Progressive dyspnea in patient with large mediastinal mass

Abstract

Liposarcoma occurs very rarely in the mediastinum. Patients often remain asymptomatic until it grows large enough to cause direct invasion or compression of adjacent organs. We report a case of a 77-year-old male presented with dyspnea of exertion and was found to have a large mediastinal mass which was eventually diagnosed as primary mediastinal well-differentiated liposarcoma. The limited respiratory function at the initial presentation prompted phrenic nerve preserving incomplete resection rather than radical removal of the adjacent mediastinal structures. After surgical removal, the recurrence for well-differentiated mediastinal liposarcomas in the mediastinum is unknown; therefore, close follow-up is crucial.

Primary Pleural Schwannoma as Incidental Findings: An Unusual Case Report

“…Schwannomas grow slowly and, since they are generally asymptomatic, other differential diagnoses cannot be considered; however, larger tumours may compromise adjacent structures and cause cough, dyspnoea, and chest pain. 7,8 Therefore, the vast majority of pleural schwannomas are discovered incidentally during investigations for other complaints. 9 Unfortunately, plain radiographs are not specific enough, which is why MRI or CT scans can be used as diagnostic tools as well, to clarify the differential diagnosis between solitary pleural lesions, such as lipomas, liposarcomas, haemangiomas, elastofibromas, single metastatic lesions, mesotheliomas, fibrous tumours, and other neurogenic tumours.…”

Giant Atypical Lipomatous Tumor of Posterior Mediastinum In Adolescent ：A Case Study and the Literature Review​

“…From related literature reports, we can nd a consistent conclusion that the complete surgical resection is the best method for the eradication of tumors.Yan [5] pointed out that patients with tumor located under the skin can be cured after complete resection of the tumor, while those with tumor located in the deep part are prone to recurrence because the tumor cannot be completely removed. Therefore, Fukuhara S et al [6] proposed that the surgical procedures for liposarcoma can be intralesional (within the tumor mass, often leaving gross tumor), marginal (through the surrounding brous membrane, often leaving microscopic foci of tumor), wide (outside the membrane and compartment, leaving no tumor other than "skip metastases"), and radical (most often involving the entire limb and including the entire compartment in which the tumor was located). Since the posterior mediastinal liposarcoma tissue is usually adjacent to important organs such as the heart, aorta, lung, superior vena cava, phrenic nerve, and diaphragm, the marginal surgery can be the target of surgical intervention, which is more reasonable.…”

Incidental dedifferentiated mediastinal liposarcoma on F-18-fluciclovine PET/CT

“…Lipomas are often homogeneous, fat-containing masses, however, lipomas within the mediastinum are extremely rare and, similar to the retroperitoneum, are presumed to be liposarcoma until biopsy is obtained [2,15]. Thickened septations and large soft tissue nodular components suggest a diagnosis of liposarcoma over a lipoma though imaging and gross examination often cannot distinguish between the two [16]. Mediastinal lipomatosis is a benign condition associated with corticosteroid use and obesity that results in excessive mediastinal fat deposition leading to mediastinal widening and displacement of the aorticopulmonary reflection on chest radiography.…”

“…On gross examination, mediastinal liposarcoma is typically a multilobulated mass with discrete lipomatous areas mixed with discrete solid, and possibly necrotic, components [1]. Similar to liposarcomas found elsewhere in the body, there are several pathologic subtypes with various degrees of cell differentiation including well-differentiated, myxoid, pleomorphic, and dedifferentiated [7,16]. A key histopathologic tool used to characterize liposarcomas in general is amplification of MDM2 on FISH [19].…”

“…Miura et al described local tumor recurrence as recurrent mediastinal soft tissue in three out of five cases of dedifferentiated liposarcomas on an average of 35 months' time despite initial complete surgical resection [9]. Radiation therapy following recurrence of mediastinal liposarcoma has been effective in a few cases, however, the effectiveness of radiation or chemotherapy is unknown given the limited number mediastinal liposarcoma cases [9,16].…”