Un’appendicite acuta rivela un liposarcoma retroperitoneale: caso clinico
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Liposarcoma is the most frequent type among the retroperitoneal soft-tissues sarcomas. The characteristic aptitude of such tumors is the slowly subtle growing of a deep-located mass, often reaching huge size, causing diffuse dull abdominal pain, anorexia and weight loss. Liposarcomas can involve or compress neighboring organs but their clinical evidence rarely shows acute symptoms. We present the case of a 57-year old men admitted at the emergency with a diagnosis of acute appendicitis. Further physical examination in our division suspected a large intraabdominal mass coexisting and probably causing the acute appendicitis. The CT scan performed showed a huge retroperitoneal fatty mass occupying the right abdominal quadrants from the liver to the obturator foramen, rounding the kidney and contiguous to an abscessual collection in the right iliac fossa. Patient underwent surgery with a resection of the mass en bloc with the ileocaecal tract involved as well as the abdominal wall delimiting the appendicular abcess. Kidney parenchyma was spared. Histologic examination revealed a lipoma – like well differentiated liposarcoma. Postoperative hemorrage occurred and managed conservatively. Patient hospital stay was fourteen days. Follow-up at three months demonstrated absence of local and distant recurrence. The reported case refers to the unusual clinical presentation of a retroperitoneal liposarcoma. Surgical behaviour in facing such rare tumors should be aggressive, althought a complete resection, allowing the patient the best outcome in terms of survival and recurrence, remains sometimes a challenge.
KEY WORDS: retroperitoneal liposarcoma, acute appendicitis.