Retroperitoneal Liposarcoma

retroperitoneal liposarcoma

Retroperitoneal liposarcomas are slow growing tumours that displace, rather than infiltrate surrounding tissue and rarely metastasize. They may attain enormous size, especially when they originate in the clinically silent retroperitoneum.

They occur at any age, but the majority occur in the 40-60 year age group. There is a strict male predominance. They are the most common primary malignant retroperitoneal tumour.

Histopathology: Stout’s system of histopathologic classification is most commonly used:
Stout’s Type I:Well differentiated myxoid type. These rarely metastasize but recur locally after inadequate excision, and have a more favorable prognosis.
Type II: Poorly differentiated myxoid type. These are clinically more malignant, recur frequently, and may metastasize. Their prognosis is less favorable.
Type III: Round cell or adenoid type. These pursue an aggressive clinical course and frequently metastasize. Their prognosis is poor.
Type IV: Mixed group. These pursue an aggressive clinical course and frequently metastasize. Their prognosis is poor.

Treatment: Radical excisional surgery based on anatomic location, size and local spread is the treatment of choice. In the retroperitoneum, the major dangers in resection are injury to mesenteric vessels, the aorta, the inferior vena cava and the renal vessels. The mortality rate of resection of retroperitoneal liposarcomas ranges from 12% to 36%. Radiation therapy has been used for incomplete resections, local recurrences, inoperable primary tumours and metastatic disease.

References:
Binder SC, Katz B, Sheridan B. Retroperitoneal Liposarcoma. Ann. Surg; 1978, 187(3): 257-261.
Dahnert W. Radiology Review Manual. 5th edition. Lippincott, Williams & Wilkins 2003.

Credit: Dr Glenys Da Costa