Presentation on theme: "« A Clear cell sarcoma » 2007-11383 FN. 25 year-old male January 2007 3cm mass on the medial side of the right heel Early August 2007 3 cm clinical right."— Presentation transcript:
25 year-old male January 2007 3cm mass on the medial side of the right heel Early August 2007 3 cm clinical right inguinal mass Preoperative MRI (images unavailable) End August 2007 General hospital: surgical biopsy of the right heel mass Pathology (reviewed): clear cell sarcoma No molecular analysis 2007-11383 FN
PET-CT 2007-11383 FN September 2007 Clinical residual mass (4 cm) on the right heel with skin infiltration Right inguinal mass (3 cm) Post surgical biopsy PET CT Chest CT: No lung metastases
Amputation? Heel surgery with free flap Induction chemotherapy? ILP? Inguinal lymph node dissection? Radiotherapy? What do you propose?
Sarcoma board Metastatic disease (inguinal lymph nodes) Conservative surgery not feasible Upfront systemic treatment Doxorubicin/Dacarbazine - 3 cycles → Stable disease (Mass 4 cm heel + Right 3 cm inguinal mass, no lung metastasis) What next ??? September 2007 2007-11383 FN
Isolated limb perfusion Melphalan 80 mg and TNF alpha 1 mg 1h (38°Celsius) + Inguinal lymph node dissection with sartorius muscular flap Pathological analysis Lymph nodes metastases of clear cell sarcoma (2 N+ / 9) 2007-11383 FN January 2008