Korean J Gastroenterol.  2013 Oct;62(4):248-252. 10.4166/kjg.2013.62.4.248.

A Case of Pleomorphic Liposarcoma in a Patient with Crohn's Disease Taking Azathioprine

• Ahn SM
• Suh SO
• Oh YM
• Yun CY
• Sim HH
• Park CA
• Song CM
• Bae JY

• KMID: 1792745
• DOI: http://doi.org/10.4166/kjg.2013.62.4.248

Abstract

Azathioprine is frequently used for the treatment of inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis. Lymphomas, squamous cell carcinomas, and undifferentiated pleomorphic sarcomas have been reported among patients receiving azathioprine therapy. Herein, we report a case of pleomorphic liposarcoma of chest wall which occurred in a 44-year-old man with Crohn's disease taking azathioprine. He was diagnosed with Crohn's disease 3 years ago after suffering from abdominal pain and hematochezia for 12 years. He had been taking 50 mg of azathioprine per day for 23 months when he visited the thoracic and cardiovascular surgery clinic due to right chest palpable mass that had rapidly grown during the past 2 months. Excisional biopsy was performed and the mass was diagnosed as pleomorphic liposarcoma. Therefore, he underwent radical excision of the right chest wall mass, which measured 11.0x6.5 cm in size. He is scheduled to receive radiation therapy and chemotherapy.

Keyword

Crohn disease; Azathioprine; Liposarcoma

MeSH Terms

Adult
Azathioprine/*therapeutic use
Colonoscopy
Combined Modality Therapy
Crohn Disease/complications/*drug therapy
Fluorodeoxyglucose F18/diagnostic use
Humans
Immunosuppressive Agents/*therapeutic use
Liposarcoma/complications/*pathology/surgery
Male
Positron-Emission Tomography
Radiopharmaceuticals/diagnostic use
Tomography, X-Ray Computed
Azathioprine
Fluorodeoxyglucose F18
Immunosuppressive Agents
Radiopharmaceuticals

Figure

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  Fig. 1. (A) Initial colonoscopy shows ulcer scars with several pseudopolyps and ileocecal valve deformity. (B) Initial CT enterogram demonstrates multifocal enhancing wall thickening of the small bowel and ascending colon with fatty infiltration (white arrows). (C) Small bowel series shows multifocal strictures in the ileal loop (black arrows).

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  Fig. 2. About 8.0×6.2 cm sized heterogenous enhancing soft tissue mass (white arrow) is noted at far lateral side of right pectoralis muscle on chest CT scan.

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  Fig. 3. 18 F-fluorodeoxyglucose (FDG) PET/CT findings. (A) PET/CT and (B) PET image reveal increased FDG uptake (A: white arrow, B: black arrow; standardized uptake value of 12.6) at the lateral aspect of right pectoralis muscle with no other abnormal metabolic lesions.

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  Fig. 4. Microscopic findings (H&E). (A) Tumor cells infiltrating adjacent skeletal muscles (black arrow; ×10). (B) There are many pleomorphic lipoblasts (black arrows) with atypical mitosis (white arrows) (×200). (C) There are hyperchromatic nuclei cells (black arrows) in the myxoid matrix (×200).

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  Fig. 5. Immunohistochemical staining findings (×200). It shows positive staining for vimentin (A) and p53 (B).

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  Fig. 6. Gross specimen. The well circumscribed mass measured 11.0×6.5 cm in size.

Reference

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