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

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