Primary pleomorphic liposarcoma of the thoracic epidural space: case report.
BACKGROUND
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.


OBJECTIVE
We describe the only reported case of a purely epidural PLS with no macroscopic bone involvement at diagnosis.


METHODS
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.
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel.
P David
PD
Halevi
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel.
Fernando
F
Ramirez-de-Noriega
Department of Pathology, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel.
Yakov
Y
Fellig
Department of Radiology, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel.
J Moshe
JM
Gomori
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel; Department of Radiology, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel.
José E
JE
Cohen
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel. Electronic address: eyal.itshayek@gmail.com.
Eyal
E
Itshayek
D000368:Aged; D003937:Diagnosis, Differential; D004824:Epidural Space / Q000601:surgery; D006801:Humans; D007796:Laminectomy; D008080:Liposarcoma / Q000473:pathology / Q000601:surgery*; D008297:Male; D013125:Spinal Neoplasms / Q000473:pathology / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery
Bone invasion; Epidural fat; Pleomorphic liposarcoma; Primary spinal tumor; Spinal cord compression; Spinal liposarcoma