Liposarcoma is a malignancy arising from fat cells and in adults it accounts for ten to twelve percent of soft tissue tumours. It appears mainly as a retroperitoneal or intra-abdominal mass. However, there are very few cases of primary intrathoracic liposarcomas arising from within the mediastinum. They are usually slow growing with an expansile rather than infiltrative behaviour; hence they present with pressure related symptoms to their neighbouring structures [1]. We report two cases of primary pleural liposarcoma complimented by a literature review.
Case 1
A 42-year-old male presented to the respiratory physicians with an eight-week history of malaise, left sided upper abdominal pain and increasing shortness of breath. He had an expectorant cough but no haemoptysis, fever, chills and rigors. He was a non-smoker with no significant past medical history.
The chest film [CxR] was suggestive of a large left sided pleural effusion, and a computerised tomogram [CT] confirmed a loculated effusion. A pleural tap was negative for malignancy and a working diagnosis of left empyema was made; the patient was referred to the thoracic department for further management.
At thoracotomy, the left lower lobe was collapsed by a well-encapsulated pedicled mass arising from the para aortic region. A frozen section confirmed the malignant nature of the mass, which was subsequently resected en-bloc and subjected to histology. The patient had an uneventful post operative recovery.
The histological examination revealed a myxoid liposarcoma with some evidence of differentiation. The patient was referred onto the sarcoma team, for adjuvant treatment. At follow up, 2 months after surgery, the patient was making an excellent recovery. The patient however showed evidence of recurrence at his six month follow up and went onto have additional surgery and chemotherapy.
Case 2
An 80-year-old female presented with increasing shortness of breath over a period of three months, with an exercise tolerance of fifty metres. There was no associated cough, haemoptysis or weight loss. On examination there was decreased air entry on the left side. CxR revealed a large left sided pleural effusion and the CT scan showed a large fluid density mass in the anterior mediastinum. The patient was discussed in a multi disciplinary meeting and proceeded to surgery.
An attempted left VATS was initially performed but this had to be converted to open thoracotomy due to the large nature of the mass. It was eventually excised confirming compression of the normal left lung.
Histology revealed a myxoid liposarcoma and positive resection margins. The patient was deemed not fit for radical radiotherapy and best supportive care was offered. She died eight months after diagnosis from disease progression,