case_images: PMC6079489_01
case_images: Abdominal computed tomography (CT). (a) Enhanced CT prior to the first surgery showed a large retroperitoneal mass in the second lumbar vertebra level, which consisted of both lipomatous (yellow asterisk) and nonlipomatous (red asterisk) components. Plain CT at 8 months (b) and 3 months (c) before our first visit showed metastatic lipomatous component (red arrow) involved in the vertebral body. (d, e) CT findings at our first visit showed both lipomatous (yellow asterisk) and nonlipomatous (red asterisk) components; in addition, the metastatic lipomatous component in the vertebral body had increased and destroyed the vertebral body. Magnetic resonance image of the lumbar spine. Axial T1-weighted (f), T2-weighted (g), and enhanced T1-weighted images (h) showed the mass with a similar intensity to fat and widespread from the vertebral body to the canal space (yellow arrow).
case_images: CRIOR2018-1708572.001.jpg
case_images: PMC6079489_01_CRIOR2018-1708572.001.jpg
case_images: fig1
case_images: She had undergone resection of retroperitoneal DDL 5 years previously (Figure 1(a)) and repeated resection for recurrence 3 years previously. Recurrence occurred again 1 year previously, and spinal metastasis of WDL component occurred in the L2 vertebrae 8 months previously (Figure 1(b)) and gradually increased (Figure 1(c)) in computed tomography (CT), but she did not undergo additional treatment (Figures 1(d) and 1(e)). T1-weighted images (Figures 1(f)-1(h)). The revised Tokuhashi score was 11/15, and the Spinal Instability Neoplastic Score (SINP) was 10/18. Therefore, we diagnosed the vertebral tumor as the metastasis of WDL component in DDL and planned surgery for symptomatic improvement. Tumor curettage and L1 laminectomy followed by percutaneous pedicle screw fixation from the Th11 to L3 using intraoperative 3-D CT computer navigation were performed (Figures 2(a) and 2(b)).
case_images: Postoperative radiograph of the anteroposterior view (a) and lateral view (b).
case_images: CRIOR2018-1708572.002.jpg
case_images: PMC6079489_01_CRIOR2018-1708572.002.jpg
case_images: fig2
case_images: T1-weighted images (Figures 1(f)-1(h)). The revised Tokuhashi score was 11/15, and the Spinal Instability Neoplastic Score (SINP) was 10/18. Therefore, we diagnosed the vertebral tumor as the metastasis of WDL component in DDL and planned surgery for symptomatic improvement. Tumor curettage and L1 laminectomy followed by percutaneous pedicle screw fixation from the Th11 to L3 using intraoperative 3-D CT computer navigation were performed (Figures 2(a) and 2(b)).
case_images: Histology of the primary site-dedifferentiated liposarcoma (a, b) and well-differentiated liposarcoma components (c, d) and the metastasis (e, f). (a, c, e) Hematoxylin-eosin stain. (b, d, f) Immunohistochemistry of MDM2. There was a mixed well-differentiated and dedifferentiated component in the primary lesion (a, c). Only the well-differentiated component was seen in the spine metastasis (e). Bar = 50 mum.
case_images: CRIOR2018-1708572.003.jpg
case_images: PMC6079489_01_CRIOR2018-1708572.003.jpg
case_images: fig3
case_images: Histological examination showed mixed well-differentiated and well-dedifferentiated liposarcoma in the primary lesion (Figures 3(a), 3(c), and 3(e)). Positive staining for MDM2 (Figures 3(b), 3(d), and 3(f)) and CDK4 (data not shown) by immunohistochemistry and negativity of DDIT3 or FUS by FISH (data not shown) confirmed dedifferentiated liposarcoma.