22520024 Visualization

A 60 Age - year Age - old Age male Sex patient had previously undergone a radical Detailed_description resection History of History a History T2bN0M0G3 Detailed_description Stage Detailed_description III Detailed_description retroperitoneal Disease_disorder sarcoma Disease_disorder , including History right Detailed_description nephrectomy History and History cholecystectomy, History in History 2002 Date .
Pathologic Diagnostic_procedure evaluation Diagnostic_procedure demonstrated a 25 Distance   cm Distance high History - grade History liposarcoma Disease_disorder with different Detailed_description histologic Detailed_description components Detailed_description , including myxoid Detailed_description , round Detailed_description cell Detailed_description , well Detailed_description - differentiated Detailed_description , sclerosing Detailed_description and pleomorphic Detailed_description patterns Detailed_description .
Surgical Diagnostic_procedure margins Diagnostic_procedure were negative Lab_value as the tumor Sign_symptom did not invade Sign_symptom the kidney Biological_structure , and since the renal Biological_structure vein Biological_structure and ureter Biological_structure were free of tumor Sign_symptom as well.
The patient did not undergo any additional History therapy History .
Surveillance Detailed_description magnetic Diagnostic_procedure resonance Diagnostic_procedure imaging Diagnostic_procedure in 2007 Date revealed an isolated Detailed_description tumor Sign_symptom recurrence Sign_symptom in the retroperitoneum Biological_structure .
An exploratory Detailed_description celiotomy Diagnostic_procedure revealed tumor Sign_symptom involvement Sign_symptom of the duodenum Biological_structure , head Biological_structure of Biological_structure the Biological_structure pancreas Biological_structure , superior Biological_structure mesenteric Biological_structure vein Biological_structure , vena Biological_structure cava Biological_structure and left Biological_structure renal Biological_structure vein Biological_structure with severe Severity adhesive Detailed_description changes Detailed_description , leading to the intraoperative assessment of unresectable Disease_disorder disease Disease_disorder .
Subsequently, the patient underwent stereotactic Detailed_description body Detailed_description radiation Therapeutic_procedure to the retroperitoneal Biological_structure tumor Sign_symptom in five Dosage fractions Dosage for a total Dosage dose Dosage of Dosage 30 Dosage   Gy Dosage , without complication Sign_symptom .
Postradiation imaging Diagnostic_procedure revealed near complete resolution of the retroperitoneal Biological_structure mass Sign_symptom .
One Date year Date later Date , the patient presented Clinical_event with weight Sign_symptom loss Sign_symptom , postprandial Detailed_description abdominal Biological_structure pain Sign_symptom , nausea Sign_symptom and vomiting Sign_symptom .
Cross Diagnostic_procedure - sectional Diagnostic_procedure imaging Diagnostic_procedure revealed a 7 Distance   cm Distance mass Sign_symptom with involvement of the third Biological_structure portion Biological_structure of Biological_structure the Biological_structure duodenum Biological_structure (Figure ​1).
However, there was no obvious involvement Sign_symptom of the pancreatic Biological_structure head Biological_structure or the other Biological_structure structures Biological_structure that were noted to be involved during the previous laparotomy.
We elected to perform another resection Therapeutic_procedure attempt, including a possible pancreatoduodenectomy or retroperitoneal vascular resection if necessary.
At exploration Diagnostic_procedure , the residual tumor Sign_symptom was an entirely intraduodenal Biological_structure , pedunculated Detailed_description mass Coreference at the posterior Biological_structure duodenal Biological_structure wall Biological_structure distal to the ampulla that filled the entire duodenal lumen.
The patient underwent a duodenotomy Therapeutic_procedure and stalk Therapeutic_procedure transection Therapeutic_procedure of the polypoid Detailed_description mass Sign_symptom , followed by partial Detailed_description duodenal Biological_structure resection Therapeutic_procedure with hand Detailed_description - sewn Detailed_description duodenojejunal Biological_structure anastomosis Therapeutic_procedure (Figure 2).
Surgical Diagnostic_procedure pathology Diagnostic_procedure examination Diagnostic_procedure revealed a 9.5 Distance   cm Distance recurrent Detailed_description high Severity - grade Severity liposarcoma Disease_disorder with polypoid Detailed_description intraluminal Detailed_description growth Detailed_description containing myxoid Detailed_description , round Detailed_description cell Detailed_description , well Detailed_description - differentiated Detailed_description , sclerosing Detailed_description and focally Detailed_description pleomorphic Detailed_description areas Detailed_description .
Surgical Diagnostic_procedure margins Diagnostic_procedure were negative Lab_value as the tumor Sign_symptom came within Distance 0.1 Distance   cm Distance of the stalk Biological_structure margin Biological_structure and there was no evidence of additional neoplastic Sign_symptom components Sign_symptom within the remaining resected duodenum Biological_structure .
The postoperative Diagnostic_procedure course Diagnostic_procedure was uncomplicated Lab_value , and the patient has demonstrated no recurrence Sign_symptom up to 30 Date   months Date from Date this resection.