A 61-year old male with PMH significant for gastric bypass, anxiety/depression, and previous alcohol abuse, presented to the ED with 10-day history of SOB and abdominal distention. He endorsed difficu..
A 61-year old male with PMH significant for gastric bypass, anxiety/depression, and previous alcohol abuse, presented to the ED with 10-day history of SOB and abdominal distention. He endorsed difficulty taking deep breaths, urinating, and bowel movements. He denied any unexplained weight loss, night sweats, or history of ascites. Physical exam revealed abdominal distension and tenderness. Hepatitis screen, AFP, CEA, and CA19-9 were negative. AST, ALT, total bilirubin, and alkaline phosphatase were all WNL. CT imaging demonstrated pleural effusion with atelectasis, large amounts of ascites with mesenteric stranding, and a 7cm mass of unknown etiology adjacent/medial to the liver. CT-guided biopsy of the perihepatic mass was consistent with well-differentiated liposarcoma. IR-guided biopsy of the omental mass demonstrated de-differentiated liposarcoma, FNCLCC grade 2. Colonoscopy to assess second primary tumor found three polyps demonstrating tubular adenoma. The patient was diagnosed metastatic primary liposarcoma of the liver. Soft tissue sarcomas comprise ~1% of all malignancies in adults. The majority of these arise from primary soft tissue, with bone as the next closest site of involvement. Liposarcomas are a subclass of soft-tissue sarcomas, arising from precursor adipocytes. Their primary focus is in the retroperitoneum and extremities. A liposarcoma with primary involvement of the liver is very rare. If the liver is involved it is usually from distant metastasis rather than a primary focus, though that is also rare. With only about a dozen cases of primary liver liposarcoma reported in the literature, the knowledge of the clinical course, management, and prognosis are limited.