-operative findings. The retroperitoneal tumorweighing 22 kg was extirpated.the Japanese population was 18 kg [7]. Thus, we believe thatwe have resected the largest retroperitoneal liposarcoma inJapan.According to the WHO classification, liposarcomas canbe classified into five histologic types: well diﬀerentiated,myxoid, round cell, pleomorphic, and dediﬀerentiated [8].The myxoid and round-cell types are considered subtypesbecause of their common chromosomal translocation [9–12].Dalal argued, on the basis of a study conducted at a singlefacility, that the most common forms of liposarcoma are welldiﬀerentiated (46%), dediﬀerentiated (18%), myxoid (18%),round cell (10%), and pleomorphic (8%).A chimera gene, TLS-CHOP, which is only found inmyxoid-type sarcomas, was discovered in a myxoid-typeliposarcoma. This gene is presumed to be responsible fortumor growth [9–12]. It can often be diﬃcult to distinguishbetween myxoid-type and dediﬀerentiated liposarcomas.Nevertheless, we observed no split signals on FISH analysisusing CHOP DNA probes.Surgical resection is still the principal treatment, andcombined resection of involved organs is necessary for anR0 resection in many cases. A previous report stated thatcombined resection of adjacent organs is required in 75% ofretroperitoneal tumors treated by tumorectomy [13].Multimodality therapies such as chemotherapy withifosfamide, anthracycline, and doxorubicin, as well asthe combination of intraoperative and intensity-modulatedradiotherapy, are also eﬀective [14]. Recently, Ecteinascidin(ET743), an alkaloid derived from the Caribbean sea squirt(Ecteinascidia turbinate), has shown definite activity in softtissue sarcoma in clinical trials [14]. However, high-gradeliposarcoma may benefit from radiotherapy or chemother-apy with a reduction in local recurrence, but with no benefitin overall survival [14]. Histologic grading is important inliposarcoma, with disease-specific survival rates after 5 yearsof 93% for well-diﬀerentiated, 74–92% for myxoid/round-cell, 59% for pleomorphic, and 44% for dediﬀerentiatedforms [15]. 83% of patients with dediﬀerentiated liposar-comas develop local recurrence, and 30% develop distantAdvances in Urology 3(a)(b)Figure 4: Histopathological findings of the tumor diagnosed ded-iﬀerentiated liposarcoma (HE stain, original magnification x200).(a) Most of the tumor cells consisted of spindle cells with high-grade atypia. (b) Some of which were identified to be lipoblasts in amyxoid background.metastasis [16]. Here, we report the largest retroperitonealliposarcoma in Japan. Judging from evidence in previouslypublished reports, we expect a poor prognosis for the patientand will be closely following him for recurrence.References[1] T. M. 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Singer, “Diagnosisand management of lipomatous tumors,” Journal of SurgicalOncology, vol. 97, no. 4, pp. 298–313, 2008.Submit your manuscripts athttp://www.hindawi.comStem CellsInternationalHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014MEDIATORSINFLAMMATIONofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Behavioural NeurologyEndocrinologyInternational Journal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Disease MarkersHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014BioMed Research InternationalOncologyJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Oxidative Medicine and Cellular LongevityHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014PPAR ResearchThe Scientific World JournalHindawi Publishing Corporation http://www.hindawi.com Volume 2014Immunology ResearchHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Journal ofObesityJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014 Computational and  Mathematical Methods in MedicineOphthalmologyJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Diabetes ResearchJournal ofHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Research and TreatmentAIDSHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Gastroenterology Research and PracticeHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014Parkinson’s DiseaseEvidence-Based Complementary and Alternative MedicineVolume 2014Hindawi Publishing Corporationhttp://www.hindawi.com

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Surgical Treatment of a Giant Liposarcoma in a Japanese Man

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