|Year : 2016 | Volume
| Issue : 6 | Page : 1-2
Bone and Soft Tissue
|Date of Web Publication||30-Nov-2016|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Bone and Soft Tissue. J Can Res Ther 2016;12, Suppl S2:1-2
Chondrosarcoma of sinonasal tract: A rare case report
S. Gupta, P. Singh , L. Pandey, P. K. Natraj, A. Mudgal
Department of Radiotherapy, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, E-mail: [email protected]
Introduction: Chondrosarcomas are slow-growing malignant tumors that usually arise from cartilaginous structure. Chondrosarcoma of the sinonasal tract is extremely rare with malignant potential, accounting for 0.07% of all benign and malignant primary sinonasal tract tumors. Diagnosis is made by radiological and pathological features. Five years survival rate for all grade combined is 54% to 81%, but disease free rate is lower. Case Report: We present a case of 27 year old male who presented to us on August 2015 after endoscopic excision of nasal mass with chief complaint of swelling in left side of face and pain. On examination his left eye was deviated towards midline with a healthy scar mark on left side of face. Intranasal examination showed growth along medial and lateral wall of left nasal cavity. His post-operative CECT paranasal sinus showed large mass lesion in base of skull predominantly involving sella, clivus, left petrous temporal bone, basisphenoid and basiocciput bone with destruction and extension, suggestive of residual tumor. His histopathology revealed Grade II chondrosarcoma. Patient was treated with chemotherapy (MAID regimen) followed by radiotherapy of total dose 60 Gy/30 fractions. Now patient is on follow-up and is asymptomatic. Conclusion: Prognosis of chondrosarcoma depends upon the grade of the tumor and location of primary tumor. Though this tumor is usually radio-resistant, wide surgical excision is considered the treatment of choice but radiotherapy and chemotherapy seems to improve the quality of life of the patient with palliation of symptoms if gross residual disease is present after surgery.
Atypical and intriguing presentations of synovial sarcoma: A case series
Vipin George Kuriakose
Department of Radiotherapy, Government Medical College, Thiruvananthapuram, Kerala, India, E-mail: [email protected]
Introduction: Synovial sarcomas are mesenchymal malignancies commonly affecting the lower extremities of young adults which may also be encountered in regions including the head and neck (<10%), thoracic and abdominal wall. Here is an illustration of three rare and unusual presentations of synovial sarcoma treated at our centre. Materials and Methods: 37 year old male presented with progressive dysphagia of 6 months with history of tracheostomy & excision biopsy larynx suggesting hemangiopericytoma one year back. CECT-neck showed soft tissue density lesion involving left supraglottic region with transglottic extension. He underwent total laryngectomy + partial-pharyngectomy + pharyngeal reconstruction. HPR revealed synovial sarcoma positive for CD99, BCL2 & EMA. He received ifosfamide containing chemotherapy followed by RT. 18 year old male with recurrent swelling over post auricular region with repeated excisions in 2010 & 2011. Biopsy revealed synovial sarcoma with positivity for CK, EMA and Vimentin. CT Thorax showed Lung metastasis. Patient is on systemic chemotherapy. 14 year old male presented with lymph nodal swelling in the Right inguinal area. Biopsy showed synovial sarcoma, positive for EMA, Vimentin, and CD99. PET scan showed increased uptake only in Right Iliac & inguinal nodes. Karyotyping is awaited. Results and Conclusion: Although a rare tumor of extremities, synovial sarcoma can present, in exceedingly rare cases in unusual anatomical sites as discussed. We believe that reporting of rare or unexpected presentations of sarcoma will eventually improve our understanding of this relatively unusual malignancy. Therefore, a high index of suspicion for this disease and importance of IHC should be kept in mind while evaluating young people.
Retrospective review of fibroblastic/myofibroblastic tumours (intermediate and malignant variety)
Sharief K. Sidhique , Anne Jennifer Prabhu, Simon Pavamani,
Sukria Nayak, V. T. K. Titus, B. Selvamani
Department. of Radiotherapy, CMC, Vellore, Tamil Nadu, India, E-mail: [email protected]
Aim: To analyze the treatment outcome of intermediate and malignant variety of fibroblastic and myofibrobalstic tumors in Christian Medical College, Vellore. Materials and Methods: Retrospective analysis of patients diagnosed with any one of the variant of Fibroblastic or Myofibroblastic tumours at our Institute from 1 st January 2004 to 31 st January 2013 was performed. Chart review of the 130 patients were done. Various parameters studied were demographic factors, pretreatment tumour features, surgical methods, surgical outcome, pathological features, radiation therapy indications and doses, chemotherapy details analyzed. Disease recurrence, distant metastasis, disease free survival and overall survival duration were also analysed. Results: The commonest histology was fibromatosis (40%), followed by Dermatofibrosarcoma protruberans (DFSP) (30%) followed by fibrosarcoma, solitary fibrous tumours and rare histologies. The age ranged from 12 to 60 for fibromatosis and 25 to 55 for DFSP. The indications for radiotherapy were recurrent tumours and tumours with positive or close margins. The details of the treatment provided and the outcome shall be presented. Conclusion: Fibroblastic and Myofibroblastic tumours represent a very large subset of mesenchymal tumours. Fibromatosis is the commonest histology followed by DFSP. Radiotherapy achieves high local control in patients with recurrent tumours and tumours with positive or close margins.
Chondroblastic osteosarcoma of mandible: A rare case report
M. Mrutyunjayarao , Shyama Prem, B. H. Srinivas, R. Pragna Sagar, V. Parthasarathy
Department of Radiotherapy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, E-mail: [email protected]
Introduction: Osteosarcoma is a highly malignant neoplasm of bones which most commonly involves the long bones but the involvement of flat bones is very rare. Recurrence rate of flat bones osteosarcomas are high. We are reporting a case of mandibular osteosarcoma treated with radical surgery, adjuvant chemotherapy and radiotherapy to avoid local recurrences. Case Report: A 32 year old male patient presented with complaints of swelling in right side of lower jaw which on examination revealed a smooth, reddish, tender lesion of size 4 Χ 3 Χ 3 cm in alveolar ridge opposite to canine and premolar tooth. No neck nodes were palpable. CECT Head & Neck revealed it to be arising from mandible. He underwent segmental mandibulectomy, right selective neck dissection and free fibular reconstruction. On histopathological examination, it was a highly cellular tumor composed of lobules of chondroid material surrounded by spindle-shaped cells with a moderate degree of nuclear atypia with increased mitotic figures. In addition to above findings, there was a lacy osteoid material in between spindle cells and an evidence of infiltration into the fibro-adipose tissue and skeletal muscle. IHC showed cells to be negative for SMA, panCK, S-100 and positive for Ki67-40%, CD99. A diagnosis of chondroblastic osteosarcoma was made and planned for adjuvant chemotherapy with IAP regimen followed by adjuvant radiotherapy with 60 Gy in 30 fractions using VMAT. He is currently on follow-up for seven months post-surgery and locally disease free. Conclusions: Mandibular osteosarcomas are rare malignancies with high chance of local recurrence and a multimodality treatment with surgery, adjuvant chemotherapy and adjuvant radiotherapy is necessary to reduce local recurrence and to improve survival.
Interstitial brachytherapy in soft tissue sarcoma: An institutional experience
Kazi S. Manir , Abhishek Basu, Krishnangshu B. Choudhury, Swapnendu Basu, Koushik Ghosh, Subir Gangopadhyay
Department of Radiotherapy, R. G. Kar Medical College and Hospitals, Kolkata, West Bengal, India, E-mail: [email protected]
Introduction: Soft tissue sarcoma (STS) is rare but aggressive neoplasm. Interstitial brachytherapy (ISBT) alone or combined with external beam radiotherapy (EBRT) as postoperative treatment improves loco-regional (LRC) & distant control. Materials and Methods: Out of twenty seven non-metastatic STS (lower limb 64%) patients (median age 37 yrs) were treated with surgery and postoperative ISBT during February 2011-January 2016, 25 patients with >6 months follow-up were analyzed. Spindle cell sarcoma was the commonest (24%) histology. 11 Patients (44%) received EBRT (45 Gy-50 Gy), where ISBT was used as boost (16-20 Gy).14 patients (56%) received ISBT alone [4 Gy per fraction]. Treatment was done with a 60 Cobalt source High Dose Rate system. Results: With a median follow up of 17 months (range 40 months) LRC rate was 80%. After successful salvage overall LRC improved to 88% (n = 22). Out of 3 patients (12%), developed lung metastasis, 2 (8%) had a local recurrence. At the time of analysis, four patients died of sarcoma (disease-specific mortality rate was 16%), while one had died of other cause. Median Disease Free survival was 19 months (95% Confidence interval: 17.6 months-20.4 months). Median loco-regional failure free survival was 19 months (95% Confidence interval: 16.3 months - 21.6 months). Tumor size (>5 cm or <5 cm) was important prognostic factors for outcome (P < 0.05). 4 patients (16%) developed ≥grade II late toxicity (fibrosis and telangiectasia). Conclusions: Combination of surgery and ISBT with/out EBRT improves local and distant control with acceptable late toxicities.
Evaluation of role of interstitial brachytherapy in soft tissue sarcoma: A single institute experience
V. Pareek , R. Bhalavat, M. Chandra, L. Nellore, K. George, D. Borade, K. Kalariya, Nandkumar
Department of Radiotherapy, Jupiter Lifelines Hospital, Thane, Maharashtra, India, E-mail: [email protected]
Background: Soft tissue Sarcomas are rare group of solid tumors comprising of 1% of all solid tumors. The management of soft tissue sarcomas have evolved due to advancements in imaging, histopathology, cytogenetics, and the use of multimodality treatment. The treatment strategies emphasizes on the control of disease locally, sparing of limb function and improvement in the quality of life. High dose brachytherapy has formed a part of the management and has the advantage of providing concentrated dose to tumors and sparing of surrounding normal tissues. In this study we examined the clinical outcome of High dose Brachytherapy for STS at our Hospital through retrospective analysis of the prospective database maintained. Objectives: To review the clinical outcome in patients with Soft Tissue Sarcoma treated at our center through High dose rate interstitial brachytherapy. Methods: Eleven patients with different sites and grades of Soft Tissue Sarcoma underwent surgery and Intraoperative catheter implantations in single planein biopsy proven Soft tissue sarcoma cases. These patients then underwent High Dose Brachytherapy with Iridium - 192. The patients received average dose of 3.5 Gy per Fraction (Two fractions per day 6 hours apart) with total dose of 35 Gy/10 Fr/5 Days and after completion of treatment were followed up at 1 month and later every 3 monthly for 2 years; Followed by 6 monthly interval. Results: The Patients were followed up for range of 1 - 42 months (Median 12 months) and overall control rate was 72.72%. The Local recurrence was noted in only one patient (9.09%) and two patients developed distant metastases (18.18%). Conclusions: The results in our study suggested the importance of HDR Brachytherapy in management of Soft Tissue Sarcoma. The local control rate was 72.72%. The dose of 35Gy over 10 fractions over 5 Days was found to be effective in local control and limb salvage in case of Soft Tissue Sarcoma as practiced at our Centre.
Key words: Interstitial brachytherapy, high dose rate, soft tissue sarcoma
| Article Access Statistics|
| Viewed||830 |
| Printed||10 |
| Emailed||0 |
| PDF Downloaded||95 |
| Comments ||[Add] |