What is the clinical evidence from this study?

Study design: Case Report. Population: Dedifferentiated liposarcoma (n=1). Intervention: Docetaxel plus gemcitabine followed by anlotinib. Primary outcome: Overall survival.

June 24, 2026Open Access

Dedifferentiated liposarcoma presenting with ascites as the initial clinical manifestation: a case report and literature review

Key Result

A 63-year-old female with dedifferentiated liposarcoma presenting with malignant ascites was diagnosed via cytopathology and MDM2 amplification, and died 26 months after treatment.

Key Points

To report a rare case of dedifferentiated liposarcoma presenting with ascites as the initial symptom.
Case report of a 63-year-old female with ascites and decreased appetite.
Ascitic smears and cell blocks identified malignant tumor cells.
Immunohistochemical staining and FISH analysis confirmed MDM2 gene amplification.
Malignant cells were detected in the peritoneal fluid, indicating DDLPS diagnosis.
FISH analysis showed clustered amplification of MDM2 gene.
The case emphasizes the importance of comprehensive testing for accurate diagnosis.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

63-year-old female patient presenting with abdominal distension and decreased appetite, diagnosed with dedifferentiated liposarcoma (DDLPS)

Intervention

Cytopathological, radiological, and molecular testing (IHC and FISH for MDM2 gene amplification)

Outcome

Accurate diagnosis of DDLPS

This case highlights the diagnostic challenge of rare sarcomas presenting with serosal effusions and emphasizes integrating cytopathological, radiological, and molecular testing for accurate diagnosis.

Limitations

Non-specific cytomorphology of malignant cells in ascites makes diagnosis challenging
Intratumoral heterogeneity may limit biopsy sampling

Abstract

Dedifferentiated liposarcoma (DDLPS) is a high-grade soft tissue sarcoma predominantly arising in the retroperitoneum, characterized by an insidious clinical course. This study reports a 63-year-old female patient who presented with abdominal distension and decreased appetite, without other systemic complaints. Malignant tumor cells were identified in both ascitic smears and cell blocks. Combined with immunohistochemical (IHC) staining, the findings were consistent with sarcoma cells. Fluorescence in situ hybridization (FISH) analysis of the tissue biopsy revealed clustered amplification of mouse double minute 2 homolog (MDM2) gene. Based on the combined results of IHC and FISH testing, the final pathological diagnosis of the tissue biopsy was DDLPS. To the best of existing knowledge, this is one of the few reported cases of DDLPS initially manifesting with malignant cells detected in peritoneal fluid. This case highlights the diagnostic challenge of rare sarcomas presenting with serosal effusions and emphasizes the importance of integrating cytopathological, radiological, and molecular testing for accurate diagnosis and optimal management. Preventing misdiagnosis of this tumor as other histological subtypes is of great clinical significance, while IHC features and FISH can provide important clues for its accurate diagnosis.

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