SESSION TYPE: Cancer Case Report Posters II
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Liposarcoma is an uncommon and poorly recognized soft-tissue tumor that exhibits a strong tendency to metastasize to the lungs. We describe an unusual case of a young patient presenting with progressive symptoms associated with metastatic liposarcoma involving the lungs and mediastinum.
CASE PRESENTATION: A 38-year-old male—visiting from Armenia—with an extensive tobacco history presented with a 6-month history of dry cough and weight loss, and 2-days of scant hemoptysis. Physical examination was notable for multiple large subcutaneous masses in the left anterior chest wall and left gluteal regions. The patient had noted these masses for about one year, but only recently had observed a rapid change in their size. Chest roentgenography showed a large well-defined mass in the right hilum and multiple nodules in the left mid-lung field. Chest computed tomography (CT) was notable for a large subcarinal and right hilar mass encasing the bronchus intermedius, and multiple bilateral random pulmonary nodules with associated feeding vessels (image 1). Abdominal CT demonstrated numerous large subcutaneous masses—most notably in the left upper quadrant abdominal wall and left gluteal wall. Ultrasound-guided fine needle aspiration of the left gluteal mass revealed primitive round cells with vacuolated cytoplasm and round hyperchromatic nuclei without intranuclear inclusions, pigments and/or nucleoli (image 2). Immunohistochemistry with S-100 stain was diffusely positive in the cytoplasm and nuclei. Although malignant melanoma was strongly considered, the absence of Melan A, HMB 45 and E- cadherin staining made it extremely unlikely. Therefore, a diagnosis of dedifferentiated liposarcoma with pulmonary and mediastinal/hilar metastasis was established. The confirmed histological diagnosis obviated the immediate need for bronchoscopy. However, it was felt that the patient would ultimately benefit from airway inspection with additional histological sampling— and possibly endoscopic intervention—upon his return to Armenia.
DISCUSSION: Liposarcomas are soft-tissue tumors which are highly prone to distant metastasis, especially in cases where the tumor is poorly differentiated. The lung is common site for metastatic disease; however, the concomitant finding of mediastinal and hilar metastasis is exceedingly rare. Histological distinction of such tumors, relative to more common ones such as malignant melanoma, can represent a diagnostic conundrum.
CONCLUSIONS: Liposarcomas are aggressive tumors that need to be recognized and treated promptly in order reduce the risk of ensuing distant metastatic disease.
1) Billingsley KG, Burt ME, Jara E, Ginsberg RJ et al. Pulmonary metastases from soft tissue sarcoma: analysis of patterns of diseases and postmetastasis survival. Ann Surg 1999;229:602-10
DISCLOSURE: The following authors have nothing to disclose: Maryum Merchant, Chisa Aoyama, Nader Kamangar
No Product/Research Disclosure InformationOlive View-UCLA Medical Center; UCLA David Geffen School of Medicine, Los Angeles, CA