Giant hypervascular atypical lipomatous tumor/well-differentiated liposarcoma of the cervicodorsal region: a case report

Abstract

We report a case of giant hypervascular atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDLPS) of the cervicodorsal region in a 62-year-old man. The mass had enlarged slowly over 17 years, with accelerated growth during the preceding 2 years accompanied by a local skin pulling sensation, but without definite airway, neurologic, or major vascular compression. Preoperative computed tomography angiography (CTA) demonstrated a lesion of approximately 20.9 cm × 28.6 cm × 25.4 cm containing internal septa, nodular components, and marked vascularity supplied predominantly by branches of both subclavian arteries. The patient underwent en bloc tumor excision with local advancement flap reconstruction; the resected specimen weighed approximately 6.01 kg, the resulting defect measured approximately 15 cm × 11 cm, the operative time was nearly 6 h, and the estimated blood loss was approximately 700 mL. Postoperative pathology showed focal spindle-cell proliferation with myxoid change and, together with the MDM2, CDK4, and p16 positivity documented in the pathology report, supported the diagnosis of ALT/WDLPS. At short-term follow-up, the incision and flaps had healed well, with no definite local recurrence. This case indicates that a long-standing, slowly enlarging giant lipomatous mass in the cervicodorsal region should not be excluded from the diagnosis of ALT/WDLPS solely on the basis of indolent clinical behavior. When a lesion is very large or imaging suggests rich vascularity, preoperative vascular assessment, hemostatic contingency planning, and simultaneous wound reconstruction design should be incorporated into the surgical plan.