Liposarcom retroperitoneal gigant

Abstract

Introducere: Liposarcomul (LS) este o tumoare malignă rară care provine din țesutul adipos. Poate apărea oriunde este prezent țesut adipos. LS retroperitoneal reprezintă 12% până la 40% din totalul liposarcoamelor, cu o rată de incidență estimată 0,5 la 100.000 de locuitori. Materiale și metode: Bărbat de 45 ani, internat cu acuze la marirea in volum a abdomenului, pierdere in greutate pe parcursul ultimelor 6 luni. Tomografia computerizata a abdomenului a vizualizat formatiune tumorala giganta multinodulara, cu structura preponderent adipoasa cu component solid, de dimensiuni 365x235x412 mm, cu deplasarea rinichiului sting in directia mediala si a anselor intestinale in flancul drept. Hidronefroza pe dreapta gr.I, pe stinga gr.II. Rezultate: s-a practicat laparotomie mediana cu decelarea unei formatiuni retroperitoneale gigante de culoare alb-grasoasa, multinodulara, ce deplaseaza colonul descendent anterior, rinichiul sting cu vasele renale si ureterul – spre dreapta, polul superior al tumorii depistîndu-se la nivelul diafragmei, iar polul inferior - în bazinul mic. A fost mobilizata tumoarea de la intestinul gros descendent, rinichiul sting, vasele renale stingi si ureterul sting, mobilizata din spatiul retroperitoneal. Excizata tumoarea cu rezectie segmentara a sigmei cu aplicarea anastamozei terminoterminale cu aparat mecanic si suturi sero-seroase. Imunohistochimie: Liposarcom bine diferentiat G1, cu infiltrarea peretelui colonului sigmoid: imunofenotip: (S100+, CD4+, MDM2+). Evolutia postoperatorie a fost fara evenimente adverse. Concluzie: Liposarcoamele retroperitoneale in majoritatea cazurilor recidiveaza. Succesul operatiei consta in ablatia tumorii cu capsula integra. Depistarea precoce a tumorilor faciliteaza un rezultat postoperator la distanta mai bun.

Introduction: Liposarcoma (LS) is a rare malignant tumor arising from adipose tissue. It can occur wherever adipose tissue is present. Retroperitoneal LS accounts for 12% to 40% of all liposarcomas, with an estimated incidence rate of 0.5 per 100,000 population. Materials and methods: 45-year-old man, hospitalized with complaints of abdominal enlargement, weight loss during the last 6 months. Computed tomography of the abdomen visualized a giant multinodular tumor formation, with a predominantly adipose structure with a solid component, measuring 365x235x412 mm, with displacement of the left kidney in the medial direction and of the intestinal loops in the right flank. Hydronephrosis on the right gr.I, on the left gr.II. Results: a median laparotomy was performed with the detection of a giant retroperitoneal formation of white-greasy color, multinodular, which displaces the anterior descending colon, the left kidney with the renal vessels and the ureter - to the right, the upper pole of the tumor being detected at the level of the diaphragm, and the pole lower - in the small basin. The tumor was mobilized from the descending large intestine, the left kidney, the left renal vessels and the left ureter, mobilized from the retroperitoneal space. The tumor was excised with segmental resection of the sigmoid with the application of end-to-end anastamosis with a mechanical device and sero-serosal sutures. Immunohistochemistry: G1 welldifferentiated liposarcoma, with sigmoid colon wall infiltration: immunophenotype: (S100+, CD4+, MDM2+). Postoperative evolution was without adverse events. Conclusion: Retroperitoneal liposarcomas in most cases recur. The success of the operation consists in the ablation of the tumor with the intact capsule. Early detection of tumors facilitates a better long-term postoperative result.