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Metastatic undifferentiated pleomorphic sarcoma causing intraoperative stroke.

Reed Spaulding¹, Theodoros Koumoundouros, Joseph C Parker

¹University of Louisville Hospital, Department of Anatomic Pathology, Louisville, KY 40202, USA. nrspau01@louisville.edu

Annals of Clinical and Laboratory Science

|May 23, 2013

Summary

A dedifferentiated liposarcoma evolved into a more aggressive pleomorphic undifferentiated sarcoma upon lung metastasis. This case highlights the risks of surgical resection and tumor dedifferentiation during metastasis.

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Area of Science:

Oncology
Pathology
Surgical Oncology

Background:

Malignant fibrous histiocytoma, formerly a common adult soft tissue sarcoma, was reclassified by the WHO in 2002 as Pleomorphic Undifferentiated Sarcoma.
The precise origin of these tumors remains under investigation.

Observation:

A case of dedifferentiated liposarcoma metastasizing to the lung within one year is presented.
The metastatic lesion exhibited a more aggressive histology, consistent with pleomorphic undifferentiated sarcoma.
The patient expired due to a massive hemorrhagic stroke caused by tumor emboli in the middle cerebral artery.

Findings:

The pulmonary metastasis showed increased histological aggressiveness compared to the primary dedifferentiated liposarcoma.
Autopsy revealed tumor emboli from the lung metastasis occluding the left middle cerebral artery, leading to a fatal stroke.

Keywords:

Pleomorphic undifferentiated sarcoma embolus liposarcoma malignant fibrous histiocytoma

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The embolic lesion's histology was consistent with pleomorphic undifferentiated sarcoma.

Implications:

This case underscores the potential for soft tissue sarcomas to dedifferentiate and become more aggressive during metastasis.
It highlights the significant risks associated with surgical resection of metastatic sarcomatous lesions.
The findings support the concept of tumor evolution and increasing undifferentiation in metastatic disease.