Case presentation

A man aged 45 years with hypertension and hyperlipidemia presented to his primary care physician with a 3-month history of a golf ball-sized right upper back mass. Ultrasound was performed, revealing a well defined lesion with mixed echogenicity, thought to be consistent with a lipoma. Clinically, however, the mass rapidly enlarged and became painful. The patient was referred to dermatology and subsequently to a surgeon. He underwent surgery at his local institution 2 months after initial presentation.

The mass was excised in two fragments measuring 8 × 7 cm and 6 × 6 cm. Pathology revealed a high-grade pleomorphic liposarcoma (PLPS). Necrosis was observed, and the mitotic rate was 26 per 10 high-power fields. The tumor involved the margins of the piecemeal excision specimens. Computed tomography (CT) imaging of the chest, abdomen, and pelvis was notable for tiny, indeterminate pulmonary nodules and a 4.3 × 2.4 × 4.7 cm, well circumscribed area with central low density in the right posterolateral chest wall soft tissues, possibly reflecting a postoperative seroma (Figure 1A). The patient noted progressive enlargement of the operative site; therefore, repeat CT imaging of the chest was performed 3 weeks later and showed an enlarging soft tissue mass concerning for residual disease (Figure 1B). Magnetic resonance imaging (MRI) of the chest showed a 4.2 × 5.0 × 6.0 cm solid mass with enhancement and diffusion restriction contiguous with the latissimus dorsi muscle (Figure 1C,D). The patient was referred to our sarcoma specialty center and had a multidisciplinary evaluation with medical oncology, radiation oncology, and surgical oncology. Preoperative radiation therapy (RT) and surgery followed by adjuvant chemotherapy with doxorubicin and ifosfamide were recommended.

中文翻译：

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计划外非肿瘤切除术后躯干高风险局部软组织肉瘤的多学科治疗

案例展示

一名患有高血压和高脂血症的 45 岁男性向他的初级保健医生报告，他的右上背部有一个高尔夫球大小的肿块，已有 3 个月的病史。进行超声检查，发现具有混合回声的明确病变，被认为与脂肪瘤一致。然而，在临床上，肿块迅速增大并变得疼痛。该患者被转诊至皮肤科，随后转诊至外科医生。初次就诊两个月后，他在当地机构接受了手术。

将肿块切除为两个尺寸为 8 × 7 cm 和 6 × 6 cm 的碎片。病理学显示为高级别多形性脂肪肉瘤（PLPS）。观察到坏死，有丝分裂率为每10个高倍视野26个。肿瘤累及零碎切除标本的边缘。胸部、腹部和骨盆的计算机断层扫描 (CT) 成像显示微小、不确定的肺结节和右后外侧胸壁软组织中边界清楚的 4.3 × 2.4 × 4.7 厘米区域，中央低密度，可能反映了术后血清肿（图1A）。患者注意到手术部位逐渐扩大；因此，3周后再次进行胸部 CT 成像，结果显示软组织肿块不断增大，可能存在残留病灶（图 1B）。胸部磁共振成像 (MRI) 显示一个 4.2 × 5.0 × 6.0 cm 的实性肿块，与背阔肌相邻，有增强和扩散限制（图 1C、D）。该患者被转诊至我们的肉瘤专科中心，并接受了肿瘤内科、放射肿瘤科和肿瘤外科的多学科评估。建议术前放疗 (RT) 和手术，然后进行阿霉素和异环磷酰胺辅助化疗。