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Program

Internal Medicine

Training Level

Resident PGY 1

Institution

Henry Ford Hospital

Abstract

Case Description: A 64 year-old female with history of PE on Eliquis with IVC filter placement, tobacco dependence, and class III obesity presents with abdominal discomfort and bilateral leg swelling. Physical examination showed a distended abdomen and bilateral leg edema and tenderness. Doppler ultrasound of the lower extremities showed extensive bilateral lower extremity deep vein thromboses (DVT). Patient developed oliguria and acute kidney injury, and ultrasound of the kidney was obtained. Kidney U.S. showed two large masses in the abdomen and pelvis. CT of the abdomen/pelvis demonstrated a mesenteric mass measuring up to 26 cm in the right mid-abdomen with multiple adjacent smaller masses. Patient underwent IR biopsy of the mass which showed a malignant neoplasm, with core biopsies showing spindled and epithelioid cells. Molecular studies were positive for MDM2 amplification, with focal weak staining for CD10 and inhibin. These features were indicative of a dedifferentiated liposarcoma given presence of MDM2; however, a poorly differentiated sex cord stromal tumor was also possible given weak staining by inhibin and CD10. Patient was not a surgical candidate but was a candidate for systemic chemotherapy. She received treatment with one cycle of Adriamycin, Ifosfamide, and Mesna (AIM) which was complicated by Ifosfamide-induced encephalopathy. She then received palliative radiation therapy and unfortunately passed secondary to cardiac arrest from suspected pulmonary embolism.

Discussion: Liposarcomas (LPS) are rare mesenchymal neoplasms involving the deep soft tissues. Dedifferentiated liposarcomas (DDLPS) are high-grade aggressive neoplasms typically occur in the retroperitoneum, and have six-fold the rate of local and metastatic recurrence and disease-specific mortality than that of well-differentiated liposarcomas (WDLPS). In patients with abdominal discomfort and bilateral extremity deep thromboses, a malignant process must be on the differential. DDLPS is a focal outgrowth from precursor WDLPS lesions; therefore, early detection of these tumors is key to prompt diagnosis and management.

Presentation Date

5-2020

Taking abdominal pain seriously: a case of aggressive dedifferentiated liposarcoma

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