Giant retroperitoneal leiomyosarcoma. Multiorgan block removal

• Retroperitoneal tumors can have a large size and require complex excisions.
• Surgery with curative intent is not always possible, and we must always evaluate the benefit risk when planning surgery for these tumors.
• Currently only surgery has any chance in curing this disease. Radiotherapy and chemotherapy are complementary to radical surgery.
• Retroperitoneal tumors usually present as large tumors but pathological diagnosis can sometimes be difficult.

INTRODUCTIONRetroperitoneal tumors are rare, mostly malignant. Locally aggressive, and more frequent in women in their 5th decade of life. Its symptoms are nonspecific, including abdominal pain and palpable mass. To diagnosis is helpful computed tomography and biopsy. It needs surgery for absolute healing.PRESENTATION OF CASE67 years old man was admitted with back pain and fever. Abdominal imaging tests showed a 15 cm abdominal mass without clear organodependencia. Endoscopy with biopsies evidenced mesenchymal neoplasia of undetermined origin. In surgery we confirm its resecability and was necessary multiorgan resection. Pathologic diagnosis: well differentiated retroperitoneal leiomyosarcoma. Started adjuvant radiotherapy. In subsequent tests showed the presence of liver metastases.DISCUSSIONRetroperitoneal tumors are developed from nerve, vascular, muscular, connective, supportive and fibroareolar tissue from this space. Its size does not modificate survival or resectability. We used TC and biopsy for its diagnose. Adjuvant therapy does not affect survival or quality of life, surgery remains the only curative option. Locoregional recurrence is the most influential figure in the prognosis. A large percentage of patients required a second surgery (between 45 and 82%).CONCLUSIONThe only curative option of retroperitoneal sarcomas is surgery, which usually requires multiple organ resection. Chemotherapy and radiotherapy are mostly a surgical supplement. Chemotherapy has not shown significant increase in survival.