Recurrent soft tissue sarcoma. A clinical case


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Abstract

The treatment of soft tissue sarcoma (SMT) has gone through a long and difficult development path — from amputation operations to complex and extensive interventions aimed at preserving organs. However, regardless of the type of surgery performed, the problem of relapses still remains relevant. Goal. To analyze recurrent soft tissue sarcoma using a clinical case example. Materials and methods. In 2011, patient D. independently discovered a neoplasm in the middle third of her right shin, and after a few months the formation disappeared. 10 years later, an education in the same field appeared. Results. In May 2022, a recurrence occurred in the area of the postoperative scar. In March 2023, another recurrence of the soft tissue area of the right shin. In August 2024, a recurrent lesion was detected in the inguinal-femoral region. Conclusions. Information about these rare cases of recurrent lesions in soft tissue sarcoma contributes to an in-depth understanding of the dynamics of malignant tumors and helps to develop more effective and personalized approaches to the treatment of patients with this pathology.

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Introduction. The treatment of soft tissue sarcoma (SMT) has gone through a long and difficult development path — from amputation operations to complex and extensive interventions aimed at preserving organs. However, regardless of the type of surgery performed, the problem of relapses still remains relevant. The tactics of monitoring after CMT therapy in the limb area should be based on individual risks of recurrence of the disease and use simple diagnostic methods. It is important to develop new personalized strategies for monitoring patients after primary therapy with soft tissue sarcomas of the extremities in order to detect relapses in time and increase overall survival [1].
According to epidemiology, the incidence of soft tissue sarcoma ranges from 1.8 to 5 cases per 100,000 inhabitants per year, which corresponds to 1-2% of the total number of malignant neoplasms on the planet. In Russia, according to statistics, about 3,500 new cases of CMT are registered annually, which is 1% of all malignant tumors. Metastasis is observed in about 40-50% of cases of CMT. The average age at the time of diagnosis is about 54 years, although some studies mention a higher age group — 5-10 years older [2].
Soft tissue sarcoma is a rare and complex group of malignant tumors that develop from the connective and supporting tissues of the body. These tumors can appear on any part of the body, but are most often found on the limbs and trunk. Soft tissue sarcomas account for only a small percentage of all cancers, but they often proceed aggressively, requiring an integrated approach to diagnosis and treatment [3, 4].
The main clinical feature of CMTS is their predisposition to relapses. Many researchers believe that the occurrence of relapses after tumor removal is more common than an exception. Despite significant advances in CMT therapy, the recurrence rate after resection of the original tumor remains comparable to the rates obtained fifty years ago. In most large-scale studies on soft tissue malignancies, there is a high probability of recurrence, ranging from 25 to 60%, and depending on the treatment method of the primary tumor and the characteristics of the disease, this figure can reach 90%. Relapse prevention should be carried out after the first operation. The use of MRI, CT, ultrasound, PET-CT is necessary to control the occurrence of relapses and metastasis [5, 6, 7].
The purpose of the work is to analyze recurrent soft tissue sarcoma using a clinical case example.
Materials and methods of research. In 2011, patient D. independently discovered a neoplasm in the middle third of her right shin, and after a few months the formation disappeared. 10 years later, an education in the same field appeared. In June 2021, subcutaneous tissue of a soft-elastic consistency was removed. The results of the immunohistochemical study made us think about polymorphocellular sarcoma G3, Ki67-50%. According to the results of the oncological consultation, surgical treatment was indicated, namely a wide excision of the shin skin.
The results of the study. In May 2022, a recurrence occurred in the area of the postoperative scar. A decision is made to excise the formation of tissues of the right shin. According to the results of histology, the growth of a malignant mesenchymal tumor was noted in the tissue. 6 courses of chemotherapy were performed.
In March 2023, another recurrence of the soft tissue area of the right shin. The oncoconsilium decides on amputation of the right lower limb with a recurrent tumor of large size.
In August 2024, a recurrent lesion was detected in the inguinal-femoral region. Inguinal-femoral lymphadenectomy was performed.
Conclusions. In the present clinical case, a similar pattern was observed in a patient after undergoing 6 courses of chemotherapy after two years of repeated surgical treatment on histological examination. The tissue type of recurrent sarcoma has not changed - G3. Information about these rare cases of recurrent lesions in soft tissue sarcoma contributes to an in-depth understanding of the dynamics of malignant tumors and helps to develop more effective and personalized approaches to the treatment of patients with this pathology.

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About the authors

Dmitry Anatolyevich Maximov

Tver State Medical University

Email: ammorozovv@gmail.com
ORCID iD: 0000-0001-5690-4277
SPIN-code: 5311-5540

PhD.

Russian Federation, 170100, Russia, Tver, Sovetskaya str., 4

Evgeniy Viktorovich Shepel

Tver State Medical University

Email: ammorozovv@gmail.com
ORCID iD: 0009-0004-6079-7493
SPIN-code: 2540-0594

PhD.

Russian Federation, 170100, Russia, Tver, Sovetskaya str., 4

Anastasia Antonovna Utkina

Tver State Medical University

Email: ammorozovv@gmail.com
ORCID iD: 0009-0006-8695-3444
SPIN-code: 3164-3640
Russian Federation, 170100, Russia, Tver, Sovetskaya str., 4

Valeria Antonovna Utkina

Tver State Medical University

Email: ammorozovv@gmail.com
ORCID iD: 0009-0000-4449-4995
SPIN-code: 2605-4106
Russian Federation, 170100, Russia, Tver, Sovetskaya str., 4

Artem Mikhailovich Morozov

Tver State Medical University

Author for correspondence.
Email: ammorozovv@gmail.com
ORCID iD: 0000-0003-4213-5379
SPIN-code: 6815-9332

PhD., Associate Professor of the Department of General Surgery

Russian Federation, 170100, Russia, Tver, Sovetskaya str., 4

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