Myxoid liposarcoma (MLPS) is the second most common histological subtype of liposarcoma and typically affects the deep soft tissues of the lower extremities. Although local recurrence rates are relatively low, delayed recurrence and metastatic disease may occur years after initial treatment. Pathologic fractures associated with extensive femoral involvement are uncommon and represent a major reconstructive challenge. We present the case of a 62-year-old female with a history of right proximal femoral MLPS treated with radiotherapy 12 years earlier who presented with progressive right hip pain and inability to bear weight following minor trauma. Imaging studies demonstrated a basicervical pathologic fracture associated with extensive osteolytic involvement of the proximal and diaphyseal femur. Due to severe functional deterioration and extensive bone destruction, the patient underwent en bloc femoral resection, followed by reconstruction with a modular total femoral tumor prosthesis as part of a limb salvage procedure. Histopathological evaluation using hematoxylin and eosin staining demonstrated recurrent undifferentiated MLPS with medullary cavity infiltration. Immunohistochemical and cytogenetic studies were unavailable because of institutional resource limitations. At six months of follow-up, the patient remained ambulatory with cane assistance, demonstrated satisfactory pain control, stable implant positioning, and no evidence of mechanical failure. This case highlights the feasibility of limb salvage surgery with total femoral reconstruction in selected patients with recurrent MLPS presenting with pathologic fracture and extensive femoral involvement. Multidisciplinary management and individualized surgical planning remain essential to optimize oncologic and functional outcomes.
Olan-Rovirosa et al. (Tue,) studied this question.