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, 9 (3), 1135-1141

Multidisciplinary Treatment Based on Surgery Leading to Long-Term Survival of a Patient With Multiple Asynchronous Rare Primary Malignant Neoplasms: A Case Report and Literature Review

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Multidisciplinary Treatment Based on Surgery Leading to Long-Term Survival of a Patient With Multiple Asynchronous Rare Primary Malignant Neoplasms: A Case Report and Literature Review

Hong-Lin Gu et al. Oncol Lett.

Abstract

Patients that present with multiple primary malignant neoplasms are increasingly encountered, but the treatment of such patients presents specific challenges and long-term survival is rare. The present study reports the case of a 45-year-old female diagnosed with three rare, distinct primary malignant neoplasms, including epithelioid hemangioendothelioma (EHE) of the brain, Ewing's sarcoma of the lumbar 2 vertebra and a malignant solitary fibrous tumour (SFT) of the liver, at different time points. The patient underwent multidisciplinary treatment according to the diagnoses, including radial resection of all primary lesions, chemotherapy (consisting of vincristine, dactinomycin, cyclophosphamide and adriamycin) and radiotherapy, to treat Ewing's sarcoma and metastases of EHE and malignant SFT. Following these treatments, the patient survived for >14 years. Multidisciplinary treatment regimens based on surgery can lead to long-term survival of patients with multiple asynchronous rare primary malignant neoplasms. The present study reported that multidisciplinary treatment regimens based on surgery can lead to the long-term survival of patients with multiple asynchronous rare primary malignant neoplasms.

Keywords: Ewing’s sarcoma; epithelioid hemangioendothelioma; malignant solitary fibrous tumour; multidisciplinary treatment; multiple primary malignant neoplasms.

Figures

Figure 1
Figure 1
Pre- and post-operative radiographic images and pathological appearance of the L2 metastatic EHE. (A and B) Pre-operative magnetic resonance imaging scan revealing a compression fracture and a slightly hyperintense mass on the L2 vertebra with compression of the spinal cord (arrows). (C and D) Post-operative radiograph subsequent to anterior L2 vertebrectomy and L1–L3 fusion. (E and F) Post-operative histopathology revealed the tumour to be EHE that was composed of vascular channels lined by atypical cells with an epithelioid shape and clear cytoplasm (magnification, ×100 and ×200, respectively; stain, hematoxylin and eosin). L, lumbar; EHE, epithelioid hemangioendothelioma.
Figure 2
Figure 2
Pre- and post-operative radiographic images and pathological appearance of the L2 primary Ewing’s sarcoma. (A and B) Pre-operative magnetic resonance imaging revealing a posterior enhancing mass and spinal cord compression at the L2 vertebrae level with involvement of the bilateral vertebral lamina and superior processus (arrows). (C and D) Post-operative radiograph subsequent to posterior lesion excision and pedicle screw fixation. (E and F) Post-operative histopathology denoting Ewing’s sarcoma, composed of small blue tumour cells (magnification, ×100 and ×200, respectively; stain, hematoxylin and eosin). L2, lumbar 2.
Figure 3
Figure 3
Pre-operative radiographic image and pathological appearance of the hepatic primary malignant SFT. (A) An abdominal computed tomography scan revealing a hyperintense mass in the S5 hepatic segment with a maximum diameter of 10 cm (arrow). (B and C) Post-operative histopathology revealed a malignant SFT composed of oval or round cells with cytoplasmic hyaline grains and a hemangiopericytoma-like vascular pattern (maginfication, ×100 and ×200, respectively; stain, hematoxylin and eosin). SFT, solitary fibrous tumour.
Figure 4
Figure 4
Pre- and post-operative radiographic images of the L2 metastatic malignant solitary fibrous tumour. (A and B) Magnetic resonance imaging scan revealing a posterior enhancing mass and spinal cord compression at the L2 level (arrows). (C) Positron emission tomography-computed tomography scan revealing a focal high uptake in the L2 level. (D and E) Post-operative radiograph subsequent to posterior palliative resection of the lumbar mass and re-fixation of larger pedicle screws. L2, lumbar 2.
Figure 5
Figure 5
Summary of the most significant procedures and diagnoses since a 45-year-old woman received an initial diagnosis of EHE of the brain. The patient eventually succumbed to respiratory-circulatory failure following multiple bone metastases, lung infection and pancytopenia. EHE, epithelioid hemangioendothelioma; MRI, magnetic resonance imaging; VACA, vincristine, dactinomycin, cyclophosphamide and adriamycin; PET-CT, positron emission tomography-computed tomography; SFT, solitary fibrous tumour; L1-3, lumbar 1-3.

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