Laparoscopic resection of a metastatic myxoid liposarcoma in the mesentery of the small intestine: a case report

Fumika Kamehama; Tatsuya Kinjo; Yoshihiro Miyagi; Tomonori Furugen; Takao Teruya; Tomoko Tamaki; Naoki Wada; Mitsuhisa Takatsuki

doi:10.1186/s40792-023-01715-7

Laparoscopic resection of a metastatic myxoid liposarcoma in the mesentery of the small intestine: a case report

Surg Case Rep. 2023 Jul 21;9(1):133. doi: 10.1186/s40792-023-01715-7.

Authors

Fumika Kamehama¹, Tatsuya Kinjo², Yoshihiro Miyagi¹, Tomonori Furugen³, Takao Teruya³, Tomoko Tamaki⁴, Naoki Wada⁴, Mitsuhisa Takatsuki¹

Affiliations

¹ Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
² Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan. t-kinjo@med.u-ryukyu.ac.jp.
³ Department of Thoracic and Cardiovascular Surgery, University Hospital of The Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
⁴ Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.

Abstract

Background: Myxoid liposarcoma (MLS), with its risk factors, tends to spread to the lungs and extraperitoneally, with intraperitoneal metastases occurring rarely. We present an unusual case of a myxoid liposarcoma that metastasized to the abdominal organs.

Case presentation: A 60-year-old female patient was referred to our hospital for the evaluation of a right upper limb tumor that had been growing for 7 years. The patient refused surgery, and during follow-up, tumor hemorrhage resulted in hemorrhagic shock. The patient's right upper limb was immediately amputated. MLS was diagnosed histopathologically. Subsequently, the patient underwent adjuvant chemotherapy. Computed tomography (CT) revealed a right buttock mass, a pelvic mass, and left cardiophrenic angle lymph nodes 3 years after the initial surgery. Contrast-enhanced abdominal CT revealed a relatively low-density, lobulated pelvic tumor. Contrast-enhanced pelvic magnetic resonance imaging (MRI) revealed a low-intensity, lobulated mass on T1-weighted images and a high-intensity mass on T2-weighted images. The pelvic mass showed no significant fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET)-CT. On clinical examination, gynecological malignancies were ruled out as the origin of the pelvic lesions. After resection of the right buttock mass, pelvic mass, and left cardiophrenic angle lymph nodes, the patient underwent laparoscopic surgery for a preoperative diagnosis of small intestinal mesenteric metastasis of MLS. A tumor was found in the mesentery of the small intestine and removed with a margin of 5 cm on both the proximal and distal sides. The specimen measured 10 × 8 × 5 cm and contained a multifocal mass. The tumor was found in the mesentery of the small intestine, with no mucosal or submucosal invasion. The patient was diagnosed with MLS with small mesenteric intestinal metastases. On postoperative day 8, the patient was discharged after an uneventful postoperative course. Twelve months after the surgery, there was no evidence of local or distant recurrence.

Conclusions: Small intestinal mesenteric metastases of MLSs are rare. Moreover, there are few reports on laparoscopic resection. In this case, the laparoscopic approach was useful in detecting the tumor location and determining the range of resection.

Keywords: Distant metastases; Laparoscopic resection; Myxoid liposarcoma; Small intestinal mesentery.