Patterns of Presentation and Histopathology of Retroperitoneal Sarcoma in a South Asian Tertiary Center

Background: Retroperitoneal sarcoma (RPS) is a rare and heterogeneous malignancy that often presents late due to its deep anatomical location and nonspecific symptoms. Data from South Asian settings remain limited. Objective: This study aimed to describe the patterns of clinical presentation, diagnostic evaluation, and histopathological characteristics of surgically managed retroperitoneal sarcoma in a tertiary center in Bangladesh. Methods: This descriptive observational case series was conducted in the Department of General Surgery (Surgical Oncology Unit) at the Bangladesh Medical University, Dhaka, from July 2021 to June 2022. Twenty-eight adult patients with histopathologically confirmed retroperitoneal sarcoma who underwent surgical management were included. Demographic data, presenting symptoms, imaging findings, histologic subtypes, tumor grade, margin status, and perioperative treatment were analyzed using descriptive statistics. Results: The mean age was 45.4 ± 16.4 years, with a slight male predominance. Abdominal lump (78.6%) and pain (46.4%) were the most common presenting features. Contrast-enhanced CT was used in all cases, with a median tumor size of 12.75 cm on imaging. Liposarcoma subtypes predominated (50.0%), and most tumors were Federation of Cancer Centers Sarcoma Group grade 2 or 3. Complete resection with negative margins was achieved in 39.3%, while multivisceral resection was required in 25.0%. Adjuvant therapy was administered in 75.0% of patients, most commonly chemotherapy alone. Conclusion: RPS in this cohort presented predominantly as large, locally advanced tumors with heterogeneous histopathology. Surgical resection remained the primary treatment modality, often requiring complex operative strategies. These findings highlight the need for early diagnosis and specialized multidisciplinary management in resource-limited settings.