Published online Jun 14, 2018. doi: 10.3748/wjg.v24.i22.2406
Peer-review started: March 10, 2018
First decision: April 11, 2018
Revised: April 18, 2018
Accepted: April 23, 2018
Article in press: April 23, 2018
Published online: June 14, 2018
This case was diagnosed as a huge retroperitoneal liposarcoma. The tumor size was large, and the tumor numbers were many. The invasion of blood vessels by the tumor was severe. In particular, the superior mesenteric vein, which is one of the most valuable veins in abdomen, had been eroded by tumors. No similar case report has been reported previously, and the research potential is enormous.
Before the patient came to our hospital, the pathological type was confirmed in the community hospital through the Fine needle aspiration biopsy, but the detailed diagnostic information of the tumor could not be clarified further in the community hospital due to technical problems. It is very necessary to run a computed tomographic angiography (CTA) test and vascular reconstruction techniques in such patients.
Patient was diagnosed clearly, no differential diagnosis
In this case, laboratory investigations showed low albumin level and positive HcAb. Tumor markers (CA19-9, CEA, CA125) levels were normal. The transaminase levels of AST, ALT, and total bilirubin were all within the normal range, showingthat the existence of the large retroperitoneal tumor did not cause damage to the liver. There may be other ways to ensure liver function besides the superior mesenteric vein.
Abdominal and pelvic contrast-enhanced computed tomography was performed and indicated a 118*258*303 mm soft tissue mass with mixed density containing fat. Abdominal CTA showed that the mass adhered to and constricted the main trunk and branch of the superior mesenteric vein (SMV), especially the ileocolic vein, the right renal vein and the inferior vena cava. The plane parallel to the renal hilum was significantly compressed, with a slender renal vein.
The pathology test confirmed the diagnosis of well-differentiated liposarcoma.
The preferred choice of treatment was surgical removal of the liposarcoma and invaded SMV. The abdominal liposarcoma was resected. The portal vein and the splenic vein were free from the tumor. After SMV interdiction, no bowel or liver ischemia was observed, and then the SMV and liposarcoma were resected simultaneously without graft substitutes.
To the best of our knowledge, this is the first report of devascularization of the superior mesenteric vein without reconstruction applied to the resection of a retroperitoneal tumor.
We believe that this case should be reported for future reference and research. The collateral circulation may have ensured this patient’s postoperative survival. However, the actual conditions for the formation of collateral circulation still require additional examination.