Primary liposarcoma of the sigmoid presenting as colonic intussusception - A case report

Abstract

Liposarcomas are malignant soft tissue neoplasms usually located in the retroperitoneum, head, neck and extremities. Although secondary invasion of the gastrointestinal tract by retroperitoneal sarcomas is frequent, primary involvement is uncommon. We report a young patient with Crohn's disease in remission presenting with intussusception of the colon due to a primary liposarcoma of the sigmoid. Emergency resection confirmed the diagnosis. The patient remains in remission after five years. This represents the youngest diagnosis of liposarcoma to date and the first occurring in the sigmoid. We also highlight the concomitant diagnosis of Crohn´s disease.

Primary colonic liposarcomatosis: report of a case with review of literature

“…Importantly, both these cases showed evidence of a predisposing/co-morbid condition in the form of metabolic syndrome and Crohn disease under medication (azathioprine) 7 , 10. However, the case of Crohn disease did not show any disease activity at the time of surgery 7. Most of the colonic liposarcomas were reported to occur in the cecum or ascending colon similar to the index case, although both the descending colon and sigmoid also can be affected (see Table 1).…”

“…However, Rudnicki et al10 and Fernandes et al7 have described two cases occurring in young individuals. Importantly, both these cases showed evidence of a predisposing/co-morbid condition in the form of metabolic syndrome and Crohn disease under medication (azathioprine) 7 , 10. However, the case of Crohn disease did not show any disease activity at the time of surgery 7.…”

“…Most of the previously described colonic liposarcomas were solitary. The endoluminal masses may present with features of obstruction (constipation), intussusception, or hematochezia 4 , 7 , 8. In contrast, abdominal pain and/or a lump in the abdomen are the usual presentations for exophytic masses similar to the index case 1 , 6.…”

Large pedunculated colonic lipoma: a rare cause of colorectal intussusception in adults

“…They become symptomatic in 75% of cases when their size is larger than 4cm and present with non-specific symptoms such as abdominal pain, constipation, bleeding, perforation and obstruction [ 11 ]. The clinical presentation of intussusception in adults is non-specific and most cases present with a chronic or sub-acute symptoms that are suggestive of chronic constipation [ 7 , 8 , 12 ]. The acute forms are rare and represent less than 20% [ 2 ].…”

“…The duration of symptoms is longer in enteric and benign lesions than in malignant and colonic ones [ 13 ]. In our case, intussusception of the sigmoid colon into the rectum is was secondary to a colonic lipoma, however a review of the literature demonstrated that, other lesions in the sigmoid wall are more likely to cause intussusception, such as sigmoid polyp [ 11 ], a sigmoid adenocarcinoma [ 14 , 15 ] and a sigmoid liposarcoma [ 12 ].…”