![]() ![]() Histologically positive lymph nodes are a determinant factor of lower survival rates in STS, as less than 28.2 months, varying by histology, in the absence of at distance metastasis. In the presence of metastatic disease, the lung is the most common site affected in up to 30%, as a synchronous or metachronous cancer. The Soft-tissue sarcomas (STS) are rare tumors, affecting almost 1% of the population. (D) Immediate postoperative surgical aspect. (B) Tridimensional resection specimen (Soft-tissue sarcoma). (A) Computed tomography of the thigh that demonstrates a soft tissue tumor in medial and adductor compartment. Based on Recist criteria (response evaluation criteria in solid tumours), the patient revealed a partial response and undergone a tridimensional resection surgery in the adductor compartment and a sentinel lymph node dissection at groin topographyįigure 4. A neoadjuvant treatment was realized with three cycles of doxorubicin and ifosfamide, using a dose of 60 mg/m mg/m 2, respectively during the period of February and march of 2020. The main symptom was tight pain and a limited inferior extremity adduction. 40-year-old female patient, Ecog 0 ( eastern cooperative oncology group) with a tumoral mass at the medial topographic site of the right thigh, located at the adductor compartment, with a computed tomography guided biopsy and histopathological examination report of clear cell sarcoma. The follow up was done with physical exam and computer extremity tomography every three months (Figures 1-3).Ĭase 2. The surgery was performed on February 2020 and until November 2020 there were no signs of locoregional recurrence or a distance. Due to the comorbidities and the advanced age, the patient did not receive any adjuvant treatment. The postoperative report of the pathological examination verified the clear cell sarcoma diagnosis with free surgical margins and sentinel lymph node histologically negative. ![]() Through the application of perilesional and intradermal Patent Blue V (1 - 2 mL) with massage in the local area of the lesion for about 5 to 10 minutes, the sentinel lymph node was identified, removed and underwent histological study. A tridimensional resection was done to treat the lesion with free surgical margins, adding the strategy of sentinel lymph node on the left inguinal topography. ![]() Due to advanced age and comorbidities, and being a lesion susceptible to adequate surgical margins, the patient underwent surgery. The patient had arterial hypertension and diabetes mellitus. The patient’s main complaint was a mass in the left leg topography with pain and bleeding. 81-year-old female patient, with a soft tissue lesion on the posterior side of the left leg, with a diagnosis of clear cell sarcoma, confirmed by histopathological findings and immunohistochemistry done through the puncture (core biopsy) guided by image examination. All the patients assign an informed consent before the mean procedure authorizing the use of clinical information and imagens by the authors.Ĭase 1. To present two surgically treated clear cell sarcoma cases that have gone through compartmental resection, performed in association with the sentinel lymph node technique. Therefore, the sentinel lymph node (SN) appears as a locoregional staging tool for sarcomas in a more accurate manner, allowing the more radical surgical treatment, appropriate in the search for a better locoregional control taxes and at a distance. Historically, the regional lymph nodes are compromised in some extent between 2% to 7% of sarcomas, raising the risk of involvement according to the histological subtype, like: epithelioid, rhabdomyosarcoma, synovial, angiosarcoma and the clear cell sarcoma. Among the subtypes of soft-tissue sarcoma, CCS is highlighted as one of the tumors that remarkably reach the local lymph nodes very frequently, making it possible to obtain a number up to 40% of histologically positive lymph nodes. Head and neck, in addition to the trunk, are less often affected. Like all the sarcoma tumors, in a great proportion, it tends to affect the extremities. Notably, at the cytogenetic level, it exhibits the presence of a characteristic and reciprocal chromosomal translocation t(12, 22) (q13, q12) resulting in the fusion of the EWS and ATF1 genes. Also called Melanoma of Soft Parts, it can generate, at times, some diagnostic issues when compared to primary cutaneous melanoma. Clear Cell Sarcoma (CCS) represents less than 1% of all sarcomas, which is characterized as a rare and aggressive neoplasm. ![]()
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