Saira 35years female metastatic pleomorphic sarcoma.pptx

Obstructive jaundice management
1. HydrationObstructive jaundice management
1. HydrationObstructive jaundice management
1. Hydration
2. Vit K (for coagulopathy)
3. Antibiotics (stasis cause infection)

2. Vit K (for coagulopathy)
3. Antibiotics (Obstructive jaundice management
1. Hydration
2. Vit K (for coagulopathy)
3. Antibiotics (stasis cause infection)
cause infection)

2. Vit K (for coagulopathy)
3. Antibiotics (stasis cause infection)

1. Soft T issue Sarcoma Dr Farah Arshad Chishtee Postgraduate Resident King Edward Medical University West Surgical Ward Mayo Hospital

2. BIODATA Pt.Name : Saira Age/Sex : 35yrs/F House wife Resident of Multan Married Children : 2 All delivered by C section No identified comorbids

3. HISTORY: My patient is a diagnosed case of pleomorphic sarcoma on posterolateral aspect of right thigh Multiple times excision of tumor was done in nishtar hospital multan and mayo hospital lahore Patient developed swelling on posterolateral aspect of right thigh 2 years back

4. FNAC( 9/06/22) Malignant neoplasm favour high grade sarcoma. COLOUR DOPPLER OF RIGHT LOWER LIMB (27 AUG 2022) Solid looking mass 6.6*5.0cm with mixed echogenicity in posterolateral aspect of right thigh in muscular plane.no significant blood flow on colour doppler . No internal calcifications or fluid component noted. No evidence of DVT . Tissue diagnosis is advised for further evaluation

5. Surgical excision of right thigh mass was done on 29 th September 2022 in nishtar hospital BIOPSY RIGHT THIGH MASS (6/10/22) undifferentiated pleomorphic sarcoma fragmented grade 3 CT CHEST e IV CONTRAST (3/11/22) Normal CT Chest Bilateral lungs, visualized liver and bony skeleton appear unremarkable with no metastasis MRI RIGHT THIGH e CONTRAST( 7/11/22): Post excision inflammatory changes seen with small volume collection No infiltration into muscle and bony skeleton Followed by 33 cycles of radiotherapy done in Minar cancer hospital multan Last cycle done on 27 th of Jan 2023

6. Patient then presented to us with recurrent lesion on the same region on 1 ST November 2023 CT CHEST e CONTRAST(14/11/23) No evidence of pleural & pulmonary metastasis BONE SCAN (1/11/23) No evidence of metastatic deposits in bone

7. WIDE LOCAL EXCISION was done on 27/11/23 EXCISIONAL BIOPSY FROM RIGHT THIGH FRAGMNETED( 8/12/23) High grade sarcoma Differentials: Pleomorphic sarcoma Rhabdomyosarcoma

8. Patient again presented with fungating lesion after one week of excision .

9. MRI RIGHT THIGH e IV CONTRAST (18/12/23) Status post excision Recurrent/residual ill defined enhancing infiltrative right thigh lesion measuring 6.4*4.7*3.4cm with bilateral inguinal lymadenopathy largest on right side measuring 2*1.2cm and on left measuring 1.7*0.8cm It is involving vastus lateralis muscle and extending into right gluteus maximus muscle Neurovascular bundle is intact Results are consistent with biopsy proven post excision pleomorphic sarcoma

10. Again excision of the recurrent lesion was done on 4 th jan 2024 BIOPSY (6/01/24) Excision recurrent mass right thigh Skeletal muscle bundles inflitrated by adipose tissue No residual tumor seen

11. Patient again presented to us in opd with recurrent mass in JULY 2024 MRI THIGH WITH CONTRAST(31/07/24) Ulcerated lesion is noted at sugical side of posterolateral right upper thigh measuring 7.8*9*2.9cm and shows avid post contrast enhancement. It is inseparable from vastus lateralis and gluteus maximus muscle and extends into subcutaneous fat Femoral vessels appears normal Sciatic nerve is intact IMPRESSION: Recurrent/residual disease in a post surgical case of pleomorphic sarcoma of right thigh

12. CT CHEST WITH CONTRAST( 9/08/24) Two enhancing soft tissue density jodules are seen in both lung fields measuring 14*12mm in posterior segment of left upper lobe and 2.4mm in posterior segment of right lower lobe. Visualized liver and bony skeleton appear unremarkable with no evidence of metastasis Rest of the scan is unremarkable

13. Plan?????