原发性腹膜后软组织肉瘤的再手术治疗

软组织肉瘤（soft tissue sarcoma，STS）是源于间叶组织和与生长在外胚层神经组织的恶性肿瘤，包括除淋巴造血组织外的非上皮组织，即纤维、脂肪、肌肉、间皮以及分布于这些组织中的血管、淋巴管和外周神经，多位于四肢、躯干和腹膜后等部位。原发性腹膜后软组织肉瘤（primary retroperitoneal sarcoma，PRS），指发生在腹膜后间隙的肿瘤，并不包括原在腹膜后间隙的各器官的肿瘤及转移性肿瘤，占全身肿瘤的0．07％-0．20％，占全身软组织肿瘤的10％-20％，男女性的发病率基本一致。由于肿瘤本身的生物学特性及腹膜后潜在间隙大的解剖特点，组织构成复杂，腹膜后间隙组织疏松及腹腔的高度适应能力，PRS病人在早期多无自觉症状，近70％病人以腹部包块为首发症状就诊，等到发现时肿瘤直径多已〉10cm，或已经侵及邻近脏器和主要血管，此时，肿瘤通常已生长5—6个月，甚至几年。到目前为止，辅助化疗及放射治疗对于PRS的作用并不明确，其治疗主要为手术，但要完全治愈并非容易。此外，它尚具有复发和转移的特点，再手术治疗困难更大。文献报道，5年、10年局部复发率分别达到72％和91％。本文结合笔者的临床经验及有关文献，将对腹膜后肉瘤的术后复发和转移两个棘手问题进行讨论，以探讨如何合理选择再手术治疗，提高手术切除率，延长存活期，改善病人生活质量。     

Giant retroperitoneal liposarcoma. Report of 5 cases

BACKGROUND: Liposarcoma is the most frequent histopathological variety of the retroperitoneum, surgery is the gold standard for treatment. CLINICAL SERIES: We report, retrospectively over 7 years (2000-2006), 5 cases (four men and one woman, the mean age was 48 years) of giant retroperitoneal liposarcomas and study their clinical characteristics intra operatively findings and course evolution. None of our patients had a percutaneous biopsy of his tumour. Surgery was indicated to all patients. Resection was performed in 4 cases (we performed a bloc resection in three cases and a simple tumour resection in one case), and in one case, abstention was decided. None of patients had an adjuvant therapy Three of the patients still alive after the follow up of 2, 3 and 4 years. CONCLUSION: Retroperitoneal liposarcomas represent a unique situation and require a more aggressive surgical approach including multiple resections for recurrences. Based on the ability of the patient to tolerate the procedure, surgery is suggested to evaluate resectability of the tumor. We must take into consideration whether prolonged survival will be attained and tumor removal will result in palliation of symptoms.     

Giant retroperitoneal liposarcoma

Liposarcoma is a malignant tumor that has an embryologic origin from mesodermal tissue depending on fatty tissue. Although liposarcoma is only 0.1% of all human neoplasms, it is the most common histology subtype of retroperitoneal soft tissue sarcomas. This tumor grows slowly. Diffuse abdominal pain is its most frequent symptom and abdominal mass is the most common sign. Aggressive surgical treatment is basic to get a complete resection and a local disease control. This objective is difficult because of the large tumor size it gets in the retroperitoneal location and the multiorgan involvement that require the resection of a high percentage of contiguous organs. We report a case of a giant retroperitoneal liposarcoma presenting like continuous left hemiabdominal pain because of the visceral compression. The right kidney was involved and suffering from renal vessel enlargement without renal function. There is a high probability of microscopic residual disease and a good follow-up of the patients is necessary as well as an adjuvant radiation therapy in some cases.     

Calcified retroperitoneal liposarcoma

Case report of a retroperitoneal liposarcoma pleomorfico with calcification in diagnosed in our hospital. We comment on its clinical characteristics, diagnostic methods and treatment. We likewise comment the possible differential diagnoses.     

Giant retroperitoneal liposarcoma

Liposarcomas are one of the most common soft tissue sarcomas of adulthood. Liposarcomas are remarkable because of their frequently large size. We report a case with an extremely large dedifferentiated liposarcoma that weighed 18 kg. Although it was capsulated and could be excised en bloc, the patient suffered a relapse 9 months later and died 1 year after the operation.     

Giant retroperitoneal liposarcoma

Liposarcoma is a malignancy of fat cells and is the most frequent soft tissue sarcoma localized in the retroperitoneum. It can reach substantial proportions. It is a slow-growing tumor, and the most frequent symptom is nonspecific abdominal pain and diffuse abdominal enlargement. Treatment is radical surgery and complete resection is essential for local control of the disease. We present a case of giant right retroperitoneal liposarcoma, which was well-encapsulated and could be completely excised. The patient is currently in follow up and at 2 years is disease-free.     

Giant dedifferentiated retroperitoneal liposarcoma

A 72 years old lady presented with a gradually increasing abdominal mass for the last 25 years, with more rapid increase in the last 05 years. Examination revealed a large mass spanning the whole abdomen. CAT scan revealed a huge retroperitoneal tumour, with tortuous ureters passing through the tumour and three tiny nodules in the right lung field. A subtotal piecemeal excision of the tumour was done after stenting the ureters with single J stents. The excised tumour mass weighed 46 Kg. The patient had a prolonged ileus that recovered in 5 days. Histopathology revealed the mass to be dedifferentiated liposarcoma. The patient and the family were satisfied with the short-term outcome of the surgery. She was ambulating with little support and was able to manage her daily affairs.     

A case of retroperitoneal liposarcoma

A case of retroperitoneal liposarcoma is reported. A 42-year-old woman was admitted to our hospital with the complaint of a palpable mass in her left abdomen. Intravenous pyelography, barium enema and an ultrasonogram revealed a huge left abdominal tumor. At operation, a huge yellow-brownish tumor found in the retroperitoneal space, was completely removed. The tumor was 32 x 24 x 12 cm and weighed 4,075 g. Histologically, it was a myxoid liposarcoma. Three courses of adjuvant chemotherapy (cis-platin) were administered. The postoperative course was uneventful and the patient has been free of disease for 16 months.     

Primary retroperitoneal liposarcoma: A case report and review of the literature

We report a case of a 43 years old woman with a retroperitoneal liposarcoma located in the left iliac fossa. The condition was discovered because of the association of left flank pain, abdominal distention and persistent urinary infection with symptoms of vesical irritation. The diagnosis was suggested by intravenous pyelography (IVP), abdominal and pelvic ultrasonography (USG) and computed tomography (CT). Treatment was exclusively surgical. During a six-month follow-up, no recurrence was observed.     

A case of retroperitoneal liposarcoma

A 77 year-old woman presented with the chief complaint of a mass in the right upper quadrant. The examination on admission including IVP, echography, Ga scintigraphy, barium enema, CT scan, and angiography revealed that the right kidney and ascending colon were displaced by the mass. Under the diagnosis of retroperitoneal tumor, operation was carried out. Most of the mass was resected with the right kidney. The pathological diagnosis of the resected tumor revealed well differentiated liposarcoma. Convalescence was uneventful and the patient has been well and free from disease for 14 months. Based on our experience and the review of the pertinent literature in English and Japanese, we emphasize the importance of definite surgery and close follow up, as liposarcoma is frequently recurrent.     

原发性腹膜后脂肪肉瘤的临床特点探究

探讨原发性腹膜后脂肪肉瘤的临床特点,为临床诊治提供参考。选取2014年1月—2018年12月于我院就诊的原发性腹膜后脂肪肉瘤患者52例,收集整理临床资料,回顾性分析临床特点。52例患者首次手术肉眼肿瘤完整切除41例(78.85%),部分切除5例(9.61%),术中单纯活检6例(11.54%)。首次手术联合脏器切除34例(65.38%),联合多脏器切除23例(44.23%)。多脏器切除主要集中左侧后腹膜脏器,切除肿瘤最大长径6.5~39.8 cm,患者术中出血量在420~7000 mL。41例肉眼肿瘤完整切除患者中,10例术后病理结果显示切缘阳性。52例患者中分化型脂肪肉瘤为主,占比59.62%(31/52);病理分级主要是1级,占比57.69%(30/52);肿瘤直径<20 cm者33例,占比63.46%(33/52);肿瘤直径≥20 cm者19例,占比36.54%(19/52)。对所有患者进行随访,随访时间5~107个月,中位随访时间为56个月。术后复发时间3~95个月,中位复发时间为49个月;术后1年、2年分别复发8例、32例,复发率分别为15.38%、61.54%。复发患者大部分为男性、肿瘤直径<20 cm。术后发生转移5例(9.62%),分别为2例肝转移、3例肺转移。结果显示,肿瘤复发时间与患者性别、肿瘤分级、肿瘤类型无关(P>0.05),与患者肿瘤最大直径有关(P<0.05)。原发性腹膜后脂肪肉瘤主要采用完整手术切除治疗,术后易复发,复发时间与肿瘤最大直径有关。     

原发性腹膜后脂肪肉瘤的外科治疗

目的探讨原发性腹膜后脂肪肉瘤（PRPI_S）的外科治疗方法。方法回顾性分析1996年1月至2008年3月经手术治疗17例PRPLS患者的治疗效果。结果17例患者共进行手术30例次,其中13例次为首次手术,17例次为再次手术。肿瘤完整切除24例次（80．0％）,其中联合脏器切除12例次（40．0％）,肿瘤部分切除5例次（16．7％）,探查活检1例次（3．3％）。结论原发性腹膜后脂肪肉瘤无论是首发还是复发,手术切除都是标准的治疗手段,晚期肿瘤姑息切除亦能减轻邻近压迫症状,改善患者生存质量,延长生存时间。     

Hand-assisted laparoscopic removal of retroperitoneal liposarcoma

Liposarcoma is known to be the most common soft-tissue sarcoma, and the treatment of retroperitoneal disease is surgical excision. We present a case of complete surgical removal with concomitant nephrectomy using a hand-assisted laparoscopic approach and provide a review of the published studies.     

A case of giant retroperitoneal liposarcoma

A 44-year-old female patient presented to us with fever and increased abdominal girth. A CT scan showed a very large retroperitoneal mass displacing the right kidney. At operation three enormous retroperitoneal tumours displacing the ascending colon and the right kidney and compressing the inferior vena cava were removed. Histopathological examination revealed a myxoid retroperitoneal liposarcoma.     

Primary mediastinal liposarcoma: clinicopathologic analysis of 24 cases

Liposarcomas are rare in the mediastinum. Here, we report the clinicopathologic features of 24 cases of mediastinal liposarcoma. Patients included 13 males and 11 females, with an age range of 3 to 72 years (median 58). Nine tumors were located in the anterior mediastinum, 7 in the posterior mediastinum, 1 in the superior mediastinum, and the precise location was not specified in 7 cases. Of the anterior mediastinal tumors, 3 appeared to arise from the thymus. Tumors were well-circumscribed, multinodular masses and ranged in size from 2.2 to 61 cm in greatest dimension (median 16 cm). Histologic examination revealed that most of the cases were well-differentiated liposarcomas (10), followed by dedifferentiated liposarcomas (8), pleomorphic liposarcomas (4), and myxoid liposarcomas (2). Of the pleomorphic liposarcomas, 2 had areas that resembled myxofibrosarcoma with atypical hyperchromatic spindle cells in a myxoid stroma, but the focal presence of lipoblasts confirmed the diagnoses. Clinical follow-up was obtained in 15 cases (range 1 to 59 mo; median 26). Complete surgical excision was attempted in 13 patients; however, local recurrence was common (5 cases), including 1 patient whose tumor recurred twice. Eleven patients were alive with no evidence of disease at last follow-up (5 well-differentiated, 5 dedifferentiated, and 1 myxoid liposarcoma). Two patients developed distant metastases (dedifferentiated and pleomorphic liposarcoma). One patient was alive with disease (pleomorphic liposarcoma), and 2 died of disease (pleomorphic and dedifferentiated liposarcoma). Overall, mediastinal liposarcomas appear to be similar, in clinicopathologic terms, to liposarcomas arising in the retroperitoneum.