Atypical Recurrence of a Mediastinal Liposarcoma in a 80-Year-Old Female

SESSION TITLE: Pleura and Chest Wall SESSION TYPE: Case Report Poster PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM INTRODUCTION: Most liposarcomas occurred in extremities and retroperitonium and account 15-20% of all tissue malignant tumor and rarely seen in the chest wall and mediastinum. Primary mediastinal liposarcomas are a rare entity, <1% of all mediastinal tumors1. The age of patients was reported as being 20-70 years with a peak in the 5th decade and no differences between the sexes. CASE PRESENTATION: A 80 y/o f, from Trinidad, 10yrs ago underwent chest liposarcoma excision and had chemotherapy in 2005. Her dyspnea was on exertion after 1 block. PT returned to USA and had a CT Angio of Chest: Large heterogeneous 10 cm x 11cm mid/ posterior mediastinal soft tissue compressing the trachea, RT mainstem bronchus, esophagus, left atrium and brachiocephalic vein. She had a mediastinal biopsy and partial 2ndand 3rd rib resection and placement of 2 endobronchial stent in the right main bronchus. Pathology of Mediastinal biopsy: recurrent liposarcoma, sclerosing type and pleural fluid showed atypical cells. DISCUSSION: Liposarcomas are tumors that enlarge slowly with local invasion yet remain undetected since patients may be asymptomatic and diagnosed incidentally. Symptoms are due to compression of the mediastinal structures. Most malignant liposarcomas develop in the posterior mediastinum2. Therefore, our case is unique since this primary mediastinal liposarcoma invaded both middle and posterior mediastinal structures. The incidence of local recurrence depends on anatomic location, extent of resection and use of adjuvant radiotherapy. It is unlikely that her tumor was completed resected because chemotherapy treatment was given. The treatment of mediastinal liposarcoma consists of wide surgical excision. If tumor cannot be resected, surgical debulking can provide relief of compressive symptoms. In our case, the tumor had spread to left atrium and left brachiocephalic vein making the debulking impossible. Radiotherapy and chemotherapy should have been considered but they have no role in cure the disease. The histology was sclerosing liposarcoma which is composed of spindles, round cells and rarely lipoblasts3. The tumor should had lipoma like attenuation. However, her CT findings were consistent with heterogeneous non fatty tumor. This demonstrates that there was no correlation between the pathology and the radiographically characteristics of this type mediastinal tumor. CONCLUSIONS: Surgery is a favorable prognostic factor for overall survival in recurrent cases. The histological type may influence the behavior and liposarcoma prognosis. Finally, our case demostrates that radiotherapy and chemotherapy are ineffective for survival and chest imaging should be utilized for surveillance. Reference #1: Schweitzer DL, Aguam AS. Primary liposarcoma of the mediastinum. Report of case, J Thorac Cardiovasc Surg Reference #2: Mclean TR, Almassi GH. Mediastinal involvement by myxoid liposarcoma. Annals of Thorac Surg. Reference #3: Ming Chen, Jun Yang, intrathoracic liposarcoma: a clinicopathologic study and prognostic analysis DISCLOSURE: The following authors have nothing to disclose: Rosa Arancibia, Khushboo Chokshi, Samir Fahmy No Product/Research Disclosure Information