Jaideep Kumar Trivedi
Apollo hospitals india
Title: Successful excision of large mediastinal liposarcoma with bilateral thoracic extension
Biography
Biography: Jaideep Kumar Trivedi
Abstract
Liposarcoma is a malignant mesenchymal neoplasm, which is commonly seen in extremities and in retroperitoneum. The mediastinal location is extremely rare for this tumour, with the occurrence of pleomorphic variety of Liposarcoma being even rarer. We report a case of giant Pleomorphic liposarcoma in anterior mediastium extending into hemithorax on both sides innolving diaphragm, pericardium, anterior chest wall and compressing heart and both lungs which was successfully managed by complete surgical excision..
Case report:
A 39 year old male patient came to the outpatient department with progressively increasing breathlessness, chest discomfort, malaise and fatigue of 3 months duration.The radiograph of chest showed large ill defined radiodense opacity, centered at
mediastinum and extending into hemithorax on both sides.Patient was investigated CT scan ,MRI was done and surgery was planned. Surgery in a mass with such a extensive size
and invasion and maintenance of ventilation with such a limited capacity of lungs was a
big challenge for us. Surgical exploration was done by mid sternotomy and the mass was just below the sternum involving whole of the substernal space and pushing the heart downwards. Pericardium was opened from below, pericardectomy was done and plane of dissection was created. Mass was successfully excised in toto along with pericardium. The total dimensions of the mass measured 34x26x17cm, weighing 4Kg. Both lungs got nicely inflated ,patient was overnight ventilated and extubated next morning.Postop recovery was uneventful and patient was discharged on day5.Pathological examination of the surgical specimen suggested
Pleomorphic liposarcoma. Patient was given adjuvant chemotherapy. No evidence of
recurrence after 6 months.
Conclusion:Mediastinal liposarcomas constitute a very rare variety of mediastinal tumours. Surgical removal is the optimal treatment for a mediastinal liposarcoma, as in other sites. If the entire tumor cannot be resected, surgical debulking often results in symptomatic relief.
Radiotherapy and chemotherapy may be added as adjuncts to surgical excision but liposarcomas seem to have low sensitivity. Recurrence is common in deep-seated liposarcomas and it becomes apparent within the first 6 months in most cases.Recurrence is related to the incomplete excision and tumor tissue left behind at the time of surgery. Hence complete surgical excision and close follow-up is recommended.