Case 49 – History

 

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Case 49

Dedifferentiated liposarcoma status post resection


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Brief presenting history

 
The patient was an obese, middle-aged Caucasian man who presented with one month of abdominal pain and swelling, and left testicular pain.

The patient’s presenting weight was approximately 300 lbs.

Abdominal CT scan showed a large left retroperitoneal mass measuring 23 x 18 x 21 cm.

Biopsy diagnosis was dedifferentiated liposarcoma.

 

Initial course.

 
Over the next month, the patient developed decreased appetite and approximately 30 lb. weight loss.

 

Surgery and immediate posteperative course

 
The patient underwent operative resection approximately 2 months after diagnosis.

The surgery and immediate post-operative period were unremarkable.

 

Post-operative course (continued)

 
The patient developed abdominal swelling and inability to defecate.

He was noted to have bowel dilatation, radiographically.

He was then found to have bilateral pulmonary embolism and was transferred to the ICU.

 

Death

 
Repeat radiographic studies were concerning for recurrent tumor.

The patient was admitted to hospice, then transferred home where he died.

The time between initial diagnosis and death was approximately 6 months.

Next: External exam

Discussion Questions


1. What is a dedifferentiated liposarcoma?
 
2. How do you interpret the history?
 
3. What postoperative complications did the patient have?
 
4. What could have caused each of the complications?
 
5. Sort through the timing of the complications. What does the timing tell you about the possible causes of each complication?