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Soft Tissue Sarcoma of the Head & Neck: Case Report in Al-Ramadi General Hospital
ساركوما الانسجة الرخوة للرأس والعنق

Author: Kamal Turki Al-Kubaisi
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2009 Volume: 22 Issue: 1 Pages: 48-54
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Abstract:Sarcoma in the head & neck area are rare. Management of soft tissue sarcoma in the head & neck is primarily surgical. However the critical anatomy of the head & neck limits the capacity to obtain wide surgical margins. This case report involves a patient who is a 54 years old woman who was referred to the maxillofacial department because of rapidly enlarging mass in the right side involving submandibular space, right cheek and temporal fossa and progressive pain complaint with hearing loss and trismus. Physical examination revealed large firm mass at the right side of the face occupying the submandibular space, infratemporal & temporal fossae, there was trismus, and no other abnormalities were found especially no mucosal lesion or swelling intraorally & no lymph node enlargement in the neck. MRI study was done to the head & neck to study the mass. CT-scan of the chest & abdomen did not show site of distant metastasis. Transoral biopsy through an incision in to the oral vestibule under local anesthesia showed on histopathological examination a malignant peripheral nerve sheath tumor. A surgical resection consisting of parotidectomy, hemimandibulectomy, infratemporal fossa dissection & temporal fossa dissection has been done. Histopathological examination of the surgical specimen revealed positive surgical margins. The patient refused to receive postoperative radiotherapy. Unfortunately 7months postoperatively she developed intracranial metastasis.Key ward: Soft tissue sarcoma

الملخص: إن ساركوما الرأس والعنق من الأمراض النادرة والعلاج الأساسي لهذا المرض هو الاستئصال الجراحي, لكن الوضع التشريحي الحرج لمنطقة الرأس والعنق يصعب الحصول على نطاق جراحي آمن.في هذا التقرير تم تسجيل حالة امرأة عمرها 54 سنة أحيلت إلى شعبة جراحة الوجه والفكين بسبب ورم سريع التنامي في الجهة اليمنى السفلى للوجه مع الم متزايد وتكزز في الفك وضعف في السمع .الفحص ألسريري أظهر وجود ورم اشتمل على المنطقة النكفية والصدغية وتحت الصدغية,ولم يظهر أعراضا أخرى مثل إصابة المنطقة الداخلية للفم أو تضخم الغدد اللمفاوية في العنق. تم إجراء فحص الرنين المغناطيسي للورم مع فحص المفراس للبطن والصدر ولم يظهر أي علامة على وجود انتشار بعيد للمرض.بعد اخذ عينة من الورم تحت التخدير الموضعي من خلال الفم أظهر وجود ورم غلاف العصب المحيطي السرطاني .تقرر إجراء جراحة لاستئصال الورم واشتملت العينة المستأصلة على الغدة اللعابية النكفية ونصف الفك السفلي مع تشريح المنطقة الصدغية و تحت الصدغية,وأظهرت الفحوصات النسيجية للعينة وجود بقايا للورم على حافة العينة وتم تحويل المريضة إلى قسم الإشعاع الذري لكنها رفضت,وبعد سبعة أشهر ظهر لديها أعراض ورم داخل القحف وتم التأكد من وجوده بواسطة المفراس.


Article
Management of Retroperitoneal Soft Tissue Sarcomas

Authors: Safa M. AL-Obaidi --- Alaa A. AL-Wadees --- Mohammed Abd-Zaid Akool
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 2 Pages: 166-174
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT: Hospital , Baghdad.*Department of surgery ,Kufa Teaching Hospital , Najaf. BACKGROUND:Most retroperitoneal tumors are malignant and about one third are soft tissue sarcomas. Sarcomasare uncommon malignant tumors arising from mesenchymaltissue . Retroperitoneal sarcomasaccount for approximately 10%-15% of soft tissue sarcomas and less than 1% of all malignantneoplasms. Surgery is the only curative treatment for retroperitoneal soft tissue sarcomas. OBJECTIVE:To define the best extent of surgery that would optimize the safe margins on retroperitoneal softtissue sarcomas , where the recurrence of tumor greatly depends on feasibility of completeresection and the grade of tumor.PATIENTS AND METHODS:Between June 2007 and December 2010,28 patients (female 16,male 12, mean age; 43.93 years,range18-69 years)were evaluated for survival and response to therapy by gender, age ,preoperativesymptoms ,symptoms duration , primary or recurrent tumors , the extended of surgical resection, orpalliative procedures .Complete resection was defined as removal of gross tumor withhistologically confirmed clean resection margins. RESULTS:Eighteen patients(64%) out of 28 patients under went simple surgical resection ,5patients(28%)underwent compartmental resection (systematic resection of noninvolved contiguousorgans),1 patient (3%) underwent enucleation of tumor ,while debulking done in 4 patients (15%).The surgical resection margin was involved only in one patient (due to tumor rupture duringresection) of those patients underwent compartmental resections, it’s was free in only (10/18,56%)patients underwent simple resection ,while it was involved in all tumors removed with enucleationor debulking (incomplete resection) .The recurrence of tumor greatly depends on state of surgical margin in resected sample (pvalue=0.001,significantlyassociated).Thehistopathological grade of tumor on the other hand also proved an important factor in therecurrence of tumor where it was higher with high grade tumor versus low grade tumor (Pvalue=0.001,significantlyassociated).CONCLUSION:Complete compartmental surgery without tumor rupture should be performed when possible toachieved clear margins. Wide resection lowers the local recurrence and improves survival rate.Both the state of surgical margin and grade of tumor are the most important prognostic factorswhich determine the survival rate and recurrence tumor.

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