A report is made on a case of liposarcoma of stomach in a 42 year old man. This is the first case of liposarcoma of stomach reported in Japan. The patient has remained asymptomatic for five years after operation.</p

Kawada, Koichi

Kawahara, Toru

Kokumai, Yoshiaki

Orita, Kunzo

Takagi, Shigeru

English

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Liposarcoma of stomach: report of a case

Okayama University Scientific Achievement Repository

Acta Medica OkayamaVolume 22, Issue 3 1968 Article 5JUNE 1968Liposarcoma of stomach: report of a caseKunzo Orita∗ Yoshiaki Kokumai† Koichi Kawada‡Toru Kawahara∗∗ Shigeru Takagi††∗Okayama University,†Okayama University,‡Nariwa Hospital,∗∗Nariwa Hospital,††Nariwa Hospital,Copyright c©1999 OKAYAMA UNIVERSITY MEDICAL SCHOOL. All rights reserved.Liposarcoma of stomach: report of a case∗Kunzo Orita, Yoshiaki Kokumai, Koichi Kawada, Toru Kawahara, and ShigeruTakagiAbstractA report is made on a case of liposarcoma of stomach in a 42 year old man. This is the firstcase of liposarcoma of stomach reported in Japan. The patient has remained asymptomatic for fiveyears after operation.∗PMID: 4239074 [PubMed - indexed for MEDLINE] Copyright c©OKAYAMA UNIVERSITYMEDICAL SCHOOLActa Med. Okayama 22, 167-173 (968)LIPOSARCOMA OF STOMACH: REPORT OF A CASEKunzo ORITA, Yoshiaki KOKUMAI, Koichi KAWADA,*Toru KAWAHARA,* and Shigeru TAKAGI*Department of Surgery, Okayama University Medical School, Okayama (Director; Prof. S. Tanaka)and *Nariwa Hospital, Nariwa-cho, Okayama Prefecture, JapanReceived for publication, April 28, 1968The voluminous literature on sarcomas of stomach indicates that themajority of them are leiomyosarcomas and malignant lymphomas, as forinstance, according to MARSHALL'S classification (1). Theoretically, sarcomaof the stomach may arise from any of the mesenchymal tissue componentsof the organ, but malignant sarcomatous tumors arising from fat tissueare extremely rare. The study reported is a case of primary liposarcomaof stomach which, to our best knowledge, is the first in Japan.CASE REPORTA Japanese farmer aged 42 was admitted to Nariwa Hospital inJanuary, 1962, because of epigastric pain, full sensation of the abdomenand diarrhea. He had been in good health untill two years before admis-sion when be began to have preprandial epigastric pain and diarrhea of 5to 6 times daily. Since onset of his distress, he had returned occasionallyto the out-patient clinic. At first, X-ray examination of gastrointestinalseries had revealed no abnormality except for slight gastroptosis and gast-ritis. Conventional dietary and medicinal therapy were given, but to noavail. At last he was advised to be hospitalized.Family history and past history were uneventful. Physical examina-tion on admission revealed a well developed, moderately nourished, alertman in no acute distress. Temperature was 36.5 cC., pulse rate 82 perminute, respiratory rate 18 per minute and blood pressure 110/80 mmHg.The skin was warm and dry. The palpebral conjunctive was ratheranemic. The tongue was slightly coated with white fur. The head andneck were negative. Lymphnodal swelling was not detected anywhere.The lungs were physically clear and the heart was not enlarged. Heartsounds were normal and no murmurs were audible. The abdomen wasflat and soft, liver and spleen were not palpable. Singht tenderness ondeep palpation in the epigastric region was detected, but there were no1671Orita et al.: Liposarcoma of stomach: report of a caseProduced by The Berkeley Electronic Press, 1968168 K.ORITA, Y. KOKUMAI, K. KAWADA, T. KAWAHARA & S. TAKAGImasses. Rectal examination was negative. There was no pitting edemaof the lower extremities. Neurological examination was not remarkable.Laboratory findings on admission consisted of the following: Examina.tion of the blood revealed 3.06 million red cells, 73 per cent hemoglobin,6.000 white blood cells with a normal differential, 7.8 gjdl serum protein.Blood serological test for syphilis was negative. The stools were soft andlight brown in color, negative for occult blood and parasitic ova. Urinaly-sis was negative. 'Liver function tests were within normal limits. Gastricanalysis revealed achlorhydria. ECG was of normal tracing.X-ray examination of the stomach revealed slight ptosis and a dime-sized well.defined filling defect in the middle portion of the body nearthe greater curvature (Fig. 1). Abruption of the mucosal folds at the siteof filling defect was noticed, but no malignant mucosal pattern was seen(Fig. 2). Gastrocamera disclosed a semi-spherical protruded tumor on theposterior wall of the middle portion of the stomach. The tumor wascovered with smooth gastric mucosa and there were no erosions or ulcers.The mucosal pattern was atrophic. Clinical diagnosis of gastric polypwith chronic gastritis was made on these findings.The operation was carried out on February 2, 1962. Under generalanesthesia the abdomen was entered through an upper midline incision.On entering the peritoneal cavity no free fluid was encountered. A cherry-sized spherical tumor which had smooth surface and elastic consistency waspalpated in the posterior wall of the body of the stomach That was coin-cident with the roentgenologically detected site. The gastric wall wasentirely thickened and rather edematous. There was no lymphnodalswelling around the stomach. In consideration of long.lasting chronicgastritis, two-thirds of the stomach including the tumor were resected anda gastrojejunostomia retrocolica oralis inferior was performed.When the excised stomach was opened, the tumor was in submucosallayer along the greater curvature at the distance of 15 cm from the pyloriccanaL It was spherical in shape, measuring I. 2 xI. 0 xI. 0cm, and elasticin consistency. The tumor was firmly fixed to the muscular layers, butthere was no connection between the tumor and the mucosa (Fig. 3). Theincised surface of the tumor was homogenous and light yellowish in colorFig. 1 X-ray picture of the stomach. A round filling defect near the greater curvature ofthe body can be seen.Fig. 2 X-ray picture of the stomach. Note the abruption of the mucosal folds at the siteof filling defect showing no malignancy.Fig. 3 Gross appearance of the resected stomach. The protruded spherical turmor is coveredwith normal gastric mucosa.Fig. 4 Incised surface of the tumor. It is similar to adipose tissue.2Acta Medica Okayama, Vol. 22 [1968], Iss. 3, Art. 5http://escholarship.lib.okayama-u.ac.jp/amo/vol22/iss3/5Liposarcoma of Stomach 169IIIi.lj. iii1111ll11~Wj III ilJiJ:5 , ....•..... 73Orita et al.: Liposarcoma of stomach: report of a caseProduced by The Berkeley Electronic Press, 1968170 K.ORITA, Y. KOKUMAI, K. KAWADA, T. KAWAHARA & S. TAKAGI4Acta Medica Okayama, Vol. 22 [1968], Iss. 3, Art. 5http://escholarship.lib.okayama-u.ac.jp/amo/vol22/iss3/5Liposarcoma of Stomach 171like adipose tissue, and several bleeding spots were seen in the center of it(Fig. 4).Sections revealed liposarcoma grown between the muscular layers andthe mucosa of the stomach. It was, for the most part, composed ofrelatively larger cells containing vacuoles in their cytoplasm and also cellshaving large nuclei were partly visible. Among them there were moderateinfiltration of lymphocytes and proliferation of fibrocytes.Hematoxylin eosin staining revealed marked proliferation of lipoblastsin varying degrees of differentiation but the interstitial tissue was scarcelyseen (Eig. 5). Histological picture showed many undifferentiated andanaplastic lipoblasts of various size (Fig. 6). Sudan III staining renderedneutral fat in the interstitial tissue stained red and lipoid in the cytoplasmlight orange (Fig. 7). PAS staining was negative for mucoid. The mucousmembrane of the stomach was slightly edematous and revealed moderateinfiltration of plasma cells, lymphocytes and polymorphonuclear leukocytes.The postoperative course was uneventful. The patient was dischargedmuch improved one month after operation and, has since been followedby occasional check-ups. Five years has passed since, and now he isasymptomatic, having no findings indicative of any growths in otherorgans or tissues. Therefore this case is assumed to be a primary liposar-coma of the stomach.COMMENTIt is a well known fact that the tumors arising from fat tissue (exactlythe tumors of fat-forming cells) of the stomach are rare. Up to date, only8 cases of lipoma of stomach have been reported in Japan by MIZUNO(2),HIKIDA(3), NOMURA(4), NISHIMURA(5), AKAZAWA (6), HAsHIMoTo(7),AKIYAMA (8), and DEMPO (9). Truly rare is liposarcoma, and no case of lipo-sarcoma of stomach has ever been reported in Japan. Of the 215 instancesof sarcomas of stomach reported in J apan till 1961, 78 are reticulosarcomas,50 are leiomyosarcomas, 28 are round cell sarcomas, 12 are lymphosarcomasand spindle cell sarcomas respectively, 11 are polymorphous cell sarcomas,9 are fibrosarcomas, 3 are neurofibrosarcomas, 2 are Hodgkin's disease,one is myxosarcoma, and 9 are unknown. Outside Japan, there are doubt-Fig. 5 Photomicrograph of the section shows marked proliferation of lipoblasts in varyingdegree of differentiation. Hematoxylin eosin staining. X80.Fig. 6 Histologic picture shows many undifferentiated anaplastic lipoblasts of various size.Hematoxylin eosin staining. X400.Fig. 7 Photomicrograph of Sudan III staining renders neutral fat in the matrix stained redand lipoid in the cytoplasm light orange. X400.5Orita et al.: Liposarcoma of stomach: report of a caseProduced by The Berkeley Electronic Press, 1968172 K.ORITA, Y. KOKUMAI, K. KAWADA, T. KAWAHARA & S. TAKAGIfull cases of liposarcoma of stomach reported by ABRAMS and TURBER-VILLE (l 0) in 1941.Even today, the histogenesis of liposarcoma is in doubt. It seems saferto regard the lipoblast as an ordinarily specialized fat forming mesenchymalcell which on occasion can produce a very wide variety of different andcomplex tissues.Undoubtedly some liposarcomas develop from pre-existing lipomas.This is stressed by SCHILLER(11 ), and KATZ(12), and reported by STOUTe13).STOUT says, however, that it is difficult to tell how often it occurs becausemany of the tumors are composed of an intermingling of fully developedfat cells with neoplastic lipoblasts and one has no means of knowingwhether or not this state of affairs existed from onset. It seems probablethat a large majority of malignant lipoblastic tumors are malignant fromtheir beginning. In our case we have no evidence as to the matter ofsarcomatous transformation of lipoma. It seems most likely to be malig-nant from the onset.In general, the majority of liposarcomas develop in the later years oflife, the mean age being 53 years and both sexes are affected equally, but,as a matter of fact, about the liposarcoma of stomach the incidence is notclear because of its rarity. Gradual accumulation of these cases will makeits incidence clearer.The diagnosis is difficult and indeed, sometimes may be made onlywith difficulty microscopically. So far as our case is concerned, theclinical impression is a polyp of stomach.Treatment of liposarcoma is primarily surgical. On liposarcoma ofstomach it goes without saying that surgery is the first choice of the treat·ment and, whenever such is possible, a wide excision. It is said that someliposarcomas are definitely radiosensitive, but we cannot place our hopeon radiation therapy in case of liposarcoma of stomach.Prognosis is questionable, but concerning our case it has passed fiveyears after operation without any signs of recurrence or metastasis.SUMMARYA report is made on a case of liposarcoma of stomach in a 42 year oldman. This is the first case of liposarcoma of stomach reported in Japan.The patient has remained asymptomatic for five years after operation.ACKNOWLEDGEMENTWe are indebted to Prof. Emeritus Y. HAMAZAKI and Dr. Y. MURAKAMI of the Depart-ment of Pathology, Okayama University Medical School for the guidance in Pathology.6Acta Medica Okayama, Vol. 22 [1968], Iss. 3, Art. 5http://escholarship.lib.okayama-u.ac.jp/amo/vol22/iss3/5Liposarcoma of StomachREFERENCES1731. MARSHALL, S. F.: in Text Book oj Surgery (CHRISTOPER), 621 pp. (Davies, L. ed'), W. B.SUNDERS Co., Philadelphia, 19562. MIZUNO, N., et al.: Tohoku Igaku Zasshi, 50, 221, 1954 (in japanese)3. HIKIDA, T., and NISHIKAWA, Y.: Clinical Surgery, 14, 153, 1959 (in japanese)4. NOMURA, S., and SANO, E.: Shinsyu Igaku Zasski, 7, 419, 1958 (in japanese)5. NISHIMURA, T., et al.: Clinical Surgery, 14, 313, 1959 (in japanese)6. AKAZAWA, K.: Chiba Igaku Zasshi, 35, 506, 1959 (in japanese)7. HASHIMOTO, T., et al.: Nihon Syokakibyo Gakkai Zasshi, 58, 301, 1961 (in japanese)8. AKIYAMA, Y., et al.: Rinsho Hoshasen, 5, 636, 1960 (in japanese)9. DIMPO, Y., et al.: Surgical Diagnosis & Treatment, 3, 865, 1961 (in japanese)10. ABRAMS, M.J., and TURBERVILLE, J. S.: Liposarcoma of stomach. South Surgeon, 10, 891,194111. SCHILLER, H.: Lipomata in sarcomatous transformation. Surg., Gynec. and obst., 27, 218,191812. KATZ, F.: Uber retroperitonea1e Lipome. Beitr. z. klin. Chir., 142, 864, 192813. STOUT, A. P.: Liposarcoma-the malignant tumor of lipob1asts. Ann. Surg., 119, 86, 19447Orita et al.: Liposarcoma of stomach: report of a caseProduced by The Berkeley Electronic Press, 1968

Liposarcoma of stomach: report of a case

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