Primary pleomorphic liposarcoma of the thoracic epidural space: Case report

Background Context Pleomorphic liposarcoma (PLS) is a rare malignant soft tissue tumor comprising 5%-15% of liposarcomas and characterized by high malignant potential. To our knowledge only three cases of this entity have been reported in the spine. Purpose We describe the only reported case of a purely epidural PLS with no macroscopic bone involvement at diagnosis. Study Design/Setting A case presenting clinical evidence that PLS may arise from the epidural fat is reported. Methods The clinical presentation, management, and outcome in a case of primary PLS of the thoracic spine, and a review of the literature, are presented. Results A 70-year-male presented with sudden onset lower extremity weakness, constipation, and back pain. Magnetic resonance imaging revealed an epidural lesion at T5 with noted mass effect compressing the spinal cord and extension to the T5-T6 foramen. Urgent decompressive laminectomy with gross total resection was performed. Histopathology revealed high-grade PLS. Adjunct radiotherapy was prescribed. The tumor recurred 3 months later. In spite of repeat surgery, additional radiation, and chemotherapy, the patient developed widespread metastases and succumbed to his disease 1 year after treatment began. Conclusions Spinal PLS is a rare entity, but nonetheless may arise from epidural fat and should be considered in the differential diagnosis of primary spinal cord lesions.