Soft Tissue Sarcoma

Fibrosarcoma

A 52 year old female professional dancer developed a progressive soft tissue mass deep to the left gluteus maximus muscle which restricted her range of motion in the hip joint. Medical workup revealed a 10.5 x 8.2 x 5.7 cm soft tissue mass deep to the gluteous maximus. Needle biopsy proved Fibrosarcoma. She was treated with extensive surgical resection with curative intent. The tumor recurred locally six months after the surgery. MRI revealed a 11.0 x 4.2 x 7.3 cm mass in the original site. She received 24 Immunepheresis procedures which produced progressive tumor reduction to 2.0 x 2.0 x 1.0 cm in size. Multiple CT directed needle biopsies of the residual mass revealed only scar tissue. She is now on a maintenance program and careful follow up with her attending physicians and remains free of detectable disease.

Chondrosarcoma

A 35 year old Caucasian woman with a history of Chondrosarcoma in the proximal right tibia treated with curettage at age 19. Local recurrence developed 12 years later, treated with resection of the knee joint and reconstruction with a prosthetic knee implant. Four years later she developed recurrence in the tibia distal to the prosthesis. Staging work-up revealed metastases at the base of the skull posterior to the left maxillary sinus, right tibia, proximal right fibula, extraosseous tumor in the soft tissue of the proximal right leg and lytic metastases in the distal right femur, the occipital bone, T2-3 vertebral bodies, right posterior ribs and facial bones on the right. She was treated for three months with Immunepheresis, 12 outpatient procedures per month. Three months after completion of the course the PET/CT revealed complete resolution of all sites of metastases and replacement of lytic bone lesions with sclerosis. Three months later she developed pain in her right fourth rib posteriorly. Her PET/CAT scan confirmed recurrence in the original sites. She was retreated with Immunepheresis for three months, 12 outpatient procedures per month. Her repeat PET/CAT scan again became negative. She has since received “maintenance” Immunepheresis (five procedures once every three months) and on this program has remained without evidence of disease now for 3.5 years. (Publication pending)

Leiomyosarcoma

A 52 year old woman with metastatic leiomyosarcoma. The tumor initially presented itself as a painless mass over the distal 1st metatarsal of her left foot. Biopsy revealed a high grade, 4 cm leiomyosarcoma. Initial treatment was surgical excision of the medial foot including the first and second metatarsus with a plantar fascio-cutaneous rotation flap for coverage. The surgical margins were adequate. Five years later she developed two nodules in the right breast. The histology after excision was leiomyosarcoma identical to the original pathology. PET/CAT revealed numerous metastases in the lungs, liver, bones and lymph nodes. There were multiple subcutaneous nodules on the arms and legs. Biopsy of these, and FNA of a liver lesion confirmed metastatic leiomyosarcoma. She had six cycles of Gemcitabine and Docetaxel with no response. Three months after the last chemotherapy she began Immunepheresis. She received two months of treatment. All palpable disease resolved at the end of the first three weeks of treatment. Subsequent PET/CAT scans revealed no evidence of disease. She is now on a maintenance program.