A 70-year-old male with a history of hypertension, insulin-dependent type 2 diabetes mellitus and severe chronic alcoholism.
Lower limb ischemia with 50% stenosis of the left iliac artery, pending the performance of femoro-femoral bypass when the patient presented pain and inflammation in the area of the right triceps surae 10 days in the lower limb.
On examination, swelling, pain and enlargement of the diameter at the level of the right pantor, more than 3 cm from the left, with diffuse swelling of the twin mass without edema or neurovascular involvement.
CBC: normal at the beginning of the disease and subsequently normocytic normochromic anemia requiring transfusion of solid concentrates on several occasions.
Biochemistry: glucose: 134 mg/dl (76-120), urea 56 mg/dl (10-50), creatinine 1.7 mg/dl (0.6-1.2), calciumdl (2.7dl, chloroethylated calcium (3.42-gOT albumin), total
LDH at baseline normal values progressively increased to 1811 U/l (120-460).
PSA: 10.27 ng/ml (< 4).
Serum Neuronal Specific Enolase (NSE): 18.6 ng/ml (half 12.5).
CEA and Ca 12,5 were repeatedly normal.
Plain radiography of the right lower extremity : erosion of the middle wall of the fibula that is related to the tumor that presents at the level of the pamphlet.
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Right-sided MRI shows a large mass of 16 x 6 x 7 cm in anteroposterior and transverse skull diameter respectively located in the posterior region of the right but hyperintensivity in the soleus and proximal third of the gey
Injury suggestive of sarcoma.
On the other hand, the patient presents progressive prostatism with nocturnal pollakiuria and dysuria. The area is vacant when there is an epigastric mass with abdominal mass extending from the right lower extremity.
Prostate increased in size, bulbous, homogeneous with possible qualifications.
Liver, gallbladder, pancreas and kidneys were normal.
The transrectal prostatic biopsy showed no malignancy.
Computed tomography (CT) of the pelvis and abdomen showed large abdominal masses occupying almost the entire abdominal cavity.
They have an inhomogeneous contrast uptake and apparently have no anatomical relationship with each other.
There are no other significant pathological findings.
Chest CT: Images compatible with bronchiectasis with mild bilateral pleural effusion.
FNA was performed on a large mass located at the level of the right pantor, all of which were markedly hardened.
The smear suggestive of myxoid mesenchymal neoformation and show hemorrhagic background on which are observed frequent cohesive cell groups with marked vascular pattern consisting of cells with monomorphous nuclei slightly elongated with small chromatin nuclei.
Rare cytoplasms occasionally microvacuolated are observed.
In the periphery of the groups metachronous stroma with giemsa technique was identified.
Cellularity does not present mitotic figures in the material obtained.
Subsequently, abdominal surgery was performed.
A total of four masses were excised one by one; they are fragile rupture and vascularization have a gelatinous appearance substance, of which is found in mesoileum so a zone of ileum is resected.
End-stage anastomosis of the ileum and cavity cleaning.
No hepatic impairment.
Pathological anatomy of the excised masses.
Macroscopic description: Multiple nodular appearance formations with the following dimensions: 14 x 12 x 8 cm, another 19 x 13.5 x 5 cm, another 11.5 x 10 x 12 cm, and the other 12 x 12 cm.
A small bowel segment measuring 15 cm in length is sent together and there are no significant alterations at the opening.
Microscopic description: Histological sections of the remitted nodular formations show a mesenchymal neoplasm composed of medium-sized cellular elements with prominent prominent large nucleus.
The cytoplasm is variable in quantity and often with fat vacuum.
Frequently, large cells with a star-shaped morphology and an eosinophilic cytoplasm with large nuclei are observed.
Mitosis is very rare (less than 5 x 10 high-power fields) and extensive areas of necrosis are also observed.
Myxoid areas are also observed focally.
The small intestine segment shows a serosa with areas of fibrosis; the rest of the parietal structure does not present significant alterations.
The anatomopathological diagnosis is malignant mesenchymal tumor highly suggestive of myxoid liposarcoma.
After surgery, chemotherapy with adriamycin was initiated, with good tumor and clinical response.
One month after the surgical intervention in the control abdominal CT requested, postoperative changes were observed with metal sutures of surgery, not visualizing images of mass or tumor recurrence.
In the following two months, the patient presented progression of her abdominal tumor despite chemotherapy performed with general deterioration, dyspnea, increased pain, decreased appetite, tiredness increased abdominal perimeter with ascites.
On examination: very distended, hard, with a large tumor occupying almost the entire left hemiabdomen, where there are tender abdomen zones with different consistency that are painful.
Oedema with fovea in the abdomen, lumbosacral area and lower limbs.
Generalized reduction of vesicular murmur, especially in both bases.
The examination was not significant.
Complementary tests showed: simple abdominal X-ray: there is a large mass effect in the central and left abdomen displacing all loops to the right.
CT (thorax and abdomen): large abdominal masses are observed, mainly in the left hemiabdomen, inhomogeneous and irregularly capture contrast.
It is accompanied by a moderate amount of ascitic fluid, findings consistent with tumor recurrence.
The patient died 8 months after surgery.
