ONCAlert | 2017 San Antonio Breast Cancer Symposium
Soft Tissue Sarcoma Case Studies

Jonathan C. Trent, MD, PhD: Pattern of This Patient's Metastatic Disease

Jonathan C. Trent, MD, PhD
Published Online:Feb 18, 2016
Michael C is a 59-year-old social worker from Los Angeles California; his medical history is notable for obesity, COPD, and mild hypertension

Soft Tissue Sarcoma with Jonathan C. Trent, MD, PhD and Shreyaskumar R. Patel, MD: Case 2

Soft Tissue Sarcoma with Jonathan C. Trent, MD, PhD and Shreyaskumar R. Patel, MD: Case 1
Soft Tissue Sarcoma with Jonathan C. Trent, MD, PhD and Shreyaskumar R. Patel, MD: Case 2


What is notable about the pattern of this patient’s metastatic disease?

Mixoid liposarcoma is one of the many different types of sarcoma. However, this one has a slightly different metastatic pattern. It’s not unusual for us to see patients with a primary mixoid liposarcoma in the extremity, which is where these always arise, and then metastatic deposits could be in the lung, could be in bone, could be in fatty tissue throughout the body. I’ve seen patients with metastatic liposarcoma involving the pericardial fat, mediastinal fat, as in this case, paratracheal fat, and, of course, one of the more common sites is the omentum or mesenteric and intraperitoneal fatty tissues.

CASE: Soft-Tissue Sarcoma Case 2

Michael C is a 59-year-old social worker from Los Angeles California; his medical history is notable for obesity, COPD, and mild hypertension.

  • In January of 2014, he presents to his PCP with complaints of right lower leg pain of several weeks’ duration
  • Physical exam was unremarkable except for swelling of the lower right calf; x-ray of the affected leg was negative for fracture
  • MRI scan of the lower right calf showed a 20 cm well defined lobular mass arising between the gastrocnemius and soleus
  • Biopsy of the mass showed myxoid liposarcoma with round cell component. Patient underwent en bloc resection of the tumor following preoperative radiotherapy
  • Gross examination showed the tumor to be 10 × 8 × 15 cm with gelatinous brownish appearance

In September of 2014, Michael returns for follow up and his CT scan shows a 4 cm posterior mediastinal mass, and a 6 cm perinephric mass suspicious for metastatic disease. He initiates treatment with anthracycline and ifosfamide chemotherapy (6 cycles) for recurrent disease and shows a partial response.

  • In May of 2015, he returns for follow up with intermittent chest and lower back pain; CT scan is consistent with progression of the mediastinal and perinephric masses, and bone scan shows new lesions occurring in the L2 and L3 lumbar vertebrae
  • At recurrence, liver and renal function and CBC are within normal limits, and his ECOG performance status is 1
  • He received treatment with trabectedin (1.5 mg/m2 24-hr infusion given every 3 week)
  • At the 2nd cycle he develops febrile neutropenia (ANC< 500 cells/mm3) requiring hospitalization
  • The oncologist reduces his trabectedin dose to 1.2 mg/m2; he continues therapy
  • Within 1 week, he shows clinical improvement and CT scan shows slight improvement
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