Multifocal mesenteric myxoid liposarcoma

Case contributed by Dr Michael P Hartung

Presentation

Abdominal discomfort, concern for inflammatory bowel disease.

Patient Data

Age: 55 years
Gender: Male

Complex multifocal small bowel obstruction with several areas of narrowing/kinking of the small bowel associated with several mesenteric masses comprised of soft tissue/fat density and variable amounts of calcification. The mesentery does have a retractile and partially twisted appearance on the coronal images, but there is no definite closed-loop obstruction. The largest soft tissue mass is in the left mid abdominal mesentery. There is a particularly large rounded calcified mass above the urinary bladder. 

Case Discussion

Pathologically proven multifocal mesenteric myxoid liposarcoma characterized by several soft tissue, fat-containing, and calcified abdominal masses resulting in a complex small bowel obstruction. This case is particularly striking for the large calcified mass above the bladder and at first quite overwhelming to review. 

From a diagnostic standpoint, it is important to recognize that a malignant process is going on in the mesentery and responsible for the obstruction. This will help to guide the surgical team appropriately so they know to consider taking this patient to the OR for both diagnostic and therapeutic reasons, and they can know to expect to be there for some time. So even if you were unsure about the specific diagnosis, reporting "Complex malignant small bowel obstruction with several mesenteric masses comprised of soft tissue and calcifications" is a very good start. 

It is helpful to keep in mind that several abdominal tumors can calcify including liposarcoma, treated lymphoma, mucinous adenocarcinoma, papillary serous cystadenocarcinoma, carcinoid, GIST, and germ cell tumors 1.

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