K.E.M.
Radiology
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Department of Radiology
Seth G.S. Medical College and K.E.M. Hospital, Mumbai , India
Case of the Month
Introduction:
Liposarcoma is a rare malignant tumour with a low incidence rate that accounts for less than 1 % of all malignancies. According to the morphological characteristics and cytogenetics, sarcomas can be divided into liposarcomas, leiomyosarcomas and malignant fibrous histiocytomas among which, liposarcomas are the most common, accounting for 41% of all the sarcomas. Liposarcoma can occur in any region where fat is present. Approximately 30% occur in the retroperitoneal cavity. 35% originate from perirenal fat. Liposarcomas manifest as painless, progressively enlarging masses; thus, nearly half of retroperitoneal liposarcomas have diameters more than 20cm at the time of diagnosis.
Primary retroperitoneal liposarcomas (PRPLS) occur mainly in patients aged 60-70 years, with no sex predominance.
In the present case record, we report on a 54 year old man with primary retroperitoneal liposarcoma.
Clinical Profile:
A 54-year-old man came with complaints of pain in the left hypochondriac region for two months, insidious onset, non-progressive, associated with a bloating sensation. There is no history of vomiting, constipation, hematemesis or melena. He had no history of trauma, weight loss, or fever. On examination, there was an ill-defined, hard swelling in the left hypochondriac region.
Radiological findings:
An AP radiograph of abdomen (Figure 1) shows a large, ill-defined radiolucency of fat density in the left hypochondriac region displacing the bowel loops to the right.
Fig1 : The AP radiograph of the abdomen shows an ill-defined radiolucency of fat density in the left hypochondriac region with displacement of bowel loops to the right.
A curvilinear ultrasound probe placed transversely in the hypogastric region showed a well defined, heterogenous spherical mass with few calcific foci.
On the CECT (Figure 2), there is a large, heterogenous fat density lesion with multiple septae, centered in the left retroperitoneal space. It extends medially to involve the prevascular space and the left psoas muscle. The lesion displaces the descending colon and small bowel loops anteriorly.
There is a well circumscribed, heterogeneously enhancing round to oval soft tissue component with amorphous calcifications.
Fig 2 Plain, venous, and excretory phase axial and coronal CT scans of the abdomen show a large 13x14x20cm (APXTRXCC) heterogenous lesion of fat density with multiple thin septae in the left retroperitoneal space. There is a well circumscribed, heterogeneously, enhancing round soft tissue component measuring about 6 cm in diameter with amorphous calcification
On MRI, the lesion shows a large, ill-defined fat intensity lesion with multiple enhancing septation involving the left perirenal, anterior and posterior pararenal and left paracolic region. Medially, the lesion extends to the preaortic and left paraaortic region. Anteriorly it causes anterior displacement of descending colon and small bowel loop. Postero-medially there is involvement of the left psoas and quadratus lumborum muscles. Posterolaterally it is limited by the posterior pararenal and lateral conal fascia that is thickened. Inferiorly, the lesion surrounds the inferior pole of the left kidney with mild anterior displacement. Anteriorly, the above lesion shows a large heterogeneously enhancing soft tissue component. Another small enhancing soft tissue component is seen inferior to the lower pole of the left kidney.
Fig. 3 The MRI shows large, ill defined, T1/T2 fat intensity lesion with multiple enhancing septation involving the left perirenal, anterior and posterior pararenal and left paracolic region Anteriorly it shows a heterogeneously enhancing soft tissue component