PRIMITIVE RETROPERITONEAL TUMORS – GIANT LIPOSARCOMA

Primitive retroperitoneal tumors are formations with varying degrees of severity. They may occur locally, being impressive due to their generous diameters, but they can also invade the entire body. The latest genetic studies have somewhat changed the vision about the etiology of soft tissue tumors, while the immunohistochemical studies offer customized results on recurrence, metastasis and survival rate. At the same time, the importance of the imaging findings is crucial, especially when the localization poses problems regarding the surgical technique and a means of adjuvant therapy must be chosen accordingly. The peculiarity of this case is that we managed to resect the impressively large retroperitoneal malignant tumor with oncological safety margins. We present the case of a patient admitted in 2012 in the Department of General Surgery II of the "Carol Davila" Central Military Emergency Hospital, because of the development of a bulky formation in the right hemiabdomen and subocclusive symptoms. A thorough investigation was performed. The initial suspicion was of a primitive retroperitoneal tumor, the CT aspect indicating a liposarcoma. The total tumoral excision was decided and performed, with the previous checking of the specific areas of metastases. The diagnosis certitude was obtained after sending the 5.5 kg piece to the anatomical pathology examination. Post-operatively, the patient was referred to the oncological service for appropriate adjuvant treatment. So far, the surgical treatment combined with the oncological one has had favorable results.

A Giant Retroperitoneal Liposarcoma Encasing the Entire Left Kidney and Adherent to Adjacent Structures: A Case Report

Retroperitoneal liposarcoma is a rare tumor. The dimension and weight of liposarcoma are variable; those over 20 kg are called ‘giant liposarcoma’. Herein, we report giant retroperitoneal liposarcoma measuring 45 cm in diameter and 25 kg in weight encasing the entire left kidney and adherent to adjacent structures. A 71-year-old woman presented for a regular checkup. Image study revealed a huge mass probably indicative of retroperitoneal liposarcoma encasing the entire left kidney and adherent to adjacent structures. We performed an organ-preserving surgical removal. The pathologic report was liposarcoma. At postoperative month 16, a follow-up CT revealed a locally recurrent tumor. The patient underwent surgical removal of the newly discovered mass. After the second surgery, the patient underwent regular follow-up CT for approximately 12 months, and to date, there has been no evidence of tumor recurrence. High-grade liposarcoma shows sensitivity to radiation therapy. However, the toxic effect of radiation therapy limits this option by treatment modality. The use of chemotherapy is also controversial. As a result, complete resection is the gold standard treatment. Here, we report a giant retroperitoneal liposarcoma encasing the entire left kidney and adherent to adjacent structures, describe successful organ-preserving surgical removal and discuss prognosis.