DOI: https://doi.org/10.36347/sjmcr.2026.v14i11.032

Pages: 2548-2552

Pleomorphic liposarcoma is the rarest and most aggressive subtype of liposarcoma, with high rates of local recurrence and distant metastasis. We report the case of a 40-year-old man who presented with a painless mass of the lateral left thigh. Excision revealed a 7.5 cm pleomorphic liposarcoma (Fédération Nationale des Centres de Lutte Contre le Cancer [FNCLCC] grade 3) with close margins (0.5 cm), followed by adjuvant brachytherapy. A bifocal recurrence in the vastus lateralis was excised 16 months later with a 1 mm margin. Over the following four years, the patient received 32 sessions of radiotherapy and 20 sessions of chemotherapy. Five years after diagnosis, a second recurrence developed in the medial compartment, abutting the femoral shaft and deep femoral vessels, and grew from 45 to 67 mm despite treatment. Staging showed no distant metastasis. At 46 years of age, the patient underwent a third resection: en bloc removal of the adductor compartment through a medial approach, preserving the femoral vessels, sciatic nerve and periosteum. Histopathology confirmed a 9 cm pleomorphic liposarcoma with tumour necrosis and clear margins (closest 0.5 cm). There was no postoperative deficit, and adjuvant radiotherapy was planned. Close margins and high grade were the main drivers of recurrence. When the disease remains confined to the limb and the neurovascular structures are displaced rather than encased, limb-sparing en bloc resection remains possible after failure of multimodal treatment. The first excision should aim for wide margins.