Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2020; 8(5): 939-945
Published online Mar 6, 2020. doi: 10.12998/wjcc.v8.i5.939
Combining surgery with 125I brachytherapy for recurrent mediastinal dedifferentiated liposarcoma: A case report and review of literature
Hui-Guo Chen, Kai Zhang, Wei-Bin Wu, Yong-Hui Wu, Jian Zhang, Li-Jia Gu, Xiao-Jun Li
Hui-Guo Chen, Kai Zhang, Wei-Bin Wu, Yong-Hui Wu, Jian Zhang, Li-Jia Gu, Xiao-Jun Li, Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Author contributions: Chen HG and Zhang K were the patient’s thoracic surgeon, reviewed the literature and contributed to manuscript drafting; Wu WB and Wu YH reviewed the literature and contributed to manuscript drafting; Zhang J and Gu LJ were the patient’s thoracic surgeon; Li XJ was responsible for the revision of the manuscript; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Xiao-Jun Li, MD, Doctor, Surgeon, Department of Cardiothoracic Surgery, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China. tjlixiaojun@163.com
Received: October 9, 2019
Peer-review started: October 9, 2019
First decision: January 7, 2020
Revised: February 3, 2020
Accepted: February 12, 2020
Article in press: February 12, 2020
Published online: March 6, 2020
Abstract
BACKGROUND

Dedifferentiated liposarcoma in the mediastinum is an extremely rare malignant neoplasm. A few previous case reports indicate that surgical resection is the major treatment, but frequent recurrence occurs locally. Due to its rarity, its clinical characteristics, optimal treatment and clinical outcomes remain unclear. Here, we report a case of multifocal recurrent dedifferentiated liposarcoma in the posterior mediastinum treated by combining surgery with 125I brachytherapy, and summarize its clinical features, treatment and prognosis.

CASE SUMMARY

A 75-year-old man was admitted to our hospital with a history of gradual dysphagia for one year and aggravated dysphagia for 3 mo. Contrast-enhanced computed tomography (CT) revealed several large cystic-solid masses with lipomatous density, and calcification in the posterior-inferior mediastinum. The patient received a wide excision by video-assisted thoracoscopic surgery. Pathological analysis confirmed the tumors were dedifferentiated liposarcomas. The tumor locally relapsed 24 mo later, and another operation was performed by video-assisted thoracoscopic surgery. Fifteen months after the second surgery, the tumor recurred again, and the patient received CT-guided radioactive seeds 125I implantation. After 8 mo, follow-up chest CT showed an enlarged tumor. Finally, his condition exacerbated with severe dysphagia and dyspnea, and he died of respiratory failure in July 2018.

CONCLUSION

We reviewed the literature, and suggest that surgical resection provides beneficial effects for dedifferentiated liposarcoma in the mediastinum, even in cases with local recurrence. 125I brachytherapy may be beneficial for recurrent unresectable patients.

Keywords: Dedifferentiated liposarcoma, Mediastinal neoplasms, Recurrence, Reoperation, 125I brachytherapy, Case report

Core tip: Dedifferentiated liposarcoma in the mediastinum is an extremely rare malignant neoplasm. Only a few cases have been reported, and its clinical characteristics, optimal treatment and clinical outcomes remain unclear. Here, we report a male patient with recurrent mediastinal dedifferentiated liposarcoma that was successfully treated by surgery combined with 125I brachytherapy. A review of the literature is also provided to improve the overall awareness of this disease. To our knowledge, this literature review covers the largest number of cases as any prior, and is the first report on dedifferentiated liposarcomas treated by 125I brachytherapy.