Laparoscopic resection with organ preservation of recurrent well-differentiated retroperitoneal liposarcoma in long-term disease-free survival: a case report.

Figures

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  Figure 1. Preoperative pelvic MRI showing the recurrent retroperitoneal tumor (dashed line). Axial view: The tumor is located posterior to the uterus and anterior to the rectum. Coronal view: The tumor extends horizontally across the pelvic cavity. Sagittal view: The tumor is situated between the bladder and rectum, occupying the posterior pelvic space.

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  Figure 2. Histopathological findings of the primary retroperitoneal tumor. Left: Hematoxylin and eosin (HE) staining showing spindle-shaped atypical cells with abundant collagenous stroma suggestive of WDLPS. Right: Immunohistochemical staining for p16, demonstrating diffuse nuclear and cytoplasmic positivity in tumor cells. Scale bar = 20 μm.

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  Figure 3. Preoperative pelvic MRI showing the extent and anatomical relationships of the recurrent tumor (dashed line). Axial view: The tumor is located adjacent to the rectum and vagina, abutting the pelvic sidewall (dash-dotted line), neurovascular bundle (NVB) (dotted line), pelvic nerve plexus (solid line), and right ureter. Coronal and sagittal views. The tumor is observed near the small intestine, rectum, bladder, and vaginal stump.

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  Figure 4. Comparison of surgical options based on preoperative MRI. Left (extended resection): The hypothetical resection area (dotted line) includes the tumor (dashed line), rectum, and vagina, corresponding to the multivisceral resection approach. Right (tumor resection): Planned organ-preserving resection where the tumor is delineated in yellow, and the surrounding organs are preserved.

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  Figure 5. Intraoperative laparoscopic view showing the recurrent tumor (dashed line) located at the right lateral aspect of the rectum. The tumor is closely attached to the vaginal stump and surrounded by fibrous tissue, without a clear dissection plane.

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  Figure 6. Intraoperative laparoscopic view following dissection of the tumor. The right ureter is isolated and preserved. The NVB, bladder, vagina, rectum, and inferior vesical artery are clearly identified.

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  Figure 7. Gross appearance of the resected tumor. Left: Anterior surface. Right: Posterior surface.

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  Figure 8. Histopathological findings of the resected recurrent tumor. Left (HE staining): Atypical spindle-shaped cells with hyperchromatic nuclei are observed within the fibrous stroma, consistent with WDLPS. Right (immunohistochemistry for p16): Tumor cells demonstrate diffuse nuclear and cytoplasmic positivity. Scale bar = 20 μm.