Advanced Retroperitoneal Soft Tissue Sarcoma...Soft Tissue Sarcoma 12th November 2018 •Exploratory lap and biopsy •Findings: Large mass arising from iliopsoas muscle, surrounding

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

12th 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

1st 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 OncologistMRI-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

• 14th December 2018: Did not start chemo. Was still pending ECHO

• 18th 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 20th to 26th 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