Liposarcoma of the retroperitoneal space, an increase in inguinal lymph nodes. Tumors of the peritoneum

Leiomyosarcoma of the retroperitoneum is a cancerous tumor that forms in the smooth muscle tissue. Localization of malignant formation can be varied. Pathology is characterized by an aggressive course and the ability to metastasize in the early stages.

Causes and risk groups for the development of sarcoma of the retroperitoneal space and abdominal cavity

Cancers are formed from epithelial cells. The described type of formation affects the connective tissue. Almost all organs that are in the designated area have it. Therefore, the disease can affect the liver, pancreas, urinary and gallbladder, stomach and intestinal loops. In addition, pathology often affects the wall of the peritoneum itself. Various factors can provoke it.

Permanent injuries: burns, fractures, scars, operations, presence of foreign body. After them, the process of tissue regeneration begins. Cells divide so actively that it becomes difficult for the immune system to identify and destroy undifferentiated elements. They accumulate in damaged tissues, and then sarcoma is formed from them.
Action of carcinogens: asbestos, arsenic, dioxide, benzene, toluene, styrene. Their molecules are able to penetrate into the nuclei of cells and cause mutation at the DNA level. This leads to the loss of the functions of themselves and future generations.
Radiation exposure. Its effect also causes cell mutation, which is why their next generation is not identified by the immune system, therefore a malignant formation is formed. Exceeding the dose of radiation therapy, the consequences of an accident at a nuclear power plant, and violation of safety rules when working with X-ray equipment can provoke such processes.
Infections. The penetration of the herpes virus of the eighth type and HIV-1 into the nuclei of cells damage their DNA. The process of mutation begins, which also leads to the formation of undifferentiated cells.
genetic predisposition. In some people, the gene responsible for stopping the tumor process is damaged. The impact of any provocative factor listed above leads to malignant formation.

In most cases, soft tissue sarcoma of the anterior abdominal wall is a secondary tumor that has developed as a result of metastases.

Sarcoma classification

Depending on which tissues are involved in the pathological process, several types of oncological tumors are distinguished. All of them are presented in the following table.

Name	Structure Features	Characteristic localization	Degree of aggressiveness
Liposarcoma	Formed in adipose tissue. Outwardly, it looks like one big knot. Rarely there are multiple lesions. The tumor grows very quickly. In a short time, the patient gains weight of 10-20 kg.	The upper part of the retroperitoneal space.	Negative survival prognosis.
Leiomyosarcoma	Affects smooth muscles. It has a characteristic clinical picture that allows you to identify the tumor in the early stages of development. The patient develops pains radiating to the chest and spine, nausea, severe dizziness, which can result in a short-term loss of consciousness. Drops are observed blood pressure, problems with defecation.	Bone tissue, internal organs, lymph nodes and brain.	An aggressive disease characterized by early metastasis and frequent recurrence. The prognosis for working capacity and survival is unfavorable.
fibrosarcoma	Develops in the thickness of the muscles. A painful, round and very dense knot is formed there, which has a bumpy surface. The skin over it is not modified.	It usually forms deep in the muscles, but with previous mechanical injuries and exposure to ionic radiation, it can occur in the subcutaneous adipose tissue.	Detection of a tumor in the early stages allows us to formulate favorable prognosis. At later stages, survival is 40-50%
Histiocytoma	Composed of foamy macrophages and various inflammatory cells. Outwardly, the tumor looks like a knot with fuzzy contours with small hemorrhages inside.	Retroperitoneal space.	Early begins to metastasize to the lungs and regional lymph nodes.
Rhabdomyosarcoma	Formed from immature striated muscle tissue	Retroperitoneal tissue	If rhabdomyosarcoma of the abdominal cavity is diagnosed, the prognosis is determined depending on the location, size of the tumor, and the age of the patient. The most favorable course is characteristic of the embryonic form.
Angiosarcoma	Originates from the perithelium and endothelium of blood vessels	Most often, the lower extremities are affected, but angiosarcoma of the peritoneum occurs as a variety.	The prognosis of life is extremely negative, decimal cases of recovery are known in the entire history of the disease.

Clinical picture

Retroperitoneal sarcoma grows rapidly, in its development it reaches a large size, therefore it puts pressure on the surrounding organs. The appearance of symptoms depends on where the process takes place. If near the nerve columns or roots, strong pain sensations are formed in the corresponding areas. In such situations, paresis and paralysis become possible.

When the growth of the sarcoma blocks the vena cava, the legs become very swollen and become cyanotic. With difficulty in hepatic circulation in the abdominal cavity, effusion begins to accumulate, ascites develops. There are swelling of the extremities, in men there is an expansion of the veins of the spermatic cord. Patients complain of a constant feeling of discomfort, they are quickly satiated with food, the body loses weight, but the waist increases. You can feel the growing neoplasm with your hand. There are signs of indigestion (nausea, vomiting, constipation, bloating), severe weakness, fatigue.

In the later stages, the body temperature rises, it stays constant and is poorly controlled by antipyretic drugs.

Diagnostics

Establishing the causes of malaise begins with an examination of the patient, a description of his clinical condition. Particular attention is drawn to the presence of external signs of sarcoma (exhaustion, pallor, swelling, jaundice), the presence of symptoms of intoxication (fever, night sweats, weakness, lack of appetite).

If the tumor grows on the abdominal wall, it is well palpable on palpation. To clarify its type, determine the localization and level of malignancy, the patient is issued a referral for laboratory tests. A biopsy and subsequent histology of the obtained biological material, a cytogenetic study are mandatory. There are no specific tumor markers for sarcoma yet, but if the development of the tumor is in the third or fourth stage, the general and biochemical analysis blood shows characteristic abnormalities.

CT scan and ultrasound are required. With their help, the size of the formation, its structure is estimated, the presence or absence of a capsule, foci of necrosis inside the sarcoma, the state of the organs located in the neighborhood is determined.

Therapy Methods

Only a combined approach provides the maximum effect. The operation is carried out first. During it, the formation is removed with the capture of two centimeters of healthy tissue. Surgeons try to preserve the functions of the diseased organ as much as possible.

After the operation, chemotherapy and radiation are prescribed. A combination of agents is injected into the patient's vein, the action of which disrupts DNA synthesis and stops the division of sarcoma cells. Drugs are prescribed courses. Each lasts three to four weeks. The dose is calculated individually, taking into account the weight of the patient and the stage of development of the sarcoma. In parallel, anticancer drugs are taken. The described type of malignant formation is sensitive to radiation, so radiation therapy is also necessarily included in the general treatment regimen.

Lack of therapy leads to the rapid growth of the tumor. She begins to squeeze neighboring organs. Blood circulation is disturbed in them, functions are gradually lost. Sarcoma metastasizes. Together with the lymphatic current, they spread throughout the body and form secondary lesions.

The abdominal cavity contains several vital organs. The appearance of sarcoma in this area negatively affects the work of the whole organism. In the absence of adequate and timely treatment, malignant neoplasms that grow from the tissues of the abdominal cavity cause fatal outcome.

Features of the tumor

The sarcoma is malignant. The tumor grows from fatty, connective, vascular and muscle tissues. In the abdominal cavity, the neoplasm develops from the cells that make up local organs or walls.

Malignant tumors of the abdominal cavity occur mainly in people over 50 years of age. At the same time, such neoplasms are more often diagnosed in women.

The first clinical manifestations characteristic of the tumor process occur during the period when the tumor reaches a large size. Thus, sarcoma of the retroperitoneal space is more often manifested.

Tumors in this zone are formed in primary or secondary forms. The latter type of sarcoma is more common. This formation appears due to metastasis of other tumors.

Primary sarcomas are formed due to the mutation of local cells, which is caused by various factors.

Causes

The true causes of the appearance of malignant neoplasms in the abdominal cavity have not been established. In some cases, local cells begin to mutate spontaneously without third-party intervention.

Among the most likely causes of the transformation of local tissues, a hereditary predisposition is distinguished. Often subject to development similar neoplasms persons among whose relatives cases of damage to the tissues of the abdominal cavity by cancer cells were previously diagnosed.

To the number possible causes development of the tumor process in the abdominal cavity include living in adverse environmental conditions, alcohol or smoking abuse, as well as constant contact with chemicals. These factors stimulate the processes responsible for cell mutation.

Neoplasms in the abdominal cavity sometimes occur as a complication inflammatory diseases. In addition, malignancy leads to the growth of sarcoma. benign tumors(polyps, adenomas and others).

Equally risky are frequent trauma to the tissues of the abdominal cavity, prolonged use of corticosteroids, and treatment with radiation therapy.

Symptoms

Symptoms depend on the type

Sarcoma of the retroperitoneum

Sarcomas of this type are characterized by deep occurrence. On the one hand, the tumor is closed by the peritoneal wall, and on the other, by the stomach and intestines. The neoplasm is characterized by rapid, but asymptomatic growth.

Large tumors in the retroperitoneal space compress the nerve trunks, which manifests itself in the form of an intense pain syndrome. In advanced cases, the growth of sarcoma leads to the destruction of the spine. In this case, paresis or paralysis develops.

Also, the course of the tumor process disrupts the blood supply. The nature of the clinical picture with such a development of oncological disease is determined by the type of vessel that compresses the tumor.

Compression of the inferior vena cava leads to swelling of the legs and abdomen. If the neoplasm compresses the blood vessels that feed the liver, fluid accumulates in the abdominal cavity.

Symptoms of this type of sarcoma are determined by the localization of the tumor process. With tissue damage on the right side, symptoms occur early.

This localization is characterized by a feeling of heaviness in the stomach and pain syndrome. The growth of the neoplasm on the left side is accompanied by dysfunction small intestine(frequent constipation) and impaired urination.

Depending on the type of tissue from which the tumor develops, there are 4 types of cancer.

Liposarcoma

Liposarcomas grow from fatty tissues. Tumors of this type with a low degree of malignancy (poorly differentiated) are localized in the retroperitoneal tissue (near the navel). More often, solitary liposarcomas appear, which are distinguished by a nodular shape.

The neoplasm is characterized by rapid growth. In a short time, the weight of liposarcoma reaches 10-20 kg. Due to the absence of pronounced symptoms, patients go to the doctor about a neoplasm in the later stages of the development of the tumor process.

In this regard, the prognosis for survival in liposarcomas is unfavorable.

Leimiosarcoma

Leimiosarcoma grows from smooth muscle. The tumor metastasizes to bones, internal organs, and the brain. An important feature of leimioscarcoma is that the first symptoms occur at the initial stage of neoplasm development.

The presence of a tumor is indicated by pain sensations that radiate to the chest or spine. The growth of leimiosarcoma is also accompanied by bouts of nausea and dizziness, discomfort in the abdominal cavity.

As the tumor process progresses, diarrhea and constipation occur, appetite decreases, temporary loss of consciousness worries.

fibrosarcoma

Fibrosarcomas are rare. The risk zone for developing this tumor includes women aged 30-40 years.

A neoplasm germinates from fibrocytes that make up the connective tissue. The survival prognosis for fibrosarcomas is favorable in 77% of cases.

Histiocytoma

Histiocytoma grows from the connective tissue. The tumor is characterized by differentiable cells. The neoplasm, as it grows, acquires a nodular shape and has foci of inflammation.

The risk group for developing histiocytoma includes people aged 30-60 years. The danger of this type of tumor is early metastasis. In 80% of patients, cancer cells enter the lungs.

Symptoms of the defeat of the abdominal wall

Sarcoma rarely germinates from the cells of the abdominal wall. In most patients, the tumor takes the form of a dipigmented spot, from which melanosarcoma develops over time.

Less often, abdominal wall sarcoma is formed due to mechanical damage, which led to scarring of local tissues. Such tumors at the initial stage of development acquire a nodular shape.

In the future, the contours of the pigment spot become less clear. Sarcoma of the abdominal wall, which has arisen due to scarring of the tissue, is characterized by rapid growth and early metastasis to neighboring organs.

The course of the tumor process in this area is accompanied by a decrease in appetite, increased fatigue, deterioration of the general condition.

Sometimes the patient's body temperature rises. In the case of infection of the sarcoma, the tissues covering the tumor are expressed and die.

Symptoms of a stomach lesion

Malignant tumors in the stomach appear mainly due to metastasis of other neoplasms. The risk group includes mainly women of reproductive age.

Depending on the characteristics of the development of sarcoma of the stomach are classified into:

Endogastric. The tumor looks like a polyp. Endogastric sarcoma grows into the lumen of the stomach, disrupting the patency of food.
Exogastric. The neoplasm grows from the submucosal layer, differs in a tuberous or lobed structure. Exogastric sarcomas reach large sizes, as a result of which they put pressure on neighboring tissues and organs.
Infiltrating. The most common type of gastric sarcoma. The tumor is characterized by rapid development. The formation grows along the wall of the stomach, often affecting neighboring structures.

A mixed type of tumor is also distinguished, which grows outside and inside the organ. The prognosis for these neoplasms is relatively favorable due to the slow development.

The growth of sarcomas in the stomach is accompanied by bouts of nausea and a feeling of heaviness. Due to insufficient patency, bloating, general weakness, and severe exhaustion of the body appear.

Symptoms of intestinal damage

Sarcomas of the large and small intestines develop in young people (up to 40 years). The prognosis is most favorable with the defeat of the last part of the organ of the gastrointestinal tract. This is explained by late metastasis of the tumor.

At the initial stage of development of sarcoma of the small intestine, pain in the lower abdomen, diarrhea, belching, bouts of nausea and poor appetite are noted. It is also possible causeless increase in body temperature, bloating.

Pain with such localization of the neoplasm is cramping in nature. In advanced cases, acute intestinal obstruction, internal bleeding and peritonitis develop.

With the defeat of the thick section, the prognosis is extremely unfavorable. Sarcomas in this area are characterized by early metastasis, and therefore patients die within one year after the discovery of the tumor process.

Neoplasm at the initial stage of development manifests itself in the form of attacks of nausea and constipation. Often, sarcomas in the colon cause symptoms characteristic of acute appendicitis. Pain, localized in the sacrum and lower back, appear during the period of metastasis.

Sarcomas in the rectum are rarely diagnosed (unlike epithelial cancer). With such a tumor, pain is moderate.

The development of a neoplasm is accompanied by a violation of defecation and the appearance of blood in the feces. In advanced cases, intestinal obstruction and anemia occur.

Symptoms of liver damage

Liver sarcomas often develop from connective tissue or blood vessels. Most tumors in this zone take the form of a small or large node, which stands out against the background of neighboring structures with a dense consistency.

Sarcomas of this type reach large sizes, which leads to liver atrophy. The appearance of a neoplasm is usually due to the course of melanoma.

The development of the tumor process is accompanied by pain in the right hypochondrium, yellowing skin, weight loss and high fever.

In children, sarcomas develop from embryonic liver tissues. These neoplasms are easily determined by palpation. The growth of a tumor from embryonic tissues causes similar symptoms as with other sarcomas in the liver.

Symptoms when other organs are affected

Sarcomas in the pancreas are rare. A neoplasm in this organ provokes symptoms that are disturbing in case of damage to the intestines and liver. In advanced cases, the tumor process provokes thrombosis. If the neoplasm develops in the tail of the pancreas, the skin does not change color.

When the spleen is damaged, apathy, loss of appetite, bouts of nausea with vomiting, frequent urination are noted. The tumor in the later stages of development causes pleurisy. In extreme cases, the spleen may rupture.

The tumor process in the kidneys causes the appearance of blood clots in the urine, pain in the lumbar region. In the absence of adequate treatment, blockage of blood vessels occurs, which leads to an increase in the size of the organ.

Diagnosis and treatment

Diagnostic methods are selected based on the nature of the clinical picture. Tumors in the abdominal cavity are detected using scintigraphy, ultrasound, MRI, CT, arteriography and other methods. A biopsy is performed to determine the type of tumor.

Treatment for sarcomas in the abdominal cavity is predominantly surgical. Depending on the indications and characteristics of distribution cancer cells partial or complete excision of the affected organ is performed. Additionally, radiation and chemotherapy are prescribed.

If necessary, regional lymph nodes are removed. Conservative treatment for sarcomas does not give positive results.

The prognosis for non-epithelial neoplasms of the abdominal cavity directly depends on the stage of development and type of tumor. Specific preventive measures for such cases have not been developed due to the lack of information about the causes of tumors.

Sarcomas are malignant neoplasms that grow from non-epithelial tissues. In the abdominal cavity, tumors of this type in most patients are secondary.

Clinical picture determined by the location of the sarcoma. In the treatment of the latter, radical intervention is usually used.

Keywords

INORGANIC RETROPERITONEAL TUMORS / LIPOSARCOMA OF THE RETROPERITONEAL SPACE/ RECURRENT / SURGERY / ULTRASOUND PROCEDURE/ CHEMOTHERAPY / CYTOREDUCTION / THE EXTRA-ORGAN RETROPERITONEAL TUMORS/ RETROPERITONEAL LIPOSARCOMA / RECURRENCE / SURGICAL TREATMENT / ULTRASOUND / CHEMOTHERAPY / CYTOREDUCTION

annotation scientific article on clinical medicine, author of scientific work - Kulikov E.P., Kaminsky Yu.D., Vinogradov I.I., Kholchev M.Yu., Klevtsova S.V.

The article describes a clinical case liposarcomas of the retroperitoneum with a relapsing course and tactics of managing a patient with this pathology on the example of a specific clinical situation. A feature of the clinical example is a long history of liposarcoma with multiple relapsing course. At the time of admission to the Ryazan Regional Clinical Oncology Center, the patient was diagnosed with the fifth recurrence of liposarcoma. For the period from 2009 to 2015. the patient underwent 5 surgeries for the primary tumor and its relapses and 11 courses of chemotherapy. In July 2015, the patient underwent the sixth operation to remove recurrent retroperitoneal tumors and underwent a course of adjuvant intra-abdominal chemotherapy with cisplatin. The patient was discharged from the hospital under dynamic observation. At the next follow-up examination 10 months after the operation, clinically and according to ultrasound data, no recurrence was detected. Patients with relapses belong to the category of patients for whom there is currently no clearly defined management strategy. but surgical method remains the leader in the treatment of patients with recurrent non-organ retroperitoneal tumors(NZO). The case report of the recurrent retroperitoneal liposarcoma is presented as well as the tactics of management patients with this pathology by the example of a certain clinical situation. The peculiarity of the clinical example of the presented patient is a long anamnesis of liposarcoma with the multiple recurrent course. At the time of admission to Ryazan Regional Clinical Oncology Center, the patient had the fifth recurrence of liposarcoma. During the period from 2009 to 2015 the patient underwent five operations on the primary tumor and its recurrences and 11 courses of chemotherapy . In July, 2015 the patient underwent the 6th operation to remove the recurrent tumors of the retroperitoneal space and the course of adjuvant intraperitoneal chemotherapy with cisplatin. The patient was discharged from the hospital to be dynamically observed. The next control examination (10 months later) showed no signs of disease recurrence according to clinical and ultrasound criteria. There is no consensus regarding the management of patients with recurrent retroperitoneal non-organic tumors and they are classified as the patients for whom today clearly defined treatment has not been established. However, the surgery remains the most successful treatment method of patients with recurrent retroperitoneal tumors and the presented clinical example demonstrates that the complete surgical resection is the only potential curative treatment modality (with maximal degree of cytoreduction ).

The text of the scientific work on the topic "Possibilities of surgical treatment of recurrent retroperitoneal liposarcomas"

doi: 10.18484/2305-0047.2016.5.513 E.P. KULIKOV 1, Yu.D. KAMINSKY 12, I.I. VINOGRADOV 2, M.Yu. KHOLCHEV 2, S.V. KLEVTSOV 1

POSSIBILITIES OF SURGICAL TREATMENT OF RECURRENT LIPOSARCOMAS OF THE RETROPERITONEAL SPACE

SBEE HPE "Ryazan State Medical University named after I.I. acad. I.P. Pavlov ", GBU "Ryazan Regional Clinical Oncological Dispensary" 2, the Russian Federation

The article describes a clinical case of retroperitoneal liposarcoma with a recurrent course and the tactics of managing a patient with this pathology using a specific clinical situation as an example.

A feature of the clinical example is a long history of liposarcoma with multiple relapsing course. At the time of admission to the Ryazan Regional Clinical Oncology Center, the patient was diagnosed with the fifth recurrence of liposarcoma. For the period from 2009 to 2015. the patient underwent 5 operations for the primary tumor and its relapses and 11 courses of chemotherapy. In July 2015, the patient underwent the sixth operation to remove recurrent retroperitoneal tumors and underwent a course of adjuvant intra-abdominal chemotherapy with cisplatin. The patient was discharged from the hospital under dynamic observation. At the next follow-up examination 10 months after the operation, clinically and according to ultrasound data, no recurrence was detected.

Patients with recurrent non-organ retroperitoneal tumors belong to the category of patients for whom there is currently no clearly defined management strategy. However, the surgical method remains the leading one in the treatment of patients with recurrent non-organ retroperitoneal tumors (NRTs). The presented clinical example demonstrates that in the presence of recurrence of NZO, the only way to prolong life is an active surgical approach with the maximum degree of cytoreduction.

Key words: non-organ retroperitoneal tumors, retroperitoneal liposarcoma, recurrence, surgical treatment, ultrasound procedure, chemotherapy, cytoreduction

The case report of the recurrent retroperitoneal liposarcoma is presented as well as the tactics of management patients with this pathology by the example of a certain clinical situation.The peculiarity of the clinical example of the presented patient is a long anamnesis of liposarcoma with the multiple recurrent course. At the time of admission to Ryazan Regional Clinical Oncology Center, the patient had the fifth recurrence of liposarcoma. During the period from 2009 to 2015 the patient underwent five operations on the primary tumor and its recurrences and 11 courses of chemotherapy. In July, 2015 the patient underwent the 6th operation to remove the recurrent tumors of the retroperitoneal space and the course of adjuvant intraperitoneal chemotherapy with cisplatin. The patient was discharged from the hospital to be dynamically observed. The next control examination (10 months later) showed no signs of disease recurrence according to clinical and ultrasound criteria.

There is no consensus regarding the management of patients with recurrent retroperitoneal non-organic tumors and they are classified as the patients for whom today clearly defined treatment has not been established. However, the surgery remains the most successful treatment method of patients with recurrent retroperitoneal tumors and the presented clinical example demonstrates that the complete surgical resection is the only potential curative treatment modality (with maximal degree of cytoreduction).

Keywords: the extra-organ retroperitoneal tumors, retroperitoneal liposarcoma, recurrence, surgical treatment, ultrasound, chemotherapy, cytoreduction.

Possibilities of Surgical Treatment of Recurrent Retroperitoneal Liposarcomas

E.P. Kulikov, Y.D. Kaminsky, I.I. Vinogradov, M. Y. Holchev, S.V. Klevtsova

It is customary to single out their introduction into an independent nosological form. By classification

Non-organic retroperitoneal tumors (NZO) - International Cancer Union NZO

neoplasms that do not have an organ are classified as soft tissue sarcomas, however, due to

belongings developing from soft tissues, due to the rarity of this pathology, objective

located in the retroperitoneal space. statistics related to NZO, in

Clinical course, diagnostic principles are absent in our country.

and treatment of retroperitoneal sarcomas According to various authors, 60-80%

have many features, therefore, the histo-tumors of the retroperitoneal space are

are malignant, and 14-40% are benign. Malignant retroperitoneal tumors are characterized by a high percentage of recurrence after surgical treatment, however, the metastatic potential of NSOs is relatively low.

To date, no effective options have been proposed for the active detection of NSOs. Most patients come to specialized oncology clinics with massive, locally advanced tumors. The most common reasons for the neglect of the disease are late seeking medical help and errors in primary diagnosis due to the weak oncological alertness of doctors in the general medical network.

The surgical method is the leading one in the treatment of patients with NZO. However, the world is actively searching for new methods of treatment and studying the role of additional methods of exposure. The most important feature surgical interventions in NZO - non-standard situations in almost all cases. Operations for NSO are among the most traumatic interventions with a high degree of operational risk. It is quite obvious that the greater the number of organs and anatomical structures undergoing resection or removal, the more difficult the stage of reconstruction and the higher the likelihood of complications. According to the Russian Cancer Research Center (RONTS) named after. N.N. Blokhin, the number of combined interventions for NSO in recent years has increased from 40.2% to 55.8% without an increase in postoperative mortality. This figure for combined operations even decreased to 3.08% compared to 4.8% in previous years. A similar trend is observed in operations that are not accompanied by multivisceral resections: 1.72% and 3.3%, respectively. At the same time, the number of radical surgeries increased from 61.9% to 84.33%. An increase in the degree of radicalism with a decrease in postoperative mortality makes it possible to consider aggressive surgical tactics in case of UO as quite justified.

The prognosis of the disease in liposarcomas (LS) largely depends on the histological subtype of the tumor. According to RONTS them. N.N. Blokhin, overall survival rates of 3, 5, 10 years, the median survival for the highly differentiated type was 77.9%, 55.6%, 30.8% and 85.0 months, for the dedifferentiated type - 61.5%, 50, 3%, 16.8% and 74.0 months, with pleomorphic - 28.6%, 14.3%, 0% and 12 months. . In patients with myxoid

the histological type of drugs with the content of the round cell component of less than 5%, the overall survival rates are significantly better than in tumors with the content of the round cell component of more than 5%. The 3, 5-year survival rates were 84%, 63% versus 60% and 36%, respectively. Thus, the content of the round cell component in the tumor of more than 5% is a significant factor in the poor prognosis in myxoid LS.

Despite extensive combined interventions and the use of the entire range of measures aimed at preventing relapses, the results of surgical and combined treatment are unsatisfactory. The recurrence rate exceeds 50%. In the presence of a recurrence of NZO, an active surgical approach is justified with the maximum possible removal of all available tumor foci. This can significantly prolong the life of the patient.

The purpose of this article is to demonstrate a case of retroperitoneal liposarcoma with a recurrent course with a description of the tactics of surgical treatment in a particular patient.

Clinical case

The patient, 53 years old, was treated in the 1st surgical department of the Ryazan Regional Clinical Oncological Dispensary (ROKOD) from 06/23/2015 to 07/17/2015 with a diagnosis of retroperitoneal liposarcoma, recurrent course, treatment since 2009, multi-stage surgical treatment, courses of chemotherapy, relapse.

The patient was admitted to the surgical department with complaints of a giant tumor in the abdominal cavity, abdominal pain, febrile temperature for 1 month. From the anamnesis it is known that since 2009 the patient has been treated at the Russian Cancer Research Center. N.N. Blokhin for retroperitoneal liposarcoma. Operated for a primary tumor in 2009; in 2010 and 2011 - removal of recurrent tumors, in the period from 2011 to 2013. 11 courses of chemotherapy were carried out. In 2013, another relapse was diagnosed, for which the patient was operated on twice. During the last operation, the right kidney was removed along with the recurrent tumor. Given the resistance of the tumor to chemotherapy and the risk of developing kidney failure adjuvant treatment was not performed. Since May 2015, the condition has worsened: pain in the abdominal cavity, weakness, fever, and an increase in the size of the abdomen have appeared. On examination

clinically and according to CT scan revealed a massive recurrence of the retroperitoneal tumor.

During additional examination: CT scan of the abdominal organs dated 17.06.2015. (RNRC named after N.N. Blokhin). In the abdominal cavity, a massive multinodular tumor formation (relapse of liposarcoma) is revealed, represented by large solid nodes up to 19 cm in diameter, mainly localized in the anterior sections of the abdomen, the stomach, body and tail of the pancreas are compressed between the nodes, the duodenum is spread on the back surface of one of the nodes intestine, the tumor is closely adjacent to the visceral surface of the left lobe of the liver. Separate inclusions of the tumor are detected behind the spleen, along the ascending and descending colon, between the loops of the sigmoid colon. The left adrenal gland is closely adjacent to the tumor (Fig. 1).

In June 2015, the patient was hospitalized in the 1st surgical department of the State Budgetary Institution ROKOD for further examination and to decide whether the recurrent tumor could be removed.

Ultrasound of the abdominal cavity dated 06/22/15. The structure of the liver is heterogeneous, the gallbladder and ducts are without pathology, the pancreas: the head is 34 mm, the body is 21 mm, in the epigastric and mesogastal regions of the abdominal cavity, a group of isoechoic formations heterogeneous structure 140x90 mm in size, located side by side and forming a conglomerate. The conglomerate extends from the anterior abdominal wall to the aorta and iliac

Fig.1. CT scan of the abdominal organs. 1 - volumetric formations; 2 - spleen; 3 - compressed stomach; 4 - liver.

vessels, the contour of the conglomerate is hilly, relatively clear, the inferior vena cava is poorly visible. The right kidney is not defined, the left kidney without features.

X-ray of the stomach from 22.06.15. Signs of pushing the stomach from the outside with volumetric formations of the abdominal cavity, without signs of wall germination.

X-ray of the lungs dated 06/22/15. Shadows of a focal and infiltrative nature were not detected, the roots were structural, the sinuses were free.

FGS dated June 26, 2015. Signs of gastroduodenitis, submucosal formation of the esophagus.

Irrigoscopy dated June 29, 2015. Signs of displacement of the ascending colon.

On 07/07/2015, under combined anesthesia, the operation was performed: removal of recurrent tumors of the retroperitoneal space with removal of the greater and lesser omentums, B2 celiac retroperitoneal lymphadenectomy, removal of tumors of the mesentery of the transverse colon and sigmoid colon.

Operation protocol. During the revision of the abdominal cavity and retroperitoneal space, it was found that a lot of tuberous multinodular tumors with clear boundaries, not associated with the main vessels, come from the retroperitoneal space:

No. 1 - from the lesser omentum, with a maximum diameter of 18 cm, with many tumor germs located along the branches of the celiac trunk and along the lesser curvature of the stomach;

No. 2 - from the root of the cervical organ under the lower edge of the pancreas, with a maximum diameter of more than 20 cm, pushing the stomach cranially, and the colon caudally (Fig. 2);

No. 3 - from the region of the gate of the spleen, with a maximum diameter of 14 cm and 10 cm;

No. 4 - in the greater omentum there are many small tumor germs from 1 cm to 3 cm;

No. 5 - in the mesentery of the sigmoid colon several tumor germs with a diameter of 1 to 6 cm;

No. 6 - in the region of the gate of the liver, several single tumor germs from 1 cm to 4 cm;

No. 7 - focus 5 cm, located between bladder and rectum;

No. 8 - a tumor 5 cm in diameter, located behind the spleen on the diaphragmatic peritoneum.

All of the above tumors were mobilized and removed with B2 celiac lymph node dissection, removal of the greater and lesser omentums from the cardia to duodenum with the intersection and ligation of the left gastric artery at the point of origin from the celiac trunk and the preservation of the short arteries of the stomach (Fig. 3, 4).

Rice. 2. Intraoperative picture during revision of the abdominal organs and retroperitoneal space. 1 - tumor in the area of the lesser omentum; 2 - tumor at the root of mesocolon; 3 - under the tupfer the colon and stomach, squeezed between the tumor nodes.

Rice. 3. View after removal of tumors from the mesocolon root, greater and lesser omentum. 1 - stomach after removal of the greater and lesser omentums; 2 - colon; 3 - pancreas; 4 - spleen; 5 - the bed of the tumor of the lesser omentum; 6 - mesocolon root tumor bed.

Rice. Fig. 4. Tumor elements removed from various 5. Liposarcoma of a differentiated structure of the abdominal cavity. Staining: hematoxylin and eosin. Boost*200.

The postoperative period was uneventful, healing by primary intention.

Histological conclusion No. 30829-38 dated July 10, 2015 - mixed liposarcoma of differentiated and myxoid structure, 0-2 (Fig. 5, 6).

On July 14 - July 16, 2015, a course of intra-abdominal chemotherapy with cisplatin No. 3 50 mg daily (total dose - 150 mg) was carried out. Adverse reactions and no complications were noted.

On July 17, 2015, the patient was discharged from the hospital under dynamic observation.

May 10, 2016 The patient came for follow-up examination. Clinically and according to ultrasound data on recurrence was not revealed.

Discussion

Rice. 6. Myxoid liposarcoma. Staining: hematoxylin and eosin. Boost*200.

The article describes the tactics of managing patients with recurrent NZO on the example of

specific clinical case. A feature of the course of the disease in the presented patient is multiple recurrences of liposarcoma, requiring repeated surgical intervention and courses of systemic and intracavitary chemotherapy.

Despite the fact that NZOs are characterized by a high probability of local recurrence, at present no one doubts the possibility and justification of surgical treatment of recurrent tumors.

The presented clinical case demonstrates the feasibility of an aggressive surgical approach in the treatment of this category of patients. Only repeated surgery with the maximum degree of cytoreduction made it possible to achieve a sufficiently long remission in this patient.

Conclusion

The presented clinical example demonstrates rare case successful treatment of retroperitoneal liposarcoma with multiple recurrent course.

The leading method of treatment that allows to prolong the life of patients with recurrent non-organ retroperitoneal tumors is optimal cytoreductive surgery.

Intra-abdominal chemotherapy should be considered as additional method antitumor effect in this category of patients.

The clinical case is presented with the consent of the patient.

LITERATURE

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4. Mytsyk YuO. The role of diffuse-weighted imaging of magnetic resonance imaging in differential diagnosis malignant neoplasms of the kidney. Science of the Young. 2014;(4): 12127.

5. Chissov VI, Davydov MI. Oncology: national hands. Moscow, RF: GEOTAR-Media; 2008. 1072 p.

6. Stolyarov VI, Gorzov PP. Combined operations for non-organ tumors of the retroperitoneal space. Question of Oncology. 1996; 42(1):103-105.

7. Stilidi IS, Gubina GI, Nered SN, Klimenkov AA, Selchuk VYu, Tyurin IE, et al. Immediate results of surgical treatment of non-organ retroperitoneal tumors. Ros Oncol Zhurn. 2007;(1):25-28.

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9. Barnes L, Tse LLY, Hunt JL, Michaels L. Ch 8: Tumors of the Paraganglionic System: introduction. In: Barnes L, Eveson JW, Reichart P, Sidransky D, eds. Pathology and genetics of head and neck tumors. Lyon: IARC Press; 2005. p. 362-70.

10. Gronchi A, Casali PG, Fiore M, Mariani L, Lo Vullo S, Bertulli R, et al. Retroperitoneal soft tissue sarcomas: patterns of recurrence in 167 patients treated at a single institution. cancer. 2004 Jun 1;100(11):2448-55.

11. Lehnert T, Cardona S, Hinz U, Willeke F, Mechtersheimer G, Treiber M, et al. Primary and locally recurrent retroperitoneal soft-tissue sarcoma: local control and survival. Eur J Surg Oncol. 2009 Sep;35(9):986-93. doi: 10.1016/j.ejso.2008.11.003.

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1. Babaian L.A. Neorgannye zabriushinnye opukholi. Izbrannye lektsii po klinicheskoi onkologii Chissov VI, Dar "ialova SL, red. Moscow, RF; 2000. 735 p.

2. Klimenkov AA, Gubina GI. Neorgannye zabri-ushinnye opukholi: osnovnye printsipy diagnostiki i khirurgicheskoi taktiki. Prakt Onkologia. 2004;5(4):285-90.

3. Kulikov EP, Riazantsev ME, Zubareva TP, Sudakov IB, Kaminskii IuD, Sudakov AI, i dr. Dinamika zabolevaemosti i deathnosti ot zlokachestvennykh no-voobrazovanii v Riazanskoi oblasti v 2004-2014 godakh . Ros Med-Biol Vestn im Akad IP Pavlova. 2015;(4):109-15.

Mesenchymal neoplasms develop from muscle, adipose and connective tissue. Retroperitoneal sarcoma is one such tumor. This is a cancerous tumor that is not related to epithelial cells, so it was isolated into a separate species. Sarcoma is a malignant process that can quickly spread and metastasize.

Why does it occur?

This pathology is primary, it is not preceded by benign formations, therefore there is no single theory explaining its occurrence. There are risk factors that increase the possibility of developing sarcoma:

genetic predisposition;
age over 50 years;
autoimmune pathologies;
oncogenes;
prolonged contact with carcinogens;
action of radioactive rays.

The presence of several factors at the same time, increase the risk of developing cancer.

Manifestation

An increase in a malignant neoplasm puts pressure on the organs, causing a malfunction in the digestive tract, which manifests itself in the form of nausea and vomiting.

Sarcoma in the abdominal cavity and retroperitoneal space is capable of not giving any clinical picture for a long period. When the formation reaches a large size and puts pressure on neighboring structures, the first symptoms appear. Patients complain about disruption gastrointestinal tract in the form of nausea, vomiting, diarrhea or constipation, heartburn, flatulence, intestinal obstruction. The tumor affects the organs of the urinary system, so there are violations of urination, pain in the lower back. As the neoplasm grows, the abdomen increases in size.

The localization of the sarcoma on the right side manifests itself faster than on the left, since there is a large venous network of the liver there. Squeezing of these vessels leads to venous insufficiency in the form of edema lower extremities, expansion of superficial veins and vessels of the esophagus. Violation of the outflow of lymph is manifested by elephantiasis of the legs and pathological accumulation of fluid.

Common symptoms of retroperitoneal sarcoma include weakness, malaise, decreased ability to work, and lack of appetite. Body temperature periodically rises to subfebrile figures without apparent reason, there is weight loss despite ascites and large abdominal volume. When metastasizing, symptoms of damage to other organs are added and lymph nodes.

Diagnostic methods

An objective examination of the patient reveals ascites, an asymmetric appearance of the abdomen with a significant size of the sarcoma. If the tumor is located superficially, it can be palpated as a rounded, dense, mobile formation. Laboratory studies include:

A blood test will determine the level of red blood cells and proteins, the results of which will indicate the presence of cancer.

General blood analysis. Shows a decrease in the level of hemoglobin and erythrocytes, an increase in ESR.
Biochemical examination. Indicates hypoproteinemia, high performance C-reactive protein, creatinine and urea.
Analysis for tumor markers of sarcoma. Characterized by results above normal.
Coprogram. In the feces, elements of undigested food, mucus, and pathological inclusions are found.

Instrumental techniques

Ultrasound of the abdominal organs, retroperitoneal space and lymph nodes is a diagnostic procedure that determines the location of the neoplasm, its size and quantity, metastases in regional lymph nodes.
CT and MRI are contrast methods of research that study the affected organs in layers, which makes it possible to study all physical characteristics sarcomas, features of the blood supply, invasion into neighboring structures, spread to the lymphatic system and other organs.
Biopsy performed under ultrasound guidance. The procedure is based on the penetration of a thin needle into the pathogenic focus to take part of the neoplasm. The material is sent for histological examination to determine the type of cells, the degree of malignancy, the rate of division and distribution.
X-ray of organs chest- is performed to detect metastases in the lungs, since the first distant foci from the retroperitoneal space are detected precisely in the respiratory system.

Sarcomas affecting soft tissues abdominal cavity and retroperitoneal space, are characterized by rapid growth and early metastasis, representing a serious danger to human life. The disease occurs in 13% of cases among all types of non-epithelial tumors. We offer to find out how the sarcoma of the abdominal cavity and retroperitoneal space proceeds and find out if it is possible to cope with it.

What is included in the region of the retroperitoneal space and the abdominal region?

The human abdominal cavity is lined inside with a thin layer of peritoneum - a tissue that controls the work of all organs in this area through the secretion and absorption of a small volume of liquid medium. In fact, this is a large bag, bounded from above by the diaphragm, and from below by the pelvic bones, consisting of two walls. The first fits the walls of the abdomen, and the second - the internal organs. But it does not cover all anatomical structures, some are located behind the peritoneum.

The retroperitoneal space includes the following organs:

kidneys, ureters;
adrenal glands;
inferior vena cava and abdominal aorta;
part of the pancreas;
lateral segments of the large intestine;
nerve plexuses;
The lymph nodes.

The abdominal cavity includes:

stomach;
part of the pancreas;
part of the duodenum;
colon;
liver;
spleen;
abdominal aorta.

In addition to these organs, the retroperitoneal space and the abdominal cavity are filled with fatty tissue, muscle fibers, nerve endings and blood vessels, as well as some other elements of connective tissue that perform a specific function.

In the case of an oncological lesion of one or more anatomical structures, the ICD-10 code has the name: C48 Malignant neoplasm of the peritoneum and retroperitoneal space.

Differences and similarities between retroperitoneal and abdominal sarcomas

We offer to find out if there are similar features in these conditions and if there are differences between them.

Abdominal sarcoma. Malignant tumors in this area are considered rare. They develop from mutated connective tissue cells that make up muscles, blood vessels, nerves, and adipose tissue. The target of sarcoma in the abdominal cavity can be the stomach, liver and other organs that are located in it.

Malignant process can be primary and secondary (metastatic). The tumor is formed in the form of nodular changes and has a characteristic gray-red tint, but when it grows into a large number of blood vessels, it becomes cyanotic. Abdominal wall sarcoma is characterized by rapid progression and early spread of metastases, including by implantation.

It differs from retroperitoneal sarcoma in its superficial location, that is, during examination, the tumor process is diagnosed without much difficulty. A growing neoplasm is easily determined by touch or visually, for example, if you ask the patient to strain the front wall of the abdomen.

The clinical picture of abdominal cavity sarcoma is characterized by the scarcity of manifestations, therefore, most often it is limited to general symptoms:

violation of the general condition of a person;
increased fatigue;
slight hyperthermia.

If we are talking about superficial tumor formations, then there may be ulceration of their surface, the addition of a secondary infection, bleeding, necrotic changes and fetid discharge caused by the decay of the sarcoma. The prognosis for this disease is most often negative.

Retroperitoneal sarcoma, unlike a malignant lesion of the abdominal wall, has the following features:

deeper location in the abdominal area;
close proximity to the spine;
in front, the neoplasm is covered by the stomach and intestinal loops;
negative impact on passive respiratory mobility.

Most often, the sarcoma grows to impressive volumes, starting to have a pathological effect on adjacent organs. Localized in the region of nerve endings, the tumor directly compresses the tissues of the spinal cord. As a result, a person begins to experience severe pain and limited mobility - partial paresis and paralysis.

In the case of development of retroperitoneal sarcoma in the area of the main blood vessels, they are pinched, which leads to problems such as swelling of the lower extremities and abdomen, cyanosis of the upper body, etc. Problems with blood circulation in the abdominal cavity lead to a pathological accumulation of fluid in it, against which ascites develops.

Like abdominal sarcoma, retroperitoneal lesions progress rapidly, metastasize early, and have a poor survival prognosis.

Causes and risk group

The true factors that provoke the development of oncology in the body are not known for certain. But on the basis of many years of observation, experts have identified the causes that, in their opinion, can provoke the formation of sarcoma in the abdominal cavity and retroperitoneal space. Let's list them:

Unfavorable heredity for oncological diseases. If among blood relatives there were cases of cancer or sarcomas, the risk of the disease in a person increases significantly.
Unsatisfactory environmental conditions. In the conditions of modern megacities, every inhabitant is daily attacked by carcinogenic factors, which are present in abundance in the atmosphere.
Labor activity in hazardous production. Despite the funds created personal protection, employees of such enterprises are somehow regularly exposed to negative substances that have an irreparable effect on human health.
Chronic diseases, infections, frequent colds cause a natural decrease in immunity, and therefore the risk of developing tumor processes in the body increases.
Bad habits. It's no secret that tobacco, alcohol and drug addiction can cause oncology.
Frequent injuries, surgical interventions on the organs of the abdominal cavity and retroperitoneal space.
Treatment with immunosuppressants, glucocorticosteroids and radiotherapy in the past.

Almost all of these factors can be controlled by a person independently. This means that you can reduce the risk of sarcoma on your own: just following a healthy lifestyle has a positive effect on overall well-being and health.

According to oncologists, the group of maximum risk for sarcomas of the abdominal cavity and retroperitoneal space includes:

elderly people;
children under 10 years old;
people who have undergone complex abdominal operations;
persons with many years of bad habits;
residents of metropolitan areas.

Symptoms (photo)

It is difficult to detect the first clinical signs of abdominal and retroperitoneal sarcoma, because, unlike synovial and Ewing's sarcoma, which are localized mainly in the limbs, it is much more difficult to notice the disease in the early stages. Malignant tumors do not appear for a long time in the initial stages, but as they grow, the following general symptoms occur:

abdominal pain;
disorders of natural excretory functions - urination and defecation;
hyperthermia, not stopped by antipyretics;
lack of appetite, weight loss;
fatigue, tiredness;
a visual increase in the area of the body where the malignant process is located.

These symptoms usually indicate that we are talking about advanced sarcoma. But there are situations when, with a large tumor formation, a person continues to feel normal, unaware of an oncological diagnosis. In such cases, the following complications signal the disease:

shortness of breath, disorders of respiratory function;
lymphostasis, ascites;
dilatation of the veins of the esophagus.

In addition to general symptoms, the clinical picture of the pathology depends on the localization of the malignant process. Let's see how it looks in practice.

Sarcoma of the small intestine. The disease progresses rapidly, causing a person to have a constant feeling of weakness and hyperthermia. When the lumen of the organ narrows, its patency is disturbed, against which food does not enter the lower intestines, and the patient complains of constant nausea, pain and flatulence.

In the diagnosis, first of all, ultrasound and gastroduodenoscopy are recommended - a method during which a biopsy of the alleged tumor is performed with its study in the laboratory to determine the degree of malignancy for the selection of optimal treatment tactics.

Colon sarcoma. The clinical picture of the disease depends on the location of the sarcoma, the size of the tumor formation and its structure. At an early stage, the oncocenter is presented in the form of a small tubercle located on the intestinal wall. However, it begins to grow rather quickly, penetrating through the entire thickness of the organ, and provokes the appearance of areas of necrosis and ulceration.

With sarcoma in this area, the following symptoms prevail:

moderate discomfort and pain;
secretion of mucus and blood during defecation;
constipation;
cachexia.

Gradually, the tumor formation blocks the intestinal lumen, provoking its obstruction. Frequent bleeding in the area of the oncocenter leads to the formation of anemia and the addition of a secondary infection. X-ray examination and MRI help to diagnose the disease. Treatment consists in radical excision of the affected area of the organ with further courses of chemotherapy and radiation.

Sarcoma of the liver. Being located in the structure of this organ, the tumor process develops almost asymptomatically for a long time, after which it leads to various complications due to the collapse of the neoplasm and internal bleeding.

Main symptoms:

pain in the right hypochondrium;
lack of appetite, exhaustion;
jaundice, hepatitis;
unreasonable hyperthermia.

The prognosis of survival in malignant liver disease is unsatisfactory. This is due to the poor response of the tumor to chemotherapy and radiation exposure, and radical removal of the organ is not possible in all cases.

Sarcoma of the pancreas. A malignant process in this organ often develops in its head, less often in the tail and body. With the progression of pathology, a person begins to complain of such symptoms:

epigastric pain;
weight loss
weakness;
stool disorders.

In the later stages, thrombosis, pathological growth of the spleen and liver, ascites develop. Large tumors can be palpated.

Sarcoma of the spleen. On the initial stages the disease proceeds almost without manifestation clinical signs. With the growth of the tumor, symptoms of intoxication of the body appear:

growing weakness;
anemia;
constant subfebrile temperature.

Also, the following specific manifestations are characteristic of sarcoma of the spleen:

depressive state;
chronic thirst;
frequent profuse urination;
pain on palpation of the abdomen;
weight loss.

With the progression of the malignant process, the patient develops complications such as ascites, pleurisy, malnutrition, etc. In most cases, sarcoma of the spleen makes itself felt only when the tumor reaches impressive volumes. This causes a late diagnosis and the development of conditions that directly threaten a person's life, for example, an organ rupture.

Kidney sarcoma. The malignant process can affect the connecting elements of the kidney itself, the renal capsule and the walls of the vessels. In this case, the sarcoma is able to simultaneously localize in both kidneys, mainly having a soft consistency - liposarcoma, or, on the contrary, solid - fibrosarcoma.

The clinical picture of the oncological process in the kidneys consists of the classic triad of symptoms:

hematuria;
pain in the lower back and lower abdomen;
determination of the tumor by palpation.

Additionally, there are general signs of malignant intoxication: anemia, weight loss and general weakness.

Classification of the international TNM system

For histological confirmation of the diagnosis, sarcoma is graded according to international classification TNM. Let's look at it in a table.

Consider summaries to the listed criteria.

T - primary tumor:

T1a - superficial, less than 5 cm;
T1b - deep, more than 5 cm;
T2a - affects the organ up to the serous membrane, but does not go beyond it;
T2b - localized in adjacent tissues of neighboring organs;
T3 - metastasizes to the lymph nodes, grows into the main nerves and vessels, the spine.

N - regional metastases:

N0 - absent;
N1 - the nearest lymph nodes are affected.

M - distant metastases:

M0 - no data;
M1 - there are secondary tumors in the body.

G - the degree of malignancy of the tumor according to Gleason:

G1 - low;
G2 - medium;
G3 - high.

stages

Consider in the following table what the stages of development of the sarcoma of the abdominal cavity and retroperitoneal space look like.

stages	Description
I	The tumor is small in size - up to 5 cm, does not spread beyond the segments of the lesion, being localized in its tissues. The functional activity of the organ is not disturbed, there is no pathological compression and metastasis. If an oncoprocess is detected at this stage, a person has a good chance of recovery.
II	The tumor grows in size, growing through all layers of the affected organ. In this regard, its direct functions are violated, but metastasis is still absent. The prognosis of survival worsens, since even with radical excision of a malignant neoplasm, frequent relapses of the pathology are noted.
III	The tumor leaves the affected organ and grows into adjacent tissues of neighboring anatomical structures. Cancer cells metastasize to regional lymph nodes.
IV	The stage is different severe course. The tumor is gigantic, forming a continuous malignant conglomerate that bleeds, becomes covered with foci of necrosis and compresses neighboring organs. The occurrence of distant metastatic neoplasms is diagnosed. The survival prognosis is sharply negative.

Types, types, forms

As mentioned above, the abdominal and retroperitoneal forms of sarcomas are primary and secondary. The first type of pathological process is caused by a mutation of healthy cells of the structural elements of organs. It is characterized by rapid development and, as a rule, has an unfavorable prognosis for survival.

Secondary sarcoma in this area is more common than primary. This is a consequence of metastasis from other malignant tumors in organism. The disease manifests itself in the form of single or multiple lesions.

Depending on which cells were involved in the oncological process, the following types of sarcomas are fixed:

Angiosarcoma. It originates from the structural elements of the blood and lymphatic vessels.
Leiomyosarcoma. It develops from muscle tissue.
Fibrosarcoma. It consists of fibrocytes - the basis of connective tissue, the cells of which are represented by fibrous and spindle-shaped elements.
Liposarcoma. Formed from adipose tissue.
Embryonic sarcoma. Found in childhood. Malignant mutations are born in the process of intrauterine development.
Histiocytoma, or pleomorphic sarcoma. A special form of abdominal and retroperitoneal sarcoma, found in 50% of all clinical cases with this pathology.

It should be noted that the disease can develop from different sides. That is, if the malignant process began to form directly in the abdominal cavity, then this condition is characterized by early venous stasis and lymphostasis, which leads to the development of swelling of the lower extremities and ascites. If the tumor is localized to the right or left of the epigastrium, the patient from the early stages of the pathology complains of dull pain and heaviness in the abdomen after any meal, including the lightest meals. In the case of the location of the sarcoma in the lower part of the retroperitoneal space, a person early encounters symptoms such as intestinal obstruction, pain in the lumbar spine and groin, sometimes in the lower extremities.

According to the degree of malignancy, that is, depending on how the structure of healthy tissues affected by mutated cells has changed, it is customary to distinguish three types of sarcomas:

Highly differentiated (G1). Modified cells are practically indistinguishable from normal ones, their functions are not changed, the neoplasm progresses slowly and does not provoke pronounced symptoms. If a tumor is detected at this stage, the patient has a good chance of being cured.
Moderately differentiated (G2). There are at least 50% of atypical cells in the tumor focus sample, the sarcoma progresses and begins to cause the first clinical signs of pathology. In the absence of adequate therapy, the malignant process quickly passes into the next stage.
Undifferentiated (G3). The cells in the tumor are almost 100% modified, having no common features with healthy tissues. The pathological process is rapidly and actively progressing, spreading metastases. The survival prognosis for patients with undifferentiated sarcomas deteriorates dramatically.

Diagnostics

Identifying retroperitoneal or abdominal sarcoma is not an easy task. For this purpose, the following methods are most often used:

radiography;
MRI and CT;
biopsy;
histological examination of the obtained biopsy.

Modern diagnostic methods make it possible to determine the presence of malignant tumors in the tissues of the abdominal cavity and retroperitoneal space at an early stage of development. But, as practice shows, patients themselves rarely turn to specialists with initial signs of cancer, since their severity is rarely noticeable. As a result, the diagnosis of sarcoma is carried out with a significant delay and with advanced forms of the disease. That is why doctors recommend paying more attention to your health and undergoing scheduled medical examinations every year.

Treatment

Therapy of sarcomas localized in the retroperitoneal space and in the abdominal cavity, as a rule, is performed using an integrated step-by-step approach:

operation - surgical excision of a neoplasm;
chemotherapy using drugs Ifosfamide, Vincristine, Methotrexate, etc.;
external beam and radioisotope therapy.

The choice of specific methods directly depends on where the sarcoma is located, the type of its differentiation, the general condition and age of the patient, the fact of metastasis.

With aggressive neoplasms, it is performed at the initial stages, provided that there are no metastatic tumors in the body. Only in this case, there is a good opportunity to get rid of oncology by removing all atypical cells from the oncological focus. Together with the sarcoma, up to 2 cm of healthy tissues are removed, without affecting the nerve endings and blood vessels, in order to maintain the functional activity of the operated organ.

Surgical treatment is contraindicated in the following cases:

persons over 75 years of age;
severe pathologies of the heart and blood vessels, liver and kidneys;
large tumors located in vital anatomical structures, such as the liver, that cannot be removed.

Depending on the stage of sarcoma in question, specialists may resort to the following treatment tactics:

Stages I and II in moderately and poorly differentiated tumor processes. An operation is performed, regional lymph nodes are removed. Then, up to 2 courses of polychemotherapy or remote irradiation will be required.
Stages I and II in highly differentiated neoplasms. Surgical intervention and a course of chemotherapy are performed before and after tumor resection.
III stage. A combination of chemotherapy and radiation therapy is given before surgery to reduce the size of the tumor. During surgical excision of sarcomas, additional excision of all affected adjacent tissues is resorted to and the nerve trunks and blood vessels affected by the disease are restored.
IV stage. Spend conservative treatment, primarily aimed at eliminating the symptoms of pathology and improving the general well-being of a person. In particular, this is the appointment of analgesic, antianemic and detoxifying drugs. Sarcomas at the last stage are inoperable, but if there is access to the tumor, then it is partially or completely resected, and single metastases are also removed.

Modern methods of treatment. Among them, remote irradiation is actively used with the use of linear accelerators and special programs that are able to independently calculate the power of the beam flux and the time of its impact on the site of a malignant focus. Radiotherapy is carried out under full computer control to eliminate errors.

Brachytherapy. It is used in the treatment of sarcomas of various localizations, including those fixed in the abdominal cavity and retroperitoneal space. The method irradiates the tumor with the required dose of radiation with the highest accuracy, without harming healthy cellular elements. The radiation source is introduced into the body using remote control. According to experts, in some cases, brachytherapy can replace external beam radiation therapy and surgery.

Folk remedies. be treated folk remedies with extraskeletal sarcomas without the participation of a doctor is not recommended. Non-official medicine is more often used by inoperable patients at the fourth stage of the cancer process, for whom any method of therapy can be a chance for salvation and gives reason to hope. But efficiency medicinal herbs and products of animal origin has not been proven, therefore, before using them, it is recommended to consult a doctor without fail.

Organ transplant/transplantation

Oncological diseases are a contraindication for transplantation of organs of the abdominal cavity and retroperitoneal space. This is due to the fact that after transplantation of individual anatomical subjects, it is necessary to prescribe immunosuppressants that significantly suppress immune system and lead to disease progression.

At the same time, experts do not deny that there is a possibility of transplantation, but only if we are talking about cured early stages of sarcoma, the absence of metastases and relapses for a certain time. Unfortunately, in Russia such tactics remain at the level of theory.

Recovery process after treatment

Postoperative therapy is aimed at preventing recurrence and dissemination of sarcoma. Highlights of rehabilitation - organization medical nutrition, antibacterial and symptomatic therapy, care postoperative wound, various physiotherapy.

After recovery period with positive dynamics, the patient is discharged from the hospital. For the first 2 years, he must visit a doctor quarterly. The oncologist closely monitors the state of the body, assesses the risk of relapses and complications associated with radiation and chemotherapy. After this period of time, visits to the doctor are reduced to 2 times a year.

The course and treatment of the disease in children, pregnant women and the elderly

Children. In children and adolescents, sarcomas of this type are rare, with the exception of embryonic liver tumors. Such neoplasms occur mainly in the early and preschool age. Their diagnosis practically does not cause difficulties - the doctor will notice an increase in the circumference of the abdomen with the naked eye, and the tumor itself can be felt through the abdominal wall.

The pain syndrome in children is not pronounced, however, with the progression of the pathological process, sharp pains in the right hypochondrium may develop due to the pressure of the growing neoplasm on neighboring anatomical structures. Additional clinical signs in this case may be anemia, lack of appetite and sudden weight loss, nausea and vomiting that does not bring relief. The prognosis for sarcomas in this case is most often negative, since tumors are highly resistant to chemotherapy and radiation, and certain types surgical interventions for certain reasons are often impossible.

Pregnant. Sarcoma of the abdominal cavity and retroperitoneal space among expectant mothers is rare. If the pathological process was detected during pregnancy, then, depending on the stage of the neoplasm, its nature and the well-being of the woman, further treatment tactics are formed.

Interruption of gestation is not always a prerequisite for successful therapy. Much depends on the duration of pregnancy and the course of the disease. In any case, a woman must fully trust the specialists, since their task is to act in the interests of the mother and child.

Elderly. With age, sarcomas are diagnosed less frequently, since this disease is still characteristic of young and middle-aged people. The clinical picture of the pathology, as a rule, has the same character as in other patients. But, as practice shows, older people turn to the doctor late, attributing the symptoms of a malignant process in the body to manifestations of somatic diseases of an acute and chronic nature.

The principles of treatment tactics for diagnosed sarcomas in elderly patients are dictated by their general health, stage of neoplasm, contraindications to chemotherapeutic, surgical and other interventions. Quite often at this age, the only solution is palliative care aimed at prolonging a person's life.

Treatment of sarcoma in Russia and abroad

We offer you to find out how the fight against sarcomas of the abdominal cavity and retroperitoneal space is carried out in different countries.

Treatment in Russia

The effectiveness of the treatment of soft tissue sarcomas in domestic oncological centers depends on the stage of the malignant process and the age of the patient. Russian specialists use classical measures of influence in the fight against neoplasms: surgery, chemotherapy, radioisotope and radiation therapy. At the same time, the operational path is considered to be fundamental.

The cost of treatment in Russia depends on the status of the medical institution and whether the patient has insurance. Many procedures can be done completely free of charge, under the compulsory medical insurance policy, even in oncological centers of federal significance located in large cities. Also, at the request of the patient, appropriate assistance can be obtained on a paid basis. On average, the fight against cancer in Russia is several times cheaper than in European countries - in Germany, Switzerland and the United States.

He has been diagnosing and treating cancer for over 100 years. The center uses the achievements of the modern level in the operational, radiation and other industries, which increases the efficiency of providing therapeutic care to the population.
St. Petersburg Clinical Scientific and Practical Center for Specialized Species medical care, Saint Petersburg. It develops and implements diagnostic, therapeutic and preventive measures aimed at combating oncological diseases.

Marina, 44 years old. "At the NMHC them. Pirogov, my sister was treated for stomach sarcoma. Everything is at a high level, doctors are trying to provide the required assistance, which is very important with such diagnoses.”

Treatment in Germany

The main goal of the fight against sarcomas in German clinics is to minimize the likelihood of disability and reduce the risk of recurrence of the tumor process. The effectiveness of diagnostics and treatment methods increases the multidisciplinary approach to each patient. Several specialists from various branches of medicine, such as oncologists, chemotherapists, radiologists, rehabilitation specialists, etc., simultaneously take part in the development of therapeutic tactics.

Oncological clinics in Germany that treat sarcomas are equipped with innovative equipment, which is updated every 5 years. At the same time, quality control systems work in all medical institutions, this is especially true for diagnostic services - thanks to them, laboratory and other errors are excluded. Thus, German specialists are able to quickly and accurately make a diagnosis, which is extremely important for malignant diseases, and monitor the effectiveness of the treatment.

The cost of complex diagnostics of sarcoma ranges from 5 to 12 thousand euros, the prices for therapy depend on the location of the tumor and the stage of the oncological process. Standard methods are used in the treatment: surgery, chemotherapy and radiation.

Which clinics in Germany can I contact?

Clinic specialists treat leukemia, sarcomas, tumors internal organs And bone tissue. Organ-preserving surgeries are a priority for local doctors. "Keyhole surgery", "hot chemotherapy" and many other fundamentally new techniques are used by German oncologists to successfully combat malignant neoplasms.
Clinic "Asklepios Barmbek", Hamburg. A multidisciplinary medical institution, in which modern medical achievements are also taken as the basis for the provision of diagnostic and therapeutic care. One of the specializations of the clinic is the interventional treatment of malignant tumors. With this method, the sarcoma is destroyed without surgery and without affecting the healthy cells of the body.

Consider reviews of the listed clinics.

Valeria, 34 years old. “My father was diagnosed with peritoneal sarcoma, the intestines were affected. In Russia, doctors doubted the operability of the tumor, and we turned to Germany, to the Helios Berlin-Buch clinic. Four sessions of irradiation and surgery greatly improved my father's health, he was discharged home. Thanks to the German doctors. There are still several stages of treatment ahead, but already in Russia.”

Oksana, 36 years old. “An x-ray showed a tumor in my sister, after the examination it turned out that it was an early stage liver sarcoma. In Germany, at the Asklepios Bambrek clinic, she underwent surgery and was discharged home a week later. Thanks to the doctors for their help."

Treatment of sarcoma of the abdominal cavity and retroperitoneal space in Israel

The fight against sarcomas in Israel is a popular service among Russian patients. The removal of a malignant neoplasm is carried out here using the latest technological equipment and advanced treatment methods, and the professionalism of local doctors is popular all over the world.

The cost of fighting soft tissue sarcoma in Israel depends on the status of the chosen clinic, the complexity of the operation, the stage of the disease, and some other related factors. Here is an example of the average prices for diagnostics and treatment:

tissue biopsy - 3.5 thousand dollars;
assessment of lymph nodes for metastases - 11 thousand dollars;
MRI - $600;
Cyber Knife - $15,000;
radiosurgery - 30 thousand dollars, etc.

After the malignancy of the sarcoma is assessed, the treatment tactics are formed. During its passage, the patient undergoes rehabilitation measures and, with positive dynamics, is discharged home.

Which clinics can be contacted?

Treatment is carried out according to modern standards, allowing to achieve success in 90-95% of cases.
Cancer Center. Chaima Shiba, Ramat Gan. State clinic with a specialized department "Sarcoma Center". The leading doctors of the country are engaged in the fight against the disease, since the center is the scientific base of the Tel Aviv Medical University.

Consider reviews of the listed clinics.

Christina, 34 years old.“A year ago, I was suspected of oncology of the spleen, but they could not classify the stage and type of tumor, and I turned to Israel. My diagnosis was not confirmed, later I found out that ⅓ of all malignant tumors are not confirmed in the clinics of this country. I recommend the clinic to everyone. Sourasky in Tel Aviv.

Vladimir, 45 years old. "At the oncology center. Haima Shiba stayed with his wife in the spring of 2016. She was diagnosed with intestinal sarcoma. Fortunately, everything is over. I would like to recommend the doctors of this clinic as sympathetic, highly professional and simply wonderful people. Thanks to them."

Complications

With the growth and progression of sarcoma, the following types of complications may occur:

pathological compression of neighboring organs and a violation of their functional activity;
intestinal obstruction, perforation and peritonitis;
elephantiasis, provoked by disorders of the outflow of lymph when squeezing the lymph nodes;
internal bleeding and intoxication of the body caused by the decay of a malignant neoplasm;
metastasis.

These complications usually develop with advanced forms of sarcoma. Most of them require urgent surgical care and worsen the overall prognosis of survival.

Metastasis

Metastases in abdominal and retroperitoneal sarcoma spread by lymphogenous, hematogenous and implantation routes. If the tumor process is located in the stomach, small or large intestine, liver, spleen and kidneys, then oncocells through the lymphatic system primarily reach the lungs, bone structures of the skeleton, brain and other distant organs.

In the blood vessels in this case, metastases spread less frequently. Predicting where a secondary tumor will occur is almost impossible. For example, with sarcoma of the stomach and intestines, oncocells can spread throughout the body along with the fluid that accumulates in the abdominal cavity - ascites - into the anatomical structures of the small pelvis, such as the ovaries and uterus in women and the prostate gland in men.

The treatment of metastatic tumors against the background of the underlying disease is much more complicated. In addition to the standard in the form combination therapy necessary surgical removal single metastases. At the same time, multiple daughter tumors are not subject to resection, since this is completely ineffective. In general, the prognosis in the stage of metastasis is significantly worse.

Relapses

In terms of the number of deaths, sarcomas rank second among all malignant diseases. Secondary oncoprocesses, or relapses, which often develop after treatment of primary neoplasms, are mainly to blame for this.

Relapses are formed both locally, in the area of surgical intervention in case of a primary tumor, and remotely - in any part of the body where atypical cells are fixed. The treatment of a new malignant process is carried out according to the same principles as the fight against the previous sarcoma, but it is important to take into account that new oncofoci respond worse to radio- and chemotherapy.

Getting a disability

Regardless of what kind of cancer a person has, he can qualify for a disability determination group if significant damage to his health has been received during the course and treatment of a malignant formation. Each patient with such a diagnosis has the right to apply to the Bureau of Medical and Social Expertise (ITU) at the place of residence to determine the disability group.

Disability registration can be dealt with 3 months after the diagnosis and the start of the main treatment. The doctor observing the patient should help in this matter - he will tell you what documentation is required to pass the commission and give the necessary explanations regarding the collection of informative data. As a rule, the ITU bureau requires the results of histological, radiological, laboratory examinations, an extract from the medical history, identity documents, etc.

There are several main criteria that determine the status of disability and measures of restriction of labor activity. Consider them:

Group III - moderate health problems. Assigned to persons who have passed radical treatment malignant process at I and II stages of sarcoma. Such patients are prohibited from performing heavy physical labor.
Group II - pronounced harm to health. It is prescribed for individuals with poorly differentiated centrally located tumors and with uncertain prognosis of survival. Such patients are deprived of the opportunity to work in standard production conditions.
Group I - pronounced health disorders. The patient is deprived of the opportunity to work against the backdrop of a severe course of oncology. As a rule, from this point on, he requires constant extraneous care, and his chances of recovery are minimal.

life forecast

According to statistics, the prognosis for abdominal and retroperitoneal sarcomas is usually unfavorable. In the absence of adequate treatment, the death of the patient occurs on average 6 months after the onset of the first clinical signs of the malignant process.

But even the therapy carried out does not guarantee that a person will not develop various complications that accelerate the lethal outcome. Consider in the following table what is the prognosis for sarcomas of the abdominal cavity and retroperitoneal space at different stages of their development.

In persons with the last, terminal, stage of the disease, the chances of surviving to the five-year milestone are zero.

Diet

The diet for sarcoma should include the maximum amount of fresh fruits and vegetables, herbs, dairy products, cereals and dietary meat, complex carbohydrates and easily digestible proteins. To block the spread and growth of metastases, it is recommended to add oily sea fish, onions and garlic, yellow and green vegetables, juices and fresh juices to the menu.

It is forbidden to eat with oncological diseases red meats, confectionery, dishes with chemical fillers, include coffee, black tea, carbonated and alcoholic drinks in the diet. Clear sources of carcinogenic substances such as smoked meats, kebabs, marinades, etc. are excluded.

During the treatment of sarcoma, each patient is recommended to organize six meals a day with a predominance in the menu of the most sparing pureed liquid dishes at a temperature close to the patient's body temperature. If the patient has no appetite, it is necessary to prepare food based on his personal preferences. It is important to observe the same nutritional principles during the rehabilitation period and after discharge from the hospital due to the fact that the recommended list of products helps prevent the recurrence of cancer in the future.

Prevention

To date, experts still do not know what caused the development and growth of abdominal and retroperitoneal sarcomas. But preliminary findings do not exclude the involvement of adverse genetic information received from blood relatives, the abuse of addictions and the conduct of an unhealthy lifestyle.

Of course, it is impossible to influence heredity in any way, but everyone can give up alcohol and cigarettes, junk food and some other negative factors. Otherwise, weak immunity and the progression of adverse factors in the body can create an environment in the body for the growth and division of atypical cells.

In addition, it is recommended to undergo a preventive medical examination annually for early diagnosis. possible pathologies and their timely elimination. At the first suspicion of the presence in the body of any disease, no matter oncological or somatic, it is recommended to consult a specialist.

Are you interested modern treatment in Israel?

Liposarcoma of the retroperitoneal space, an increase in inguinal lymph nodes. Tumors of the peritoneum

Causes and risk groups for the development of sarcoma of the retroperitoneal space and abdominal cavity

Sarcoma classification

Clinical picture

Diagnostics

Therapy Methods

Features of the tumor

Causes

Symptoms

Sarcoma of the retroperitoneum

Liposarcoma

Leimiosarcoma

fibrosarcoma

Histiocytoma

Symptoms of the defeat of the abdominal wall

Symptoms of a stomach lesion

Symptoms of intestinal damage

Symptoms of liver damage

Symptoms when other organs are affected

Diagnosis and treatment

annotation scientific article on clinical medicine, author of scientific work - Kulikov E.P., Kaminsky Yu.D., Vinogradov I.I., Kholchev M.Yu., Klevtsova S.V.

Related Topics scientific papers in clinical medicine, author of scientific work - Kulikov E.P., Kaminsky Yu.D., Vinogradov I.I., Kholchev M.Yu., Klevtsova S.V.

The text of the scientific work on the topic "Possibilities of surgical treatment of recurrent retroperitoneal liposarcomas"

Why does it occur?

Manifestation

Diagnostic methods

Instrumental techniques

What is included in the region of the retroperitoneal space and the abdominal region?

Differences and similarities between retroperitoneal and abdominal sarcomas

Causes and risk group

Symptoms (photo)

Classification of the international TNM system

stages

Types, types, forms

Diagnostics

Treatment

Organ transplant/transplantation

Recovery process after treatment

The course and treatment of the disease in children, pregnant women and the elderly

Treatment of sarcoma in Russia and abroad

Treatment in Russia

Treatment in Germany

Treatment of sarcoma of the abdominal cavity and retroperitoneal space in Israel

Complications

Metastasis

Relapses

Getting a disability

life forecast

Diet

Prevention