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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
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.
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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
ARTICLE HIGHLIGHTS
Case characteristics
A three-month history of persistent epigastralgia and right hypochondralgia.
Clinical diagnosis
Abdominal tumor.
Differential diagnosis
Neoplastic etiology.
Laboratory diagnosis
Routine blood tests showed elevated low-density lipoprotein cholesterol, decreased creatine kinase, and abnormal glucose tolerance.
Imaging diagnosis
Abdominal mesenchymoma based on MRI, including of fat suppression radiography.
Pathological diagnosis
Immunohistochemical study of atypical stromal cells, namely tumor cells were positive for MDM2 and CDK4 and negative for α-SMA, S-100 protein, CD34 and STAT-6, which led to the pathological diagnosis of atypical lipomatous tumor (ALT).
Related reports
ALT is an intermediate tumor with risk of local recurrence but no potential for metastasis. However, ALT may be difficult to distinguish from benign adipose tumors and poorly differentiated sarcomas. Up to now, MDM2 and CDK4 immunostaining have been particularly useful in separating ALT from the large group of differentiated adipose tumors, and they are important for the differential diagnosis. To date, surgical resection has been the mainstay of curative treatment. Long survival is correlated with the active resection of recurrence and recognition of high-grade dedifferentiated type liposarcoma at an early stage. As far as we know, there have been no reported ALT cases occurring from the ligamentum teres of the liver.
Term explanation
ALT: Atypical lipomatous tumor.
Experiences and lessons
When neoplastic lesion is confirmed by image inspection, we should thoroughly investigate, including further image investigations and pathologic examination. The latter is especially important.
