Abstract YO30
Case summary
A 53-year-old man presented with an 11-month history of a painless neck mass. On examination, he had a 10 x 5 cm mass at the left carotid triangle, and a fungating mass at the left tonsillar fossa, which on CT scan was 3.2 x 2.2 cm and invading into the parapharyngeal space.
Biopsy revealed an undifferentiated malignancy. Immunohistochemistry was negative for CK, LCA, EMA, synaptophysin, chromogranin and 34beta-E12, positive for vimentin and focally positive for S-100, favoring malignant melanoma. However, both HMB-45 and melan-A were negative, leading to a classification of undifferentiated sarcoma.
Chest and abdominal CT scan were negative for distant metastases. The tumor was deemed unresectable due to its close attachment to the great vessels, hence a sequential chemoradiation approach was pursued. He underwent six cycles of doxorubicin (60 mg/m2), resulting in 80% tumor regression. Unfortunately, he was lost to follow-up and was unable to undergo radiotherapy. He returned eight months later with re-enlargement of the neck mass to 6 x 5 cm. He remained free of distant metastases, and underwent two cycles of dacarbazine (250 mg/m2, day 1-5), which did not confer any response.
The indolent behavior of the tumor prompted pathological re-evaluation. Further staining showed diffuse positivity for CD21 and negative for CD1A and CD34, consistent with follicular dendritic cell sarcoma. The patient underwent three cycles of gemcitabine (1000 mg/m2, day 1 and 8) plus docetaxel (75 mg/m2, day 1), resulting in 50% tumor regression. This allowed dissection of level IB – V lymph nodes, which found disease in 10/23 nodes. He subsequently underwent adjuvant radiotherapy for the neck and primary radiotherapy for the tonsillar mass, with weekly gemcitabine (400 mg/m2) as a radiosensitizer. Evaluation three months post-treatment did not show any sign of disease progression.
Follicular dendritic cell sarcoma is very rare, accounting for <0.4% of soft tissue sarcomas. Only 60 cases of tonsillar occurrence have been reported in literature. Tonsillectomy is sufficient in most cases. For our patient, a trimodality approach done due to the presence of high risk features (R2 resection, LN involvement, tumor recurrence) provided good disease control.
Clinical trial identification
Editorial acknowledgement
Resources from the same session
248P - Retrospective review of metastatic carcinoma of cervix from a tertiary cancer institute of south India
Presenter: Arkoprovo Halder
Session: Poster display session
Resources:
Abstract
249P - Accuracy of endometrial biopsy by Pipelle: A systematic review and meta-analysis
Presenter: Jinhai Gou
Session: Poster display session
Resources:
Abstract
250P - Non-endometrioid endometrial cancer: Analysis of different adjuvant treatment modalities
Presenter: Gonçalo Nogueira da Costa
Session: Poster display session
Resources:
Abstract
251P - A prognostic index model for predicting long-term recurrence of uterine leiomyoma after initial myomectomy in women aged 18-44 years
Presenter: Xiu Ming
Session: Poster display session
Resources:
Abstract
252P - Uterine sarcomas in Qatar: Clinico-pathological characteristics and treatment outcome
Presenter: Ashraf Fadlelseid
Session: Poster display session
Resources:
Abstract
253P - Anti-PD-1-induced reinvigoration of tumour-infiltrating CD8+ T cells in epithelial ovarian cancer patients is correlated with T cell factor-1
Presenter: Junsik Park
Session: Poster display session
Resources:
Abstract
254P - Cyclin E1 is a shared biomarker of subsets of high grade serous ovarian cancer (HGSOC) and basal like breast cancer (BLBC)
Presenter: Diar Aziz
Session: Poster display session
Resources:
Abstract
255P - MEX3A is a prognostic biomarker and correlates with RNA splicing and cell proliferation in endometrial cancer by analysis of RNA-seq data
Presenter: Huining Jing
Session: Poster display session
Resources:
Abstract
256P - Lnc-AL445665.1-4 may be involved in the development of multiple uterine leiomyoma through interacting with miR-146b-5p
Presenter: E Yang
Session: Poster display session
Resources:
Abstract
257P - Treatment results of low risk gestational trophoblastic neoplasia (GTN) from a tertiary hospital, Chennai, India
Presenter: Rakesh M. P
Session: Poster display session
Resources:
Abstract