Cano-Padilla Adrián, Ramírez Augusto, Cervantes-Rivera Paola, Bellido-Magaña Rosalba, Flores-Vargas Gilberto, Padilla-Raygoza Nicolás
General Surgery, León General Hospital, Guanajuato State Public Health Institute, Leon, CP 37672, México.
Department of Thoracic and Vascular Surgery, León General Hospital, Guanajuato State Public Health Institute, Leon, CP 37672, México.
Ecancermedicalscience. 2023 Oct 2;17:1608. doi: 10.3332/ecancer.2023.1608. eCollection 2023.
Soft tissue sarcomas make up 7%-15% of childhood solid tumours. The aetiology of this disease is unknown. It is a fast-growing, painless tumour; histologically similar to adult fibrosarcoma, but having a lesser risk of metastasis and a better prognosis. The treatment is aimed towards localised intervention; complete surgical resection is the appropriate treatment as long as it can be performed.
An 11 years old female was referred for resection of a soft tissue tumour on the right elbow with significant peripheral vascularisation. Tumour resection was scheduled, with the placement of a partial thickness skin graft, and a piece was sent to pathology; a histological type consistent with paediatric fibrosarcoma was obtained with margins less than 1 mm from the lesion. Therefore, the patient was referred to the paediatric oncology unit. Further studies with positron emission tomography were requested, in which no evidence of macroscopic anatomy-metabolic tumour activity was found. Subsequently, treatment was started by paediatric oncology with 2 sessions of chemotherapy and 20 sessions of radiotherapy with sufficient progress; finally, assessment by plastic and reconstructive surgery was performed and an adequate quality of graft was observed, without the need for any other intervention by their service.
The involvement of the vascular surgeon in performing the tumour resection permitted the preservation of the best circulation to the extremity, thereby, avoiding amputation. The difficult decision made by the reconstructive surgeon to place a partial thickness graft over the surgical site, and to start radiotherapy/chemotherapy by paediatric oncology, were key to the success in achieving the patient's satisfactory progress.
软组织肉瘤占儿童实体瘤的7%-15%。该疾病的病因尚不清楚。它是一种生长迅速、无痛的肿瘤；组织学上与成人纤维肉瘤相似，但转移风险较低，预后较好。治疗旨在进行局部干预；只要能够进行，完整的手术切除就是合适的治疗方法。
一名11岁女性因右肘软组织肿瘤伴明显外周血管化而被转诊进行切除。计划进行肿瘤切除，同时放置部分厚度的皮肤移植片，并送一块组织进行病理检查；病理结果为与儿童纤维肉瘤一致的组织学类型，切缘距病变小于1毫米。因此，该患者被转诊至儿科肿瘤科。要求进一步进行正电子发射断层扫描研究，未发现宏观解剖学-代谢性肿瘤活动的证据。随后，儿科肿瘤科开始进行治疗，进行了2个疗程的化疗和20个疗程的放疗，病情进展良好；最后，进行了整形和重建手术评估，观察到移植片质量良好，无需该科室进行任何其他干预。
血管外科医生参与肿瘤切除手术，得以保留肢体的最佳血液循环，从而避免了截肢。重建外科医生做出在手术部位放置部分厚度移植片的艰难决定，以及儿科肿瘤科开始进行放疗/化疗，是患者取得满意病情进展的关键。
