http://hemoncstaff.blogspot.com/2015/08/20150901juntaastorga.html

1. 61-yo male with a recurrent
neck mass
01/09/2015

2. 61 yo male with a recurrent neck mass
• 61 yo Male
• Arterial Hypertension
• Hemochromatosis (Phlebotomy)
• 10.2012: Painless left level IV neck mass
• 12.2012: Neck dissection (R0)
• Poorly differentiated Neoplasm
• 2º opinion: Dr. Fletcher (Harvard):
• Fusocellular Malignant Neoplasm
• XX.2013: Neck dissection (R0)
• Same histology
• 06.2015: Relapse
• 07.2015: Neck dissection

3. 61 yo male with a recurrent neck mass
• 61 yo Male
• Arterial Hypertension
• Hemochromatosis (Phlebotomy)
• Recurrent neck mass (Neck dissection in 2012 and 2013)
• 07.2015: Neck dissection
• 1.6 cm
• R1
• Malignant infiltrating tumor with fusocellular and epithelioid components
• 1-3 mitoses per HPF
• Positive IHC for: CD34, Vimentin, CD68, Smoth muscle actin (Weak)
• Negative IHC for: S100, Melan A, Desmin, CK, CD45, EMA, ALK, myogenin
• Negative IHC (MSKCC): MDM2, CDK4, S100
• Positive retention of H3K27m3
• MIB-1 (Ki67): 20%

4. 61 yo male with a recurrent neck mass
Cristina Antonescu’s considerations
Malignant infiltrating neoplasm
Fusocellular + Epithelioid
(Pleomorphic & giant cells)
Variable proliferation
MPNST
De-differentiated liposarcoma
Fibrosarcoma / UPS
S100(-)
H3K27m3
MDM2(-)
CDK4(-)

5. 61 yo male with a recurrent neck mass
Cristina Antonescu’s considerations
Malignant infiltrating neoplasm
Fusocellular + Epithelioid
(Pleomorphic & giant cells)
Variable proliferation
MPNST
De-differentiated liposarcoma
Fibrosarcoma / UPS
S100(-)
H3K27m3
MDM2(-)
CDK4(-)
Myxofibrosarcoma?
Mucina

6. Should we treat with RT?
YES

7. Gemcitabine + RT (Phase 1 study)
[Tseng WW, Cancer, 2015][P1T, 36 pts (resectable, high-risk, extremity
sarcomas)] MTD: Neoadjuvant Gemcitabine 700 mg/m2 on days 1, 8,
22, 29, 43 and 50 with EBRT (50 Gy in 25 fractions over 5 weeks) [grade
4 toxicities; 5-yr locoregional RFS, DMFS and OS were 24%; 85%, 80%,
86%, respectively]