DOI: 10.14260/jemds/2014/3196 CASE REPORT J of Evolution of Med and Dent Sci/ eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 3/ Issue 35/Aug 14, 2014 Page 9264 GIANT LIPOSARCOMA IN SCAPULAR REGION: A CASE REPORT Krishna Gopal 1 , Sanjeev Kumar 2 , Sushmita 3 , Ashwani Kumar 4 , Ashish Prasad 5 , S. K. Jha 6 , K. H. Raghwendra 7 , Sangeeta Pankaj 8 HOW TO CITE THIS ARTICLE: Krishna Gopal, Sanjeev Kumar, Sushmita, Ashwani Kumar, Ashish Prasad, S. K. Jha, K. H. Raghwendra, Sangeeta Pankaj. “Giant Liposarcoma in Scapular Region: A Case Report”. Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 35, August 14; Page: 9264-9271, DOI: 10.14260/jemds/2014/3196 ABSTRACT: Liposarcoma is the most common soft tissue sarcoma in adults, which usually involves lower extremities, trunk, retroperitoneum, or abdominal cavity. Till date, only a few cases of enormously huge liposarcoma have been reported. We report a case of huge mass of size 60 × 45 × 35 cm in scapular region in a middle aged person; which developed from a preexisting lipoma and was gradually increased in size as sub-mucosal non-ulcerated mass and which ultimately become ulcerated and infected with gas forming organisms. This tumor was successfully resected in toto under general anesthesia and after follow up for two years no recurrence was reported. KEYWORDS: Huge liposarcoma, Scapular region ulceration, Surgical excision. INTRODUCTION: Liposarcomas are the second most malignancy of soft tissue, which hallmark are lipoblasts or immature fat cell. 1-3 These are usually found in late adult life and rarely in childhood with a male/female ratio of 2:1. 1, 4, 5 Most of the cases are de novo and frequently develops from deep seated stroma rather than sub-mucosal or subcutaneous fat. 2,6 CASE REPORT: A 48 years male was presented to the outpatient department with chief complaint of backache due to a huge mass in upper back and foul smell. History revealed that a pea nut sized bulging was noticed by him in scapular region for 10 years and which had been increasing very slowly. When it attained the size of a cricket ball, he consulted a local surgeon, who advised him for fine needle aspiration cytology. FNAC report primarily revealed to be an atypical lipomatous tumor; to which initially he ignored as it was not causing too much distress; but after 3 months he felt that this tumor had been increasing very rapidly; then he consulted us in our medical institute where on examination a foul smelling giant mass in the left scapular region was found (Fig-1); which was extending from mid axillary line to vertebral column and from shoulder to 12 th rib and on palpation it was non-tender and firm to hard in consistency. The skin over tumor was ulcerated on the lateral side. The CT scan showed a 60 × 45 × 35 cm mass, occupying almost left half of back, extending to anterior chest wall up to midline, inferiorly up to left renal angle and crossing mid line posteriorly (Fig-2); which was non-enhancing, non-calcific, multi-compartmental soft tissue mass in relation to left scapula without obvious bony erosion; while X-ray of chest showed a huge smooth rounded opacity in the back of the chest wall without any bony involvement (Fig-3). His ultrasound report of pelvic and abdominal regions was normal. Trucut biopsy reported the mass primarily to be a low grade liposarcoma. After thorough clinical examination; wide surgical excision of this tumor was planned under general anesthesia and hence the patient was sent for pre anesthetic evaluation where he was investigated properly. Except being thin built and low hemoglobin (Hb - 9.5 gm %) his routine