Liposarcoma: A ‘Beer Belly’ in Disguise

Figures

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  Figure 1. Scout computed tomography of the abdomen without contrast. The patient had a large abdomen relative to the body habitus.

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  Figure 2. Initial computed tomography imaging without contrast in the emergency department results showed a 32 cm incidental lipomatous lesion of the left hemiabdomen with mass effect on the bowel and with mild soft tissue compartment in the axial (red circle in A), sagittal (red circle in B), and coronal planes (red circle in C).

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  Figure 3. Initial coronal computed tomography without contrast imaging depicted a left kidney displaced transversely due to the lipomatous mass (red circle in A). Not shown: the left ureter was largely deviated to the right hemiabdomen at its upper portion due to the mass and returned to the left hemiabdomen at the renal pelvis. Other computed tomography image findings depicted the mass pushing the left colon into the right hemiabdomen (red circles in B, C). All organ structures involved (left kidney, left ureter, colon, aorta) were viable throughout the patient’s hospital stay.

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  Figure 4. Computed tomography angiography with intravenous contrast depicted a large lipomatous abdominal mass extending from the upper abdomen to the pelvis and measured approximately 32 cm, in the axial (A), sagittal (B), and coronal planes (C). Internal septations were noted. Arterial supply appeared to be originating from the inferior mesenteric artery and a secondary branch was noted on the infrarenal abdominal aorta (red circles). Venous drainage appeared to be via the inferior mesenteric vein.

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  Figure 5. Gross images of the well-circumscribed, soft, fatty, 30 cm × 32 cm × 15 cm mass obtained intraoperatively. The total weight was 8150 grams.

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  Figure 6. Histological imaging depicted that liposarcoma is made of well-differentiated adipose tissue with scattered atypical cells with hyperchromatic nuclei (black arrows). Original magnification was ×200, histological stain used was hematoxylin and eosin.

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  Figure 7. High magnification of histologic image from previous figure depicting atypical cells (×400 magnification, with hematoxylin and eosin stain).