Andrés Felipe Cardona

Clinical oncology and Traslacional

Functional Unit Sarcomas and
Melanoma

Name: Paola Castro Control – 29.12.20

Age: 39 years
HC: 52863462
It dates birth: 22.09.1981
Natural: City of Resident and
pertinent Guatemala: Pereira
Telephone: 3138179608
Email: paocastro42@hotmail.com Occupation:
industrial Engineer Colsanitas/Sanitas

Dx: 1. Sarcoma intimal auriculo-ventricular Left T xNxMxG3 - IMS(-), TMB 9 Mts/Mb, KITAmp,
PDGFRAAmp, CDK4AMP, KRASAmp, MDM2Amp, FGF10Amp-make a mistake, FRS2Amp, KDRAmp
Clinical picture that initiated does some weeks with the presentation of evolutionary dyspnea in
relation to functional commitment for the execution of any exercise (taquicardia and palpitaciones).
Extra institucionalmente made an ecocardiograma TT that documented the presence of masses in
the left ventricle with obstruction of the tract of entrance and exit of the cavity.
Treatment:
a. Resección Masses intra cardiac + Replacement valvular mitral (05.11.20; Dr. Carlos
Eduardo Obando).
During the procedure found auricular commitment (25 mm) and ventricular left (mass of 40x30 mm
dependent of the papillary muscle posteromedial) with commitment of the papillary muscles and of
the valve mitral, in addition to the tract of exit and entrance of the SAW (multiple injuries accesorias
resecadas in his majority with affectation of the back wall). Replacement valvular mitral with
mechanical prosthesis On-X 25-33 mm.
*Pathology (Protocol Q20200013651, FSFB – Dr. Marcela Mejía 13.11.20): malignant neoplasia
of high compatible degree with a sarcoma indiferenciado with areas pleomórficas and epitelioides,
sclerosis and change mixoide with necrosis geographic in 10% of the piece (intimal). The
inmunohistoquímica showed 22 mitosis by 10 CGA and reactivity for MDM2, and focal for CD 34 andS
100. Besides, negatividad for desmina, actin of ML, miogenina and SOX 10.
Treatment:
a. Placing of catéter implantable (pending programming).
b. Paclitaxel Weekly/CBP x 1 cycle (30.11.20); 2 cycle (21.12.20).

Antecedents:
 Pathological: (-).
 Allergic: (-).
 Familiar: aunt with leukaemia mieloide acute (78), 2 maternal uncles diabéticos.
 Transfusionales: (-).
 Tx: (-).
 GO: M14, G2P2To0, Planning: mirena.
 Qx: Correction mandibular condyle right, 2 cesáreas.
 Toxic: (-).
 Farmacological: omeparzol 20 mg VO c/day, amiodarona 200 mg VO c/day, metoprolol 50
mg VO c/8h, Warfarina 2.5 mg VO c/day, acetaminofen/hidrocodona 325 mg VO c/8h.

Follow-up:
 PET/TAC (24.11.20): usual Catchment in central nervous system and neck, unchanged
focal. Catchment and in the sternum, secondary to esternotomía, usual finding for the time
of the surgery, that does not have pathological implication. Prosthesis of breasts with
diffuse minimum catchment in the outlines, usual finding in this type of devices.
Prosthesis valvular
 mitral Unchanged of the catchment. Minimum catchment on the lateral wall of the left
ventricle, diffuse, that can corresponds to changes postquirúrgicos. Usual catchment in liver
and spleen, physiological activity in walls of the stomach, intestine, kidneys, bladder. There
are not changes of the catchment skeletal muscle; there are not changes in the osseous
marrow.
 RM Gd Cerebral: differed by the recent placing of valve mitral mechanical.
 AG (19.11.20): LDH 347, BUN 11, PT 7.2, albumina 4.3, BT 0.63, BD 0.33, DD 4.394,
fibrinógeno 437, Pt 35, INR 3.0, cortisol 17.7, T4L 1.75, AU 3.3, CT 135, HDL 53, LDL 63, Cr
0.86, FA 134, GGT 110, HbA1c 5.2, ALT 61, AST 31, PCT 8.9, homocisteína 7.5, glicemia
78, glicemia post 114, Hcto 35, Hb 11.6, LT 10.630, N 8.070, Plt 325.000, TSH 2.2, T3L 3.6,
Ac Anti peroxidasa 9.4, Ac Anti-Tg 10, ferritin 254, Vit B12 1292, Vit D 36, basal insulin 8.9.
 AG (09.12.20): ALT 108, AST 65, Cr 0.78, LDH 471, FA 195, BUN 9.8, PT 7.0, albumina 4.2,
Globulins 2.7, BT 0.74, Hcto 36, Hb 12.1, LT 14.010, Plt 222.000, DD 317, Fbg 233, INR
2.6, Pt 31, cortisol 12.9, TSH 2.3, T4L 1.8.

Complementary studies:
 Foundation One Heme (14.12.20): IMS(-), TMB 9 Mts/Mb, IMS(-), TMB 9 Mts/Mb, KITAmp,
PDGFRAAmp, CDK4AMP, KRASAmp, MDM2Amp, FGF10Amp-make a mistake, FRS2Amp, KDRAmp.

S/:
 Disgeusia And xerostomía slight without exulceraciones.
 It denies palpitaciones, pain precordial, dyspnea or fatigue.
 Habit deposicional controlled with diet.
 Stable weight and suitable pattern of consumption.

Physical examination: Weight 56.3 Kg, Cuts 160 cm, SC 1.59, IK 100%, FC 78, FR 18, TA
128/72, CyC: humid oral mucosa, without injuries, orofaringe normal, no adenopathies or IY, C/P:
rhythmical cardiac noises, very timbrados, without soplos or aggregated, RsRs: MV symmetrical
and normal, Abdomen: soft, depresible, without masses and megalias, Ext: no edema, Neurológico:
without apparent focal deficit.

Analysis/Plan: Patient with sarcoma intimal auriculo-ventricular left T xNxMxG3 treaty with exéresis
R1 by commitment of the back wall of the ventricle. The cardiac neoplasias are rare, and present an
incidence that oscillates between 0.001 and 0.030%; a fourth part corresponds with malignant
tumors, being the most frequent the sarcomas that involve 95% east segment. Of them, the
angiosarcomas, the sarcomas indiferenciados and the pelomórficos with shots mixoides are used to
to be the most representative. Recently it included in the classification the pattern intimal (around
240 cases reported) characterised by the amplification and aberrant expression of MDM2, as well as
for the presence of mutations in PDGFR (To/B), EGFR, CDK4, and HMGA1. From limited series of
cases confirmed the utility of the chemotherapy adyuvante, being the base the use of the Paclitaxel
in weekly guideline (the utility of the antraciclinas conventional seem to be inferior in this group).
This medicine administer alone or in combination with CBP, and recommended the execution of
IMRT differed or therapy with protons with dose that oscillate between the 54 and 60 Gy (patients
with resecciones R1).

It presents in course of the second cycle without apparent toxicity and with the result of the
genotipificación that multiple evidence alterations by amplification including PDGFRA, KIT and
MDM2. I anticipate the formulation of the following cycle, argue the possibility to employ
homologous medicines to the stage of the GIST and quote to control the 22.01.21 with AG; RM Gd
cerebral and cardiac. I remain in wait of the secondary evaluation in the MDACC and give general
recommendations more signs of alarm.

Formulation:
1. Paclitaxel 128 mg IV days 1, 8 and 15 c/21 days
2. Carboplatino 450 mg IV day 1 c/21 days
3. Palonosetron 0.25 mg IV c/21 days
4. Fosaprepitant 150 mg IV c/21 days
 5. Dexametasona 16 mg IV day 1 and 8 mg IV days 8 and 15 c/21 days
6. Ondansetron 8 mg VO c/8h in case of nausea or emesis in domicile
7. Pegfilgrastim 6 mg SC c/21 days (device)
8. Difenhidramina 50 mg VO before the taxano

Andrés Felipe Cardona Zorrilla, MD MSc PhD.

Internal medicine – Clinical Oncology – Epidemiol