Spinal metastasis in pleomorphic liposarcoma: A rare location for a rare malignancy

Soft tissue sarcomas are rare mesenchymal tumors originating from non-epithelial connective tissue. The most common subtype of liposarcoma is a well-differentiated, dedifferentiated type, and pleomorphic liposarcoma (PLPS) is quite a rare subtype, constituting only about 5–10 %. The most common site of PLPS is the lower extremities, but the abdominal wall is a rare site of origin in this rarer subtype. We present a rare case of a 58-year-old male who presented with a painless lump in the lower left abdomen for six months. An 18FDG PET CT scan showed an enhancing soft tissue mass with central necrosis at the subcutaneous plane of the left iliac fossa on the anterior abdominal wall, measuring 6.5 (AP) x 5.3 (T) x 6.0 (CC) cm (SUV max-13.41). The patient underwent a wide excision of the mass, and a histopathological examination along with immunohistochemistry confirmed the diagnosis of pleomorphic liposarcoma. The patient then received adjuvant radiotherapy. Within a week of completing the radiotherapy, the patient developed acute backache at the lower dorsal area, with pain radiating lower down at lumbo-sacral area of back. Soon afterwards, within a week, the patient developed acute paraparesis. An MRI of the dorso-lumbar spine revealed altered marrow signals with a soft tissue component at the D10 vertebra level, extending into the spinal canal and causing cord compression, likely due to a metastatic lesion. The patient underwent palliative radiotherapy at the affected site. Three months after radiotherapy, the patient reported a significant improvement in pain and partial improvement in sensory and motor deficits. This unique case of localized abdominal wall PLPS exhibited early dissemination to the D10 vertebra, resulting in acute paraparesis for the patient. The poor prognosis associated with the histological subtype of PLPS, despite timely surgical excision and adjuvant radiotherapy, emphasises the need for new targeted therapies. Advances in molecular biology and cytogenetics will further improve clinical outcomes for PLPS patients.