Case Report Surgical Treatment As A Choice For A Rare Anterior Mediastinal Mass: Primary Giant Mediastinal Dedifferentiated Liposarcoma

Maulidya A. Dandanah ¹, Marshal Marshal ¹, Noni N. Soeroso ², Soekimin Soekimin ³

¹ Cardiac,Thoracic and Vascular Surgery Division, Departement of Surgery Faculty of Medicine University of Sumatera Utara, University Hospital of Sumatera Utara, Medan, Indonesia; ² Department of Pulmonology and Respiratory Medicine Faculty of Medicine University of Sumatera Utara, University Hospital of Sumatera Utara, Medan, Indonesia; ³ Department of Pathology Anatomy,Faculty of Medicine University of Sumatera Utara, University Hospital of Sumatera Utara, Medan, Indonesia;

Date, time and location: 2018.05.25 15:30, Congress Hall, 2F–C

Abstract

BACKGROUND

Surgical treatment for anterior mediastinal mass are depend on the pathology and what other organ are involved.Liposarcoma is malignancy of fat cells which comprises about 1% of all malignancies, particulary found in lower extremity. Primary liposarcoma of the mediastinum is extremely rare, usually occurs in 6^th decades, commonly in the anterior mediastinum.

CASE

A 54-year-old male, admitted to emergency room with main complain shortness of breath, worsening since 3 months before admission. Chest x-ray showed homogenous consolidation in the whole left lung. Thorax CT scan with contrast revealed giant fat-containing mass with heterogenous density compressing great vessels, enhanced with contrast, with multiple calcification. Patient underwent sternotomy for tumor removal and open biopsy. The tumor was 50 x 30 cm in size, capsulated, and histopathology report along with CD-30, Vimentin and Pancytokeratin immunohistochemistry confirmed the diagnosis of dedifferentiated liposarcoma. After surgery, patient was scheduled for adjuvant chemoradiotherapy.

DISCUSSION

Dedifferentiated liposarcoma was defined as an atypical liposarcoma that progresses over time with variable histologic grade. This is essentially a low grade liposarcoma admixed with a high grade spindle cell sarcoma. These tumors tend to grow more aggressively than a low grade well differentiated liposarcoma.Mediastinal liposarcomas may extend into the pleural spaces and achieve a large size before detection. Approximately 40% of mediastinal liposarcomas recur after surgery.

CONCLUSION

Primary mediastinal liposarcoma is an extremely rare case which is quite challenging to diagnose. Treatment include surgical excision followed by radiotherapy and/or chemotherapy.