A 60-year-old male with a history of moderate COPD presented with increased abdominal circumference during the previous months without other accompanying symptoms.
Complete blood count and coagulation tests were normal.
Glucose, urea, potassium acid, creatinine, total calcium, phosphorus, LDL cholesterol, total bilirubin, AST, ALT, GGT, LDH12 albumin, alkaline vitamin B transfer, total protein amylase
Total cholesterol 243 mg/dl (110-200), HDL cholesterol 120 mg/dl (42-68), iron 44 microg/dl (65-165); Ca 19.9, 82.03 U/l (< 40).
CEA, PSA and alpha-fetoprotein were normal.
Globular sedimentation rate was 41 mm (< 14).
In a second determination of tumor markers Ca 19.9, 91.23 and the rest normal.
Magnetic resonance imaging (MRI) scan of the pelvis showed the presence of a large multilobulated mass except for a pelvic mass, whose signal, with the exception of the septums, was preferentially fat.
The maximum dimensions of the mass are 26 cm in the caudal skull axis, 24.5 cm in the transverse axis and 21 cm in the anteroposterior axis.
It crosses the midline and produces an important mass effect on the left kidney, which rotates and displaces cranially, without observing signs of obstructive uropathy.
It also exerts a mass effect on the left transverse colon, displacing it against the abdominal wall.
The findings are suggestive of liposarcoma.
Surgical intervention was performed by suprainfraumbilical midline laparotomy in which a large mass of appearance was found left renal cell to retrovesical space.
An attempt was made to remove block with resection of fibers of the left psoas infiltrate.
The anatomopathological report of the extracted piece was macroscopically described: it appreciates 45 x 40 x 15 cm. with a weight of 6,300 g. The surface shows a discoloured connective tract with a lobule, without necrosis.
In the microscopic description, the histological sections show all of them the same aspect: most of them are composed of adipose tissue with large adipose cells with large vacuola size and mature aspect.
The presence of atypical nuclei is also observed focally, with vaccinated cytoplasm.
These areas of mature tissue are diffusely distributed throughout the neoplasia, and foci with atypical nuclei, sometimes hyperchromia are shown in isolation.
Diagnosis: Well differentiated liposarcoma.
A new determination of Ca 19.9 after surgery showed normalization (24.17 U/l), remaining tumor markers normal.
Subsequently, complementary radiotherapy was performed and the patient was asymptomatic.
Follow-up MRI scans performed five months after surgery showed a postoperative state of retroperitoneal liposarcoma with no macroscopic evidence of lesion.
This patient presented a favorable evolution, asymptomatic at present more than a year after the surgical intervention.
