Retroperitoneal Dedifferentiated Liposarcoma With Penetrating Abscess Formation Secondary to Ileal Invasion: A Case Report

TL;DR

A rare case of dedifferentiated liposarcoma invading the intestine and causing abscesses is reported, highlighting diagnostic and treatment challenges.

Contribution

The paper presents a rare clinical case of intestinal invasion by dedifferentiated liposarcoma and discusses management strategies.

Findings

Dedifferentiated liposarcoma can cause intestinal perforation and abscess formation, which is extremely rare.

Complete tumor resection is challenging, requiring a balance between infection control and curative intent.

Multidisciplinary management is essential for recurrence and long-term patient outcomes.

Abstract

Liposarcoma is a relatively common malignant soft tissue tumor in adults. Dedifferentiated liposarcoma (DLS) is a particularly invasive subtype characterized by high recurrence rates and a poor prognosis. We describe a case of a retroperitoneal liposarcoma with poor differentiation that presented with peritonitis accompanied by ileal infiltration and perforating abscess formation. A 77‐year‐old male presented to our hospital with abdominal pain and fever. Computed tomography revealed a 13 cm tumor in the right lower abdomen with internal air density. An ileocecal resection was performed. Histopathological examination revealed a solid proliferation of spindle‐shaped atypical cells. Immunohistochemical results were positive for MDM2 and negative for CD34 and c‐kit. Fluorescence in situ hybridization confirmed MDM2 amplification, leading to a diagnosis of dedifferentiated liposarcoma. The postoperative course was initially favorable; however, 6 months later, a penetrating abscess recurred and progressed to an enterocutaneous fistula. Intestinal penetration by dedifferentiated liposarcomas is extremely rare. This case highlights the challenges of preoperative diagnosis, the importance of surgical strategies that balance infection control with curative resection, and the need for multidisciplinary management of recurrence.

Dedifferentiated liposarcomas with intestinal invasion and abscess formation are rare. Preoperative pathological diagnosis remains challenging, requiring biopsy confirmation. When complete resection is unfeasible, prioritizing diagnosis and complication avoidance over incomplete resection enables a smooth transition to postoperative multidisciplinary treatment, preserving patient activities of daily living.

Figures