Recurrent giant retroperitoneal liposarcoma

Rationale: This report describes an exceptionally large recurrent tumor with a long-standing and recurrent clinical course, thereby adding to the limited literature on giant myxoid liposarcoma. Patient concerns: A 48-year-old male with a 13-year history of recurrent liposarcoma presented with progressive abdominal distension and marked abdominal enlargement over 4 months. Imaging demonstrated a massive abdominopelvic mass measuring 352 mm in maximum diameter. Diagnoses: Histopathological examinations from multiple prior resections had consistently confirmed recurrent myxoid liposarcoma. Interventions: During the current admission, the patient underwent complete resection of a giant retroperitoneal tumor, with pathology again verifying myxoid liposarcoma. No adjuvant chemotherapy or radiotherapy was administered. Outcomes: At 18-month follow-up, the patient developed multiple abdominopelvic metastases, indicating the aggressive biological behavior and high recurrence risk of retroperitoneal myxoid liposarcoma. Lessons: This case describes an exceptionally large recurrent retroperitoneal liposarcoma measuring 43 × 32 × 23 cm and weighing approximately 20 kg, with a prolonged 13-year clinical course characterized by multiple recurrences and repeated surgical resections. It demonstrates that even an extremely large recurrent tumor may remain amenable to surgical resection following comprehensive imaging evaluation and multidisciplinary planning, with appropriate preparation for possible adjacent-organ resection. Nevertheless, the development of multifocal abdominopelvic recurrence 18 months after surgery underscores the persistent risk of recurrence and the need for structured, long-term postoperative surveillance. This case contributes to the limited literature by illustrating both the feasibility and the inherent limitations of repeated surgical management for giant recurrent retroperitoneal liposarcoma.