Pulmonary Liposarcoma of Probable Primary Origin in a Patient with Severe SARS-CoV-2 Pneumonia

Abstract

Liposarcoma is a malignant tumor derived from adipose tissue that represents up to 20% of all soft tissue sarcomas. It has a higher incidence in men, and between the 5th and 7th decade of life. Primary pulmonary origin is rare, being identified in less than 0.5% of all lung tumors. There are few cases of pulmonary liposarcoma reported in the literature. We present the case of a 57-year-old man, with a history of arterial hypertension, type-2 diabetes mellitus and alcoholic liver cirrhosis, hospitalized for severe SARS-CoV-2 pneumonia. Upon admission, chest CT revealed multiple diffuse, patchy ground-glass areas, with no organizing areas or evident endobronchial lesions. He evolved with deterioration in pulmonary mechanics and oxygenation, requiring connection to invasive mechanical ventilation. Control chest X-rays without evidence of condensation, atelectasis or pleural occupation. Fiberoptic bronchoscopy showed a round, whitish endobronchial mass towards the left posterior apical bronchus that oscillated with ventilation, and whose immunohistochemistry was positive for MDM2, CDK4, P16, S-100, and negative for PAN-CK, consistent with well-differentiated liposarcoma. Due to catastrophic ventilatory failure and subsequent death, it was not possible to expand the search for an extrapulmonary primary tumor. Fiberoptic bronchoscopy is crucial in critically ill patients who need invasive mechanical ventilation, in whom there is also no improvement in oxygenation or pulmonary mechanics despite established therapy.