Multiple surgical excision for recurrent primary mediastinal liposarcoma

Abstract

Liposarcoma is one of the most common soft tissue malignancies, occurring mostly in the extremities and retroperitoneal cavities, and occasionally in the mediastinum of the thoracic cavity. Here, we present a patient undergoing four operations over a period of 33 years because of repeated recurrence of mediastinal liposarcoma. A 34-year-old woman underwent her first surgery for mediastinal liposarcoma in 1986. Ten years later, a recurrent tumour was found during follow-up. The patient underwent a second operation for complete excision. The pathology was liposarcoma, partly myxoid and partly dedifferentiated. The patient remained tumour-free for 22 years, until one year ago, when a third operation was performed to resect the recurrent tumour which was myxoid liposarcoma. Unfortunately, upon computed tomography imaging three months later a fatty mass was spotted which increased rapidly in size. The patient underwent further surgery to achieve radical excision of the recurrent liposarcoma. Postoperative recovery was uneventful, and a follow-up examination showed no recurrence to date. For mediastinal liposarcoma, surgical removal is the treatment of choice. Considering that the tumour is prone to recurrence, the lesion should be removed as thoroughly as possible in the first operation. If the tumour recurs repeatedly, multiple resections are beneficial to patient survival on most occasions.

Mediastinal liposarcoma: a case report and review of the literature

“…Five patients had no recurrence during follow-up periods ranging from 10 months to 7 years [ 12 , 19 ]. However, late follow-up exceeding 10 years revealed recurrence in two patients, as reported by Lui et al and Luna-Martínez et al , respectively [ 9 , 18 ]. This indicates that adjuvant radiotherapy is essential in minimizing the risk of recurrence, although late follow-up (more than 10 years) is necessary to detect any tumor recurrence.…”

“…In our analysis of previous cases, various symptoms were identified, including difficulty in breathing, coughing, trouble swallowing, chest discomfort, hoarseness, chest pain, and palpitations. The most common symptom was dyspnea, which was observed in 15 cases [ 1 , 5 , 8 – 12 , 14 , 16 , 18 , 19 ]. These symptoms are generally non-specific and occur due to the tumor in the mediastinum exerting pressure on or invading surrounding structures [ 4 ].…”

“…Based on the literature, surgical resection is the primary intervention for all cases, underscoring its significance in treatment. Furthermore, Lui et al reported a case of a patient who suffered from recurrence thrice and underwent surgical management each time, which underscores the value of surgery even with multiple resections [ 18 ]. The utilization of adjuvant radiation therapy can boost local tumor control and decrease the likelihood of local recurrence, especially in patients with an unrespectable tumor.…”

“…Nevertheless, the utility of chemotherapy in managing ML remains a contentious topic [ 2 ]. Among the cases identified in the literature, eight patients underwent radiotherapy as an adjuvant therapy, with follow-up periods ranging from 10 months to 16 years [ 9 , 12 , 14 , 18 , 19 ]. Five patients had no recurrence during follow-up periods ranging from 10 months to 7 years [ 12 , 19 ].…”

Liposarcoma gigante mediastinal. Cirugía radical con abordaje Clamshell y manejo en la Unidad de Cuidados Críticos

“…La cirugía de los sarcomas mediastinales, u otros tumores malignos de esta localización, irán bien si la resección en la primera cirugía es R0 con márgenes de sección adecuados y en consecuencia la recurrencia esperable podría ser casi nula, a diferencia de aquellos catalogados R1 con bordes de sección comprometidos microscópicamente, quienes tendrían altas posibilidades de recurrencias. [7][8][9] Por ello, la primera cirugía es de crucial trascendencia, deberá operar un cirujano con amplia experiencia. La valoración del uso de recuperador sanguíneo para mantener buena volemia es importante.…”