Resection of a huge mediastinal well-differentiated liposarcoma involving left thoracic cavity

Zhang, Ming; Zhang, Shao-Qin; Shi, Hao; Li, Weidong; Wei, Zhengliang

doi:10.1186/s13019-019-0965-0

Cited by 8 publications

(5 citation statements)

References 10 publications

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“…It should be mentioned that only 8 historical WDLs (6.8%) were analyzed by FISH, including 6 MDM2-amplified cases, 1 case with equivocal MDM2-FISH results, and 1 CPMnonamplified case (10,12,20,(31)(32)(33)(34). In our study, all 18 tested WDLs were 12q13-15 amplified, including 17 MDM2amplified cases and 1 FRS2-amplified/MDM2-nonamplified/ CDK4-nonamplified tumor (case 4).…”

Section: Discussionmentioning

confidence: 77%

Primary intrathoracic liposarcomas: A clinicopathologic and molecular study of 43 cases in one of the largest medical centers of China

Xie

Jing²,

Zhao³

et al. 2022

Front. Oncol.

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IntroductionPrimary intrathoracic liposarcoma is extremely rare, and most published series lack genetic analyses. The aim of our study is to better understand the clinicopathologic and genetic features of these rare lesions.Materials and methodsForty-three primary intrathoracic liposarcomas were identified and most cases were analyzed by systematic genetic studies, including fluorescence in situ hybridization (FISH), whole-exome sequencing (WES), and Sanger sequencing.ResultsThis series included 27 males and 16 females (ratios, 1.68:1) aged 24-73 years (median, 53 years). Tumors mainly occurred in the mediastinum (n=23, 53.5%), followed by pleural cavity (n=16, 37.2%) and lung (n=4, 9.3%). The study included 21 well-differentiated liposarcomas (WDLs), 19 dedifferentiated liposarcomas (DDLs), 2 myxoid pleomorphic liposarcomas (MPLs) and 1 pleomorphic liposarcoma (PL), without identification of myxoid liposarcoma. FISH analysis identified MDM2 amplification in 17 of 18 WDLs (94.4%) and all DDLs (16/16, 100.0%). The MDM2-nonamplified WDL was CDK4-nonamplified but FRS2-amplified. WES and Sanger sequencing found somatic TP53 mutation in the 2 MPLs. Follow-up information was available for 33 of 38 cases (86.8%). Thirteen patients (39.4%) showed no evidence of disease, 10 patients (30.3%) were alive with disease, and 8 patients (24.2%) died of disease. Fourteen cases developed recurrence and 1 with metastasis.ConclusionsWDL/DDL was the overwhelming subtype in this location, followed by MPL and PL. Analysis of the FRS2 gene, in combination with MDM2 and other genes of 12q13-15, may more precisely characterize WDL/DDLs. MPL is the most fatal subtype of this site. Further studies are needed to explore the role of TP53 in the pathogenesis of MPL.

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Section: Discussionmentioning

confidence: 77%

Primary intrathoracic liposarcomas: A clinicopathologic and molecular study of 43 cases in one of the largest medical centers of China

Xie

Jing²,

Zhao³

et al. 2022

Front. Oncol.

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“…Therefore, Clamshell incisions are difficult to achieve sufficient exposure in this case. It has been reported that mediastinal liposarcoma was removed through a left thoracic incision ( 8 ), but the tumor invaded the superior vena cava and pericardium in this case, so this type of incision is not suitable for fully exposing the superior vena cava and pericardium. Median sternotomy is a common approach to resecting mediastinal tumors.…”

Section: Discussionmentioning

confidence: 85%

Giant mediastinal liposarcoma resected by median sternotomy: a case report

Zhang¹,

Yimin²,

He³

et al. 2020

Transl Cancer Res TCR

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Liposarcoma is a type of common tumor in soft tissue, but liposarcoma originating in the mediastinum is rare. Here, we report a case of the anterior mediastinal liposarcoma resected by a median sternal incision and complicated with reexpansion pulmonary edema after surgery. A 68-year-old female patient with chest tightness and shortness of breath for more than 2 years, recently presents with increased chest tightness and shortness of breath, as well as right upper extremity and lower back pain. Enhanced chest CT scan showed an uneven and low-density mass in the anterior mediastinum with clear border. Most of the mass showed fat density, the anterior part of the mass was solid, and the liquid density was seen in the pericardial cavity. Surgery was performed with a median sternal incision, and part of the pericardium and the innominate vein wall were removed during the removal of the entire liposarcoma. The size of the tumor was about 20 cm × 10 cm × 8 cm. The patient developed a reexpansion pulmonary edema after the giant mediastinal liposarcoma resection, but she was discharged successfully on the 10th postoperative day with the treatment by anti-glucocorticoids and diuretics. Postoperative pathology showed welldifferentiated liposarcoma. Now within the half-year follow-up, the patient remained well and there is no sign of recurrence. Median sternotomy is considered to be a good surgical procedure for giant mediastinal liposarcomas. Attention should be given to prevent reexpansion pulmonary edema after surgery.

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“…The amplification of these two genes is accepted as a diagnostic criterion for distinguishing well-differentiated liposarcoma from lipoma which can be a diagnostic pitfall, as our presented case has shown ( 1 , 6 , 16 ). Chemoresistance and low radiosensitivity of tumors arising from mesenchymal origin favor surgical approach as the only option for radical treatment ( 17 ). Surgical resection is therefore the most common treatment strategy for mediastinal liposarcoma.…”

Section: Discussionmentioning

confidence: 99%

“…Although en bloc excision of the needle tract with the primary tumor can be performed, the evidence for improved oncologic outcomes is lacking ( 18 ). Previous case presentations have reported a variety of surgical approaches; however incision should be adopted to the location of the lesion ( 13 , 17 , 19 ). Median sternotomy represents a standard approach to anterior mediastinal tumors and can be extended to both sides in terms of hemiclamshell or clamshell incision and can be used for initiation of extracorporeal circulation if necessary ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

“…Median sternotomy represents a standard approach to anterior mediastinal tumors and can be extended to both sides in terms of hemiclamshell or clamshell incision and can be used for initiation of extracorporeal circulation if necessary ( 20 ). Extensive vascular and bronchoplastic resections and reconstructions of adjacent mediastinal organs such as the heart or esophagus are described very rarely in the literature ( 17 , 19 ). Surgical radicality is a crucial prerequisite for successful therapeutic outcome.…”

Section: Discussionmentioning

confidence: 99%

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Resection of a giant mediastinal liposarcoma by median sternotomy with vascular reconstruction—a case report

Benej,

Klikovits,

Krajc

et al. 2023

Mediastinum

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Background Primary mediastinal liposarcoma is a rare malignancy of mesenchymal origin with local aggressive biological behavior which is often diagnosed as an incidental finding without any symptoms. Chemoresistance and low radiosensitivity of these tumors favors surgical resection as the only option for radical treatment. The potential need for extended resections of adjacent structures is not uncommon and could be challenging. Only a limited number of cases with successful vascular reconstruction for the treatment of mediastinal liposarcoma has been reported so far. Case Description A 69-year-old female patient was admitted to our department with dry cough and a huge mediastinal mass for further investigation and treatment. Based on the results of preoperative examinations a mediastinal liposarcoma was suspected. The tumor was resected through median sternal incision with resection of the pericardium with subsequent mesh replacement and “ en bloc ” resection of the innominate vein with vascular graft reconstruction. The postoperative course was uneventful. Six months follow-up after surgery showed no signs of local recurrence or dissemination. Conclusions Extended resection and vascular reconstruction for the surgical treatment of primary mediastinal liposarcoma is often necessary to ensure adequate radicality and to reduce the risk of local recurrence. Therefore, these patients should be treated in high-volume centers with sufficient experience.

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Resection of a huge mediastinal well-differentiated liposarcoma involving left thoracic cavity

Cited by 8 publications

References 10 publications

Primary intrathoracic liposarcomas: A clinicopathologic and molecular study of 43 cases in one of the largest medical centers of China

Primary intrathoracic liposarcomas: A clinicopathologic and molecular study of 43 cases in one of the largest medical centers of China

Giant mediastinal liposarcoma resected by median sternotomy: a case report

Resection of a giant mediastinal liposarcoma by median sternotomy with vascular reconstruction—a case report

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