Dow University of Health Sciences, Karachi, Pakistan.
The Medical Research Circle, Goma, Democratic Republic of Congo.
J Med Case Rep. 2024 Sep 13;18(1):440. doi: 10.1186/s13256-024-04747-1.
In this report, we describe an uncommon instance of fungating synovial sarcoma affecting the posterior aspect of the neck. Although the existing literature has documented a limited number of cases, this particular case contributes to the knowledge about it, which is scarce.
A total of 5 months before the examination, a Pakistani-Asian male, age 20 years, complained of a malodorous fungating swelling on the posterior aspect of his neck. An examination revealed a foul-smelling, 10 × 13 cm fungating enlargement surrounded by maggots and hemorrhaging at the site of the incision. A hemoglobin level of 6 and a total leukocyte count (TLC) of 23,000 indicated the patient's disoriented and pallid appearance. He was expeditiously admitted, and preoperatively, the general well-being of the patient was optimized. After a comprehensive discussion with the medical team, a strategy for marginal excision and coverage with a latissimus dorsi (LD) flap and grafting was devised. The tumor was successfully excised, and an LD flap with graft was conducted on the patient during surgery; however, the infection caused the failure of half of the graft. Following that, the lesion was debrided, and re-grafting was performed. The patient was subsequently administered 5 cycles of chemotherapy and 32 cycles of radiotherapy. He was diagnosed with pulmonary metastasis 2 years later. Sadly, the patient died during a follow-up visit 3.5 years later.
The patient's unfavorable prognosis after surgical intervention, radiotherapy, and chemotherapy, despite undergoing all-encompassing treatments, underscores the importance of early detection and intervention in fungating tumor cases.
在本报告中，我们描述了一例罕见的滑膜肉瘤肿块样变发生于颈部后外侧。尽管现有文献记录了有限数量的病例，但该特定病例有助于增加对其的了解，因为这方面的知识还很匮乏。
在检查前 5 个月，一名 20 岁的巴基斯坦裔亚裔男性主诉颈部后侧有恶臭性肿块样变。检查发现切口处有恶臭、10×13cm 的肿块样变伴溃烂，周围有蛆虫和出血。血红蛋白水平为 6g/dL，总白细胞计数（TLC）为 23,000，提示患者定向力障碍和面色苍白。他被紧急收治入院，在术前，患者的一般健康状况得到了优化。在与医疗团队进行全面讨论后，制定了边缘切除及覆盖背阔肌（LD）皮瓣和植皮的方案。成功切除了肿瘤，在手术中为患者进行了 LD 皮瓣加植皮，但感染导致一半的植皮失败。随后，对病灶进行清创和再次植皮。之后，患者接受了 5 个周期的化疗和 32 个周期的放疗。2 年后，他被诊断为肺转移。不幸的是，在 3.5 年后的随访中，患者死亡。
尽管患者接受了全面的治疗，包括手术干预、放疗和化疗，但预后仍不理想，这突显了早期发现和干预肿块样变肿瘤的重要性。
