Giant gluteal lipoma-like liposarcoma: a case report
© Sultan et al; licensee BioMed Central Ltd. 2008
Received: 17 July 2007
Accepted: 29 July 2008
Published: 29 July 2008
Liposarcoma is the second most common soft tissue sarcoma in adults with a peak incidence between the 4th and 6th decade of life and slight preponderance to the male gender. It originates from multipotential primitive mesenchymal cells, rather than mature adipose tissue.
An unusual case of a rapidly growing giant lipoma-like liposarcoma of the left gluteal and perineal areas in a young male was presented. The patient was managed by wide local excision of the lesion and coverage with split thickness skin graft. The key issues surrounding the treatment of lipoma-like liposarcoma and literature review is discussed.
For such unusual case of this particular rapidly growing tumor, a longer follow-up is needed to evaluate the outcome in these cases.
Liposarcoma is the second most common soft tissue sarcoma in adults. This tumor originates from multipotential primitive mesenchymal cells rather than mature adipose tissue . It commonly arises from extremities, particularly thighs, retroperitoneum, inguinal and paratesticular regions [2, 3]. Chest wall, breast, mediastinum, small intestine, omentum and mesentery may also be involved. The peak age incidence of well differentiated, dedifferentiated, and pleomorphic liposarcoma occurs between the 4th and 6th decade of life with slight preponderance to the male gender. The authors described an unusual case of a rapidly growing giant lipoma-like liposarcoma of the left gluteal region in a young adult patient. To the best of our knowledge, no such case is reported in the English literature.
Post-operative CT scan of the abdomen and pelvis with oral and IV contrast were done as part of the metastatic workup and showed no abnormalities.
The case was discussed in the tumor board meeting and the decision was made to achieve an adequate loco-regional control by wide local excise. The operation was done in a left lateral decubitus position under general anesthesia with oro-tracheal intubation. Total excision of the lesion was done with a 2 cm free margin down to a deep sub-facial plane exposing the gluteal maximus muscle which was found to be free of the disease. The resultant soft tissue defect was covered with a split thickness skin graft taken from the left thigh. Part of the graft was lost because of a localized pseudomonas infection which healed completely with daily wound care and without surgical intervention. The final histopathology diagnosis was well-differentiated and well defined completely excised lipoma-like liposarcoma, therefore adjuvant radiotherapy was not indicated. The patient was followed for about 16 months showing no evidence of recurrence.
Adipocytic tumors represent the largest single group of mesenchymal neoplasms, due to the high prevalence of lipomas and their variants. Liposarcoma represents the single most common soft tissue sarcoma in adults, accounting for approximately 20% of all cases. Its principal histological subtypes; well differentiated, myxoid/round cell and pleomorphic are entirely separate diseases with different morphology, genetics and natural history. The principal changes in the recent WHO classification demonstrates that atypical lipomatous tumors and well differentiated liposarcoma are essentially synonymous and that site-specific variations in behavior relate only to surgical resectability .
This male patient was quite young though the peak incidence is considered between the 4th and 6th decade of life. The presentation was due to the discomfort in maintaining the day today activities and foul odor it emitted. The lesion was a cutaneous outward growth and it attained considerable size in a short period of time and presented a difficult dilemma for the diagnosis.
Liposarcomas can be divided into three basic histological categories; well-differentiated liposarcomas which morphologically subdivided into lipoma-like, sclerosing, inflammatory or spindle cell type, myxoid liposarcoma and pleomorphic liposarcoma .
Well-differentiated liposarcomas account for about 40%–45% of all liposarcoma and therefore represent the larger subgroup of adipocytic malignancies. Although the recurrence rate can reach up to 30% of the cases, this tumor which is surgically amenable behaves as a benign neoplasm and is not known to metastasize, thus requiring a less aggressive treatment . The most important prognostic factor for well-differentiated liposarcoma is its anatomic location where superficial lesions are considered favorable while deeply seated lesions such as retroperitoneal or mediastinal liposarcoma are associated with increased recurrence and metastatic rates [1, 6].
The benefit of wide local excision over marginal excision is recognized in the literature . In our case, we have excised the lesion with 1 cm margin down to a subfascial plane over the gluteal muscles to have good local control. We could not find any evidence in the literature suggesting a benefit in outcome with the use of postoperative radiotherapy. Some authors caution against its use to treat this lesion due to the uncertainty about its role in the dedifferentiation process 4.
An unusual case of a rapidly growing, giant gluteal lipoma-like liposarcoma was presented. Surgical excision is the main treatment for most primary soft tissue sarcomas. As such every effort should be made to achieve complete tumor resection. A longer follow-up is needed to evaluate the outcome such cases. Although not used in this case, we wonder if radiotherapy could be used in such giant tumors to improve the loco-regional control.
The reporting of this case was approved by the ethics committee of Al-Babtain center for Burns and plastic surgery, Ibn-Sina Hospital, Sabah Health Centre, State of Kuwait.
- Amato G, Martella A, Ferraraccio F, Di Martino N, Maffettone V, Landolfi V, Fei L, Del Genio A: Well differentiated "lipoma-like" liposarcoma of the sigmoid mesocolon and multiple lipomatosis of the rectosigmoid colon. Report of a case. Hepatogastroenterology. 1998, 45 (24): 2151-2156.PubMedGoogle Scholar
- Montgomery E, Fisher C: Paratesticular liposarcoma: a clinicopathologic study. Am J Surg Pathol. 2003, 27 (1): 40-47. 10.1097/00000478-200301000-00005.View ArticlePubMedGoogle Scholar
- Dalla Palma P, Barbazza R: Well-differentiated liposarcoma of the paratesticular area: report of a case with fine-needle aspiration preoperative diagnosis and review of the literature. Diagn Cytopathol. 1990, 6 (6): 421-426. 10.1002/dc.2840060607.View ArticlePubMedGoogle Scholar
- Sommerville SM, Patton JT, Luscombe JC, Mangham DC, Grimer RJ: Clinical outcomes of deep atypical lipomas (well-differentiated lipoma-like liposarcomas) of the extremities. ANZ J Surg. 2005, 75 (9): 803-806. 10.1111/j.1445-2197.2005.03519.x.View ArticlePubMedGoogle Scholar
- Dei Tos AP: Liposarcoma: new entities and evolving concepts. Ann Diagn Pathol. 2000, 4 (4): 252-266. 10.1053/adpa.2000.8133.View ArticlePubMedGoogle Scholar
- Laurino L, Furlanetto A, Orvieto E, Del Tos AP: Well-differentiated liposarcoma (atypical lipomatous tumors). Semin Diagn Pathol. 2001, 18 (4): 258-262.PubMedGoogle Scholar
- Capodiferro S, Scully C, Maiorano E, Lo Muzio L, Favia G: Liposarcoma circumscriptum (lipoma-like) of the tongue: report of a case. Oral Dis. 2004, 10 (6): 398-400. 10.1111/j.1601-0825.2004.01040.x.View ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.