Tian Ye, Fox Edward, Drabick Joseph, Pameijer Colette
Penn State College of Medicine, Hershey, Pennsylvania, USA.
Orthopedic Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA.
BMJ Case Rep. 2018 Aug 11;2018:bcr-2018-224618. doi: 10.1136/bcr-2018-224618.
A 54-year-old man presented with a painful lesion on the right posterior calf with MRI identifying a 5 cm lesion in the medial head of the gastrocnemius. He underwent wide local excision of the tumour, and the final pathology was consistent with atypical granular cell tumour. Three years later, he developed a recurrent right popliteal mass. Complete staging workup also identified multiple lung nodules and a caecal polyp that were consistent with metastatic granular cell tumour. He was started on pazopanib and deemed a poor candidate for palliative resection due to encasement of the popliteal vessels. The patient refused above-the-knee amputation (AKA) at that point and was evaluated for isolated limb infusion as an alternative. He received three cycles of isolated limb infusion within a 2-year period and achieved good response from the first two cycles. He underwent AKA 4 years after his diagnosis of malignant granular cell tumours and is currently doing well.
一名54岁男性因右小腿后侧疼痛性病变就诊，MRI检查发现腓肠肌内侧头有一个5厘米的病变。他接受了肿瘤的广泛局部切除，最终病理结果与非典型颗粒细胞瘤一致。三年后，他出现了右腘窝复发性肿块。全面的分期检查还发现多个肺结节和一个盲肠息肉，与转移性颗粒细胞瘤相符。他开始使用帕唑帕尼治疗，由于腘窝血管被包裹，被认为不适合进行姑息性切除。此时患者拒绝了膝上截肢（AKA），并接受了孤立肢体灌注评估作为替代方案。他在2年内接受了3个周期的孤立肢体灌注，前两个周期取得了良好的反应。他在被诊断为恶性颗粒细胞瘤4年后接受了膝上截肢手术，目前情况良好。
