PARTIAL HEPATECTOMY BY RETROPERITO-NEAL TUMOR WITH HEPATIC INVASION: A CASE REPORT

Case Presentation: P.S.S., female, 43-years-old, with a significant increase in volume and abdominal pain for six months, associated with fever, chills, and weight loss of 4kg. She denies comorbidities and smoking, and no family history of neoplasms. On examination, she had a regular general condition; a globous abdomen, distended, with a palpable mass in the hypochondrium and right iliac fossa with poorly delimited contours. She had a full abdominal computed tomography scan showing an expansive pelvic-abdominal lesion measuring 19.4 × 19.9 × 15.8 cm, linked to the right hepatic lobe with signs of infiltration, suggesting neoplasia, and hypodense hepatic nodules suggesting hemangioma, unable to differentiate between primary liver tumor and contiguous hepatic infiltration. Performed an en bloc resection of the abdominal tumor with right colectomy and partial hepatectomy (segments III, IVB, V and VI). Frozen section procedure suggested hepatocellular carcinoma, whereas the pathology revealed malignant neoplasia of epithelioid, fusiform and pleomorphic cells, and liver with neoplastic infiltration. Immunohistochemistry confirmed highgrade pleomorphic spindle cell sarcoma, positive CDK4 and Vimentin, focal marking of smooth muscle actin, and may correspond to undifferentiated liposarcoma. Classified as stage T4N0M1, and currently in the second cycle of chemotherapy. Discussion: Retroperitoneal sarcomas are rare and aggressive neoplasms with presentation usually in advanced stages. They constitute up to one-third of retroperitoneal tumors, liposarcoma being the most common histological type. Undifferentiated liposarcoma and undifferentiated high-grade pleomorphic sarcoma often are located in the thigh and retroperitoneum. Vimentin, the intermediate filament-like protein, helps confirm the mesenchymal origin of the tumor. The CDK4, mutual to the differentiated and undifferentiated sarcomas, is considered a highly sensitive lipogenic marker. The principal determinant of therapeutic efficacy is the complete resection of the primary tumor; however, the clinical progression is related to the histological grade and subtype. Final considerations:It is essential for the physician to identify signs and symptoms and to know laboratory, imaging, and anatomopathological diagnostic tools. Early diagnosis provides effective treatment, and greater possibilities for a safe and efficient surgical approach, improving quality and increasing patient survival.

Publication History

Article published online:
23 October 2019