Spontaneous Regression in a Patient With Infantile Fibrosarcoma

Infantile Fibrosarcoma of the Bone: A Case Report and Literature Review

Introduction

In adults, fibrosarcoma (FS) of the bone is a rare occurrence. Infantile FS, particularly in the distal radius, is an exceedingly uncommon tumor and, to the best of our knowledge, has not yet been documented in the literature. In the subsequent report, we present a case involving a 2-year-old male diagnosed with primary FS of the distal radius.

Case Report

We hereby report the case of a 2-year-old Caucasian boy presenting with primary bone FS in the distal radius. X-rays revealed an osseous mass with an extraosseous component. MRI showed heterogeneous enhancement, suggestive of non-liquefied necrosis or possible fibrosis within the extraosseous soft-tissue component. The patient underwent a resection of the tumor, followed by central translocation of the ulna.

Conclusion

Managing infantile FS of the bone requires a multidisciplinary approach. A high index of suspicion is crucial for diagnosing the tumor. Further studies are needed to enhance our approach and management of infantile FS of the bone.

Paediatric fibrosarcoma treatment

Introduction

Soft tissue sarcomas make up 7%-15% of childhood solid tumours. The aetiology of this disease is unknown. It is a fast-growing, painless tumour; histologically similar to adult fibrosarcoma, but having a lesser risk of metastasis and a better prognosis. The treatment is aimed towards localised intervention; complete surgical resection is the appropriate treatment as long as it can be performed.

Case report

An 11 years old female was referred for resection of a soft tissue tumour on the right elbow with significant peripheral vascularisation. Tumour resection was scheduled, with the placement of a partial thickness skin graft, and a piece was sent to pathology; a histological type consistent with paediatric fibrosarcoma was obtained with margins less than 1 mm from the lesion. Therefore, the patient was referred to the paediatric oncology unit. Further studies with positron emission tomography were requested, in which no evidence of macroscopic anatomy-metabolic tumour activity was found. Subsequently, treatment was started by paediatric oncology with 2 sessions of chemotherapy and 20 sessions of radiotherapy with sufficient progress; finally, assessment by plastic and reconstructive surgery was performed and an adequate quality of graft was observed, without the need for any other intervention by their service.

Conclusion

The involvement of the vascular surgeon in performing the tumour resection permitted the preservation of the best circulation to the extremity, thereby, avoiding amputation. The difficult decision made by the reconstructive surgeon to place a partial thickness graft over the surgical site, and to start radiotherapy/chemotherapy by paediatric oncology, were key to the success in achieving the patient's satisfactory progress.

Treatment of infantile fibrosarcoma: A tertiary care center experience

OBJECTIVE

Infantile fibrosarcoma (IFS) is a highly locally aggressive nonrhabdomyosarcomatous soft tissue sarcoma that most commonly occurs in young infants. There exists no standard treatment this lesion due to its rarity. We shared our treatment experience for IFS in this study.

METHODS

Patients' record between January 2013 and December 2018 were reviewed and patients with newly diagnosed IFS were included. The clinical characteristics, treatment strategy, treatment-related toxicities and clinical outcome were retrospectively analyzed.

RESULTS

Eleven patients were admitted in our center, including 4 girls and 7 boys, and the median age at diagnosis was 5 months (range 1-23 months). Ten patients achieved complete remission (CR) after the completion of initial treatment. The main short-term adverse effects was myelosuppression. Three patients experienced relapse, including two patients with local progression and one patient with distant metastasis. After a median follow-up of 3.5 years (range 1.5-7 years), 9 patients were alive and 2 patients died. The 3-year overall survival (OS) rate was 93.5% (95% CI 83.7-98.2).

CONCLUSION

We formulated the treatment strategy according to group grade and the experience from previous studies, which may be effective and feasible for the treatment of IFS.

Spontaneous Regression of Multiple Pulmonary Metastasis of Sacral Chordoma: A Case Report

CASE

A 53-year-old man was referred to our institution for the treatment of sacral chordoma and underwent a wide resection. Multiple lung metastases were observed in both the lungs, a year after the surgery, and the diagnosis was confirmed by biopsy. The patient refused treatment, and the lesions continued to increase in size gradually. However, 3 years and 6 months after the surgery, computed tomography of both the lungs showed spontaneous regression of the lesions without any obvious causes. The metastatic lung lesions had disappeared at the final follow-up, 7 years and 5 months after the multiple pulmonary metastases were diagnosed.

CONCLUSION

We report the first case of spontaneous regression of pathologically proven pulmonary metastases of a sacral chordoma.

Pancreatic enzyme autodigestion of an unresectable retroperitoneal liposarcoma

This is a case of a 71-year-old man who had multiple synchronous retroperitoneal liposarcoma (LPS) foci composed of both well-differentiated and dedifferentiated histologies. In addressing this, the patient underwent a margin negative resection of a 11.8×8.8 cm right-sided dedifferentiated LPS requiring pancreaticoduodenectomy; however, a 13.1×7.2 cm left-sided well-differentiated LPS (WDLPS) was not resected due to its involvement of the proximal mesenteric vessels. The patient's postoperative course was complicated by grade B postoperative pancreatic fistula involving the anatomical territory of the residual WDLPS. Over the next 12 months, serial CT scans demonstrated a stepwise reduction in size of the WDLPS until it completely regressed. The authors hypothesise that enzymes shed from the pancreatic fistula initiated the autodigestion and subsequent necrosis of the WDLPS with associated tumour regression.

Non-rhabdomyosarcoma soft tissue sarcomas diagnosed in patients at a young age. An overview of clinical, pathological, and molecular findings

OBJECTIVE

Disease spectrum in pediatric sarcoma differs substantially from adults. We report a cohort of very young children with non-rhabdomyosarcoma soft tissue sarcoma (NRSTS) detailing their molecular features, treatment, and outcome.

METHODS

We report features of consecutive children (age <2 years) with NRSTS (2000-2017). Archival pathological material was re-reviewed, with additional molecular techniques applied where indicated.

RESULTS

Twenty-nine patients (16 females, 55%) were identified (median age 6 months; range 0-23). Most common diagnoses included infantile fibrosarcoma (IFS, n = 14, 48%), malignant rhabdoid tumor (MRT, n = 4, 14%), and undifferentiated sarcoma (n = 4, 14%). Twenty-seven of 29 (93%) had tumor molecular characterization to confirm diagnosis. Clinical presentation included a swelling/mass (n = 23, 79%). Disease extent was localized (n = 20, 69%), locoregional (n = 6, 21%), or metastatic (n = 3, 10%). Seventeen of 29 (59%) who underwent surgery achieved complete resection (R0). Other treatments included conventional chemotherapy (n = 26, 90%), molecularly targeted therapies (n = 3, 10%), and radiation (n = 5, 17%). At last follow-up (median 3 years; range 0.3-16.4), 23 (79%) were alive, disease-free and six (21%) had died of disease. All patients with IFS were alive and all those with MRT died. A cancer predisposition syndrome (CPS) was confirmed in three of 10 (30%) genetically tested patients.

CONCLUSION

We recommend tumor molecular characterization in all young patients including evaluation for CPS to optimize treatment options and prognostication.

Cervical Infantile Fibrosarcoma: a rare cause of paediatric parapharyngeal neck mass

Soft tissue tumors are not uncommon in childhood and comprise entities that range from common to very rare malignancies. Infantile fibrosarcoma (IFS) is a rare pediatric malignancy mainly seen in the first two years of life. The data about the incidence of infantile fibrosarcoma occurring in the neck in the Indian subcontinent is scarce. To the best of our knowledge, only one case of infant cervical IFS has been reported previously in the Indian subcontinent. We present another case of an eight-year-old male patient with a rapidly growing mass on the left side of the neck. He was successfully treated with a combined modality of surgery and chemotherapy with a good outcome. Among the soft tissue tumors of childhood, IFS is a rare entity. It has a good prognosis and lesser chance of distant metastasis as compared to adult fibrosarcoma. Though surgical excision is the mainstay of treatment, chemotherapy also has a significant role in the treatment of primary tumor and metastasis. We discuss the stated case to bring to the notice this uncommon cause, which can be considered as a differential diagnosis of upper cervical swellings. A better understanding of this entity would help in early diagnosis and aggressive treatment, reducing the overall morbidity and mortality.

LncRNA-135528 inhibits tumor progression by up-regulating CXCL10 through the JAK/STAT pathway

Spontaneous tumor regression can be observed in many tumors, however, studies related to the altered expression of lncRNA in spontaneous glioma regression are limited, and the potential contributions of lncRNAs to spontaneous glioma regression remain unknown. To investigate the biological roles of lncRNA-135528 in spontaneous glioma regression. The cDNA fragment of lncRNA-135528 was obtained by rapid-amplification of cDNA ends (RACE) technology and cloned into the plvx-mcmv-zsgreen-puro vector. Additionally, we stably silenced or overexpressed lncRNA-135528 in G422 cells by transfecting with siRNA against lncRNA-135528 or lncRNA-135528 overexpression plasmid. Then, we examined lncRNA-135528 overexpressing and lncRNA-135528 silencing on glioma cells and its effects on CXCL10 and JAK/STAT pathways. The main findings indicated that lncRNA-135528 promoted glioma cell apoptosis, inhibited cell proliferation and arrested cell cycle progression; the up-regulation of lncRNA135528 led to significantly increased CXCL10 levels and the differential expression of mRNA associated with JAK/STAT pathway in glioma cells. lncRNA-135528 can inhibit tumor progression by up-regulating CXCL10 through the JAK/STAT pathway.

Spontaneous Regression of Myxofibrosarcoma of the Thigh after Open Biopsy

Spontaneous regression of sarcoma is exceedingly rare. A 62-year-old male presented with myxofibrosarcoma of the thigh which regressed after open biopsy. Treatment strategy for this condition is not well-documented in the literature. In this report, we describe the case of a spontaneously regressed myxofibrosarcoma successfully treated by resection where the extent of the tumor was determined from the initial MRI. This case demonstrates that myxofibrosarcoma has the potential to regress spontaneously, and astute awareness of this phenomenon is necessary for appropriate management of this condition.