CASE 8676 Published on 09.08.2010

Multiple metastases from liposarcoma

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

D'Errico L, Caproni G, Laliscia C, Bemi P, Sighieri E, Mantarro A, Caramella D, Bartolozzi C.

Patient

75 years, female

Clinical History
A 75 year old female patient with a history of mastectomy and chemotherapy for breast cancer, hypertension, saphenectomy for thrombosis, presented at our hospital for a nodule in the right groin detected after a self-palpation.
Imaging Findings
The patient underwent US that confirmed a lesion. A needle biopsy proved a malignant spindle cells neoplasia, with immunoreaction for actin and calponin and proliferative activity (monoclonal Mib-1) of 15-20%, compatible to pleomorphic liposarcoma.
Abdominal and chest CT demonstrated morphology and extension of the soft tissue mass and lung involvement (Fig.1). Laboratory tests were normal. She underwent three cycles of chemotherapy and surgical resection of the liposarcoma.
After one year she reported pain in the left eye and a CT evaluation was required. More lesions with the same characteristics of the primary tumour were seen in the left IX rib and at the sphenoidal, pericardial and perineal levels. The dimensions of the pulmonary metastases were increased (Fig.2).
She was treated with radiotherapy to the rib and the skull.
In the following months, she developed a diffuse metastatic involvement. CT demonstrated further lesions in the IV hepatic segment, quadratus lumborum, renal parenchyma and capsula (Fig.3).
Brain MR showed stability of the sphenoidal and cavernous sinusal metastasis, as result of radiotherapy. However, two nodules were seen in the diploe and in the skin of the right parietal bone (Fig.4).
She presented respiratory difficulties and pain in the left lateral thorax wall. The lung involvement appeared diffuse to a CT. All lesions in the liver, in the pericardium, and the rib and perineal region increased. More metastases were observed in renal parenchyma, capsula and fascia and pararenal space. New localizations of disease were visible in the supraspinous and infraspinous muscles (Fig.5).
She is being treated with analgesic therapy.
Discussion
Liposarcoma is the most common soft tissue sarcoma and may develop anywhere, but predominantly in the retroperitoneum and the soft tissues. The tumour grows slowly and the symptoms often appear late. Distant metastases are rare, while local recurrence is usually more frequent and often shows even more aggressive behaviour than primitive disease with a higher tendency to penetrate into adjacent organs. Distant metastases generally are found in the lung, sometimes in the extrapulmonary tissue, such as the retroperitoneum, abdominal wall, pleura, diaphragm, breast and colon; however, metastases to the serosa of pericardium and of the kidneys are rare.
Liposarcoma displays light-microscopic evidence of fatty differentiation in the form of lipoblasts. This tumour can be distinguished into three main categories on the basis of distinct clinicopathologic and cytogenetic features: well-differentiated/dedifferentiated liposarcoma, myxoid/round cell liposarcoma, and pleomorphic liposarcoma (PLS).
PLS is the rarest subtype of liposarcoma, accounts for only about 5% of all liposarcomas and is distinguished from other high-grade sarcomas by the presence of pleomorphic lipoblasts. It is generally considered to be a high-grade sarcoma given its high rate of recurrence and metastasis. This tumour has a wide range of histologic appearances, but no clinical or pathologic feature appears to be predictive of a more aggressive clinical course.
Differential Diagnosis List
Multiple metastases of liposarcoma, with favourite involvement of serosa.
Final Diagnosis
Multiple metastases of liposarcoma, with favourite involvement of serosa.
Case information
URL: https://www.eurorad.org/case/8676
DOI: 10.1594/EURORAD/CASE.8676
ISSN: 1563-4086