Advanced Retroperitoneal Soft Tissue Sarcoma Susan C. Msadabwe Cancer Diseases Hospital
No conflicts of interest
Soft Tissue Sarcoma Seen by the local surgeon. Noted abdominal mass CT scan • Huge soft tissue mass in abdomen and pelvis approx. 16*10cm • Displacement of surrounding tissues with no plane of separation between iliopsoas, left middle ureter, left common iliac artery, internal and external iliac. • Chest CT no mets
Soft Tissue Sarcoma 12 th November 2018 • Exploratory lap and biopsy • Findings: Large mass arising from iliopsoas muscle, surrounding the sigmoid colon • Recovered well from surgery • Histology: High Grade Sarcoma • Referred to Cancer Centre
1 st December 2018 Seen at Cancer Centre by Oncologist • Fair condition, ECOG 2 • In wheel chair due to pain in left lower limb. • Mild Left lower limb oedema, good peripheral pulse, sensation & Power intact • Per abdomen: Huge intraabdominal mass. Immobile. Tender. Smooth. Reaching Left pubis. • Per vagina-huge extra-vaginal mass pushing vault to right. • Per rectum-mucosa normal, extra mucosal mass felt from 10 to 3 o'clock.
IHCs • Vimentin-diffusely positive • CD45 negative • EMA negative • MYOD1 nuclear positive staining of tumour cells • S100 negative • SMA negative • Desmin- Focal positive staining. Poorly differentiated malignant neoplasm, pleomorphic rhabdomyosarcoma
Discussed at MDT Clinical Oncologist/Surgical Oncologist MRI-not done. Corrective maintenance
Management • T4NOMO Stage IIIB • MDT discussion for operability- inoperable • Discussion with patient & family • For Neoadjuvant Chemotherapy with AIM 14/12/18 Surgery +/- Radiation depending on surgical/pathological finding
Discussion Points • Role of neoadjuvant chemo • Role of neoadjuvant RT • Role of Post OP RT • Role of Adjuvant Chemo
Progress • 14 th December 2018: Did not start chemo. Was still pending ECHO • 18 th December 2018: Admitted with acute confusional state • No other neurology with cranial nerves, power, sensation intact • No S/S of infective aetiology • Labs normal
• MRI brain • Hyperintense lesion in the left frontal parietal • Midline shift • Surrounding oedema • Osseous metastasis C4/5
Treatment • Dexamethasone, GI protection • Palliative WBRT 20Gy in 5 fractions 20 th to 26 th December 2018 • Condition continued to deteriorate • Best supportive care, End of life • Demised 3 weeks later
Discussion Point • Role of PET CT in staging STS
Acknowledgements • Patients family • Hospital Staff
Located in Zambia, Victoria Falls is the largest curtain of falling water on the planet measuring 1700 meters in width and just over 100 meters in height
Recommend
More recommend
