Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2018; 6(12): 548-553
Published online Oct 26, 2018. doi: 10.12998/wjcc.v6.i12.548
Atypical lipomatous tumor in the ligamentum teres of liver: A case report and review of the literature
Daisuke Usuda, Kento Takeshima, Ryusho Sangen, Kisuke Nakamura, Kei Hayashi, Hideyuki Okamura, Yasuhiro Kawai, Yuji Kasamaki, Yoshitsugu Iinuma, Hitoshi Saito, Tsugiyasu Kanda, Sachio Urashima
Daisuke Usuda, Kento Takeshima, Ryusho Sangen, Yuji Kasamaki, Tsugiyasu Kanda, Department of Community Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi, Toyama-ken 935-8531, Japan
Daisuke Usuda, Yasuhiro Kawai, Yoshitsugu Iinuma, Department of Infectious Diseases, Kanazawa Medical University, Uchinada-machi, Ishikawa-ken 920-0293, Japan
Kisuke Nakamura, Kei Hayashi, Hitoshi Saito, Department of General and Digestive Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi-shi, Toyama-ken 935-8531, Japan
Hideyuki Okamura, Sachio Urashima, Department of Gastroenterology, Kanazawa Medical University Himi Municipal Hospital, Himi-shi, Toyama-ken 935-8531, Japan
Author contributions: Usuda D collected the case data, prepared the photos, and wrote the manuscript; all authors proofread the pathologic materials; Takeshima K, Sangen R, Nakamura K, Hayashi K, Okamura H, Kawai Y, Kasamaki Y, Iinuma Y, Saito H, Kanda T and Urashima S proofread and revised the manuscript; all authors approved the final version to be published.
Informed consent statement: Both written and verbal informed consents were obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Daisuke Usuda, MD, MTM, PhD, Department of Infectious Diseases, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa-ken 920-0293, Japan. united19771108@yahoo.co.jp
Telephone: +81-76-2188452 Fax: +81-76-2188453
Received: June 11, 2018
Peer-review started: June 11, 2018
First decision: June 20, 2018
Revised: July 11, 2018
Accepted: August 11, 2018
Article in press: August 12, 2018
Published online: October 26, 2018
Processing time: 139 Days and 2.2 Hours
Abstract

A 61-year-old male was referred to our hospital with a three-month history of persistent epigastralgia and right hypochondralgia. Initial examination revealed a fist-size mass at the epigastric fossa. Ultrasonography showed a hemangioma and a mosaic echoic lesion in the ventromedian with poor blood-flow signal and linear hyperechoic part inside, and a clear border to the surroundings. Dynamic computed tomography revealed a highly enhanced effect from the portal-venous phase continuing to the equilibrium phase. T1-weighted gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced image revealed a high intensity effect at the early phase that continued to the next phase. On the other hand, it contained a low intensity area by a fat suppression of that image. In addition, a T2-weighted image did not show a high intensity effect. Laparotomy was performed on the second day of hospitalization. The tumor had arisen from the ligamentum teres of the liver, and no metastasis or invasion of other organs was noted. It consisted of a lipid component of mature adipocytes and a fibrous component of deep dyeing pleomorphic or multinuclear atypical stromal cells. Immunohistochemical study of the atypical stromal cells demonstrated that they were positive for MDM2 and CDK4. A pathological diagnosis of atypical lipomatous tumor (ALT) was made, and the patient was discharged on the eighth day following the procedure. At the 6-mo follow-up dynamic CT, the patient was free of recurrence or metastasis. We experienced a patient with ALT in the ligamentum teres of the liver. This case suggests the need for a careful and detailed examination when encountering patients presenting with a mass; when neoplastic lesion is confirmed by image inspection, we should thoroughly investigate, including further image investigations and pathologic examination. The latter is the most important.

Keywords: Liposarcoma; Atypical lipomatous tumor; Malignant adipose mesenchymal tumor; Ligamentum teres of liver; Operation

Core tip: Liposarcoma is one of the most common adult soft tissue sarcomas, accounting for approximately 20% of all mesenchymal malignancies. Atypical lipomatous tumor (ALT) is the most common intra-abdominal primary sarcomas. On the other hand, it is an extremely rare malignant adipose mesenchymal tumor. We report the first case of ALT occurring in the ligamentum teres of liver.