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1
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Paredes O, Eom SS, Park SH, Kim YW. Laparoscopy-assisted trans gastric wedge resection: A safe treatment for gastric pyloric liposarcoma: A case report and literature review. Heliyon 2024; 10:e30410. [PMID: 38774071 PMCID: PMC11106821 DOI: 10.1016/j.heliyon.2024.e30410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/24/2024] Open
Abstract
Background Gastric liposarcoma (GL) is extremely rare and radical surgery has been the conventional treatment, even in small tumors. Laparoscopic wedge resection has been reported worldwide for subepithelial tumors of the stomach. Case presentation The patient was an asymptomatic 63-year-old man presenting with a subepithelial gastric tumor. The esophagogastroduodenoscopy showed a 3 cm ulcerated soft tumor located in the posterior wall of the antrum just above the pylorus. Two preoperative biopsies were performed with a negative result for malignant neoplasm. Dynamic computerized tomography revealed 35 × 35 mm well-defined pyloric mass with fat density. Despite the difficult location of the tumor, function-preserving surgery was performed. Surgery was initiated by a laparoscopic approach with four trocars. After the dissection of the greater omentum, the greater curvature and the posterior wall of the stomach were exposed. A gastrostomy was performed in the anterior wall of the antrum. Due to the difficulty in identifying the tumor location, a mini-laparotomy was conducted. After assessing the pylorus and section parameters, the tumor was extracted by gastrostomy and resected with a linear stapler. The patient was discharged after five days with no complications. The histological diagnosis was a well-differentiated liposarcoma. Resection margins were clear. The tumor cells tested negative for MDM2. No adjuvant therapy was indicated. The patient is alive without recurrence. Conclusions Despite its rarity, gastric liposarcoma should be respected for differential diagnosis in submucosal tumors. The main diagnostic method is histological, and surgery is the conventional treatment without yet having a consensus. Minimally invasive wedge resection might be a suitable treatment even if the location is close to the pylorus. Multicenter studies are required to obtain better results in the management of this pathology.
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Affiliation(s)
- Oscar Paredes
- Center for Gastric Cancer, National Cancer Center, Goyang, South Korea
| | - Sang Soo Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, South Korea
| | - Sin Hye Park
- Center for Gastric Cancer, National Cancer Center, Goyang, South Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, South Korea
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea
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2
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Choi K. Laparoscopic management of a gastric liposarcoma with malignant transformation from a gastric lipoma: A rare case report. Int J Surg Case Rep 2023; 113:109039. [PMID: 37992666 DOI: 10.1016/j.ijscr.2023.109039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Liposarcoma is one of the most common mesenchymal neoplasms in adults. Among liposarcomas, gastrointestinal tract involvement is uncommon, and liposarcoma of the stomach is a particularly rare entity, In addition, few cases of gastric liposarcoma with malignant transformation from benign gastric lipoma have been reported. PRESENTATION OF CASE Here we present the case of a 62-year-old male patient who was diagnosed with gastric liposarcoma and managed with laparoscopic surgical resection. He was first diagnosed with subepithelial lipoma of the stomach 4 years ago and was under observation, but underwent laparoscopic distal gastrectomy due to malignant transformation of gastric lipoma. He has been following up for 1 year after surgery, and there are no recurrence or other complications to date. CLINICAL DISCUSSION This patient was initially diagnosed with gastric lipoma and was surgically resected after 4 years of observation to show malignant transformation. To the best of our knowledge, this case represents the first report of gastric lipoma demonstrating malignant transformation into gastric liposarcoma. CONCLUSION Gastric lipoma can be transformed into gastric liposarcoma, so if the size is large or the rate of size change is fast, surgical resection is recommended in the early state, and en-bloc resection including node dissection and reconstruction are desirable during surgery.
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Affiliation(s)
- KyeongWoon Choi
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Ilsan, Gyeonggido, Republic of Korea.
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3
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Baker WG, Albright S, Aragan T, Mederos R. Giant Dedifferentiated Gastric Liposarcoma: Largest to Date. Cureus 2023; 15:e39595. [PMID: 37384096 PMCID: PMC10295811 DOI: 10.7759/cureus.39595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 06/30/2023] Open
Abstract
Liposarcoma is one of the most common soft tissue malignancies in adults, accounting for 15% to 20% of all sarcomas. We report a case of the largest dedifferentiated gastric liposarcoma recorded to date in a patient who presented with upper gastrointestinal bleeding. Initial pathology reports indicated a benign cause even after multiple biopsies were performed; only after surgical resection was the diagnosis confirmed. We discuss histopathology, genetic markers, and differential diagnoses.
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4
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Cure HW, Gómez D, Pedraza M, Bulicie HC, Cabrera LF, Gil LPG, Acevedo D, Cabrera L, Moreno V, Mendoza A. Laparoscopic management of gastric liposarcoma: A case report and review of the literature. Int J Surg Case Rep 2020; 73:268-270. [PMID: 32721886 PMCID: PMC7388163 DOI: 10.1016/j.ijscr.2020.07.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/03/2020] [Accepted: 07/13/2020] [Indexed: 01/08/2023] Open
Abstract
Soft tissue tumors are characterized by frequent somatic chromosomal rearrangements. Symptoms include epigastric pain, nausea, anorexia, and gastrointestinal bleeding. Gastric liposarcoma is the least common sarcoma of the gastrointestinal tract. CT and pathological analysis of resected specimens enable diagnosis. The gold standard of treatment is surgery with radical resection of the tumor. Introduction Liposarcoma is one of the most common mesenchymal neoplasms in adults. Predominant locations are the retroperitoneum and limbs, it rarely occurs in the gastrointestinal tract. Gastric liposarcoma is extremely rare, with fewer than 30 cases reported around the world. Presentation of case Here we present the case of a 70-year-old female patient who was diagnosed with gastric liposarcoma and managed with laparoscopic surgical resection. The patient is currently being followed up and is alive without recurrence 12 months after the operation. Discussion Gastric liposarcoma approach requires proper diagnosis with computed tomography and endoscopy, in order to develop an adequate surgical plan. Laparoscopic en-bloc resection and gastrointestinal reconstruction is the ideal management in this type of patient. Conclusion Gastric liposarcoma is an extremely rare entity, his management consists of wide en-bloc resection with a gastrointestinal reconstruction.
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Affiliation(s)
- Hector W Cure
- Department of Neuroscience, University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel Gómez
- Department of General Surgery, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Mauricio Pedraza
- Department of General Surgery, Universidad El Bosque, Bogotá, Colombia.
| | | | - Luis Felipe Cabrera
- Department of General Surgery, Universidad El Bosque, Bogotá, Colombia; Departament of Surgery José Félix Patiño, Fundación Santa Fe de Bogotá, Universidad de los Andes, Universidad El Bosque, Colombia
| | | | - David Acevedo
- Department of General Surgery, Universidad El Bosque, Bogotá, Colombia
| | - Laura Cabrera
- Department of General Surgery, Universidad El Bosque, Bogotá, Colombia
| | - Valery Moreno
- Department of General Surgery, Universidad El Bosque, Bogotá, Colombia
| | - Andrés Mendoza
- Department of General Surgery, Universidad El Bosque, Bogotá, Colombia
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5
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Lochman P, Rejchrt S, Páral J. Proximal Gastrectomy in a Case of Giant Gastric Liposarcoma and a 5-Year Follow-Up. Case Rep Oncol 2020; 13:617-620. [PMID: 32595472 PMCID: PMC7315206 DOI: 10.1159/000507477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/22/2020] [Indexed: 12/20/2022] Open
Abstract
Even though liposarcomas account for 10–20% of all mesenchymal malignancies, they are extremely rarely located in the stomach. We report the case of a female patient with gastric liposarcoma. CT revealed a giant hypoechogenic tumour subcardially on the posterior gastric wall. Endoscopic tumour resection by piecemeal technique was done, and a lipoma was confirmed on histopathological examination. A recurrent bleeding tumour was proven 6 weeks later. The patient underwent an open proximal gastrectomy with pyloroplasty, and liposarcoma was surprisingly revealed in the resected specimen, finally. Five years later, our patient had been without recurrence or any somatic difficulties. The CT finding of a submucosal fatty tumour with heterogeneous density within the gastric wall should raise the suspicion for liposarcoma. The goal is the surgical removal of the tumour with sufficient margins ensuring R0 resection.
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Affiliation(s)
- Petr Lochman
- Department of Field Surgery, Faculty of Military Health Science, University of Defence, Hradec Králové, Czechia.,Department of Surgery, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czechia
| | - Stanislav Rejchrt
- 2nd Department of Internal Medicine - Gastroenterology, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czechia
| | - Jiří Páral
- Department of Field Surgery, Faculty of Military Health Science, University of Defence, Hradec Králové, Czechia.,Department of Surgery, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czechia
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6
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Sonoda A, Sawayama H, Miyanari N, Mizumoto T, Kubota T, Baba H. Giant myxoid liposarcoma of the stomach: Report of a case. Int J Surg Case Rep 2019; 60:234-238. [PMID: 31252381 PMCID: PMC6600042 DOI: 10.1016/j.ijscr.2019.06.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 02/07/2023] Open
Abstract
Myxoid liposarcoma of the stomach is extremely rare. The tumor in the present case was too large to confirm its origin. Imaging findings of liposarcoma vary, and few reports have described gastric liposarcoma with a huge cyst. Even for large tumors, curative resection can provide the patient a good prognosis. Introduction Liposarcoma is one of the most common soft tissue sarcomas in adults, but liposarcoma arising primarily from the stomach is very rare. Presentation of case A 56-year-old man was referred to our hospital with abdominal distension and discomfort. A computed tomography scan showed a huge mass located between the stomach and transverse colon. The preliminary differential diagnoses were sarcoma with a mucinous component, gastrointestinal stromal tumor, lymphangioma, and mesenteric cyst. Upper and lower endoscopy was not performed because the patient declined. The patient underwent surgical resection, and the tumor was completely removed. Macroscopic examination revealed a 39- × 26- × 20-cm tumor weighing 13,000 g. On histological examination, the tumor was diagnosed as a myxoid liposarcoma in the gastric submucosa. The patient was still doing well 2 years postoperatively. Discussion Preoperative diagnosis of liposarcoma of the stomach is difficult. In the present case, the tumor was very large but was able to be resected completely. Conclusion Even in patients with very large myxoid liposarcoma, curative resection can provide a good prognosis.
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Affiliation(s)
- Akari Sonoda
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Japan
| | - Hiroshi Sawayama
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Japan
| | - Nobutomo Miyanari
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Japan
| | - Takao Mizumoto
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Japan
| | - Tatsuo Kubota
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Japan.
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7
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Sullivan IW, Hota P, Dass C. Gastric lipomas: a case series and review of a rare tumor. BJR Case Rep 2019; 5:20180109. [PMID: 31501708 PMCID: PMC6726183 DOI: 10.1259/bjrcr.20180109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/07/2018] [Accepted: 12/12/2018] [Indexed: 12/17/2022] Open
Abstract
The purpose of the study was to investigate and review the multimodality imaging findings of gastric lipomas. Seven patients with gastric lipomas identified by CT imaging at a single institution between 2003 and 2017 were retrospectively evaluated. Patient demographics, clinical presentation, non-invasive imaging, endoscopic, and pathological findings were recorded.The most common location for gastric lipoma was the gastric antrum (3/7). The mean lipoma size was 2.7 cm ± 0.8 cm. Six out of seven lipomas demonstrated homogenous fat attenuation with mean Hounsfield units (HU) between -80 and -120. A single lipoma measuring -50 HU demonstrated soft tissue septations. In addition to routine CT and MRI, gastric lipomas were diagnosed on the low-dose CT protocols such as coronary calcium scoring, renal stone, and positron emission tomography-CT (PET-CT). Our CT findings corroborate those reported previously. Soft tissue septations visualized in one lesion likely represented post-biopsy changes, adding this etiology to a differential which previously included only ulceration. Cases characterized by MRI are rare in the literature, and our study provides one such example. To our knowledge this study represents the first documentation of gastric lipomas on PET-CT and other low-dose CT imaging protocols.
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Affiliation(s)
- Ian W Sullivan
- Department of Radiology, Temple University
Hospital, Philadelphia, PA, USA
| | | | - Chandra Dass
- Department of Radiology, Temple University
Hospital, Philadelphia, PA, USA
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8
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Kang WZ, Xue LY, Wang GQ, Ma FH, Feng XL, Guo L, Li Y, Li WK, Tian YT. Liposarcoma of the stomach: Report of two cases and review of the literature. World J Gastroenterol 2018; 24:2776-2784. [PMID: 29991881 PMCID: PMC6034148 DOI: 10.3748/wjg.v24.i25.2776] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 05/26/2018] [Accepted: 06/09/2018] [Indexed: 02/06/2023] Open
Abstract
Liposarcoma of the stomach is extremely rare, and only 37 cases have been reported worldwide. We herein report two cases of liposarcoma of the stomach. The first patient was referred to our hospital with upper abdominal discomfort. The endoscopic examination revealed a tumor mass about 3 cm in diameter. The patient underwent a partial gastrectomy and had an uneventful recovery. The histopathological examination revealed a well-differentiated liposarcoma. The second patient had symptoms of upper abdominal discomfort combined with nausea and anorexia. Several palpable masses were found with endoscopy. Endoscopic submucosal dissection was the treatment used, and the postoperative course was uneventful. The histopathological diagnosis was a well-differentiated liposarcoma. The two patients did not undergo any adjuvant therapy. They are both currently in good condition without recurrence. Therefore, we believe that the outcome of liposarcoma of the stomach is positive, and surgical resection may be the first choice for treatment at present.
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Affiliation(s)
- Wen-Zhe Kang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Li-Yan Xue
- Department of Pathology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Gui-Qi Wang
- Department of Endoscope, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Fu-Hai Ma
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiao-Long Feng
- Department of Pathology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Lei Guo
- Department of Pathology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yang Li
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wei-Kun Li
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yan-Tao Tian
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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9
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Girardot-Miglierina A, Clerc D, Suter M. Gastric liposarcoma in a patient with severe obesity. Ann R Coll Surg Engl 2018; 100:e88-e90. [PMID: 29484946 PMCID: PMC5958859 DOI: 10.1308/rcsann.2018.0018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2017] [Indexed: 01/11/2023] Open
Abstract
Liposarcoma is the most common soft tissue sarcoma in adults. Predominant locations are the limbs and retroperitoneum. Intra-abdominal liposarcoma represents only 2% of all cases and visceral location is exceptional. Gastric liposarcoma is extremely rare, with fewer than 20 cases reported. The treatment of choice is wide en-bloc surgical resection. If the tumour arises in the area of the cardia, resection involves resection of the proximal stomach as well as the distal oesophagus. Traditional reconstruction with oesophagogastrostomy often leads to troublesome reflux. We report a case of gastric liposarcoma arising in the gastro-oesophageal junction in a severely obese patient.
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Affiliation(s)
| | - D Clerc
- Department of Surgery, Riviera-Chablais Hospital, Monthey, Switzerland
| | - M Suter
- Department of Surgery, Riviera-Chablais Hospital, Monthey, Switzerland
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10
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Tomofuji K, Watanabe J, Ishida N, Kajiwara S. Gastric liposarcoma resected by laparoscopic total gastrectomy to achieve a wide surgical margin. BMJ Case Rep 2017; 2017:bcr-2017-221703. [PMID: 29212871 DOI: 10.1136/bcr-2017-221703] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Gastric liposarcoma is an extremely rare tumour that usually affects the extremities and retroperitoneum. Preoperative diagnosis is difficult, and operative procedures are not well standardised. A 61-year-old woman presented with melaena, epigastric discomfort and palpitations. Upper endoscopy revealed a submucosal tumour at the posterior gastric fundus with an actively bleeding ulcer on the top. Our preoperative diagnosis was lipoma, and we performed laparoscopic intragastric surgery. However, the histopathological diagnosis was liposarcoma. Laparoscopic total gastrectomy was performed to achieve a wide surgical margin. Several recent series have shown that a positive microscopic margin is associated with a higher rate of local recurrence than a negative margin. We have added a staged operation to obtain a wide margin in cases involving a positive surgical margin. Preoperative diagnosis of liposarcoma is still challenging. Gastric lipoma-like tumours should be resected with a wide margin because of their possibility of malignancy.
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Affiliation(s)
- Katsuhiro Tomofuji
- General surgery, Uwajima city hospital, Uwajima, Ehime prefecture, Japan
| | - Jota Watanabe
- General surgery, Uwajima city hospital, Uwajima, Ehime prefecture, Japan
| | - Naoki Ishida
- General surgery, Uwajima city hospital, Uwajima, Ehime prefecture, Japan
| | - Shinsuke Kajiwara
- General surgery, Uwajima city hospital, Uwajima, Ehime prefecture, Japan
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