Left-sided compartmental resection of an 18 kg retroperitoneal liposarcoma: a case report

Figures

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  Figure 1. (A) Preoperative clinical photograph showing massive abdominal distension due to a large retroperitoneal tumour occupying the left abdomen and extending across the midline. (B) Coronal and sagittal section of tumour demonstrating the cranio-caudal extent of tumour. (C) The pancreas (body, tail, and neck) encased by the tumour. Left kidney and hilum also seen encased by the tumour. (D) Intraoperative photograph demonstrating a giant retroperitoneal lipomatous tumour occupying the abdominal cavity. Intraoperative view on medial rotation of the tumour with exposure of the root of the mesentery and medial tumour plane, enabling identification of major vascular structures during compartmental resection.

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  Figure 2. (A) Intraoperative photograph demonstrating the caudal-to-cranial approach during compartmental resection. The left psoas muscle is indicated by the yellow arrow, the left external iliac vein by the blue arrow, the left external iliac artery by the black arrow, and the internal iliac artery by the white arrow, illustrating exposure of major vascular structures during retroperitoneal dissection. (B) View from caudal end showed transected lower sigmoid colon marked with black arrow. Clipped left ureter marked with yellow arrow. (C) Intraoperative view following distal pancreatectomy with splenectomy. The splenic vein stump is indicated by the black arrow, the portal vein by the blue arrow, and the pancreatic stump by the white arrow, demonstrating the operative field after completion of pancreatic transection and vascular control.

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  Figure 3. Tumour bed following left-sided compartmental retroperitoneal resection demonstrating major vascular landmarks. The SMA is indicated by the pink arrow, the IVC by the blue arrow, the left renal vein stump by the yellow arrow, the left renal artery by the orange arrow, the abdominal aorta by the black arrow, the IMA stump by the green arrow, and the left hemidiaphragm by the violet arrow. IMA, inferior mesenteric artery; IVC, inferior vena cava; SMA, superior mesenteric artery.

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  Figure 4. (A) Gross specimen including the retroperitoneal tumour along with the left kidney, adrenal gland, distal pancreas, spleen, left hemicolon, psoas fascia, and peritoneal layer. (B) Haematoxylin and eosin–stained section (×20 magnification) demonstrating a well-differentiated component of liposarcoma, characterized by proliferation of oval to spindle-shaped atypical stromal cells infiltrating and splaying between mature adipocytes. (C) Immunohistochemical staining for MDM2 (×20 magnification) demonstrating strong diffuse nuclear positivity in tumour cells, supporting the diagnosis of liposarcoma. (D) Preoperative and postoperative clinical images of the abdomen demonstrating the stoma prior to closure and the following Hartman’s reversal.