Asian Journal of Case Reports in Surgery

Background: Retroperitoneal spindle cell liposarcoma is a rare soft tissue sarcoma characterized by slow growth but significant local expansion, often presenting late due to the silent nature of the retroperitoneal space. Diagnosis is challenging, especially in patients with significant comorbidities, and management requires a multidisciplinary approach.

Materials and Methods: We report the case of a 55-year-old male with a history of ischemic heart disease and post-percutaneous transluminal coronary angioplasty (PTCA) status, who presented with progressive abdominal distension and pain over two months. Clinical examination and imaging revealed a large retroperitoneal mass. Comprehensive evaluation including contrast-enhanced computed tomography (CECT), 18F-FDG PET-CT (18F Fluorodeoxyglucose Positron Emission Tomography – Computed Tomography), echocardiography, and histopathological analysis following core needle biopsy was performed. 

Results: Imaging demonstrated a giant retroperitoneal mass measuring approximately 23 × 24.3 × 33.4 cm with low-grade FDG uptake, displacing surrounding abdominal structures without evidence of distant metastasis. Echocardiography revealed severe left ventricular systolic dysfunction with an ejection fraction of 30%. Histopathology confirmed malignant spindle cell sarcoma, consistent with spindle cell liposarcoma. Due to high perioperative cardiac risk, definitive surgery was deferred, and the patient was managed with supportive cardiac therapy under multidisciplinary supervision.

Conclusion: This case illustrates the diagnostic complexity and therapeutic dilemma associated with giant retroperitoneal liposarcomas in patients with significant cardiac comorbidities. A multidisciplinary approach, including precise histological characterization and individualized perioperative planning, is critical for optimal outcomes in such high-risk patients.