Retroperitoneal dedifferentiated liposarcoma – diagnostic and surgical challenges: a case report

Introduction: Primary retroperitoneal liposarcoma is a rare variety of tumors accounting for 0.07%–0.2% of all malignancies. This type of sarcoma often causes diagnostic and therapeutic challenges due to its delayed presentation and anatomical location. Though there are some oncological measures like chemotherapy and radiotherapy still persist, complete surgical resection is the mainstay of treatment. However, the recurrence rate is very high in the case of retroperitoneal sarcomas. Case presentation: A 34-year-old male patient presented to our surgery department with abdominal distension, a lumpy feeling in his upper abdomen, and a significant weight loss over the past 3 months. On examination, there was a large intraabdominal mass measuring about 20 × 15 cm in the epigastric, left hypochondriac, umbilical, and left lumber region, which was partially mobile, partly hard, and partly cystic in consistency; the surface was smooth, and the margin was regular. After diagnostic and radiological workup, our primary suspicion was, it might be a case of retroperitoneal liposarcoma. Computed tomography (CT) guided fine needle aspiration tomography (FNAC) reveals, it was a spindle cell sarcoma. However, after six cycles neoadjuvant chemotherapy, resection was performed. Complete resection (R0) was done with extraction of a soft tissue mass of 12.5 kg, followed by adjuvant chemotherapy for three cycles. No recurrence is found after 3-month follow-up. Conclusion: Though retroperitoneal sarcoma may challenge the surgeon’s skill, complete marginal clearance along with oncological consultation may delay the recurrence and improve the quality of life of the patients. However, careful and long-term follow-up is required to detect early recurrence and increase the life expectancy of the patients.