Gigantski, brzorastući lipom Retziusovog prostora

Goran Augustin, Lucija Brkić, Zlatko Marušić

U 57-godišnje, prethodno zdrave postmenopauzalne žene suprapubična tvorba otvorene etiologije viđena je tijekom redovnoga ginekološkog ultrazvučnog pregleda. U razmaku od 50 dana tri transabdominalna ultrazvuka (UZV) i kompjuterizirana tomografija (CT) pokazale su rapidan porast u masi i veličini (od 5,6 x 1,1 cm do 11 x 6 cm na UZV, 19 x 11 cm na CT). Anamnestički, bolesnica je imala trombocitopeniju (1 x 109/L) i intrauterini uložak (IUD) s hormonalnim otpuštanjem. Karcinoembrijski antigen (CEA) bio je blago povišen (4.1 IU/L). Abdominalni CT s intravenskim kontrastom opisao je inkapsuliranu masu intenziteta masnog tkiva bez jasnoga primarnog sijela. Nije bilo znakova infiltracije ili invazije okolnih organa. Diferencijalna dijagnoza uključivala je lipom i low grade liposarkom. Nakon eksplorativne laparotomije i kompletne ekstirpacije tumora (24 x 19 x 7 cm) iz Retziusovog prostora, patohistološka dijagnoza bila je lipom s negativnim estrogenskim i progesteronskim receptorima. Postoperativni tijek bio je uredan te je nakon godinu dana magnetna rezonancija (MR) pokazala da nema recidiva.

In the 57-year old, healthy postmenopausal female, an asymptomatic suprapubic mass was an accidental finding on a regular gynecologic ultrasound (US). In 50 days, three transabdominal US and computed tomography (CT) scans showed a rapid increase in mass size (from 5.6 x 1.1 cm to 11 x 6 cm to 12.5 x 7 cm on the US, 19 x 11 cm on CT). Previous medical history noted thrombocytopenia (1 x 109/L) and an intrauterine device (IUD) with the hormonal release. The carcinoembryonic (CEA) marker was slightly elevated (4.1 IU/L). Abdominal CT with intravenous contrast revealed encapsulated mass with the intensity of fatty tissue without discernible primary origin. No signs of infiltration and invasion of surrounding structures were found. CT differential diagnosis included lipoma and low-grade liposarcoma. After exploratory laparotomy and complete extirpation of the tumor (24 x 19 x 7 cm) from the Retzius space, the histopathology confirmed a lipoma with negative estrogen and progesterone receptors. The postoperative course was uneventful, and one year after surgery, US and magnetic resonance (MR) imaging did not show recurrence.