Spinal metastasis in pleomorphic liposarcoma: A rare location for a rare malignancy

Neha Lall , Anand Kumar , Deepika Joshi , Varun Kumar Singh , Ipsita Dhal , Ashish Verma
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Abstract

Introduction

Soft tissue sarcomas are rare mesenchymal tumors originating from non-epithelial connective tissue. The most common subtype of liposarcoma is a well-differentiated, dedifferentiated type, and pleomorphic liposarcoma (PLPS) is quite a rare subtype, constituting only about 5–10 %. The most common site of PLPS is the lower extremities, but the abdominal wall is a rare site of origin in this rarer subtype.

Case report

We present a rare case of a 58-year-old male who presented with a painless lump in the lower left abdomen for six months. An 18FDG PET CT scan showed an enhancing soft tissue mass with central necrosis at the subcutaneous plane of the left iliac fossa on the anterior abdominal wall, measuring 6.5 (AP) x 5.3 (T) x 6.0 (CC) cm (SUV max-13.41). The patient underwent a wide excision of the mass, and a histopathological examination along with immunohistochemistry confirmed the diagnosis of pleomorphic liposarcoma. The patient then received adjuvant radiotherapy. Within a week of completing the radiotherapy, the patient developed acute backache at the lower dorsal area, with pain radiating lower down at lumbo-sacral area of back. Soon afterwards, within a week, the patient developed acute paraparesis. An MRI of the dorso-lumbar spine revealed altered marrow signals with a soft tissue component at the D10 vertebra level, extending into the spinal canal and causing cord compression, likely due to a metastatic lesion. The patient underwent palliative radiotherapy at the affected site. Three months after radiotherapy, the patient reported a significant improvement in pain and partial improvement in sensory and motor deficits.

Conclusion

This unique case of localized abdominal wall PLPS exhibited early dissemination to the D10 vertebra, resulting in acute paraparesis for the patient. The poor prognosis associated with the histological subtype of PLPS, despite timely surgical excision and adjuvant radiotherapy, emphasises the need for new targeted therapies. Advances in molecular biology and cytogenetics will further improve clinical outcomes for PLPS patients.
多形性脂肪肉瘤脊柱转移:罕见恶性肿瘤的罕见部位
软组织肉瘤是一种罕见的间充质肿瘤,起源于非上皮性结缔组织。脂肪肉瘤最常见的亚型是分化良好的去分化型,多形性脂肪肉瘤(PLPS)是一种非常罕见的亚型,仅占约5 - 10% 。PLPS最常见的部位是下肢,但在这种罕见的亚型中,腹壁是一个罕见的起源部位。病例报告我们提出一个罕见的58岁的男性谁提出了一个无痛的肿块在左下腹部六个月。18FDG PET CT扫描显示前腹壁左髂窝皮下平面软组织肿块增强,伴有中央坏死,尺寸为6.5 (AP) x 5.3 (T) x 6.0 (CC) cm (SUV max-13.41)。患者接受了广泛的肿块切除,组织病理学检查和免疫组织化学检查证实了多形性脂肪肉瘤的诊断。患者随后接受辅助放疗。放疗结束后一周内,患者出现下背区急性背痛,疼痛向下腰骶区放射。此后不久,在一周内,病人出现急性麻痹。后腰椎MRI显示骨髓信号改变,在D10椎体水平有软组织成分,延伸到椎管并导致脊髓受压,可能是由于转移性病变。患者在患处接受姑息性放疗。放疗后三个月,患者报告疼痛明显改善,感觉和运动缺陷部分改善。结论本例独特的局限性腹壁PLPS表现为早期播散至D10椎体,导致患者急性截瘫。尽管及时进行手术切除和辅助放疗,但组织学亚型与PLPS预后不良相关,这强调了新的靶向治疗的必要性。分子生物学和细胞遗传学的进步将进一步改善PLPS患者的临床预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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