Citation Information :
Guerra OF, Gomez AP, Guerra CD, Zuñiga AM. Mixed-type Retroperitoneal Liposarcoma—A Combination of the Well-differentiated and Myxoid Types: Case Report and Literature Review. Curr Trends Diagn Treat 2023; 7 (1):17-20.
Introduction: Soft tissue sarcomas represent less than 1.5% of malignant tumors. They are characterized by destructive growth, recurrence, and distant metastases to the lungs. The sites more frequently affected are the extremities in 40% and the retroperitoneum in 15–20% of the cases.
Case description: A 57-year-old female presented reporting a history of pain for 12 months and a progressively growing abdominal mass. The initial histological analysis indicated a diagnosis of lipoma in the mesentery, but a nuclear magnetic resonance of the abdomen showed two retroperitoneal masses. After laparoscopic resection, immunohistochemistry confirmed a well-differentiated liposarcoma and myxoid liposarcoma. One year later, the patient had a second surgical intervention due to tumor relapse, with pathology showing a well-differentiated liposarcoma.
Discussion: Mixed-type liposarcoma is the most uncommon histotype. It is still an unknown entity. It shows the combined features of myxoid/round and liposarcoma well-differentiated/dedifferentiated. Also, it can show the characteristics of the myxoid subtype/round or pleomorphic liposarcoma. All these different presentations generate conceptual conflicts when establishing the protocols for management and treatment.
Conclusion: Mixed-type liposarcoma represents the most uncommon subtype of liposarcoma. Complete surgical resection with negative margins remains the standard of treatment. In order to achieve negative margins, en bloc multivisceral resection and neoadjuvant therapies (chemotherapy or radiotherapy) are often necessary in selected cases.
Fletcher CDM. The evolving classification of soft tissue tumors – an update based on the new 2013 WHO classification. Vol. 64, Histopathology. John Wiley & Sons, Ltd; 2014. p. 2–11. DOI: https://doi.org/10.1111/his.12267.
Quagliuolo V, Gronchi A, editors. Current treatment of retroperitoneal sarcomas. Milano: Springer Milan; 2019.
Brennan MF, Antonescu CR, Alektiar KM, et al. General Description. In: Management of Soft Tissue Sarcoma. Springer International Publishing; 2016. p. 3–17. DOI: https://doi.org/10.1007/978-3-319-41906-0_1.
Kindblom LG. Lipomatous tumors – How we have reached our present views, what controversies remain and why we still face diagnostic problems: A tribute to Dr. Franz Enzinger. Adv Anat Pathol 2006;13(6):279–285. DOI: 10.1097/01.pap.0000213053.00060.5.
Agha RA, Franchi T, Sohrabi C, et al. The SCARE 2020 guideline: updating consensus surgical Case Report (SCARE) guidelines Int J Surg 2020;84:226–230. DOI: 10.1016/j.ijsu.2020.10.034.
Ohyabu Y, Sameshima H, Nakayama M, et al. The retroperitoneal liposarcoma: a case report. Hinyokika Kiyo 1989;35(2):307–313. Available from: http://hdl.handle.net/2433/116430.
Dumitra S, Gronchi A. The Diagnosis and Management of Retroperitoneal Sarcoma. Oncology (Williston Park). 2018;32(9): 464–469.
Mota MMDS, Bezerra ROF, Garcia MRT. Practical approach to primary retroperitoneal masses in adults. Rad Bras 2018;51(6):391–400. DOI: 10.1590/0100-3984.2017.0179.
Sarcoma NICE quality standard 78, 2015. Available from: https://www.nice.org.uk/guidance/qs78.
Benjamin RS, Bui MM, Choy E, et al. NCCN Guidelines Version 2.2021 Soft Tissue Sarcoma.
Dangoor A, Seddon B, Gerrand C, et al. UK guidelines for the management of soft tissue sarcomas. Clin Sarcoma Res 2016;6:20. DOI: 10.1186/s13569-016-0060-4.
Casali PG, Abecassis N, Bauer S, et al. Soft tissue and visceral sarcomas: ESMO–EURACAN Clinical Practice Guidelines for diagnosis, treatment, and follow-up. ESMO Guidel Comm 2018;29(4):iv51–iv67. DOI: 10.1093/annonc/mdy096.
de Vreeze RSA, de Jong D, Koops W, et al. Oncogenesis and classification of mixed-type liposarcoma: A radiological, histopathological and molecular biological analysis. Int J Cancer 2011;128(4):778–786. DOI: 10.1002/ijc.25390.
Brennan MF, Antonescu CR, Maki RG, et al. Natural history: importance of size, site, and histopathology. In: management of soft tissue sarcoma. New York: Springer; 2013. p. 19–35.
Mullinax JE, Zager JS, Gonzalez RJ. Current diagnosis and management of retroperitoneal sarcoma. Cancer Contro 2011;18(3):177–187. DOI: 10.1177/107327481101800305.
Dumitra S, Gronchi A. The Diagnosis and Management of Retroperitoneal Sarcoma. Oncology (Williston Park). 2018;32(9): 464–469. PMID: 30248168.