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