Synchronous occurrence of small cell lung cancer and primary rectal dedifferentiated liposarcoma with osteosarcomatous differentiation: A rare case report

Abstract

Rationale: Rectal dedifferentiated liposarcoma (DDL) and DDL with osteosarcomatous differentiation both are extremely unwonted. In addition, there are no reports of simultaneous DDL with osteosarcoma differentiation with small cell lung cancer (SCLC) to date. Therefore, it is imperative to alert clinicians and pathologists to this extremely rare and instructive synchronous tumor. Patient concerns: The patient was a 63-year-old male who presented with intermittent hematochezia and a swelling in the anus. Irregular masses were found on computed tomography (CT) examinations of the chest and abdomen respectively. Diagnosis: The final diagnosis of synchronous occurrence of SCLC and primary rectal DDL with osteosarcomatous differentiation was established by radiological, histological, immunohistochemical and molecular findings. Interventions: The patient underwent a puncture biopsy of the right lung mass and a complete resection of the rectal mass. Outcomes: The patient abandoned treatment, and multiple SCLC metastases appeared multiple metastasis 8 months after the operation. In the end, he expired suddenly due to severe cerebral hemorrhage caused by brain SCLC metastasis. Lessons: DDL with osteosarcoma differentiation is infrequent, and its accurate diagnosis is based on morphology, immunohistochemistry and the necessary molecular tests. In rare cases, DDL occurs concurrently with other malignancies and and will be a challenge for pathologists and clinicians at this time. Accordingly, a comprehensive examination to identify possible synchronous tumors is very important in clinical practice.

A Rare Case of Dedifferentiated Liposarcoma with Osteosarcomatous Differentiation-Diagnostic and Therapeutic Challenges

“…In clinical practice, it is also important to have a comprehensive clinical work-up for the identification of possible synchronous tumors that may have an impact on the patient's treatment and prognosis [5].…”

“…LPSs of the gastrointestinal tract occur very rarely and can be found in the stomach, small intestine, and colon. Localization is also possible in the rectum [5]. LPSs are connected with certain mutations in adipocytes, causing the cells to begin to divide indefinitely and form a tumor mass.…”

“…Myogenic differentiation is the most common type, and the impact of myogenic differentiation on prognosis has been studied. Bone tissue formation has been reported in 0.6-29% of cases in large studies of DDL, and bone formation was most commonly described as "osteosarcoma" or "metaplastic osteogenesis" [5]. In contrast to myogenic differentiation, the clinical significance of osteogenic differentiation in DDL has not been systematically studied [9].…”