A 68-year-old woman with no history of interest presented to the emergency department with bleeding from a tumor located in the left arm.
The tumor is large (21x15 cm) and occupies the entire distal half of the arm. It is ulcerated, with necrotic areas of great cutaneous fragility and bleeding.
He claimed to have noticed a small diameter tumor that had progressively increased in size in the last two years and for which he had never consulted.
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In the emergency department, electrocoagulation of the bleeding point is performed under local anesthesia and a tissue sample is taken for pathological study.
She was admitted to the hospital and subjected to study.
Preoperative tests, imaging diagnostic tests and a tumor extension study were performed.
An upper arm x-ray showed a soft tissue mass without bone invasion.
The tonic extension study (THA), also suggestive non-adenopelvic, presents a pulmonary nodule with well-defined borders and juxtapleural location, located in the upper segment of the ipsilateral axillary lobe, shows some
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Biopsy of the tumor results in an area with massive «high» dermis due to fibrotic proliferation with a low-grade appearance and another necrotic zone, suggesting a proliferation of fibrotic cells.
Differential diagnoses include fibrotic malignant sarcoma, fibromyxoid sarcoma or myxofibrosarcoma.
Once the studies were completed, the patient was assessed in a joint clinical session by the Plastic Surgery Departments, On-going Surgery to decide on the therapeutic approach to take.
We opted for surgical treatment of the tumor and application of adjuvant chemotherapy on the pulmonary nodule, which is not considered subsidiary of surgical removal.
The intervention consisted of complete resection of the tumor with wide margins and direct closure of the underlying defect.
Adjuvant chemotherapy was 6 cycles with Ifosmamide, Mesna, Adriamycin and Dacarbacin.
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The anatomopathological study of the excised tumor revealed macroscopically a piece of 21x16x15cm, partially relapsing central areas due to extensive skin consistency with important areas of deep ulceration and expansive growth edge, necrosis and necrosis.
The microscopic study determined a nodular global pattern, although in many areas it was lost by the large size of the nodules.
Histologically there were very variable aspects, predominating the areas of sarcomatoid appearance with elongated cells of ovoid nuclei and slightly acidophilic cytoplasm; in other areas there were variable amounts of mucoid material, glans and glans.
Immunohistochemical study was positive for cytokeratins (AE1-AE3) in epithelial areas and negative in sarcomatoid areas (50%), positive vimentin in sarcomatous areas and negative epithelial proliferation index in pure sarcomatous zones (50%).
The definitive histological diagnosis was a tumor of epithelial origin of high degree of malignancy, called malignant chondroid syringoma.
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The patient was followed up in the outpatient clinic of Plastic Surgery, presenting good evolution of the scar, with no evidence of recurrence at 2 years.
Magnetic resonance imaging (MRI) of the arm with no evidence of local recurrence.
Thoracic-abdominal imaging studies show decreased axillary lymph nodes and pulmonary nodule (4mm).
Currently, quarterly controls are still being carried out by Plastic Surgery and Ongoing Services.
