PMC503399_01
CT appearance at multiple cuts (A - E) of a huge retroperitoneal mass with lipomatous and nonlipomatous components. The nonlipomatous component (arrow X, Panel D) contains calcific elements. Note the posterior extension of the lipomatous component (arrow Y, Panel D), which extends superiorly (Panels A - C). The exact boundaries of this component are difficult to appreciate on CT.
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F1
Computed tomographic (CT) scan revealed a large, heterogeneous lobulated mass occupying most of the abdomen (Figure 1). This was not fully appreciated preoperatively, as that component of the tumor was so much less conspicuous on CT than the rest of the tumor, given its fatty consistency (Figure 1E).
Operative exposure of the tumor through a T-type abdominal incision.
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F2
Resection was accomplished through a T-type incision (Figure 2), and entailed removal of the right kidney, terminal ileum, ascending colon, sigmoid colon and the left spermatic cord structures, all of which were intimately attached to the mass.
En bloc resection specimen of heterogeneous tumor with attached organs. Note the lipomatous regions (A), the calcified areas (B), and the remaining nonlipomatous component (C).
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F3
The tumor was submitted for histological examination in two parts measuring, 30.0 x 10.0 x 6.5 cm and 32.0 x 20.0 x 10.0 cm, weighing 19.8 kg in total (Figure 3).
Histologic appearance of various elements of the tumor as sampled in different regions. A. Well differentiated liposarcoma. B. Low grade spindle cell component. C. Cellular spindle cell component. D. Chondrosarcomatous component.
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F4
Microscopic examination revealed a juxtaposition of well differentiated liposarcoma and a spindle cell sarcoma with heterologous chondrosarcomatous elements consistent with a dedifferentiated liposarcoma (Figure 4).
CT appearance at multiple cuts (A - D) of the recurrent tumor. The recurrence was more homogeneous than the primary tumor, consisting almost completely of the calcific component of the nonlipomatous portion of the tumor.
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F5
Four months after resection the patient had a follow-up CT scan, which demonstrated an intra-abdominal recurrence consisting almost completely of a calcified, nonlipomatous tumor (Figure 5).