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INTERSCAPULOTHORACIC DISARTICULATION IN ONCOLOGY BY RARE HIGH-GRADE OSTEOSARCOMA – A CASE REPORT
Apresentação do caso
Male, 23 years old, admitted in oncology service complaining of pain and tumor in the right shoulder for three months. Magnetic resonance imaging (MRI) of the right shoulder showed an infiltrative lesion affecting the head and proximal diaphysis of the humerus, measuring 12.5x11x10cm, with necrotic areas, extensive cortical rupture, and extensive soft tissue component with muscle infiltration. Chest computed tomography showed axillary lymph nodes and small indeterminate pulmonary nodules. Biopsy of the humerus lesion identified a malignant neoplasm of spindle cells and immunohistochemistry suggested a low-grade leiomyosarcoma, not finding osteoid. After neoadjuvant chemotherapy with docetaxel and gemcitabine for four cycles, control MRI showed a significant increase of the lesion dimensions (19.7 x 17.6 x 17.2 cm), the soft tissue component, and the necrotic areas. Also demonstrated intratumoral and peritumoral neovascularization, bone destruction with cortical rupture, and infiltration of the glenohumeral joint, the rotator cuff, deltoid, teres major, biceps, and triceps muscles, in addition to the axillary and brachial vascular bundles. Then, performed an interscapulothoracic disarticulation (ID) with resection of the right upper limb en bloc with the scapula, the middle third of the clavicle, chest wall segment, and axillary lymphadenectomy. The anatomopathological revealed high-grade conventional osteosarcoma, with free margins, 20% necrosis, and 31 free lymph nodes. Currently, in outpatient follow-up and asymptomatic.
Osteosarcoma is rare, less than 1% of all diagnosed cancers. The conventional high-grade subtype is aggressive, affecting the long bone metaphysis. The ID technique consists of enlarged en bloc resection of the entire affected upper limb, including the scapula and portion of the clavicle. With the advancement of medicine, ID has become uncommon, performed in less than 5-10% of cases. Thus, ID is a challenging surgery that allows adequate oncological safety margins in selected conditions, especially in extensive neoplasms of the proximal humerus and scapula. The present case configures an indication of ID aiming at cure, despite the locally advanced lesion.
Although currently performing the ID is unusual, due to extensive resection and the advancement of other therapeutic techniques, this treatment is relevant in some cases to ensure oncologically satisfactory results.
Osteosarcoma, Humeral head, Disarticulation
Sarcomas / tumores ósseos*
ANDRÉ LUIZ COSTA E SILVA, JOSÉ AMÉRICO SANTOS COSTA NETO, ANA LUISA SILVA MAIA, LAURA CRISTINA COSTA E SILVA, MARINA ALVARES PRUDENCIO, ROSANE NAYARA MEDEIROS ALVES FERNANDES, INGRID PINHEIRO MOLINA, EDUARDA MORGANA ANDRADE ALMEIDA, GUSTAVO TORRES LOPES SANTOS, THIAGO COSTA PIRES