HIGH GRADE RETROPERITONEAL FIBROHYS-TIOCYTOMA: CASE REPORT

A 69-year-old man presented with a consumptive syndrome associated with abdominal pain and bulging. Abdominal tomography revealed a massive solid-cystic mass in the retroperitoneal region occupying left flank in close contact with the kidney, measuring 21.0×13.0×11.0 cm. Similar right flank mass measuring 13.0×7.0×6.0 cm and hypogastric mass in contact with ileal loops measuring 8.2×6.2×5.0 cm. The investigation was complemented by upper digestive endoscopy, which revealed a high lesion in the second duodenal portion. We opted for a surgical approach, which included left colectomy, left nephrectomy, splenectomy, body-caudal pancreatectomy, segmental enterectomies (30cm and 110cm from the Treitz angle), resection of right flank tumor and terminal transver- sostomy. Patient evolved satisfactorily and was discharged 7th postoperatively. Anatomopathological study showed results of samples as origin of high grade malignant fibrohistiocytoma and result of immunohistochemical study pt4 p n0 pM1, histological grade G3, staging 4. Patient continued outpatient follow-up at our service with the oncologic surgery and clinical oncology team , in which it was decided not to undergo chemotherapy treatment and start palliative character to the case. Retroperitoneal tumors are malignant formations of low incidence (estimated at 0.2 to 0.6% of all tumors) and with high rates of malignancy (about 85% of cases) and aggressiveness. Malignant fibrous histiocytoma is one of the retroperitoneal neoplasms belonging to the subgroup known as soft tissue sarcoma, originating from mesodermal tissues. Its most frequently reported locations are in extremities (50% of cases), retroperitoneum (40% of cases) and then head and cervical (10% of cases). A neoplasm most commonly found in males and adulthood, with unspecific and insidious systemic clinical manifestations. Usually diagnosed at an advanced stage, presenting few curative chances. In cases with treatment possibility, the combination of surgical resection with chemotherapy is indicated. The case in point is an extremely rare neoplasm, difficult to diagnose and poor in prognosis, requiring accurate diagnostic investigation and treatment as early as possible.

 

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Artikel online veröffentlicht:
23. Oktober 2019