Male patients aged 45 years old presented with huge left side chest wall mass. Biopsy revealed chondrosarcoma. Chest CT is attached and investigations show no distant metastasis.
How can you manage this case?
Dr Arafat,
I suggest that you write this email: [email protected] ;
the authors should know the best treatment; they have published about this kind of ca. Abstract: The present study reports three cases of primary intrathoracic chondrosarcomas in two males and one female aged between 45 and 64 years. Clinically, one case presented with cough and blood sputum, while the other two cases of primary intrathoracic chondrosarcoma were found incidently during a routine health examination. Radiologically, the chondrosarcomas presented as large masses with intratumoral calcification. Chondrosarcoma should be distinguished from other calcified pulmonary lesions. In this study, all three cases underwent surgical treatment, and in one case, the surgery was accompanied by radiotherapy. To date, all patients have been followed up for between two and three years and are alive.
Authors:
Oncol Lett. 2014 Sep; 8(3): 1151–1154.
Published online 2014 Jun 23. doi: 10.3892/ol.2014.2275
Primary chondrosarcoma presenting as an intrathoracic mass: A report of three cases
XUE-YUAN WANG,1,* SU HU,1,* LING-CHUAN GUO,2 JIE CHEN,3 MO ZHU,1 FEI-RONG YAO,1 and CHUN-HONG HU
The first step should be surgical removal. It will not be easy because the tumor mass is huge, but surgery is the best option.
According to UpToDate, especially "... high-grade chondrosarcomas [..] have a high metastatic potential and a poor prognosis following resection alone" and "... we generally suggest adjuvant radiotherapy for incompletely excised high-grade conventional, dedifferentiated, or mesenchymal chondrosarcomas". Furthermore and with regard to chemotherapy, "we suggest that patients be enrolled in clinical trials testing new strategies" whenever you are planning to try a chemotherapeutic regimen. Surgical removal and adjuvant radiotherapy seems to be the best option in a case like this one.
What kind of surgery can be performed on this patient? The tumor invades 8 ribs and the scapula moreover, we are not sure if we can dissect it from the lung. The tumor grows to this size in 6 years.
I agree with Daniel.
The first step should be cytoreductive surgery. Removal of the bulk as far as it is possible. You will not be able to remove all of it. But unless you remove the maximum possible, no further treatment is possible. Then radiotherapy.
As a non conventional treatment I would use metronomic cyclophosphamide 50 mg a day plus celecoxib 400 mg a day plus acetazolamide 500 mg a day plus amiloride 10 mg a day, and lansoprazol 180 mg a day, without interruption.
This is an antiangiogenic treatment with cellular acidification.
It needs local resection, as a part of planning, CT and MRI films should be fused and virtual surgical resection practiced. Also a 3 D printed model can further help in Deciding the steps. Single lung ventilation would help in excision.