Primary small bowel mesentery de-differentiated liposarcoma causing torsion with no recurrence for 5 years: A case report and review of the literature.
Primary small bowel mesentery de-differentiated liposarcoma causing torsion with no recurrence for 5 years: A case report and review of the literature.
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DOI：
10.1097/md.0000000000013446
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发表时间：
2018-11
期刊：
影响因子：
1.6
通讯作者：
Uchiyama K
中科院分区：
文献类型：
--
作者：
Matsuo K;Inoue M;Shirai Y;Kataoka T;Kagota S;Taniguchi K;Lee SW;Uchiyama K
脂肪肉瘤是一种罕见的恶性软组织肿瘤。LPS的管理相对困难，因为没有特征性症状或生物标志物，也没有任何既定的有效治疗。因此，报告每个LPS病例的累积是必要的。我们经历了一个极其罕见的情况下扭转引起的原发性小肠系膜脂多糖。一位70岁男性患者因腹痛和突然呕吐来我院就诊。未触及肿块，肿瘤标志物检测在正常范围内。然而，计算机断层扫描显示，由于LPS肿瘤引起的小肠扭转引起肠梗阻。在使用肠梗阻导管进行肠梗阻减压后，迅速进行了手术治疗。扭转被发现是由肿瘤，起源于小肠肠系膜。肿瘤与部分小肠一起被沿着切除。组织病理学检查发现不同大小的脂肪组织生长，并含有非典型细胞。此外，免疫组化检查导致MDM 2、CDK 4和p16 INK 4的阳性免疫反应，这表明肿瘤是去分化的LPS。患者于术后第14天出院，无任何并发症，术后5年未观察到肿瘤复发。肠扭转的鉴别诊断中应考虑LPS，由于复发的可能性很高，因此需要仔细处理。应仔细随访患者至少5年，并需要进一步积累数据，以建立适当的LPS管理。
Liposarcoma (LPS) is a rare malignant soft-tissue tumor. Management of LPS is relatively difficult, because there are no characteristic symptoms, or biomarkers, nor any established effective treatment. Hence, the report of the accumulation of each LPS case is necessary. We experienced an extremely rare case of torsion caused by a primary small bowel mesentery LPS. A 70-year-old male consulted our hospital with the complaints of abdominal pain and sudden vomiting. No lump could be palpated, and tumor markers tested were within normal limits. However, computed tomography revealed an intestinal obstruction caused by torsion of the small bowel due to an LPS tumor. After decompression of the intestinal obstruction by use of an ileus tube, surgical treatment was performed with rapidity. The torsion was found to be caused by the tumor that originated from the small bowel mesentery. The tumor was resected along with a portion of the small bowel. The growth of adipose tissues of various sizes and containing atypical cells was detected by histopathological examination. Also, immunohistochemical examination resulted in positive immuno-reactions for MDM2, CDK4, and p16INK4, which indicated the tumor to be a de-differentiated LPS. The patient was discharged on postoperative day 14 without any complications, and no recurrence of the tumor was observed at 5 years after the operation. LPS should be considered in differential diagnosis of bowel torsion, and careful management is required because of the high possibility of recurrence. Patients should be followed carefully for at least 5 years, and further accumulation of data will be required in order to establish the appropriate management of LPS.