ABSTRACT
RESUMEN Fundamento: los sarcomas de partes blandas son tumoraciones agresivas que pueden provocar la muerte de los pacientes, existen muchos tipos histológicos y se pueden localizar en cualquier parte del cuerpo humano. Objetivo: conocer un paciente con sarcoma pleomórfico indiferenciado en la región del muslo derecho. Presentación del caso: paciente de 52 años de edad, de raza blanca, masculino, sin antecedentes mórbidos de salud, acude a la consulta externa de Ortopedia y Traumatología por referir tener una bolita en el muslo derecho que en el último mes ha crecido y se acompaña de ligero dolor en la zona. Mediante la exploración física se observó aumento de volumen a nivel del muslo derecho en la cara posterolateral. A la palpación se comprobó la tumoración de bordes irregulares, mal definidos, móvil de localización por debajo de la fascia y consistencia dura. Al tener en cuenta todos los elementos anteriores, se decidió llevar el paciente al quirófano, para tratamiento de tipo quirúrgico, donde se realizó exéresis de la tumoración descrita con anterioridad, la que fue enviada al Departamento de Anatomía Patológica para estudio histológico que reveló sarcoma pleomórfico indiferenciado con células gigantes. Conclusiones: el sarcoma pleomórfico indiferenciado es una tumoración maligna infrecuente de partes blandas con un pronóstico reservado. Los síntomas y signos son más evidentes en el periodo de crecimiento rápido. Los exámenes imagenológicos como el ultrasonido de alta definición y la imagen de resonancia magnética son los más importantes. El tratamiento de elección primario es el quirúrgico, seguido de la radio y quimioterapia.
ABSTRACT Background: soft tissue sarcomas are aggressive tumors that can cause the death of patients, there are many histological types and can be located anywhere in the human body. Objective: to report a patient with undifferentiated pleomorphic sarcoma in the right thigh region. Case report: a 52-year-old white male patient with no morbid health history, who goes to the external Orthopedics and Traumatology clinic referring to have a little ball in the right thigh that has grown in the last month and it is accompanied by slight pain in the area. On physical examination, an increase in volume was observed at the level of the right thigh in the posterolateral area. On palpation, the tumor of irregular, bad-defined edges, mobile location below the fascia and hard consistency was checked. Taking into account all the previous elements, it is decided to take the patient to the operating room, for surgical treatment, where the tumor described above was extracted, it was sent to the Pathology department for histological study that revealed undifferentiated pleomorphic sarcoma with giant cells. Conclusions: undifferentiated pleomorphic sarcoma is an uncommon soft tissue tumor with a poor prognosis. Symptoms and signs are more evident in the period of rapid growth. Imaging tests such as high definition ultrasound and magnetic resonance imaging are the very importants. The primary treatment of choice is surgery, followed by radio and chemotherapy.
ABSTRACT
Abstract Objective: To evaluate the degree of similarity between manual and semiautomatic segmentation of soft-tissue sarcomas on magnetic resonance imaging (MRI). Materials and Methods: This was a retrospective study of 15 MRI examinations of patients with histopathologically confirmed soft-tissue sarcomas acquired before therapeutic intervention. Manual and semiautomatic segmentations were performed by three radiologists, working independently, using the software 3D Slicer. The Dice similarity coefficient (DSC) and the Hausdorff distance were calculated in order to evaluate the similarity between manual and semiautomatic segmentation. To compare the two modalities in terms of the tumor volumes obtained, we also calculated descriptive statistics and intraclass correlation coefficients (ICCs). Results: In the comparison between manual and semiautomatic segmentation, the DSC values ranged from 0.871 to 0.973. The comparison of the volumes segmented by the two modalities resulted in ICCs between 0.9927 and 0.9990. The DSC values ranged from 0.849 to 0.979 for intraobserver variability and from 0.741 to 0.972 for interobserver variability. There was no significant difference between the semiautomatic and manual modalities in terms of the segmentation times (p > 0.05). Conclusion: There appears to be a high degree of similarity between manual and semiautomatic segmentation, with no significant difference between the two modalities in terms of the time required for segmentation.
Resumo Objetivo: Verificar a similaridade entre as segmentações manual e semiautomática de sarcomas de tecidos moles na ressonância magnética (RM) e a similaridade interobservador e intraobservador entre as segmentações manuais. Materiais e Métodos: Estudo retrospectivo que incluiu 15 exames de RM de pacientes com diagnóstico de sarcoma de tecidos moles realizados antes de intervenções terapêuticas. As segmentações manual e semiautomática foram realizadas por três radiologistas utilizando o software 3D Slicer. O coeficiente de similaridade Dice (CSD) e a distância de Hausdorff foram utilizados para avaliar a similaridade das segmentações. Análise estatística descritiva e coeficiente de correlação intraclasse (CCI) foram realizados para comparar volumes tumorais. Resultados: A comparação dos métodos manual e semiautomático obteve valores de CSD entre 0,871 e 0,973. A comparação dos volumes segmentados pelos dois métodos de segmentação mostrou CCI entre 0,9927 e 0,9990. As análises intraobservador e interobservador obtiveram valores de CSD, respectivamente, de 0,849 a 0,979 e de 0,741 a 0,972. Não houve diferença significativa entre os tempos de segmentação dos métodos semiautomático e manual (p > 0,05). Conclusão: Houve alta similaridade entre as segmentações de sarcomas de tecidos moles obtidas pelos métodos manual e semiautomático, sem diferença significativa para o tempo despendido para as segmentações.
ABSTRACT
RESUMEN Fundamento: los sarcomas de partes blandas son lesiones frecuentes en la actualidad y pueden afectar a un gran número de pacientes a cualquier edad, sus tipos histológicos son muy variados de allí el comportamiento clínico de estas enfermedades. Objetivo: conocer una paciente con mixofibrosarcoma en la región anterior de la rodilla derecha. Presentación del caso: paciente de 56 años de edad, femenina de raza blanca con antecedentes de hipertensión arterial esencial, acude a la consulta externa de Ortopedia y Traumatología por referir tener una tumoración en la parte anterior de la rodilla derecha que se acompaña de ligero dolor e incapacidad funcional. Esta apareció hace dos años, pero ha incrementado su tamaño de forma rápida en los últimos tres meses. Al tener en cuenta todos los elementos anteriores, se decidió llevar a la paciente al quirófano, para tratamiento de tipo quirúrgico, donde se realizó exéresis de la tumoración descrita con anterioridad a través del tejido sano circundante con margen de seguridad. La pieza fue enviada al departamento de anatomía patológica para estudio histológico, que luego informó tumoración de tipo mixofibrosarcoma. Conclusiones: el mixofibrosarcoma es una lesión maligna que se localiza en la extremidad inferior, de crecimiento lento con ausencia o poco dolor, los medios imagenológicos aportan información muy importante para su diagnóstico, en específico el ultrasonido de alta resolución y la imagen de resonancia magnética. El tratamiento quirúrgico oportuno mediante la resección amplia mejora el pronóstico.
ABSTRACT Background: soft tissue sarcomas are frequent lesions today and can affect a large number of patients at any age, their histological types are very varied hence the clinical behavior of these entities. Objective: to present a patient with myxofibrosarcoma in the anterior region of the right knee. Case report: 56-year-old white woman with a history of essential arterial hypertension, who goes to the outpatient department of Orthopedics and Traumatology for referring to having a tumor in the anterior part of the right knee that is accompanied by slight pain and functional disability. It appeared two years ago, but it has increased its size rapidly in the last three months. Taking into account all the previous elements, it was decided to take the patient to the operating room, for surgical treatment, where the tumor described above was removed surgically through the surrounding healthy tissue with safety margin, the piece was sent to the department of pathological anatomy for histological study, which later reported a tumor of myxofibrosarcoma type. Conclusions: myxofibrosarcoma is a malignant lesion that is located in the lower limb, of slow growth with absence of little pain, the imaging means provide very important information for its diagnosis, specifically high resolution ultrasound and magnetic resonance imaging. Timely surgical treatment through extensive resection improves the prognosis.
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Abstract Case report of a pediatric patient with a diagnosis of bony histiocytic sarcoma of the scapula, submitted to oncologic resection (Tikhoff-Linberg type II surgery), who returned to previous activities and was disease-free after 24 months of follow-up.
Resumo Relato de caso de paciente pediátrico com diagnóstico de sarcoma histiocítico ósseo em escápula, submetido à ressecção oncológica (cirurgia de Tikhoff-Linberg tipo II), com retorno às atividades prévias e livre de doença após 24 meses de seguimento.