1. « A Clear cell sarcoma » 2007-11383 FN

2. 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

4. 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

5. Amputation? Heel surgery with free flap Induction chemotherapy? ILP? Inguinal lymph node dissection? Radiotherapy? What do you propose?

6. 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

7. 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

8. CR:

9. February 2008 RECIST PR: 26mm x 20mm Moderate vascularization after dynamic injection = sign of good response 2007-11383 FN

10. Surgery of the residual tumor? Radiotherapy?

11. March 2008 Radiotherapy (45 Gy on the heel, 65 Gy on the inguinal region) Ended in May 2008 RECIST CR 2007-11383 FN

12. August 2008

13. December 2008 May 2009 November 2009 2007-11383 FN

14. February 2010 Thoracic Surgery 2007-11383 FN Adjuvant treatment?

15. January 2011 + 3 years after ILP 15 mm nodule on the inguinal incision Re evolution on the heel

16. March 2011 2007-11383 FN

17. ? MET INHIBITORS and ANTI ANGIOGENICS

18. Doxorubicin/Dacarbazine started in February 2011 Patient deceased in March 2011 (+ 4 years after diagnosis) March 2011 2007-11383 FN