En-block resection of a giant retroperitoneal lipoma presented as huge abdominal swelling: a case report
Keywords:Retroperitoneal lipoma, Well differentiated liposarcoma, En-bloc resection, Tumour, Histopathology
Retroperitoneal lipomas are an extremely rare entity with only less than 20 cases described in the literature so far. They can attain immoderate size due to space provided in the retroperitoneum and cause abdominal symptoms like abdominal pain, swelling and obstipation due to mass effect. Case presented here as of 53 years old male with complaint of abdominal swelling that had been progressive for the last 1 year. On computed tomography (CT) it revealed giant retroperitoneal mass? liposarcoma? occupying the space immensely. Intraoperatively, two giant retroperitoneal tumours were found which did not show any features of infiltration to nearby structures, therefore the sole tumour annihilation was achieved, which was diagnosed as benign lipoma on histopathology report later. The most important differential diagnosis is the well differentiated liposarcoma, which could only be confirmed after resection and histopathological assessment. Retroperitoneal lipomas are clearly not distinguishable from well differentiated liposarcomas on CT guided and USG guided biopsy and thus it could be misleading. Hence surgical resection with negative margins along with histopathological confirmation is treatment of choice with regular follow up to diagnose early recurrence if any.
Terada T. Giant fibrolipoma of the spermatic cord. Pathol Int. 2010;60(4):330-2.
Harrington AC, Adnot J, Chesser RS. Infiltrating lipomas of the upper extremities. J Dermatol Surg Oncol. 1990;16(9):834-7.
Weiss SW. Lipomatous tumors. Monogr Pathol. 1996;38:207-39.
Macarenco RS, Erickson-Johnson M, Wang X, Folpe AA, Rubin BP, Nascimento AG, et al. Retroperitoneal lipomatous tumors without cytologic atypia: Are they lipomas? A clinicopathologic and molecular study of 19 cases. Am J Surg Pathol. 2009;33(10):1470-6.
Suga H, Eto H, Inoue K, Aoi N, Kato H, Araki J, et al. Cellular and molecular features of lipoma tissue: comparison with normal adipose tissue. Br J Dermatol. 2009;161(4):819-25.
Leffell DJ, Braverman IM. Familial multiple lipomatosis: report of a case and a review of the literature. J Am Acad Dermatol. 1986;15:275-9.
Casali PG, Jost L, Sleijfer S, Verweij J, Blay JY, ESMO Guidelines Working Group. Soft tissue sarcomas: ESMO clinical recommendations for diagnosis, treatment and follow up. Ann Oncol. 2008;19(2):89-93.
Dalal KM, Antonescu CR, Singer S. Diagnosis and management of lipomatous tumors. J Surg Oncol. 2008;97(4):298-313.
Mauro SD, Salibra M, Filippone GF, Trovato P, Sferlazzas G, Pasquale MCD. Clinical comments on a case of retroperitoneal lipoma. Chir Ital. 1985;37(1):80-92.
Hinman F. The Principles and Practice of urology. Philadelphia: WB Saunders Co; 1935.
Chander B, Krishna M, Thakur S, Mahajan N, Vij A, Diwakaran J. Extremely rare giant fibrlipoma: a case report. J Cancer Res Ther. 2012;8(2):314-6.
ESMO/European Sarcoma Network Working Group. Soft tissue and visceral sarcomas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23(7):92-9.