An Impactful Routine Check

Detecting a Myxoid Lipoma Tumour during a
general medical check-up

Soft-tissue Sarcomas are Malignant Tumours and are usually named for the type of tissue in which they begin. The main types of Sarcoma that occur in the retroperitoneum are Liposarcoma (Cancer of the fatty tissues) and Leiomyosarcoma (Cancer of the involuntary muscle).

THE CASE

A 60-year-old known diabetic and normotensive gentleman was brought to BLK Super Speciality Hospital with incidentally detected mass in abdomen (on ultrasound) during routine health check-up. He was asymptomatic and there was no associated history of pain in abdomen, distention, any urinary or abnormal bowel issues. There was no past history of loss of weight or appetite. Abdomen ultrasound showed increased perinephric fat, fat stranding with mild right hydronephrosis. On examination, a vague mass of about 6 x 5 cm in size was visible with irregular borders palpable in the right loin and both kidneys, palpable with bi-manual palpation. No other palpable organomegaly or ascites was visible.

Further Investigations

A series of further investigations were conducted. CECT of the abdomen showed diffuse hypertrophy of bilateral perirenal fat entirely surrounding and embedding both kidneys, infiltrating soft tissue seen within the fat with septations and nodularity. A large mildly enhancing soft tissue lesion in pre and right paracaval region was seen with areas of necrosis within. MRI of the whole abdomen showed well circumscribed space occupying lesions in perinephric spaces. Another well-defined space occupying lesion was seen at the level of right renal hilum in paracaval location, measuring 6.1 x 8.8 x 9.8 cm. PET CT showed a large heterogenously enhancing soft tissue mass of size 9.6 x 6.7 x 9.7 cm with SUV max 6.54 located in the right paravertebral region extending from level of right renal hilum to the L4 vertebra. The mass was causing anterior displacement and compression of right ureter.

DTPA scan showed small non obstructed kidneys with moderate to severely impaired cortical functions. After all relevant investigations and PAC, the patient underwent Exploratory Laparotomy and excision of two right perirenal mass.

Intra-op Findings

A well circumscribed, hard lesion of about 8 x 8 cm in right side retroperitoneum, medial to ureter, displacing the same laterally was observed. Another mass of 12 x 8 cm in size was located in the left perirenal fat. Final HPE report showed Benign Tumour consistent with Myxoid Lipoma.

Conclusion

Incidental detection by routine ultrasound leading to diagnosis of extensive Lipoma around patient’s kidney.


Dr. Kapil Kumar

Dr. Kapil Kumar
Director - BLK Cancer Centre
& HOD Surgical Oncology
BLK Cancer Centre
BLK Super Speciality
Hospital, New Delhi








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