SHM Converge Scientific Abstract ePoster Gallery-(Very) Bad to the Bone: Not Your Average Liposarcoma

Pdf Summary

This case describes a 75-year-old man with recurrent well-differentiated retroperitoneal liposarcoma who presented with worsening right flank pain, poor appetite, and 25-pound weight loss after recent cryoablation of a retrocaval lesion. Initial evaluation showed palatal petechiae, anemia and thrombocytopenia, elevated LDH, and abnormal urinalysis. CT imaging revealed interval growth of the retrocaval mass and new lytic thoracic bone lesions, suggesting progressive malignancy rather than infection or nephrolithiasis.<br /><br />During hospitalization, empiric antibiotics were started, but urology felt the pain was due to tumor progression. Peripheral smear showed leukoerythroblastosis and rare schistocytes. Because of concern for marrow pathology, a bone marrow biopsy was performed and demonstrated dedifferentiated liposarcoma with heterologous rhabdomyosarcomatous differentiation, confirming bone marrow infiltration by the tumor.<br /><br />The report emphasizes that liposarcoma involvement of the bone marrow is exceedingly rare but usually indicates aggressive, terminal disease. It also highlights the association between hyperleukocytosis and dedifferentiated liposarcoma, suggesting that new leukocytosis in a patient with known liposarcoma may signal transformation and should lower the threshold for bone marrow biopsy. Other causes of cytopenias, such as hemolysis, DIC, ITP, and marrow suppression, should be excluded.<br /><br />After discharge, the patient received eribulin in an attempt to improve cancer-related cytopenias and symptoms, but he later developed progressive neutrophilic leukocytosis and persistent marrow disease. Given ongoing decline, he transitioned to hospice and died shortly thereafter.<br /><br />Overall, the case underscores that in patients with progressive liposarcoma, especially with unexplained cytopenias or leukocytosis, early consideration of bone marrow involvement is critical because the prognosis is poor and treatment is primarily palliative.

Asset Subtitle

Evan Raff

Meta Tag

Author List Amy Tierney, Evan Raff, Laleh Hakima, Mukhtar Adem, Spencer Scott

Category Clinical Vignettes

Concept Liposarcoma

Concept Marrow infiltration

Concept Dedifferentiation

Concept Bone Marrow Biopsy

Concept Metastatic Liposarcoma

Distinguished Non-Finalist

Presenter Organization University of North Carolina School of Medicine

Presenting Author Evan Raff

Track Adult

Keywords

retroperitoneal liposarcoma

bone marrow infiltration

dedifferentiated liposarcoma

hyperleukocytosis

cytopenias

bone marrow biopsy

rhabdomyosarcomatous differentiation

tumor progression

lytic bone lesions

hospice care

Liposarcoma

Marrow infiltration

Dedifferentiation

Bone Marrow Biopsy

Metastatic Liposarcoma