J Haddad1, F Gouailler2, E Aleton3, L Chaigneau4, J Pauchot5. 1. Service de chirurgie orthopédique, traumatologique et plastique, chirurgie de la main, CHU Jean-Minjoz, 1, boulevard Flemming, 25030 Besançon, France. 2. Service de chirurgie vasculaire et de médecine vasculaire, CHU Jean-Minjoz, 1, boulevard Flemming, 25030 Besançon, France. 3. Service de médecine physique et de réadaptation, soins de suite et de réadaptation, CHU Jean-Minjoz, 1, boulevard Flemming, 25030 Besançon, France. 4. Service d'oncologie médicale, CHU Jean-Minjoz, 1, boulevard Flemming, 25030 Besançon, France. 5. Service de chirurgie orthopédique, traumatologique et plastique, chirurgie de la main, CHU Jean-Minjoz, 1, boulevard Flemming, 25030 Besançon, France. Electronic address: julien.pauchot@gmail.com.
Abstract
INTRODUCTION: The soft tissue sarcomas (STM) are tumors developed at the expense of connective tissue. They are rare and have severe prognosis. The principles of management are recalled through an extended case of shoulder sarcoma. CLINICAL CASE: A 48-year-old patient has a sarcoma of the right pectoralis major muscle confirmed by biopsy. After multidisciplinary meeting, a wide surgical excision exposing the subclavian vessels and brachial plexus is performed with double cover flap pedicled latissimus dorsi and serratus and thin skin graft. RESULT: Healing process is acquired at 3 months. Adjuvant chemotherapy is established (adriamycin, ifosfamide) along with radiotherapy (54Gy). CONCLUSION: Sarcomas treatment has to be realized after considering multidisciplinary meeting (RCP) in dedicated structures. Surgery is the main treatment, it should ideally be R0, that is to say, integral with healthy tissue margin around the tumor (or healthy anatomical barrier). Optimal surgery performs a resection "without seen tumor". The diagnosis has to be made with a biopsy before the surgical treatment. Healing is quickly obtained due to adjuvant treatments.
INTRODUCTION: The soft tissue sarcomas (STM) are tumors developed at the expense of connective tissue. They are rare and have severe prognosis. The principles of management are recalled through an extended case of shoulder sarcoma. CLINICAL CASE: A 48-year-old patient has a sarcoma of the right pectoralis major muscle confirmed by biopsy. After multidisciplinary meeting, a wide surgical excision exposing the subclavian vessels and brachial plexus is performed with double cover flap pedicled latissimus dorsi and serratus and thin skin graft. RESULT: Healing process is acquired at 3 months. Adjuvant chemotherapy is established (adriamycin, ifosfamide) along with radiotherapy (54Gy). CONCLUSION:Sarcomas treatment has to be realized after considering multidisciplinary meeting (RCP) in dedicated structures. Surgery is the main treatment, it should ideally be R0, that is to say, integral with healthy tissue margin around the tumor (or healthy anatomical barrier). Optimal surgery performs a resection "without seen tumor". The diagnosis has to be made with a biopsy before the surgical treatment. Healing is quickly obtained due to adjuvant treatments.