Mediastinal liposarcoma is a malignant lipoma. Malignant fatty tumors are found 5 times less benign, more often in men.
Pathological anatomy of mediastinal liposarcoma
Macroscopically, liposarcoma has the form of massive nodes formed by dense tissue, may have a capsule. Infiltrative growth is watched during relapses. Vascularization of the tumor is abundant, so it may have a reddish color on the incision, sometimes orange or whitish-cream. Microscopic one consists of mature fat cells and immature – lipoblasts. The more lipoblasts in a tumor, the more pronounced its malignancy. It is characterized by slow growth, late metastasis, a tendency to relapse. It metastasizes to the liver, lungs, pleura, skin, supraclavicular and deep cervical lymph nodes.
The clinical picture of fatty tumors is diverse. Most often, patients complain of pain of varying intensity in the region of the heart, right hypochondrium or epigastrium, shortness of breath, palpitations or bradycardia, a feeling of heaviness in the epigastric region and hypochondrium, heartburn, belching, nausea, coughing, asthma, fatigue, weakness, feeling of pain.
The leading methods for diagnosing fatty tumors of the mediastinum is x-ray, including roentgenoscopy, radiography, tomography and special methods (pneumomediastinum, pneumoperitoneum, etc.). X-ray examination reveals a heterogeneous shadow of medium intensity, located in different parts of the mediastinum, often in the right cardio-diaphragmatic angle. The contours of the tumor are wavy, the shape is rounded. In the lateral projection, the shadow is adjacent to the anterior chest wall and the diaphragm; in the case of the abdomino-mediastinal lipoma, it overlays the shadow of the heart.
X-ray CT allows specialists to resolve many diagnostic difficulties, allowing patients to avoid the use of special x-ray methods, determine the soft tissue nature of the tumor, its relationship with the surrounding organs and structures. The fuzzy outlines of the tumor, the infiltration of the surrounding tissues, the rapid growth of education indicate the malignant nature of the process.
Surgical treatment. Transthoracic access is usually applied, taking into account the localization of the tumor. Cervico-mediastinal lipomas can be removed by cervical access, abdomino-mediastinal lipomas – transrectal one. Malignant fatty ones require radical excision along with regional lymph nodes, subsequent radiotherapy is warranted.