Indian Journal of Pathology and Microbiology

LETTER TO EDITOR
Year
: 2009  |  Volume : 52  |  Issue : 1  |  Page : 131--132

Primary peritoneal liposarcoma in a middle-aged patient


Shirin Niroomanesh1, Fatemeh Mirzaie2, Alireza Bateni3,  
1 Department of Obstetrics and Gynecology, Mirza Koochak Khan Hospital, Medical Sciences/ University of Tehran, Tehran, Iran
2 Department of Obstetrics and Gynecology, Kerman University of Medical Sciences, Kerman, Iran
3 Department of Pathology, Erfan Hospital, Tehran, Iran

Correspondence Address:
Fatemeh Mirzaie
P.O. Box: 13185-1678, Tehran
Iran




How to cite this article:
Niroomanesh S, Mirzaie F, Bateni A. Primary peritoneal liposarcoma in a middle-aged patient.Indian J Pathol Microbiol 2009;52:131-132


How to cite this URL:
Niroomanesh S, Mirzaie F, Bateni A. Primary peritoneal liposarcoma in a middle-aged patient. Indian J Pathol Microbiol [serial online] 2009 [cited 2021 Sep 27 ];52:131-132
Available from: https://www.ijpmonline.org/text.asp?2009/52/1/131/44982


Full Text

Sir

Primary neoplasms of the peritoneal and sub-peritoneal region are relatively rare, the majority of them are malignant and are often associated with a poor prognosis. [1] Primary peritoneal liposarcoma is rare and to our knowledge only a few cases (6 cases) have been reported. [2],[3] We present a case of abdominal liposarcoma originating from the peritoneum.

A 57-year-old female with a complaint of hugeness of the abdomen was referred to our clinic. A total abdominal hysterectomy with bilateral oophorectomy had been performed 10 years earlier for abnormal uterine bleeding. A hernial repair surgery had been performed 7 years earlier.

An increase in the size of the abdomen began 1 month prior to the patient reporting to our hospital. There was no pain, discomfort, or gastrointestinal symptoms or changes in appetite. On examination, a large firm mass with the approximate size of 3035 cm was found in the left lower part of the abdomen.

All biochemical parameters (including blood counts, blood urea nitrogen, creatinine and liver function tests) were within normal range. An ultrasound of the abdomen showed an echogenic mass on the inner side of the abdominal wall. A computerized tomography (CT) scan revealed a large abdominal mass with homogeneous density with the possible origin of the abdominal wall .

Considering these findings, the patient underwent a laparotomy for further evaluation. During surgery, a large, encapsulated, lobulated, yellowish mass about 30 cm in diameter was found below the fascia and anterior to the peritoneum in the left lower part of the abdomen. The tumor was resected and the frozen section examination was reported as fibrolipoma. Subsequent histological study showed that the tumor was composed of mature adipocyts with few fibrous septae. Some atypical cells with pleomorphic, hyperchromatic, vesicular nuclei, high N/C ratio and vacuolated cytoplasm were also identified [Figure 1] and [Figure 2].

A diagnosis of well-differentiated liposarcoma was given. The patient was referred for chemotherapy. After 5 months of treatment, the patient was well and no complications or recurrence have been reported.

Primary neoplasms of the peritoneal and subperitoneal region occur much less frequently than metastatic cancers in these locations. [4] The peritoneal liposarcoma is a malignant tumor with a poor prognosis despite surgical resection. [5] The diagnosis is always late as it remains asymptomatic for a long time giving the tumors time to grow in size.

Most of the previously reported cases were in the middle aged or the elderly, as seen in our case. Their presenting symptoms range from abdominal pain to ascitis and increase in abdominal size, similar to our case. [2],[3] In these cases, many of the symptoms go undetected, which leads to a late diagnosis causing most cases to present with space-occupying symptoms owing to a huge tumor mass. It is usually very difficult to detect the origin of such a huge abdominal sarcoma pre- and post-operatively.

Imaging modalities may help in the proper diagnosis of the origin of the tumor pre-operatively. CT findings can suggest this specific diagnosis when the tumor contains areas of fat attenuation. Fat attenuation is less likely to be seen in higher-grade liposarcomas, such as the pleomorphic and round cell subtypes. However, in cases such as ours imaging modalities may not help in a pre-operative diagnosis of tumor type and surgical pathology remains the gold standard of definite diagnosis.

 Acknowledgement



The authors would like to thank the Farzan Institute for Research and Technology for technical assistance.

References

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2Sato H, Minei S, Sugimoto S, Kishimoto Y, Yoshida T, Takimoto Y. Multicentric liposarcoma. Int J Urol 2004;11:1133-5.
3Karila-Cohen P, Kotobi H, Weber N, Merran S. Peritoneal liposarcoma. J Radiol 2004;85:91-4.
4Pickhardt PJ, Bhalla S. Primary neoplasm's of peritoneal and sub peritoneal origin: CT finding. Radiographics 2005;25:983-95.
5Tsutsumi H, Ohwada S, Takeyoshi I, Izumi M, Ogawa T, Fukusato T, et al . Primary omental liposarcoma presenting with torsion: A case report. Hepatogastroenterology 1999;46:2110-2.