SESSION TITLE: Surgery Cases
SESSION TYPE: Case Reports
PRESENTED ON: Sunday, March 23, 2014 at 09:00 AM - 10:00 AM
INTRODUCTION: We present a case of a patient diagnosed with synovial sarcoma of the left arm with pulmonary metastasis.
CASE PRESENTATION: In March 2004, the patient, a 20-year old male, presented a rounded, consistent mass of 10x15 cm size, bulking at the left axilla and affecting the left arm and scapula, without cutaneous affection but with important collateral circulation (Fig 1). After a CT guided needle biopsy, the mass was diagnosed of synovial sarcoma. Radical surgical treatment was performed, based on the complete left scapula and clavicle disassembling broaden to thoracic wall (4 first ribs, major and minor pectorals, mayor serratus and latissimus dorsi), wall reconstruction with a PTFE mesh (Dualmesh ®) and partial myocutaneous flap closure of scalenus, deltoid, supra and infraspinosus muscles (Fig. 2).The treatment was completed with adyuvant Ifosfamid and Adriamicin. 9 months later, a follow up CT scan showed a 7 cm lesion in left lower lobe, compatible with metastasis, which was managed with surgical resection plus Cisplatin and DTIC. In April 2006, three more nodules appeared in the right lung. They were treated with surgery plus Gemcitabin and Docetaxel. In March 2007, a new pulmonary nodule was located in left lower lobe requiring a left lower lobectomy. In August 2007, multiple bilateral nodules were detected. As complete resection of all the nodules was impossible, surgical treatment was rejected. Therefore, the nodules were treated with high dose Ifosfamid, achieving a complete pulmonary remission. In March 2008, right pleural effusion was diagnosed. A thoracentesis detected the presence of malignant cells. The patient received 9 more cycles of Trabectedin, attaining a complete remission. 9 years after the patient is asymptomatic and has continued his follow up without evidence of local or distant recurrence.
DISCUSSION: The factors involved in the recovery of the disease are the histology of the lesion, the tumor spread, the response to the systemic treatment and the possibility of surgical resection of the lesion.
CONCLUSIONS: In this case report the initial surgical aggressive attitude against the primary tumor as well as against the recurring metastatic lesions and the good response to chemotherapy made possible the total control of the disease.
Reference #1: Treasure T, Fiorentino F, Scarci M, et al. Pulmonary metastasectomy for sarcoma: a systematic review of reported outcomes in the context of Thames Cancer Registry data. BMJ Open 2012;2:e001736. doi:10.1136/bmjopen-2012- 001736.
DISCLOSURE: The following authors have nothing to disclose: Gemma Gonzalez Velasco, María Teresa Gómez Hernández, Maria Rodríguez, Nuria María Novoa Valentín, Marcelo Fernando Jiménez López, Jose Luis Aranda Alcaide, Gonzalo Varela Simó
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