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Soft tissue sarcoma at a dialysis access site in a transplant recipient.

Abstract

Soft tissue sarcomas typically present as soft, painless masses on an extremity. Here, we present a patient with metastatic soft tissue sarcomas at his dialysis access site. This association with dialysis access has not been documented previously. A 62-year-old man presented with a nonhealing wound on his left upper extremity after excision of a pseudoaneurysmal arteriovenous fistula. The patient had received a second kidney transplant that was functioning well. Immunosuppression included tacrolimus, mycophenolate mofetil, and prednisone. He was induced with thymoglobulin twice. A biopsy was performed showing a high-grade pleomorphic sarcoma. A magnetic resonance image of his left upper extremity showed an 11 × 5.5 × 3 cm mass abutting the biceps and brachialis muscles. Also, we discovered several lesions in the axilla and the left side of the neck, which were suspicious for metastases. A positron emission tomography-computed tomography scan confirmed a left upper extremity soft tissue mass, with marked fluorodeoxyglucose uptake, in abnormally enlarged axillary, and supraclavicular lymph nodes of the left thorax, consistent with metastases. The patient underwent chemotherapy and radiation therapy. Soft tissue sarcomas are rare. A high index of suspicion is needed to make a diagnosis. This is the first reported case of a soft tissue sarcoma discovered at a dialysis access site. As with all malignancies, early diagnosis is key to patient survival. Thorough physical examinations and increased vigilance by physicians caring for immunosuppressed patients is invaluable.

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  • Publisher Full Text

    • Authors

    Andre J, Parsikia A, Minimo C, Khanmoradi K, Campos S, Zaki R, Ortiz J

    Institution

    Albert Einstein Medical Center, Department of Surgery, Philadelphia, PA, USA. andrejas@einstein.edu

    Source

    Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation 10:4 2012 Aug pg 410-5

    MeSH

    Arteriovenous Shunt, Surgical
    Biopsy
    Chemoradiotherapy
    Humans
    Immunosuppressive Agents
    Kidney Transplantation
    Lymph Nodes
    Lymphatic Metastasis
    Magnetic Resonance Imaging
    Male
    Middle Aged
    Neoplasm Grading
    Positron-Emission Tomography and Computed Tomography
    Renal Dialysis
    Sarcoma
    Soft Tissue Neoplasms
    Treatment Outcome
    Upper Extremity
    Whole Body Imaging

    Pub Type(s)

    Case Reports
    Journal Article

    Language

    eng

    PubMed ID

    22845769