Introduction

Soft tissue tumours are very common in the general population. Most of them are benign and they require excision for functional and appearance reasons. In literature the incidence of 4 types of histopathology in a specimen is very rare[1] and our aim is to present one.

Case presentation

An 87-year-old Greek man, who had been generally active and his past medical history was free of disease, was referred to our hospital for a giant swelling on his back. He has had this tumor since at least 10 years, but he had not undergone an operation as it has been asymptomatic (Fig. 1). Due to the dimensions of the tumor, the patient has undertaken a chest computer tomography scan in order to determine the borders and the invasion of the tumor to the surrounding tissues (Fig. 2)

Figure 1
figure 1

Preoperative image of the patient

Full size image
Figure 2
figure 2

Chest CT scan of the patient

Full size image

The patient was referred for a surgical removal of the tumor. Due to his age, he has not taken general anesthesia and the whole operation has been under regional anesthesia. Intraoperatively, a giant liposarcoma, 18 × 14 × 6 cm, was found and been removed and also another tumor, 12 × 10 × 8 cm, white and homogenous (Fig. 3, 4, 5).

Figure 3
figure 3

The tumor during the operation

Full size image
Figure 4
figure 4

The actual size of the tumor

Full size image
Figure 5
figure 5

The area of the removed lesion

Full size image

The pathology report referred 4 types of neoplasia. There was growth of mesenchymal neoplasma with figure of non-differentiated liposarcoma. There was also growth of well-differentiated liposarcoma (Fig. 6), whereas in the non-differentiated parts of the tumor malignant fibrous histiocytoma (Fig. 7), osteosarcoma (Fig. 8), chondrosarcoma (Fig. 9) and parts with pericellular pattern were found. The skin segment was soft fibroma.

Figure 6
figure 6

Growth of well differentiated liposarcoma (x 100) hematoxylin and eosin staining

Full size image
Figure 7
figure 7

Non-differentiated part of the tumor with the pattern of malignant fibrous histiocytoma (x 100) hematoxylin and eosin staining

Full size image
Figure 8
figure 8

Part of osteosarcoma (X 200) hematoxylin and eosin staining

Full size image
Figure 9
figure 9

Part od chondrosarcoma (x 100) hematoxylin and eosin staining

Full size image

The perioperative period was uneventful and the patient was discharged home 3 days later.

Discussion

The existence of 4 histological types of neoplasia is very rare and was treated surgically under local anesthesia. Preoperative evaluation of such tumours is essential in order to determine the borders and characterize the tumour [2]. This can be done either with CT scan or MRI scan. The definite diagnosis is set by histology and requires careful analysis of the specimen.

Consent

Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.