An Intra-abdominal Space Occupying Lesion: Weighing in at 36 Pounds
Document Type
Conference Proceeding - Restricted Access
Publication Date
5-9-2025
Abstract
as are an even more uncommon sub-type of soft tissue sarcoma, making up an estimated 12-15% of all soft tissue sarcomas annually. As no current screening regimen exists for such malignancy, and they are characterized by indolent growth; many patients present with vague symptoms only after the tumor has grown large. This report presents a case of an extremely large de-differentiated intra-abdominal liposarcoma, in a patient who had not received regular health care in 40+ years.
Our patient is a 67 year-old male with no known medical history who has not routinely seen a physician since the 1980s. He presented to an OSH with respiratory distress and was transferred to Butterworth Hospital after CT Abdomen/Pelvis showed large intra-abdominal mass. Prior to hospitalization, he reported months of weakness, 40 pounds of weight loss, progressive loss of appetite, and 1 month of notable progressive abdominal distention. The symptom that brought him to the hospital, however, was shortness of breath secondary to abdominal pressure. Physical exam on admission was notable for lower extremity edema, presumed to be secondary to compression of the inferior vena cava. Primary resection was the only therapy appropriate for the patient at the time of admission due to the severity of his compressive symptoms and presumed decreased venous return to the heart.
He underwent exploratory laparotomy and radical resection of a large, myxoid appearing mass that was adherent to small bowel, omentum, bladder, and rectus sheath at the junction of rectus sheath and pubic symphysis. Urology was called into the room to place ureteral stents pre-operatively and to repair the dome of the bladder primarily when adherent tumor necessitated removal of a small, full thickness piece of bladder tissue. The mass was removed segmentally due to the myoid nature of the tissue and sent for pathologic analysis. At this time, it was measured at 16, 329 g (36 lbs). histologic analysis demonstrated a de-differentiated liposarcoma with pleomorphic lipoblasts, myogenic and myxoid features. Specimens of resected bladder peritoneum and jejunum included adherent sarcoma, however tumor margins were negative. At this time he was staged at pT4N0M0, AJCC Grade 2. After an extended stay inpatient, which included 1 week in SICU, he recovered well and was discharged to sub-acute rehab.
Intra-abdominal and retroperitoneal sarcomas continue to be challenging malignancies to treat due to high rates of local recurrence. De-differentiated liposarcoma is a particularly aggressive sarcoma subtype with a 5 year survival of only of 20-40%, most commonly due to local recurrence. This report is submitted to demonstrate a course of treatment with primary resection with curative intent for a massive intra-abdominal de-differentiated liposarcoma. His care is ongoing and future developments will be reported in the final presentation.
Recommended Citation
Morris M, Snow D, Wright P. An intra-abdominal space occupying lesion: weighing in at 36 pounds. Presented at: Research Day Corewell Health West; 2025 May 9; Grand Rapids, MI.
Comments
2025 Research Day Corewell Health West, Grand Rapids, MI, May 9, 2025. Abstract 1836