A case of primary gastric undifferentiated high-grade pleomorphic sarcoma diagnosed with chief complaint of fever: a case report and literature review

Undifferentiated Pleomorphic Sarcoma of the Proximal Thigh With Neoplastic Fever and Metachronous Sternal Metastases: A Case Report and Review of the Literature

Undifferentiated pleomorphic sarcoma (UPS) is a rare subtype of undifferentiated soft tissue sarcoma (USTS). UPS is a fast-growing malignant tumor with a high mitotic rate and a high risk of distant metastasis that increases proportionally to tumor size. Obtaining an early diagnosis confers a more favorable prognosis. Neoplastic fever (NF) is the refractory fever subsumed under the category of classic fever of unknown origin (FUO) caused by malignant neoplasms. NF is a paraneoplastic syndrome that rarely occurs in STS. Among UPS tumors, there is an exceptional subtype that causes refractory fever and signs of systemic inflammation. The coexistence of UPS with NF (UPS-NF) represents an unusual event. We present an exceptional case of a 58-year-old male patient with a two-month history of FUO that revealed an atypical clinical presentation of NF generated by a rare STS of the anterior thigh with subsequent sternal metastases. The patient received neoadjuvant chemotherapy and underwent a compartmentectomy with a microscopic residual tumor (R1), followed by postoperative adjuvant radiotherapy with unfavorable results. The patient also presented overlapping paraneoplastic manifestations (NF and areolar hyperpigmentation) that occur concurrently with the onset of metachronous sternal metastases, highlighting the uninvolved lung parenchyma.

Pleomorphic type undifferentiated gastric sarcoma, report of a case

Reports on pleomorphic type of undifferentiated sarcoma (PUS) originating from the gastrointestinal tract, especially the stomach, are extremely rare. We herein report a case of pleomorphic type undifferentiated gastric sarcoma. The patient was a 67-year-old woman. The chief complaint was upper abdominal pain. Upper gastrointestinal endoscopy, ultrasonography, and contrast-enhanced computed tomography showed two submucosal tumors at the greater curvature of the fundus and the lesser curvature of the gastric angle. Endoscopic ultrasound-guided fine-needle aspiration revealed a c-kit-negative spindle cell tumor at the greater curvature of the fundus. Total gastrectomy, splenectomy, and partial resection of the diaphragm and liver were performed. One lesion had invaded the lateral segment of the liver, left diaphragm and spleen. The postoperative course was uneventful. Histopathological and immunohistochemical examinations of the resected specimen revealed PUS. Peritoneal dissemination was detected at 8 months after surgery. However, no effective therapeutic agents were adopted for chemotherapy. The patient had poor performance status due to disease progression and underwent best supportive care. The patient died 10 months after surgery. This case highlights the imaging, histological diagnosis, and treatment strategy for PUS originating from the stomach. Surgeons should be aware of PUS as a differential diagnosis in cases with submucosal tumor of the stomach.

A case of undifferentiated pleomorphic sarcoma of a retro-gastric origin, case report and review of literature

Introduction and importance

Undifferentiated pleomorphic sarcoma (UPS) is one of the most common sarcomas affecting elderly patients, majority of UPS usually in the extremities, trunk, and retroperitoneum. However, its rarely observed in the digestive system. There are minimal data published regarding this topic.

Case presentation

Here we present a 58 years old female patient with a rare case of the pleomorphic sarcoma of retro-gastric mass measures about (24.7 × 23.5 × 17.4 cm) who underwent exploration laparotomy founded a freely and mobile retro-gastric mass measuring 30 × 20 cm with a cystic and solid component. The mass was freely and mobile located with no true gastric relation is the first one to be reported.

Clinical discussion

The undifferentiated pleomorphic sarcomas or MFH has been regarded as the most common soft tissue sarcoma for many years (Kabashima et al., 2017). The incidence increases with age, with an inclusive incidence of about 1–2 cases per 100,000 patients per year, predominately 1.2:1 for males. Undifferentiated pleomorphic sarcoma of the stomach is rare and counted to have a worse prognosis when compared to the other types of pleomorphic malignant fibrous histiocytoma.

Conclusion

We present a rare case of high-grade undifferentiated pleomorphic sarcoma of the retro-gastric mass with no invasion to the surrounding structures, managed with surgical resection of the tumor.

•

A rare case of the of retro-gastric sarcoma with no true direct relation to the stomach, the first case reported

•

Undifferentiated pleomorphic sarcoma is usually reported in the extremities, trunk, and retroperitoneum and observed in the digestive system.

•

The potential of adjuvant radiotherapy for USP showed no sufficient data was supporting such treatment

Rapid growth of metastatic brain tumor from gastric undifferentiated pleomorphic sarcoma: A case report

Background:

Brain metastasis from undifferentiated pleomorphic sarcoma (UPS) is a rare occurrence, and its clinical course is little known. In this report, we investigate a case of a rapidly growing brain metastasis from gastric UPS.

Case Description:

An 82-year-old man with a known gastric tumor, pathologically compatible with UPS, underwent partial gastrectomy at an outside facility. 3 months later, a 4-cm brain tumor was detected, which was completely resected. The patient was diagnosed with metastatic tumor from previously treated gastric UPS. Within 2 months of the initial resection, a large recurrent mass was detected in the same location, which was again removed. Although the patient underwent radiotherapy and chemotherapy for other metastatic tumors, he died 5 months after the second craniotomy.

Conclusions:

Brain metastasis from gastric UPS is rare and difficult to treat. Although aggressive treatment, such as surgical intervention, may improve patient survival in some cases, the timing of treatment is challenging because cerebral metastasis rapidly grows and and patients frequently suffer from synchronous systematic metastasis. Therefore, early detection and close follow-up of rapidly progressing brain metastasis are important to improve treatment outcomes.

Aggressive undifferentiated pleomorphic sarcoma of the stomach involving long-term survival: A case report and literature review

Primary gastric undifferentiated pleomorphic sarcoma (UPS) is a rare disease with insufficient long-term follow-up data. In the present study, a 70-year-old male complained of abdominal fullness and visited our hospital. Abdominal computed tomography revealed a large tumor in the upper part of the stomach, which was accompanied by smaller tumors in the small intestinal mesentery. An endoscopic ultrasound-guided fine-needle biopsy examination of the gastric tumor revealed features of pleomorphic sarcoma and high-grade spindle-shaped cells. Total gastrectomy was performed on the primary tumor, together with combined resection of the small intestine for the metastatic tumors. However, the tumor recurred in the mesentery of the sigmoid colon 6 months after the operation. A second operation was performed to resect the recurrent tumor. Since the second surgical procedure, the patient has remained free from recurrence for >7 years. Although the prognosis of abdominal UPS was considered to be poor, even after curative surgery, the present case experienced a long-term survival of gastric UPS after undergoing surgical resection alone.