Liposarcoma Pain Managemen

A massive myxoid liposarcoma with hyperferritinemia Fletcher R ...

Sir,

Liposarcomas are one of the most common sarcomas of adulthood. The following case discusses a gentleman who presented with a massive abdominal myxoid liposarcoma associated with significant hyperferritinemia. We present the case and a discussion of hyperferritinemia and neoplasms, with reference to the potential of ferritin as a marker of disease recurrence.

A gentleman of 82 years of age presented with epigastric pain. Initial investigations were unremarkable except for a serum ferritin of 1542 ng/ml. An ultrasound scan was performed, which showed a large complex cystic mass in the epigastrium slightly to the left of the midline, containing echogenic material with thickened walls and septae in parts [Figure - 1] . A repeat serum ferritin assay was 2190 ng/ml. All other routine blood tests were again unremarkable. The patient wanted no further investigations. Six months later in June of the following year he developed acute abdominal pain. A CT scan at that time revealed a mass 30 x 30 cm with calcification within it. It displaced the colon around it and engulfed the stomach and duodenum. The patient underwent a laparotomy and the huge mass was resected. Histology later confirmed the mass to be a myxoid liposarcoma with clear resection margins and no involvement of surrounding organs [Figure - 2] .

He was reviewed in the outpatients department four months after surgery. His serum ferritin had returned to the normal range. He failed to attend further outpatient follow-up appointments and contact was lost with him. Two years later the patient presented acutely with a palpable lump at the site of his previous laparotomy scar. This was shown to be a local recurrence of the myxoid liposarcoma in the subcutaneous tissue of his abdominal wall [Figure - 3] , rather than a metastasis and was associated once more with a rise in serum ferritin to 1687 ng/ml that could not otherwise be accounted for. However, he refused any further intervention and preferred to be left alone with no further follow-up. He has not re-presented to the hospital and is still thought to be alive.

Of the soft tissue sarcomas, liposarcomas are the most common in adults. The most recent World Health Organization classification of soft tissue tumors recognizes five categories of liposarcomas: (1) well-differentiated; (2) dedifferentiated; (3) myxoid; (4) round cell; and (5) pleomorphic.

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