07 April 2022
Gundhild Mechtersheimer, Heidelberg, GERMANY
A 27 yo nulligravida presents with abnormal uterine bleeding. A polypoid mass of maximal 15mm diameter was incompletely excised on colposcopy. IHC and Archer NGS revealed NTRK3 rearranged spindle cell sarcoma of the cervix utteri. Staging CT was negative. A modified radical hysterectomy was carried out containing remains of 25mm of the sarcoma. 3 months postoepratively, there were no signs of local nor systemic disease. Detailed current pathological background knowledge on NTRK1/2/3 kinase fusions is discussed.
Norbert Dion, Quebec, CANADA
A 69yo physician presented with a pathological fracture of the right proximal femur contaminating the entire hip joint. A CT-guided biopsy was suggestive of chondrosarcoma, staging studies were negative. Surgical options are presented and discussed. A periacetabular extra-articualr Ganz-OT/ type II internal hemipelvectomy was performed with negative margins. Reconstruction was carried out with an allograft-prosthetic composite (APC). At 11 months postoperatively, the patient was free of dissease and walks without crutches and without limping.
Andrew Bishop, Houston, USA
A 32yo male prsented with a 20cm large spindle cell sarcoma of the lateral inferior pelvis extending through the sciatic notch. In addition, a chondrogenic supraacetabular lesion was biopsied revealing a high-grade chondrogenic malignancy; further staging was negative. The patient received 6 cycles of AI chemotherapy followed by preoperative radiation for the main mass and SBRT for the supraacetabular mass, before undergoing type III internal hemipelvectomy. At 18 months postoperatively, the patient was ambulatory with gait adaptations, but the right supraacetabular chondrosarcoma increased in size. Another biopsy confirmed G2 chondrosarcoma, and cryoablation was performed. At 4 months of follow-up, the patient was free of disease.
Emanuela Palmerini, Bologna, ITALY
A 33 yo male presents with an aggressive lytic lesion of the right calcaneus, extending into the surrounding soft tissues. Work-up revealed a high-grade spindle cell sarcoma of bone with a EML4-NTRK3 rearrangement. MAP neoadjuvant chemotherapy was initiated. Because of an important local tumor progression, neoadjuvant second line larotrectinib was initiated. After good response, the tumor was locally resected. No adjuvant therapy was used.