primary hepatic liposarcoma
Introduction
Introduction to primary hepatic liposarcoma Liposarcoma is a malignant tumor that originates from the primitive mesenchymal tissue. It usually occurs in the thigh and retroperitoneum. It can also be seen in the buttocks and armpits. Soft tissues in other parts can also be seen occasionally, rarely in the liver. The hepatic primary liposarcoma has a great similarity with the pathological morphology of other parts of liposarcoma. The tumor is ellipsoidal or irregular, soft, and the volume is often found to be large. The tumor surface is grayish yellow. Or grayish white, common necrotic area, necrotic area is easy to soften, brittle, tissue surrounding the tumor is compressed, can form an incomplete thin layer pseudo-envelope, well-differentiated liposarcoma can appear intact envelope, observed under the microscope, There are differentiated mature fat cells and immature mesenchymal cells and atypical cells in the sarcoma. The cytoplasm shows lipid droplets, the nucleus is elliptical or round, the particles are coarse, deep stained, and the mucus is visible. There is a rich mucus-like matrix between the cells, which is positive for acin blue staining and no cirrhosis of the surrounding liver tissue. Liposarcoma is a moderately malignant tumor in soft tissue sarcoma. The 5-year survival rate can reach 35% to 40%. About 40% to 50% of liposarcoma has lung metastasis. The main age of onset is middle and old age. In the case of primary hepatic sarcoma of the liver, two cases were middle-aged women and two were children. Two cases were reported in adults, one male and one female, with well-differentiated and mucinous types, as no trace was observed. Reported that there is still no data on its prognosis. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: hiccup
Cause
Primary hepatic liposarcoma etiology
(1) Causes of the disease
Liposarcoma is a common malignant soft tissue tumor, which originates from mesenchymal cells differentiated from adipocytes into adipocytes. Therefore, heterotrophic fat cells with different degrees of differentiation contain lipids, depending on the degree and type of tumor cells. Can be divided into four types: well-differentiated type, mucin-like type, round cell type and polymorphic type, but the tumor is usually mixed with polymorphic cells.
From the point of view of origin, there are cases of adipose sarcoma in the adipose tissue, 60% in the limbs, 15% in the retroperitoneal space, and 15% in the trunk. The liposarcoma in the liver is extremely rare. The number of primary liposarcomas of the liver reported to date has not exceeded 10 cases.
(two) pathogenesis
The hepatic primary liposarcoma has a great similarity with the pathological morphology of other parts of liposarcoma. The tumor is ellipsoidal or irregular, soft, and the volume is often found to be large. The tumor surface is grayish yellow. Or grayish white, common necrotic area, necrotic area is easy to soften, brittle, tissue surrounding the tumor is compressed, can form an incomplete thin layer pseudo-envelope, well-differentiated liposarcoma can appear intact envelope, observed under the microscope, There are differentiated mature fat cells and immature mesenchymal cells and atypical cells in the sarcoma. The cytoplasm shows lipid droplets, the nucleus is elliptical or round, the particles are coarse, deep stained, and the mucus is visible. There is a rich mucus-like matrix between the cells, which is positive for acin blue staining and no cirrhosis of the surrounding liver tissue.
Liposarcoma is a moderately malignant tumor in soft tissue sarcoma. The 5-year survival rate can reach 35% to 40%. About 40% to 50% of liposarcoma has lung metastasis. The main age of onset is middle and old age. In the case of primary hepatic sarcoma of the liver, two cases were middle-aged women and two were children. Two cases were reported in adults, one male and one female, with well-differentiated and mucinous types, as no trace was observed. Reported that there is still no data on its prognosis.
Prevention
Primary hepatic liposarcoma prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
1, the diet should pay attention to light, mostly with food porridge, noodle soup and other foods that are easy to digest and absorb. 2, can eat more fresh fruits and vegetables to ensure the intake of vitamins. 3, give liquid or semi-liquid food, such as a variety of porridge, rice soup and so on.Complication
Primary hepatic liposarcoma complications Complication
1. Often there is loss of appetite, weight loss, fatigue, and occasional intractable hiccups.
2. Patients with advanced stage may have chest and abdomen and distant metastasis and dyscrasia.
Symptom
Symptoms of primary hepatic liposarcoma Common symptoms Appetite loss, weight loss, hiccups, dull pain, spider, liver, palm, fatigue, liver sag
There is no obvious symptom in the early stage of hepatic primary liposarcoma. With the enlargement of the tumor, the patient has dull pain or dull pain in the right upper quadrant, often radiating to the right shoulder. The pain is caused by the swelling of the tumor and the traction of the liver capsule. Often loss of appetite, weight loss, fatigue, occasionally intractable hiccups, liver primary liposarcoma and other liver malignant tumors, patients generally do not have jaundice performance, several cases have been reported tumor volume is huge, generally 10cm ×10cm×10cm or more, the weight is several kilograms, but no jaundice appears. The physical examination revealed that the patient's right flank was full and full, the liver volume increased obviously, the texture was soft, the edges were dull, the surface was smooth, and there was no tenderness or paralysis. Pain, visible liver palm, spider mites.
Examine
Examination of primary hepatic liposarcoma
Hepatic primary liposarcoma showed signs of impaired liver function. Enzymological examination and tumor markers such as AFP and CEA were negative. Patients often presented with pain in the right upper quadrant. After the huge liver was found, the initial diagnosis was made by imaging examination, but the diagnosis was confirmed. Liver biopsy is still needed.
The imaging findings of this disease are quite characteristic.
1. B-ultrasound can be seen in the liver with a large and uniform strong echo zone.
2. CT showed a low-density area with clear edges. The CT value was small, up to -90Hu, which was the lowest CT value of intrahepatic tumors. There was no enhanced response after injection of contrast agent.
3. MRI T1, T2 weighted image is a high signal area.
Hepatic liposarcoma is indistinguishable from hepatic lipoma in imaging examination.
Diagnosis
Diagnosis and diagnosis of primary hepatic liposarcoma
The diagnosis of this disease is difficult before surgery, and the rate of misdiagnosis is extremely high. The diagnosis depends on the intraoperative and postoperative pathological examination.
1. Clinical manifestations.
2. Laboratory and other auxiliary inspections.
Because this disease is extremely rare, and there is no specific clinical manifestation and diagnosis method, it is often ignored by doctors in clinical practice. It is easy to be misdiagnosed as liver cancer, liver cyst, liver abscess, hepatic hemangioma, etc., no history of hepatitis, cirrhosis, normal liver function. A-fetoprotein-negative, even if the liver mass is huge, but no jaundice, ascites, splenomegaly, etc., help to distinguish from liver cancer, huge primary hepatic liposarcoma, often combined with central tissue necrosis, liquefaction, formation of cystic cavity, It resembles a hepatic cyst, but the patient is often accompanied by fever, weight loss, and B-ultrasound can be seen within the capsule. The thickness of the capsule is uneven. During the operation, the frozen pathological examination can confirm the nature of the lesion to avoid misdiagnosis and mistreatment. .
