bs_bs_banner
doi:10.1111/jgh.12433
E D U C AT I O N A N D I M A G I N G
Hepatobiliary and Pancreatic: Large pancreatic liposarcoma
Figure 1
Figure 2
A young man, aged 24, was investigated because of progressive abdominal distension. On examination, he had a large mass in the mid-abdomen. A contrast-enhanced computed tomography (CT) scan revealed a mass, 25 x 17 x 11 cm, in the mid-abdomen as shown on the axial and coronal scans in Figure 1. The mass had a heterogeneous appearance but many areas of the mass were of low-density consistent with fat. The preoperative diagnosis was that of a retroperitoneal liposarcoma. Laparotomy revealed a relatively firm tumor with a smooth surface (Figure 2). The mass appeared to arise from the body of the pancreas with sparing of the tail of the pancreas (arrowheads). A resection of the body of the pancreas was performed with a pancreaticogastrostomy for the distal pancreatic remnant. At histology, the diagnosis was that of a myxoid pancreatic liposarcoma with surgical margins that were free of tumor. After 44 months, a second operation was performed to remove a local recurrence, 4 x 3 cm in size. He is currently asymptomatic after 3 further months of follow-up. Liposarcomas are malignant neoplasms of adipose tissue. Histologically, the most common types are the well-differentiated liposarcoma, the myxoid liposarcoma and the dedifferentiated liposarcoma. These tumors largely develop in middle-aged or older individuals. Common sites for the dedifferentiated liposarcoma include the retroperitoneum and the spermatic cord. In
contrast, well-differentiated and myxoid liposarcomas usually occur in subcutaneous and intramuscular sites and are uncommon in the retroperitoneum. Retroperitoneal liposarcomas, in particular, are often relatively large at the time of diagnosis and only rarely arise from the pancreas. The behavior of liposarcomas is strongly influenced by the histology such that the dedifferentiated liposarcoma is more likely to recur locally and metastasize. The most important factor influencing prognosis is the adequacy of surgical resection at the time of primary presentation. The CT scan illustrated above is typical of a liposarcoma with low density areas consistent with fat as well as thick septae of soft tissue. Dedifferentiated neoplasms have less fat and can have a similar appearance to other sarcomas. The differential diagnosis on imaging may also need to include benign lipoma, angiomyolipoma and malignant fibrous histiocytoma.
1800
Contributed by Kunitaka Kuramoto*, Daisuke Hashimoto*, Shinya Abe*, Akira Chikamoto*, Toru Beppu*, Ken-ichi Iyama† & Hideo Baba* Departments of *Gastroenterological Surgery and † Surgical Pathology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
Journal of Gastroenterology and Hepatology 28 (2013) 1800 © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
Copyright of Journal of Gastroenterology & Hepatology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
doi:10.1111/jgh.12433
E D U C AT I O N A N D I M A G I N G
Hepatobiliary and Pancreatic: Large pancreatic liposarcoma
Figure 1
Figure 2
A young man, aged 24, was investigated because of progressive abdominal distension. On examination, he had a large mass in the mid-abdomen. A contrast-enhanced computed tomography (CT) scan revealed a mass, 25 x 17 x 11 cm, in the mid-abdomen as shown on the axial and coronal scans in Figure 1. The mass had a heterogeneous appearance but many areas of the mass were of low-density consistent with fat. The preoperative diagnosis was that of a retroperitoneal liposarcoma. Laparotomy revealed a relatively firm tumor with a smooth surface (Figure 2). The mass appeared to arise from the body of the pancreas with sparing of the tail of the pancreas (arrowheads). A resection of the body of the pancreas was performed with a pancreaticogastrostomy for the distal pancreatic remnant. At histology, the diagnosis was that of a myxoid pancreatic liposarcoma with surgical margins that were free of tumor. After 44 months, a second operation was performed to remove a local recurrence, 4 x 3 cm in size. He is currently asymptomatic after 3 further months of follow-up. Liposarcomas are malignant neoplasms of adipose tissue. Histologically, the most common types are the well-differentiated liposarcoma, the myxoid liposarcoma and the dedifferentiated liposarcoma. These tumors largely develop in middle-aged or older individuals. Common sites for the dedifferentiated liposarcoma include the retroperitoneum and the spermatic cord. In
contrast, well-differentiated and myxoid liposarcomas usually occur in subcutaneous and intramuscular sites and are uncommon in the retroperitoneum. Retroperitoneal liposarcomas, in particular, are often relatively large at the time of diagnosis and only rarely arise from the pancreas. The behavior of liposarcomas is strongly influenced by the histology such that the dedifferentiated liposarcoma is more likely to recur locally and metastasize. The most important factor influencing prognosis is the adequacy of surgical resection at the time of primary presentation. The CT scan illustrated above is typical of a liposarcoma with low density areas consistent with fat as well as thick septae of soft tissue. Dedifferentiated neoplasms have less fat and can have a similar appearance to other sarcomas. The differential diagnosis on imaging may also need to include benign lipoma, angiomyolipoma and malignant fibrous histiocytoma.
1800
Contributed by Kunitaka Kuramoto*, Daisuke Hashimoto*, Shinya Abe*, Akira Chikamoto*, Toru Beppu*, Ken-ichi Iyama† & Hideo Baba* Departments of *Gastroenterological Surgery and † Surgical Pathology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
Journal of Gastroenterology and Hepatology 28 (2013) 1800 © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
Copyright of Journal of Gastroenterology & Hepatology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
